Haiti earthquake: Aid effort shifts to long-term care

In the initial days after the Haitian earth shook violently Jan. 12 – flattening whole sections of the capital, cutting off services, and killing an estimated 150,000 people – the priority was on search and rescue as well as emergency food and medical assistance.

Now, two weeks after the earthquake that brought Haiti to a halt and left perhaps 1 million people homeless in the capital alone, the massive international aid effort is shifting.

While most of the 2,500 search-and-rescue personnel who swarmed in from all corners of the globe have returned home, attention is falling increasingly on long-term care for the hundreds of thousands of wounded, providing sanitation before disease-breeding conditions set in, and moving perhaps a million people out of precarious, makeshift camps into safer, cleaner, and better organized tent communities.

“It’s noticeably calmer. There’s not that life-or-death urgency about pulling out trapped people or providing first aid, but there’s going to be a second wave of problems that will be just as critical,” says Skyler Badenoch, manager of international programs for Build On, a Connecticut-based organization that specializes in building rural primary schools.

Sanitation concerns

Already in Haiti to build schools in the country’s south, Mr. Badenoch now finds himself managing a latrine project at a camp in the capital’s Carrefour district – “because if we don’t get sanitation going, things are going to get real bad, real quick.”

Despite early complaints of a slow mobilization of international resources – particularly from the United States – and confusion over who was in charge of a massive intervention involving hundreds of countries, international agencies, and relief organizations, the results after two weeks are impressive.

Some 300,000 people are receiving water and food rations every day, with the latter number expected to jump to 1 million a day by the end of the week, according to Haitian health officials. After an initial lack of medical supplies that left some Haitian doctors performing amputations without anesthesia, thousands of life-saving surgeries have been performed and medical supplies are generally plentiful.

Clean-up and rebuilding

The US and other countries are now bringing in heavy equipment like trucks and bulldozers for the massive cleanup and rebuilding effort to come. One UN official estimates that the US alone has mobilized about $1 billion in aid, equipment, and personnel.

“There’s always a certain amount of fog of war at the outset of this kind of operation, but the coordination has come along quickly with the focus on working with the Haitian government,” says Thomas Sizemore, principal deputy director of preparedness and emergency operations for the US Department of Health and Human Services.

Appearing with Haiti’s Minister of Health Alex Larsen at a Monday press conference announcing the formation of 19 public health rapid assessment teams, Dr. Sizemore said the task now is to address public health concerns before they become critical. “We are moving from the emergency and acute response [phase] to tackling the health threats and demands now facing those who survived the quake,” he says.

Mr. Larsen says enough tents have already been secured to build camps to house 400,000 people “in a decent, safe, and healthy environment.” But Haitian President René Préval said 200,000 more tents were needed before the expected start of the rainy season in May.

Acknowledging that officials are likely to face resistance from residents who do not want to leave their neighborhoods – even if the alternative is the unhealthy homeless camps that have sprung up in public squares and gardens – Larsen says provisions are already contemplated for public transport to ensure that camp residents can return to their home areas and economic livelihoods.

But the reality is that many neighborhoods will have to be razed and completely rebuilt, officials say, and they add that such major construction cannot occur with people living in close proximity.

'Clusters' improve aid delivery

Officials and some nongovernmental experts say the coordination of the dizzying number and variety of aid providers responding to Haiti’s crisis is an improvement over past experiences. And they credit a number of recent international disaster assistance measures that they say have streamlined intervention and made it more efficient – including a new United Nations-administered “cluster system” for organizing aid providers around certain critical tasks like rescue or infrastructure.

“I really think the operation is moving pretty well, especially given the magnitude of the damage and the density of the population in this case, and I think we can credit the organizing system now in place,” says Jens Kristensen, the senior humanitarian officer with the UN’s stabilization mission (MINUSTAH) in Haiti.

Mr. Kristensen, who survived five days buried in the rubble of the UN’s Port-au-Prince building, says the “cluster” system – assigning one international agency to coordinate the efforts around a particular task – has “streamlined the process of bringing organizations together, cut down on duplication of effort, and made for a system that is more predictable.”

Bright spots

Despite the immensity of the human suffering, officials say there are some bright spots that will help in the weeks ahead.

Larsen says Haiti’s public health system was not wiped out and is already back administering programs in vaccinations, tuberculosis prevention, and HIV/AIDS. And Health and Human Services’ Sizemore says Haiti’s agriculture, long neglected, could be an engine in the recovery.

Noting that this disaster was not like a hurricane, which can wipe out crops and result in massive erosion, he says, “It appears the agricultural infrastructure is intact, and that’s going to be a big help” in the rebuilding phase.

Johanna Mendelson Forman, a Latin America expert with the Center for Strategic and International Studies in Washington, says a “re-dedication to agriculture” would allow Haitians to grow more of their own food, “creating a more secure future.” But she says first will have to come “decentralization away from the capital, construction of new infrastructure, roads, and distributive energy systems to end rural isolation.”

Getting corruption in check will also be high on donors’ minds, Ms. Mendelson Forman says. She notes the recent calls for creation of a “Haiti fund” – modeled after a similar fund created after Central America’s hurricane Mitch disaster -- that would be jointly managed by Haitian government leaders and members of the international community.

The rescue and emergency assistance phase in Haiti may have just about wrapped up in two weeks, but disaster experts say that food and water distribution will go on for at least another six months to a year, and that rebuilding could be a decade’s project.

Build On’s Badenoch, now constructing latrines at a camp that sprouted on the grounds of a Silesian Order’s church in Port-au-Prince, says the priest in charge seemed overwhelmed when he told him the camp might be at his church for a year or more.

“I too would like to get back right now to doing what we do best, which is building schools, but suddenly there are these new priorities that really have to be taken care of first,” he says. “Rebuilding after this is going to take a long time.”