Haiti After the Earthquake (24 page)

The earthquake was another reminder of the weakness of Haiti's public institutions and the vulnerability of its population without any kind of social safety net. Into the breach have come humanitarian groups, NGOs, development experts, missionaries, and many others, but whether such goodwill can be converted into substantial reconstruction projects that grow the Haitian economy, mend its infrastructure, strengthen its health, education, and sanitation systems, and furnish its government and institutions with sovereignty and resources remains to be seen.

A
ppreciating the historical roots
of Haiti's chronic problems did not make solving them easy, as was clear before the quake. And it would be hard to rank Haiti's post-quake problems in order of importance. But it was increasingly clear that living conditions in the spontaneous settlements that stretched across the city and to other affected areas would be near the top of the list.

Although my coworkers from Partners In Health and Zanmi Lasante were providing medical services in four of the camps, I hadn't spent much time at these sites. It was tempting to assume that others with more expertise in such matters were helping Haitian authorities address this new crisis of homelessness. A number of large institutions with experience in such settings—including the International Organization for Migration, the UN Office for the Coordination of Humanitarian Affairs (OCHA), and Red Cross affiliates—were charged with tending to the displaced, and the UN had pulled together a “shelter cluster” to coordinate responses to the knotty problem of shelter. In retrospect, I had a naïve view on how long these tent cities would be around before people would find their way to safer temporary shelters or repaired homes. How temporary was temporary? During a visit to one of those camps, Chelsea Clinton
shocked me by noting that, on average, displaced persons in Africa spend well over a decade in such “temporary” settlements.
¹

As it became clear that displaced Haitians would fill Port-au-Prince's interstices and public spaces, from soccer pitches to public parks to churchyards, the shelter experts in humanitarian disasters devised dozens of plans. But plans didn't always, or often, lead to implementation. Hundreds of thousands lacked adequate housing—many were living under bedsheets jerry-rigged as roofs—as well as food, water, and medical care. Although the Haitian government had suggested building numerous small camps instead of a few large ones—because security and sanitation worsened with increasing sprawl—the majority of those
anbatant
(“under the tents”) lived cheek-to-jowl in large encampments. By mid-February, more than one million people were living in almost a thousand such camps.

It's not that we weren't thinking about the shelter problem from the beginning: it was impossible to walk for more than a few minutes in Port-au-Prince without seeing spontaneous settlements. A few days after the quake, before we'd even heard the term shelter cluster
,
I met several Partners In Health and Zanmi Lasante colleagues for an impromptu meeting about our urban strategy. We debated for hours in the UN logistics base. Should we be providing medical services in the rapidly forming camps, or were the experts on the case? And what about adding staff in the city to complement our teams already working there?

These were weighty decisions that would, we knew, affect our work for years to come. Setting up tent clinics would require additional staff, some of whom we could surely recruit from among camp residents. But even well-staffed clinics couldn't do much without medications, equipment, food, water, sanitation—and we had none of those things in urban Haiti. In the same heated meeting, my colleagues asked simply, “What is our obligation to the camps and to the General Hospital?” Loune Viaud, who had spoken very little, gave a shrug as if to say, “What choice do we have?” She was pretty sure we could set up decent clinics and recruit staff rapidly. The other Haitians there also seemed confident about our capacity for growth in
Port-au-Prince. The more reluctant staff feared we wouldn't do a good enough job; all of us knew camp conditions were brutal. One of the most experienced doctors put it this way: “I went into one of the camps and, although I hate to say it, almost lost all hope.” Thinking as UN Deputy Special Envoy, I couldn't ignore the camps on the grounds that they were “outside our catchment area,” as public health professionals are wont to say. And although I respected the shelter experts, no group had as much experience implementing projects in Haiti as Loune and our Zanmi Lasante teams did. I was relieved when consensus emerged that we would try to help out in the camps.

The spontaneous settlements were dispiriting in large measure because of the execrable living conditions. Many of those providing services within the camps also felt dispirited; by mid-February, some humanitarians were already speaking of failure. Wasn't it a failure that the vast humanitarian machine could not move the internally displaced to higher ground before the rains started? Couldn't they at least make sure camp residents had enough to eat and drink?

