Haiti, one year after the earthquake
Johanneke Tummers
January 12, 2010, 16:53h. The earth in Port-au-Prince shakes with a force of 7.0 on the Richter scale. Houses collapse and complete
buildings disappear when cracks form in the earth. Only minutes after the earthquake, it becomes apparent what has been destroyed
in just a few seconds: 230 000 people died, 1.5 million others became homeless and around 600 000 Haitians fled to other parts of
the country.
One year later, I went to Haiti for the Netherlands Red Cross, to critically look at the aid that has been provided in the year that had
past. How could it be that so many people were still living in tents? How could cholera have such a devastating effect? In just a week,
I came to learn the harsh reality of delivering humanitarian aid in a disaster zone.
Disaster response
From the first moment after the earthquake,
many non-governmental organizations
(NGOs) got on their feet and started delivering aid in the areas that were hit by the
earthquake. Items needed immediately after
such a disaster are clean drinking water, food,
tents, and medicines. It is estimated that at
a certain moment during the last year, as
many as 12 000 NGOs were active in Haiti.
For such a large number of NGOs to perform in an effective way, good coordination
is vital. Unfortunately, Haiti did not have a
strong government or organizational system
to assist aid on such a large scale. Haiti is
a country that has a turbulent history with
many periods of being governed by dictators. Hence, Haiti never benefitted from
Many people were left lying on
the streets
strong leaders who invested in development
or fought to eradicate poverty. When the
$/
Haiti
9 446 000
inhabitants
1 070
income per year
♂ 60yrs ♀ 64yrs
life expectancy
earthquake struck, it left the entire country
paralyzed. One can imagine that the effective delivery of aid was to become problematic under such circumstances.
Rebuilding Haiti
Normally, the emergency phase after a disaster lasts about a year-and-a-half. After this,
the NGOs start their reconstruction activities, such as building shelters, houses, latrines, schools, and hospitals. In Haiti however, it soon became apparent that the end
$
9.5%
of GDP for health
?
/
doctors/10 000 people
of the emergency phase was not even near.
NGOs talk about extending the emergency
phase for another two to three years. Which
factors complicate the delivery of aid in a
country as Haiti?
Difficulties faced
When driving through Port-au-Prince, the
rows of tents next to the road just seem endless. Every free space in the capital is covered
with the colorful mixture of grey, white, blue,
and black materials. The people who live in
those tents had to abandon their houses because of the earthquake, and are now waiting
for a temporary shelter. All the building material has finally passed customs, but there is
one large problem in Haiti; there is no land
Driving through Port-au-Prince,
the rows of tents next to the
road just seem endless
wide. It is estimated that the actual number
of cholera deaths is three times higher than
the reported number. The reported cases are
only the ones seen in clinics, and many patients do not even make it there. One of the
most important reasons for the fast spread of
cholera is the level of sanitation in Haiti. According to the WHO, before the earthquake
only 15% of the population had access to a
toilet or latrine, which is one of the lowest
percentages in the world. Many people use
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Cholera outbreak
Eight months after the earthquake, Haiti
had to digest another disaster. Cholera broke
out and killed thousands of people within
a couple of weeks. As of 16 January 2011,
Haiti's public health ministry reported
194 095 cases of cholera and 3 890 deaths,
with an overall fatality rate of 2% nation-
Global Medicine 12 – September 2011
available to build on. Most Haitians used to
rent their piece of land from a wealthy landowner, but there is no such thing as a land
register, where records of landownership
are kept. It is simply not known who owns
which piece of land. Right now, NGOs in
Haiti are facing a situation where they have
all the material to build houses, but no free
land to put them on. Rich landowners do
not have any incentive to give some of their
land up to accommodate the poor. And a
NGO who simply builds shelters on a free
piece of land has a good chance that their
building material will be stolen during the
night. Since most Haitians are extremely
poor, owning land was never a possibility for
them. Many NGOs have now promised to
build shelters for these displaced people, and
for many, waiting in the camp is the only
way to ever become a landowner.
Another issue is that although living conditions in the camps are not ideal, most of the
camp inhabitants have better facilities than
they ever had before. In the camps there are
latrines, people get clean drinking water, and
usually there is a medical ward on the campsite. The majority of the houses in Port-auPrince have been declared safe again. However, people know that if they move back to
their homes, they will be stripped of all these
benefits and also loose their chance to own a
piece of land.
