Hospital staffers hung up on El Nuevo Herald phone calls last week to ask about the cholera cases. But Miami-based Radio/TV Martí reported that when it called recently, a nurse answered, “You’re asking if we have cholera? All the wards are full!”

Havana dissident Dania Virgen García, who stays in contact with political prisoners throughout the island, said cholera is spreading prison to prison because of their notoriously bad hygiene. García added that she had received several reports that some prisoners died from cholera but were counted among Sandy’s 11 Cuban fatalities.

Santiago dissident Pedro Montané said he spoke last week with several people who confirmed to him in private that their relatives were being treated for cholera at the 28th of September Clinic, but did not want to give their names.

The government jailed the doctor who first reported a dengue epidemic in 2000 for more than a year, and is now holding Calixto Ramón Martínez Arias, the independent journalist who first reported the cholera outbreak in Manzanillo.

And Santiago blogger Janis Hernandez wrote that several young children playing on a sidewalk recently were chanting, “Cholera’s going around, cholera’s going around … I am going to inject you. Better wash your hands.”

Scores of other cases were reported in Guantánamo, Ciego de Avila, Yateras, Baracoa, Maisí, Palma Soriano, San Luis, Palmarito de Cauto, Songo-La Maya, Sagua de Tánamo and Antilla. Guantánamo’s Agostinho Neto Provincial Hospital alone saw 80 suspected cases, said one resident who asked for anonymity.

Smaller numbers of cholera cases were reported in western Cuba and Havana. But the capital is suffering through an outbreak of dengue, also known as Breakbone Fever. A 1981 epidemic killed 158 Cubans and affected 344,000 more.

So many dengue cases are now jamming Havana hospitals that long-running shortages of medicines, needles, bandages, chlorine, soap and other supplies are turning into emergencies, according to several recent dissident reports.

What’s more, Cuba’s water and sewer systems are so deteriorated after decades of little or no maintenance that experts say it will be impossible to stop future outbreaks of contagious diseases like cholera and dengue.

More than half the water pumped through the country’s pipes never reaches its destination because of breaks and waste, Cuban television reported in June. Pipes with low or no water pressure can be contaminated by bacteria or critters.

The country of 11.2 million people has only 3,300 miles of sewer lines and eight waste treatment plants, according to a July report by the National Institute for Hydraulic Resources to the legislative National Assembly of People’s Power.

A study conducted by researchers at the U.S. Agency for International Development in 2007 showed only 65 percent of the population had access to piped drinking water, and that sewage services reach only 38 percent of the people.

Even in Havana, more than 100,000 residents were receiving potable water by truck in April 2011 because of breaks in the pipes and a drought, according to an article in the Granma newspaper, official voice of the Communist Party.

Montané said his tap water in Santiago often runs the color of chocolate, and Madaula said poor parts of the city still have no water because of Sandy’s disruptions. Most suburban and nearby farms have latrines and water wells, she added.

Santiago’s small waste treatment plant can handle only 45 percent of the flow and is often down altogether. The rest goes directly into the bay, said Manuel Cereijo, an electrical and computer engineering professor at the University of Miami.

With such tattered infrastructure, and with the government lacking the money to fix it, infectious diseases likely will continue to hit the island, said Julio Cesar Alfonso, a Cuban-trained Miami doctor who keeps in touch with physicians on the island.

“It is very probable that in coming years cholera will remain in Cuba as an endemic disease … as part of the island’s suffering.”