Tuesday, December 28, 2010

Failing Haiti

Photo by John Carroll
Southern Haiti

From: Isabeau Doucet

Haiti: where aid failed

Why have at least 2,500 people died of cholera when there are about 12,000
NGOs in the country?

Haiti should be an unlikely backdrop
for the latest failure of the humanitarian relief system. The country is
small and accessible and, following last January's earthquake, it hosts one
of the largest and best-funded international
aiddeployments in
the world. An estimated 12,000 non-governmental organisations
are there. Why then, have at least 2,500 people died of
a disease that's easily treated and controlled?

I recently went to Haiti's capital, Port-au-Prince, and found my Médecins
Sans Frontières (MSF) colleagues overwhelmed, having
already treated more than 75,000 cholera cases. We and a brigade of Cuban
doctors were doing our best to treat hundreds of patients every day, but few
other agencies seemed to be implementing critical cholera control measures,
such as chlorinated water distribution and waste management. In the 11
months since the quake, little has been done to improve sanitation across
the country, allowing cholera to spread at a dizzying pace.

Ten days after the outbreak hit Port-au-Prince, our teams realised the
inhabitants of Cité Soleil
still had no access to
chlorinated drinking water, even though aid agencies
under the UN water-and-sanitation cluster had accepted funds to ensure such
access. We began chlorinating the water ourselves. There is still just one
operational waste management site in Port-au-Prince, a city of three million

On the one hand, Haitians were deluged with text messages imploring them to
wash before eating, while on the other they had to bathe their children in
largely untreated sewer water. Before the quake, only 12% of Haiti's 9.8m
people received treated tap water, according to the US Centres for Disease
Control (CDC).

The road to controlling a cholera epidemic has been paved by hundreds of
previous outbreaks worldwide. Yet, in Haiti, there are vast gaps in the
deployment of well-established control measures. Now the epidemic is
nationwide, making more than 120,000 people sick and killing at least 2,500.

In the face of this ferocious outbreak, investigations into its origin have
not been released publicly, even though this information is fundamental to
understanding the epidemic's behaviour.

Hypotheses of cholera's origin range from the contamination of the river
Artibonite by UN peacekeepers, through climate change to voodoo. In the
absence of transparency, fear and suspicion have provoked violence. The
population's anxiety is only amplified by catastrophic epidemic projections
by the Pan American Health Organisation (PAHO), a sister of the World Health

PAHO's epidemic modelling has not led to effective aid deployment. Huge
amounts of aid are concentrated in Port-au-Prince, while scant support has
been provided to inexperienced health workers in rural areas, where cholera
is flourishing. MSF teams have found health centres with shortages of
life-saving oral rehydration solution, and clinics that were simply shut.

It is against this backdrop that many non-governmental agencies have
launched fundraising appeals, even while their post-earthquake coffers
remain filled. The UN's Office for the Co-ordination of Humanitarian
Affairs(OCHA) has repeatedly claimed that
underfunding of its $174m cholera appeal,
launched primarily to benefit private groups, is hampering the response –
despite the fact that Haiti is the top-funded UN appeal for 2010. As nearly
a million Haitians remain homeless in the face of a full-blown public health
emergency, arguments that existing funds are tied up in longer-term
programmes ring hollow.

The inadequate cholera response in Haiti – coming on the heels of the slow
and highly politicised flood relief effort in Pakistan – makes for a damning
indictment of an international aid system whose architecture has been
carefully shaped over the past 15 years.

Throughout the 1990s, the UN developed a significant institutional apparatus
to provide humanitarian aid through the creation of the Department for
Humanitarian Affairs in 1992, later renamed OCHA, all the while creating an
illusion of a centralised, efficient aid system. In 2005, after the Asian
tsunami, the system received another facelift with the creation of a rapid
emergency funding mechanism (CERF), and the "cluster" system was developed
to improve aid efforts.

The aid landscape today is filled with cluster systems for areas such as
health, shelter, and water and sanitation, which unrealistically try to
bring aid organisations – large and small, and with varying capacities –
under a single banner. Since the earthquake, the UN health cluster alone has
had 420 participating organisations in Haiti.

Instead of providing the technical support that many NGOs could benefit
from, these clusters, at best, seem capable of only passing basic
information and delivering few concrete results during a fast-moving
emergency. Underscoring the current system's dysfunction, I witnessed the
Haitian president, René Préval, personally chairing a health cluster meeting
in a last-ditch effort to jump-start the cholera response.

Co-ordination of aid organisations may sound good to government donors
seeking political influence. In Haiti, though, the system is legitimising
NGOs that claim responsibility for health, sanitation or other areas in a
specific zone, but then do not have the capacity or know-how to carry out
the necessary work. As a result, people's needs go unmet.

While co-ordination is important, it should not be an end in itself. It must
be based on reality and oriented towards action to ensure that needs are

In Haiti, the cholera outbreak will continue to claim lives for the
foreseeable future. What is clear, though, is that the aid community at
large has failed to prevent unnecessary deaths, in a population already so
tragically affected by one catastrophe after another.

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