“
Nadine Célestin Gedeon, Head of Legal Affairs of La Croix-Rouge Haïtienne (Haitian Red Cross):
Aid should not be seen as charity, it is a right. Delivering aid in a country as Haiti, has to be done using a rights-based approach and should therefore
take human dignity into account. The problem regarding the lack of cooperation between NGOs arises because NGO activities are not coordinated
together with local authorities. Communities need to participate in the process and have a say. They have to be able to influence decision makers. The
general public will probably start recognizing and appreciating the difficulties that NGOs are facing if they become more transparent in their work.
the rivers as a bathroom, and in these same
rivers people wash their laundry or bathe
themselves and their children. It is not hard
to imagine that a disease such as cholera can
spread fast under these unsanitary circumstances.
A large obstacle for effective medical aid
was the fear among people for cholera. The
people of Haiti had never encountered cholera before, and were afraid to touch or treat
infected people. Taxi drivers did not want to
take patients to a hospital or clinic in their
cars out of fear for the disease. Many people
were left lying on the streets. Even though
cholera can be treated relatively easy with
oral dehydration fluid, it is vital for patients
’’
to start treatment within 24-48 hours. For
many patients, help came too late. Currently,
another point of concern is remoteness of areas. Many villages are difficult to reach, and
therefore have not yet been visited by volunteers who educate Haitians about cholera
prevention, or instruct people on what to do
in case of infection.
The Netherlands Red Cross in Haiti
Recommendations
Providing aid on a scale as large as in Haiti will never be easy, and this article only
touches upon a few of the problems and difficulties NGOs face daily. However, valuable
lessons can, and should be learned. In order
to improve aid delivery, it is extremely important that NGOs and existing governmental structures improve their cooperation in
disaster zones. The example of Haiti shows
that even though there is a lot of money and
good-will available in the form of NGOs,
they still depend on general conditions and
rules that exist within a country. Another
known problem is the lack of cooperation
between different NGOs. For example, one
city we visited had a cholera treatment center
set up by Médecins sans Frontières that was
situated close to a Red Cross base. Neither
knew about each other’s’ presence in the city.
The Netherlands Red Cross (NLRC) and other national Red Cross and Red Crescent societies work closely
together with the Haitian Red Cross. Together with the International Federation of the Red Cross and Red
Crescent Societies (IFRC), the Haitian Red Cross coordinates the different aid projects of the Red Cross in
Haiti. A national fundraising campaign for Haiti in the Netherlands raised 20 million Euros for the NLRC.
Approximately six million were directly spent on the procurement and distribution of emergency items,
in coordination with the IFRC. The remaining fourteen million are spent on projects of the NLRC in Haiti,
which focus mainly on water and sanitation. In the months after the earthquake, the NLRC constructed
170 shelters and 100 latrines in Petit-Guave. Also, the NLRC started building 6 500 pit latrines and is
constructing ten water points with safe drinking water within two years, in the cities of Leogane and
Jacmel. In addition to providing pit latrines to households, the NLRC and the Haitian Red Cross educate
the communities about the importance of general hygiene measures.
appreciate the difficulties that NGOs face
when trying to deliver aid in disaster areas.
Far too often when people donate money
to an NGO, they expect the NGO to fix
the problem within a certain timeframe.
When after a year they still see people living in tents, they start to criticize NGOs and
When people donate money to an NGO, they expect the NGO to
fix the problem within a certain timeframe
wonder whether their money has been well
spent. It is good to keep in mind that the
conditions NGOs are working under are extremely difficult, and they do not operate in
a vacuum. They are dependent on the general conditions in a country, and also on the
goodwill and capabilities of a government.
The NGOs on their turn should make it a
priority to be transparent about their budget,
projects and eventual problems they are facing. It is good to remember that in the end,
both NGOs and donors have the same goal,
which is to help those who need it most.
About the author:
Johanneke Tummers is enrolled in the second year of the Selective Utrecht Medical
Master of the University of Utrecht (SUMMA). She just started a four-year period as a
Board member of the Board of Governors of
the Netherlands Red Cross.
Further reading:
7.0
Hoe ik Haiti overleefde – Jean Mentens
De
Crisis Karavaan – Linda Polman
Dowell,
S.F., Tappero, J.W., Frieden, T.R. (2001)
’Public Health in Haiti — Challenges and Progress’ New England Journal of Medicine 364; 4
Global Medicine 12 – September 2011
Ideally however, the two parties should combine their strengths. For example, the Red
Cross volunteers could educate people about
cholera prevention and refer infected patients to the treatment facilities of Médecins
sans Frontières, hereby forming an effective
frontier to fight cholera.
On a more general note, it would also help
if the general public learns to recognize and
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