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 strong leaders who invested in development or fought to eradicate poverty. When the 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 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 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-au-Prince 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.

 

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% nationwide. 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 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.

 

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. 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 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 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