In mid-February, I visited Parc Jean-Marie Vincent, one of the largest camps in Port-au-Prince. (The actor Sean Penn and his group had set up shop in the only larger camp, sitting precariously on what was once the Pétionville Golf Club.) The park was named after Father Jean-Marie Vincent, the Haitian priest, who was martyred in 1994 for helping to organize the poor in Haiti's parched northwest. Father Vincent had launched literacy projects and a bank for poor people (an anticipation of the microcredit movement) before being gunned down on the steps of his own rectory. I'd known him personally, and wondered what he would've thought about the park-turned-camp bearing his name. It wouldn't have shamed him, I felt sure. These were, at least, his kind of people.

One of the many fine people we'd met (and hired) was Dr. Dubique Kobel, a young Haitian physician trained in Cuba who had recently returned to live and work in the poor Port-au-Prince neighborhood where he'd grown up. His wife, Nadège (also a doctor), had given birth to a baby girl mere months before the quake leveled their neighborhood. The Drs. Kobel took the baby, who was unharmed, and sought shelter in the tent city being hastily erected in Parc Jean-Marie
Vincent from all sorts of ersatz construction materials. Few tents were available, but the Kobels eventually found one and pitched it on a stretch of cement. (The park had been made in part out of an abandoned runway.) The Kobels's new home was a few hundred yards from where they'd lived before the quake. Along with new colleagues from Zanmi Lasante and Partners In Health, they soon found themselves delivering medical care to a population the size of a medium-sized city.

Dr. Dubique guided me through the camp. It was a stunning scene: on that day, he estimated that about forty-eight thousand souls were packed into the tiny space. But Dr. Dubique was upbeat, glad to have medications, basic lab capacity, and some experienced colleagues from central Haiti, including one of my favorite protégés, Dr. Anany Prosper. (In spite of the setting, there were some happy reunions that day.) Anany had helped launch a clinic in a town called Petite Rivière de l'Artibonite and had recently assumed similar duties in Parc Jean-Marie Vincent and three other spontaneous settlements.

Some progress had been made: regular clinical services (delivered, alas, in sweltering tents); the slow transformation of shelters from dun-colored to blue as cardboard and sheets were replaced by turquoise plastic sheeting; a couple of new tent schools; some minor improvements in lighting. (The pitch darkness into which the camp was plunged each night increased the risk of sexual violence and other crime.) But there didn't seem to be more than a few score latrines, and the entire place was hot and dank. How long could the good morale among doctors and nurses last in these conditions? Surely the shelter experts were working on these challenges?

Shelter experts were, in fact, also unhappy with the pace and quality of the services offered to the displaced. Although Parc Jean-Marie Vincent was bigger than most camps, it was in other senses par for the course. Dr. Dubique underscored the need for scaled-up provision of food, water, and shelter—the same services we tried to afford our patients in rural Haiti. He also pushed for more investment in security to make the camps safe for women and children. But it was clear, as Dr. Dubique took me through the camp, that resources and expertise were insufficient to meet all these needs.

The day after the quake, hours after President Clinton's speech at UN headquarters, I'd met with John Holmes, the head of OCHA. He seemed like a reasonable and experienced professional. Perhaps I should seek his counsel about security, water, sanitation, and alternatives to tarps and plywood and tin? Holmes directed me to internally displaced persons experts in the shelter cluster. My colleagues from Partners In Health (including Louise Ivers) had already consulted them, and were finding that the U.S. military and a missionary group, Operation Blessing, were more reliable partners when it came to working in the park.

What exactly was the cluster system? The UNʹs cluster strategy divided labor into discrete areas according to its lead agencies: the WHO (World Health Organization) was charged with coordinating medical aid; the World Food Program, with food aid; and UNICEF, with attending to children's needs. As the weeks passed, swelling settlements and crowded hospitals revealed a wide gap between the existing humanitarian capacity and the unmet needs of Haitians affected by the quake. The cluster system needed reform. Dissatisfaction with aid delivery was abundant and not only within the camps. An internal memo written by John Holmes himself was leaked to the press on February 17. I include it here, with gratitude for his candor:

If I read him right, Holmes wasn't sure that the A team was on the job; nor did he think that enough resources were reaching the most urgent projects. Holmes continued: