ABACO ISLANDS, Bahamas — With time running out to save stranded survivors of Hurricane Dorian, Bahamian and U.S. rescue crews combed through rubble in the hardest-hit areas Friday and braced for the death toll to rise.

Five days after the storm made landfall in the Bahamas as a Category 5 hurricane, authorities said it was unclear how many people were in need of assistance and how many had died. Officials and aid organizations struggled to reach remote towns in the sprawling island nation, with logistical issues preventing the deployment of rescue boats and aircraft.

“My house is gone, everything I have is gone; this is all I’ve got left,” Eddie Peredema, a gardener in Marsh Harbour, said as he pointed to his green T-shirt. “We need food, we need shelter. We need help, right now.”

Marsh Harbour, the largest town in the Abaco Islands, was devastated by the storm, as were surrounding areas. Teams in hazmat suits are searching for survivors and bodies amid storm debris, storing remains in a refrigerated container in the back of a health clinic.

Aerial helicopter footage taken by Brandon Clement of WxChasing / LSM Aerial on Sept. 3, showed the vast destruction of Hurricane Dorian in Abaco, Bahamas. (Brandon Clement / LSM)

Already, the United States is expanding its response, amid signs that the scope of the effort so far has not been enough. As many as 43 people have been confirmed dead — 35 in the Abacos Islands and eight in Grand Bahama — but the number was expected to rise. Thousands of people are possibly missing and tens of thousands may need urgent help.

“We acknowledge that there are many missing and that the number of deaths is expected to significantly increase,” Prime Minister Hubert Minnis said in a statement Friday night. “This is one of the stark realities we are facing in this hour of darkness.”

The Coast Guard has expanded its presence from five rescue helicopters on Monday to a dozen, along with eight cutters. The service has 1,000 members positioned to assist with relief efforts in the Bahamas and across the southeastern United States.

Scenes from the path of Hurricane Dorian

Sept. 7, 2019 | Destroyed homes and debris left by Hurricane Dorian in the Mudd neighborhood of Marsh Harbour, Bahamas. (Carolyn Van Houten/The Washington Post)

Rear Adm. Douglas Fears said his service has carried out 208 rescues in the Bahamas this week and staged helicopters on Andros Island, a sparsely populated archipelago south of Grand Bahama Island, whose northern side was overwhelmed by the storm.

Aboard the USCGC James, a national security cutter that is coordinating the Coast Guard’s rescue response in the Bahamas, service members monitored air traffic on computer scanners and tracked emergency calls on a whiteboard as they prioritized the most desperate cases.

A 5-month-old was “starving,” one report said. A 90-year-old man had a broken back, read another. Two diabetics, two children and one spouse, read a third. A woman somewhere on a baseball field had a decreasing heart rate. A 60-year-old man needed dialysis, and a 400-pound man was suffering from blood clots.

George F. Menze, a Coast Guard pilot, said he wished there were a clinic closer to the affected islands than the hospital in Nassau, a trip that can take 45 minutes by helicopter. But he said the response is typical for a hurricane as devastating as Dorian, which he said was “like a giant tornado.”

Service members on the James dispatched helicopters across the ravaged area, sometimes with little more than coordinates to go on and no way to communicate with people on the ground. Plans shifted constantly, as more urgent medical cases were called in and more survivors were found.

In one case Tuesday, they rescued a man who had been trapped for 16 hours under the collapsed remains of his house. 

Overall, they took 30 people to the hospital Thursday, and 17 more a day earlier, as Air Force and Marine Corps teams have worked to assess the damage to runways and other infrastructure.

Flying over the Abaco Islands in his helicopter Friday, Menze said the area is “kind of ground zero.” His first task on the flight was to find a group trapped in a garage near Marsh Harbour. But there was no place to land the MH-60 Jayhawk. 

Others already on the ground could help them, so he headed north to Guana Cay, where there were American citizens and Bahamians in need of medical attention, including a woman who was running out of insulin.

From the air, Menze and his crew saw a car that had been hurled on top of a boat. Houses were smashed into sticks. Swimming pools were filled with murky brown water.

On the ground, Willis Levarity, 48 — who on ordinary days is the “director of fun” at a resort featuring paddle boarding, golfing and swimming — waved his hands at the crew. The helicopter landed on a golf course.

Gina Roberts, 52, boarded with her daughter Shannon, 34, a Type 1 diabetic whose insulin supply was running low. Roberts had to leave her husband behind. That morning, she received word that her father had died of an illness unrelated to the storm.

Roberts said that during the storm, golf carts flew in the air. Stone houses shifted off their foundations. Some saw tornadoes rip into the ground. 

Other victims traveling on the helicopter told harrowing tales of barely surviving and of many more dead, swept away.

Schamere McKenzie, 22, a supermarket cashier from Murphy Town, said her family fled their home as the hurricane ripped it apart. They survived in their Buick.

She had been with her parents, sister and a 7-year-old nephew, and was evacuated with her mother, who suffers heart ailments. McKenzie said she saw a truck filled with bodies headed to the morgue Thursday.

As the Coast Guard transported them to Nassau, McKenzie’s mother, Sandra, thanked the service members. “You are a blessed people,” she said, near tears.

The U.S. Agency for International Development, which is overseeing the American relief effort in the Bahamas, has delivered emergency shelter materials for 35,000 people, and hygiene and water containers for about 3,000.

John Morrison, spokesman for Urban Search and Rescue Virginia Task Force 1, based in Fairfax County, said the group was working with USAID and dispatching 57 rescue workers and four dogs to search house to house for victims or people in need. An aerial survey of the storm’s path showed that at least half of homes and buildings were destroyed.

The humanitarian crisis could have ripple effects: One search-and-rescue volunteer who delivered supplies to Grand Bahama this week said he saw at least 26 boats, overloaded with people, leaving the island and heading west to Florida, about 140 miles away. “They’re doing what they can to get off the island,” said Russ Montgomery , who goes on search-and-rescue missions coordinated by the CrowdSource Rescue group. He said that people he met on the hard-hit northern islands are not waiting on help from the Bahamian government, but instead were making cooking fires with debris from destroyed houses and drinking rainwater out of truck beds.

In Freeport, a group of about a dozen friends reported that they had conducted rescues via personal watercraft Tuesday, parking in some cases on people’s roofs to save them.

Desean Smith, 39, said in a phone interview that his cousin had called him during the storm as her home began flooding. Within an hour, the water had risen from her ankles to her waist, and it was chest-level when Smith arrived on his watercraft.

He took his cousin and her family to higher ground and saw many more people who needed to be rescued. He estimated that he and his friends transported 40 people to safety in two hours.

“It’s like a war zone,” Smith said. “All of the landscape, everything that was green and lush before, is dead.”

Lamothe reported from Washington and Faiola from Marsh Harbour, Bahamas. Lori Rozsa in West Palm Beach, Fla., and Rachelle Krygier in Miami contributed to this report.