BOGOTA, Colombia — Ismael Arias was headed to the market when the devastating 7.4 magnitude earthquake hit western Colombia last week, sowing death and destruction. His home region of Choco was the epicenter.

Leaving home early that day likely saved his life, he says — the two-story home he had spent years building with his modest wages collapsed during the quake.

“The house is completely destroyed,” said the 66-year-old math teacher in Quibdo, the regional capital.

At least 312 people were killed by the Aug. 10 quake, according to figures published Wednesday by the central government, and 29,000 homes were destroyed.

Recovery will be particularly challenging for Choco, which was already struggling with high poverty rates, poor infrastructure and underfunded health and education services.

According to the United Nations Office for the Coordination of Humanitarian Affairs, 69,000 people in Choco were affected or displaced by the earthquake — about 10% of its population.

The regional government says more than 200 schools were damaged, and poor internet access will make it difficult for children to take online lessons. With around 600,000 inhabitants, mostly Afro-Colombian or Indigenous people, Choco has long been one of the country’s most neglected regions.

Largely covered by mountains and rainforests, only two precarious roads connect Choco to the rest of Colombia. Many towns are only reachable by plane or boats, and the rivers can be dangerous. There are no roads linking communities along the more than 650 kilometers (406 miles) of Choco’s coastline hugging the Pacific Ocean to the interior.

In large swaths of the region, rebel groups fight over the control of illegal mines and drug trafficking routes, displacing civilians or imposing lockdowns that prevent villagers from working their fields for days at a time.

“We are facing a triple crisis,” said Luis Mora, the United Nations Population Fund’s representative in Colombia. “You have the humanitarian crisis caused by the earthquake, now joining the under development crisis and the crisis caused by armed conflict in this territory.”

The agency has been supplying kits with personal hygiene products to women affected by the earthquake and working to create safe spaces for women within shelters.

Cristian Maturana, a doctor at Quibdo’s only public hospital, said that after the earthquake hit, the emergency room overflowed with patients with broken bones and other injuries.

In the days that followed, 36 patients with multiple fractures were flown to a hospital in the city of Medellin, in the neighboring region of Antioquia — because his hospital lacked enough personnel and equipment to treat them, Maturana said.

The hospital’s only refrigerator capable of storing blood donations was also damaged by a power surge following the quake, rendering transfusions impossible. It was replaced over the weekend with a fridge donated by a group of oncologists in Bogota, the country’s capital.

“These have been tough days,” Maturana said, adding that support from elsewhere in Colombia and abroad “has been crucial.”

The emergency room is currently operating at twice its capacity, with patients being treated in chairs or on stretchers in the hospital’s hallways, Maturana said.

Donations of antibiotics, bandages, blood pressure monitors and other equipment have been helpful, but the hospital still needs wheelchairs and more beds.

“These seem like basic things,” Maturana said. “But they are items we have long had shortages of.”

Camilo Prieto, a doctor with the Colombian Environmental Movement, a humanitarian group, said his organization brought in more than 2 tons of medical supplies, including electrocardiogram and ultrasound machines last week. The group also flew some of the aid to remote towns with helicopters and small planes.

“By land it would be very difficult,” Prieto said. “But some companies and owners of private planes have given us flight hours.”

Wiston Mosquera, the Roman Catholic bishop of the Quibdo diocese, said he hopes the quake brings attention to many of Choco’s structural problems, like poor healthcare facilities, the lack of roads or the permanent problems with the power supply.

“We are decades behind the rest of Colombia’s regions,” said Mosquera, who was born and raised in Choco.

Colombian President Abelardo de la Espriella has visited Choco twice since the earthquake, and promised a plan that will include billions of dollars in infrastructure investment and programs to generate jobs.

Choco’s unemployment rate was the highest in Colombia last year, according to DANE, the nation’s statistics agency. The region’s GDP per capita was 14.3 million Colombian pesos in 2025, or about $3,500 dollars, a quarter of Bogota’s per capita income.

De la Espriella said he will designate a government official to oversee Choco’s recovery, and provide subsidies to families left homeless by the earthquake so that they can rent new homes.

Arias, the math teacher who lost his home, said he’s skeptical of such promises because of the region’s history of neglect. He said he spent around $32,000 building his home, taking out loans from banks, and will be hard pressed to raise those kinds of funds with his current teacher’s salary.

“Even if I am helped, I don’t think I will get enough,” Arias said. He and his partner are for now staying at a relative’s home.

“It’s not the same,” he says. “You don’t have the freedom there that you get in your own house.”