Haitian gangs have for a month prevented the distribution of diesel and gasoline, crippling businesses and hospitals and creating shortages of basic goods including water just as the country is struggling with a new outbreak of cholera.

The State Department has created a new visa restriction policy targeting those who support the gangs and has sent a Coast Guard vessel to patrol Haitian waters.

US officials who briefed reporters on Washington’s response stopped short of offering to send troops to the island nation despite appeals from the Haitian government for an international armed force.

“We are … working to increase and deploy in the coming days security assistance to the Haitian National Police to strengthen their capacity to counter gangs and re-establish a stable security environment,” Secretary of State Antony Blinken said.

“We will accelerate the delivery of additional humanitarian relief to the people of Haiti.”

Assistant Secretary of State for Western Hemisphere Affairs Brian Nichols on Wednesday traveled to Port-au-Prince with a delegation that includes Lieutenant General Andrew Croft of the US Southern Command, the State Department said.

During an earlier phone briefing with reporters, a senior Biden administration official said it was “premature to talk about just a US security presence” when asked whether Washington had ruled out sending troops.

Sporadic looting and gun battles between gangs and police have become increasingly common in recent weeks as the shortages have led to mounting desperation. Protests to demand interim Prime Minister Ariel Henry’s resignation have at times devolved into looting.

The Pan American Health Organization on Wednesday said civil unrest is making it harder to contain the outbreak of cholera, adding that 18 deaths have been confirmed as of Oct. 9 and hundreds of potential cases are being studied.

UN Secretary-General Antonio Guterres has proposed that one or several countries send “a rapid action force” to help Haiti’s police, according to a letter to the UN Security Council, without suggesting that the force be deployed by the United Nations.

Another Biden administration official during the phone briefing said the travel bans were meant to hold accountable those who are linked to the gangs.

“Our intent in doing so is to demonstrate that there are consequences for those who fund and foment violence in Haiti,” the official said.

Raleigh Mayor Mary-Ann Baldwin said the shooting occurred near the Neuse River Greenway, a popular trail in the area.

“This is a sad and tragic day for the city of Raleigh. Just after 5:00 pm today, multiple people were shot,” she told a press conference.

The Raleigh Police Department “has confirmed five fatalities. One of them was an off-duty Raleigh police officer.”

The shooter, a “white male juvenile,” was taken into custody shortly after 9:30 pm, Raleigh Police Lieutenant Jason Borneo said in a follow-up press conference.

The mayor had earlier reported that the shooter was being “contained in a residence in the area” by police.

One victim, Borneo said, remained in critical condition.

Also among the wounded was a canine officer who had been taken to the hospital, although Borneo reported that an injured police officer had been released.

When asked about a motive for the shooting, he said it would likely “come to bear” in the coming days.

North Carolina Governor Roy Cooper, who attended the evening press conference, told journalists that: “Tonight terror has reached our doorstep.”

“The nightmare of every community has come to Raleigh. This is a senseless, horrific, and infuriating act of violence that has been committed.”

Gun violence is a major problem in the United States where more than 34,000 people have died in shootings so far in 2022 alone, more than half of which were from suicide, according to the Gun Violence Archive website.

“We must do more,” Baldwin told the press conference.

“We must stop this mindless violence in America. We must address gun violence. We have much to do, and tonight we have much to mourn.”

The North Carolina shooting occurred after a jury earlier in the day rejected the death penalty and backed life imprisonment for Nikolas Cruz, who shot and killed 17 people at a Florida high school in 2018.

Mass shootings have repeatedly stunned the nation, reigniting debate on gun control, a hot-button cultural issue that has made little headway in Congress.

However, several of the most recent gun rampages, including a shooting at a school in Texas and a supermarket frequented by African-Americans in New York state, caused particular shock across the country, prompting lawmakers to agree in June, for the first time in 30 years, to pass modest reform of gun control laws.

Nearly 400 million guns were in circulation among the civilian population in the United States in 2017, or 120 guns for every 100 people, according to the Small Arms Survey project.