PORT-AU-PRINCE, Haiti—The day begins early in the capital city: In the middle of packed streets, whole families rouse from sleep as the sun comes up, stumbling out of makeshift tents crammed along the entire length of cracked medians. Others huddle under tarps and sheets that cover the open space in small parks and soccer fields, a sign they are either now homeless or afraid to return to homes that might be structurally damaged.

On another street corner, some 200 people form a growing mass at a tiny bus stop, waiting for the multi-colored school buses that have long bustled through the streets of Port-au-Prince. But nine days after the city’s 7.0-magnitude earthquake, many of the buses aren’t heading across town—they’re heading away from town, loaded with the few possessions some people have left: a chair here, a bundle of clothes there. Two mild aftershocks Thursday morning deepen fears that leaving the city may be best.

As Haitians flee Port-au-Prince in search of critical supplies of food and water, many may not realize what awaits them—more need for miles and miles. As non-governmental organizations and news media pour into the overwhelmed city, fewer seem to be focused on the needs of rural communities with equally overwhelming needs.

At a community well just outside of Port-au-Prince, a group of villagers crowd around the only water source, washing clothes, taking baths, and gathering drinking water. As a Samaritan’s Purse worker tests the quality of the water, Franklin Marceus waits for help. He’s ridden his bicycle here, hoping aid workers would show up. He wants us to visit his community a few miles down the road, devastated by quake damage.

The centerpiece of Marceus’ village was an orphanage that housed 30 young children. On a tiny dirt road piled high with rubble, Marceus points out what remains of the children’s home: a mostly collapsed structure, completely uninhabitable. Twenty-nine of the children escaped; a handicapped 10-year-old girl died. Down a twisting series of gutted roads, Marceus shows us where the children now live: a series of tattered tents on a tiny, shadeless patch of dirt, already baking in the morning sun and blanketed with the smell of sewage and burning trash.

The women who tend the orphans look tired as they tend to a small fire and a pot of food to feed nearly three-dozen people. The children look happy to see attention from the outside world, smiling broadly and holding our hands as we walk through what’s left of their neighborhood. What will happen to the children now that village families can’t care for themselves? “We really don’t know,” replies Marceus.

At a nearby camp, dozens more Haitians wonder what will happen to them. They’re packed into makeshift shacks outside a makeshift medical clinic treating quake victims. As the heat grows more stifling, a woman recovering from a leg amputation shifts uncomfortably on a thin blanket under the shade of a pink sheet. On a nearby folding table under a tarp covering, a volunteer doctor tends to small baby, lancing an infected groin with limited anesthesia as the baby wails in pain. Chris Buresh, an assistant clinical professor of emergency medicine at the University of Iowa Hospitals and Clinics, is helping lead the effort at the camp, working in cooperation with Japanese medical personnel that have set up an X-ray machine and surgical rooms. They need both, says Buresh, “We’re seeing mostly amputees.”

Villagers outside the city say the UN has visited, and a handful of U.S. Army trucks roll through the streets. But widespread aid isn’t visible in these areas, even as city-dwellers stream toward them.

After a water treatment assessment by Samaritan’s Purse in the tiny town of Petit-Goave, Gideon Sanon, a pastor of a local Apostolic church, says the people in his church aren’t losing heart. “We’re believing the Lord will take care of us, and praying that He will send us help,” he says. “But mostly, we’re just praising Him that we are still alive.”