Hurricane Helene has become one of the deadliest hurricanes in the United States, at least since the emergence of modern weather forecasting.

There have been at least 213 deaths in six states as a result of the storm, whose flooding, wind and storm surge inundated communities from the southeast to the southern Appalachians. Many people may still be unaccounted for. Officials say they expect the death toll to rise as search and rescue efforts continue.

The current death toll ranks third highest among hurricanes that have made landfall in the United States since 2000, trailing Maria in 2017 and Katrina in 2005. It has surpassed the devastating Hurricane Ian in 2022, as well as the death toll from 2012’s Superstorm Sandy, which was not classified as a hurricane by the time it made landfall.

Many of the deaths have occurred in the mountains of western North Carolina, which suffered catastrophic flooding after more than 20 to 30 inches of rain fell in less than three days. The rainfall occurred in two rounds, one before and one after the storm made landfall in Florida’s Big Bend region as a Category 4 with maximum sustained winds of 140 mph.

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Deaths related to the hurricane spread from Florida to as far north as Virginia.

Hurricanes cause the most death and destruction of all weather hazards, the National Oceanic and Atmospheric Administration says, and have become deadlier in recent decades. The actual number of hurricane deaths could be much higher than previously estimated because of the thousands of indirect deaths that can occur years after a storm.

Here are the 10 deadliest hurricanes to strike the United States before Helene and since 1954, when forecasters began issuing routine hurricane forecasts.

Hurricane Maria (2017); 2,975 deaths

Landfall location and date: Southeast Puerto Rico; Sept. 20

Intensity at landfall: Category 4; 155 mph winds

Territories most affected: Puerto Rico, U.S. Virgin Islands

Maria was the most destructive hurricane in Puerto Rico in modern times. Nearly the entire island lost power, cellphone service and clean drinking water due to the extreme wind, storm surge and flooding from up to 38 inches of rain. Many remained without electricity for more than three months. More than 300,000 homes were destroyed by the combination of Maria and Hurricane Irma, which passed near Puerto Rico two weeks earlier. The storm’s official death toll in Puerto Rico was estimated by a statistical study that analyzed death records and expected mortality rate.

Hurricane Katrina (2005); 1,392 deaths

Landfall location and date: Southeast Louisiana, Aug. 29

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Intensity at landfall: Category 3; 125 mph winds

States most affected: Louisiana, Mississippi, Florida, Alabama, Georgia

Katrina was an unusually large hurricane with hurricane-force winds that extended 120 miles from the eye of the storm. Most of the more than 1,000 deaths in Louisiana and over 200 deaths in Mississippi were because of flooding from storm surge, which is the rise in ocean water over normally dry land. Numerous levees and flood walls were breached in the New Orleans area, where thousands of homes and businesses were destroyed, while entire coastal communities in Mississippi were obliterated.

Hurricane Audrey (1957); More than 500 deaths

Landfall location and date: Southwest Louisiana; June 27

Intensity at landfall: Category 3; 125 mph winds

States most affected: Louisiana, Texas

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Audrey was the earliest major hurricane (Category 3 or higher) to make landfall in the United States. The U.S. Weather Bureau warned late on June 26 that the storm would make landfall the next afternoon, but it sped up during the night and arrived at 9:30 a.m. local time, too soon for many people to evacuate. The storm battered much of Louisiana and southeast Texas with damaging winds and a massive storm surge on the coast. The exact number of deaths is unknown because many missing people were never found.

Hurricane Camille (1969); 256 deaths

Landfall location and date: Southwest Mississippi, Aug. 17

Intensity at landfall: Category 5; 175 mph winds

States most affected: Mississippi, Alabama, Virginia

Camille is one of only four Category 5 hurricanes, and the second strongest on record, to strike the United States. Winds gusted to 100 mph across much of southern Mississippi and the storm surge on the coast reached 25 feet. Southeast Mississippi, Dauphin Island and the Alabama coastline, including the Mobile area, suffered the most damage. More than 100 of the deaths occurred in Virginia, where the storm dumped more than 1 to 2 feet of rain despite having weakened to a tropical depression.

