The death toll from a recent cholera outbreak has surpassed 1,000, officials there announced on Tuesday. As President Rene Preval urged for calm in the country’s second largest city of Cap Haitien, protesters clashed with United Nations troops amid rumors that the outbreak could have come from Nepalese workers from the U.N. Stabilization Mission in Haiti (MINUSTAH).

Last week, the United Nations issued an appeal for $163 million in international aid to help combat the epidemic. But for some residents in Haiti, the troops’ continued presence has done more harm than good.

At least two people have been killed so far in gunfire and street protests against what Haitian nationals are calling the latest U.N. occupation, reports the Christian Science Monitor. This is only the most recent stand-off with U.N. troops, as the outbreak has swelled long-held resentment against the 12,000-person U.N. force that’s been in the country since the 2004 overthrow of popular President Jean-Bertrand Aristide.

“Gunshots, throwing bottles, barricades of burning tires will not help us eradicate cholera bacteria. On the contrary, it will prevent the sick from receiving care and to deliver medicine where it is needed,” outgoing President Préval told protesters on Tuesday, according to reports.

It’s feared that if the violence continues, the country will have to postpone its highly anticipated national elections, which are scheduled for November 28. That timing has led MINUSTAH officials to suspect that the demonstrations are politically motivated. And for some residents, that’s exactly the point.

“No one wants elections because people are falling in the street and there is no medication,” radio journalist Joseph Junior told CSM reporters. “It’s impossible to have elections. It’s totally, totally impossible in this climate to force people to go vote when they can’t even get to a hospital for treatment.”

Yahoo! News noted that cholera is transmitted by feces and can be prevented if people

have access to safe drinking water and regularly wash their hands. That, of course, is impossible as Haiti struggles to recover from January’s devastating earthquake that killed more than 250,000 people and decimated much of the capital city’s already fragile infrastructure. The bacterial infection attacks the small intestine and causes severe diarrhea and vomiting

The cholera outbreak emerged in late October and has since become the worst epidemic of its kind in centuries. In addition to the 1,000 deaths, an estimated 15,000 have remained hospitalized. While the outbreak began in the countryside, it reached the capital city of Port-au-Prince in early November, where more than 1.3 million residents remain homeless following the quake. On Tuesday officials confirmed that the outbreak had spread to neighboring Dominican Republic, where a maximum health alert has been issued by that country’s health ministry.