PORT-AU-PRINCE, Haiti - The nursing home where she lived is in ruins. So Merzelia Joseph stood up next to her bed in the open and urinated on the ground.

"I'm so weak, I can't walk," said Joseph, a blue plastic rosary strung around her neck. "We are all very, very hungry. Somebody brought us some spaghetti today, but I am still hungry and we have nothing to drink."

Another elderly woman, Elmina Joseph, broke in to shout: "We're not hungry. We're starving! We're dying here and nobody is helping us."

Four days after The Associated Press first reported on more than 80 elderly Haitians begging for food and medicine in a downtown Port-au-Prince slum, aid was finally trickling in Thursday. A nun distributed small bowls of spaghetti to the old people, and two aid workers arrived from HelpAge International, a London-based organization that helps the elderly.

But it wasn't nearly enough, and the pensioners continued to suffer just a mile (1 1/2 kilometres) from the international airport where aid is pouring in. Their plight underlined the Darwinism in the aftermath of last week's 7.0-magnitude earthquake: As survivors scramble for food and water, it is the weakest who go without.

"What can you say?" said Louis Belanger, a spokesman for Oxfam Great Britain. "It is very often the case that the strongest and fittest get help. ... Those left behind are the elderly and the women with children, so we are working hard to make sure aid is co-ordinated."

On the grounds of the Municipal home for the elderly Thursday, old people lay listlessly in beds out in the open with sheets smeared with excrement, surrounded by hundreds of people living in makeshift tents. One man wore just a T-shirt, hsi private parts exposed. A woman, just skin and bones, held her head. A body lay in the debris of the nearby nursing home.

Six pensioners died in the Jan. 12 earthquake, part of an estimated 200,000 victims. Another three have since perished of hunger and exhaustion. Two are buried 10 feet (three meters) away near the walls of a destroyed chapel. A dirty red sheet covers the body of the third. Several more are barely clinging on after days of slow agony.

Of the 329 living camps that have sprung up around Port-au-Prince, 10 are full of old people, according to HelpAge International. The group said it is working with the Haitian charity CARPA to help the residents from several homes fopr the elderly.

On Thursday, HelpAge workers brought tarpaulins to the Municipal home, which they tied to the branches of trees to provide some shade in the tropical heat. Emergency programs co-ordinator Margaret Chilcott said the group will hire someone to do some cooking and get water points set up. Chilcott also noted that more caregivers were needed, and said she saw one man not eating despite his hunger, apparently because he couldn't eat without help.

"There are a whole lot of issues here - protection issues, health issues," Chilcott said. "Now that we have seen what the need is, we can move very quickly."

A young Haitian caretaker on the scene was grooming the old ladies' hair.

"They haven't eaten for days because we don't have anything to give them," said Celires Jean-Baptiste, 49. "We have no water. We have no soap to bathe them. We have no food. We have nothing.

"I just have to do what I can," she said, as she tried to comb the knots out of the hair of Anacia Aleius, who banged her fist on the bed in pain.

The pensioners have had little help in the past week. On Sunday, refugees pulled their beds out into the open so they wouldn't sleep in the dirt among the running rats. Some relatives and volunteers have since offered what tiny food portions they could, or helped clean and medicate the worse-off patients.

On Monday, the Brazilian aid group Viva Rio brought a large tanker of drinking water, the first large-scale aid to arrive.

John LeBrun, one of the nursing home's former cleaners, also carried in a bag of rice that was cooked the same day. "I found it in a storage house nearby," he said. He wouldn't elaborate on how he secured such a costly good - a 110-pound bag of rice now costs $60 amid the shortages - but grinned evasively and said it came from a "broken" store.

It was the pensioners' first meal in four days, and their last until a nun delivered spaghetti on Thursday.

The food did not come in time for Jean-Marc Luis. He died Wednesday night.

"He died of hunger," said security guard Nixon Plantin.

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Associated Press writers Alfred de Montesquiou in Port-au-Prince and John Rice in Mexico City contributed to this report.