Hurricane Diane (1955); About 200 deaths

Landfall location and date: Southeast North Carolina, Aug. 17

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Intensity at landfall: Category 1; 74 mph winds

States impacted most: North Carolina, Pennsylvania, New Jersey, New York, Connecticut, Rhode Island, Massachusetts

Diane’s storm surge damaged houses, flooded roads and destroyed sea walls along the southeast North Carolina coast. The storm dumped up to 20 inches of rain in two days, leading to destructive flooding in eastern Pennsylvania, northwest New Jersey, southeast New York and southern New England. Diane followed just days after another Category 1 storm, Hurricane Connie, killed 74 people mostly because of flooding in the same region.

Superstorm Sandy (2012); 159 deaths

Landfall location and date: Southeast New Jersey; Oct. 29

Intensity at landfall: Category 1; 80 mph winds

States impacted most: New York, New Jersey, Connecticut

Sandy’s highest storm surge and most severe flooding occurred in New Jersey, New York and Connecticut, including coastal areas of New York City. It was an unusually large storm that spread strong winds as far west as Wisconsin and north into Canada, and raised water levels along the entire East Coast. At the time of landfall, the storm was no longer classified as an official hurricane by the National Hurricane Center because it had lost its tropical characteristics. That led to the storm becoming known as “Superstorm Sandy.”

Hurricane Ian (2022); 156 deaths

Landfall location and date: Southwest Florida; Sept. 28

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Intensity at landfall: Category 4; 150 mph

States affected most: Florida, Georgia, South Carolina, North Carolina

Ian rapidly intensified over the Gulf of Mexico, briefly reaching Category 5 status with winds of 161 mph, then weakened slightly before landfall. The storm unleashed a destructive storm surge, damaging winds and severe flooding across much of central and northern Florida where rain totals reached 10 to 16 inches in six to 12 hours. More than 19,000 structures in Lee County, home to Fort Myers, were destroyed or severely damaged. The storm then emerged off Florida’s east coast into the Atlantic before making another landfall as a Category 1 in northeast South Carolina.

Hurricane Harvey (2017); 103 deaths

Landfall location and date: Middle Texas coast; Aug. 25

Intensity at landfall: Category 4; 130 mph winds

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States impacted most: Texas, Louisiana

After making landfall, Harvey stalled over southeast Texas for days, unloading historic rainfall totals of 30 to 50 inches in the Houston area and up to 60 inches to the east near Port Arthur, Tex. — the most rain on record from a tropical cyclone in the United States. Catastrophic flooding damaged or destroyed more than 200,000 homes and businesses, and there were more than 17,000 rescues. Harvey eventually drifted offshore and made another landfall near Cameron, La., on Aug. 30, dumping 20 to 40 inches of rain in southwest Louisiana.

Hurricane Agnes (1972); 128 deaths

Landfall location and date: Florida Panhandle; June 19

Intensity at landfall: Category 1; 75 mph

States impacted most: Florida, Georgia, Alabama, Pennsylvania, Maryland, Virginia, D.C., Delaware

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Agnes quickly weakened as it made landfall, causing minimal damage from wind and storm surge along the Florida Panhandle coast. However, the storm spread heavy rain inland across the southeast United States, then re-intensified to a tropical storm and, together with another weather system, deluged the Mid-Atlantic with up to 19 inches of rain. Most of the storm’s damage and deaths were due to catastrophic flooding in Pennsylvania, New York, Maryland and Virginia.

Hurricane Hazel (1954); 95 deaths

Landfall location and date: Near North Carolina-South Carolina border; Oct. 15

Intensity at landfall: Category 4; 125 mph

States impacted most: North Carolina, South Carolina, Virginia, Maryland, Pennsylvania, Delaware, New Jersey, New York

Hazel remains the strongest hurricane to make landfall in North Carolina. The storm came ashore close to the border with South Carolina, whipping the coast with winds as high as 150 mph and a storm surge that destroyed every pier along a 170-mile stretch of coast. More than 50,000 homes were destroyed or damaged in North Carolina with the greatest damage occurring in Brunswick County. In South Carolina, Myrtle Beach and Garden City were severely damaged. Strong winds, heavy rain and flooding reached all the way north to Ontario, Canada.

Allyson Chiu and Nicolás Rivero contributed to this report.

The information above was sourced from NOAA, FEMA, Hurricanes: Science and Society and news reports. All death counts are approximate due to inherent uncertainties in confirming deaths and in linking deaths to indirect storm impacts.