Paul Anticoni on Haiti's slow recovery two years after the disaster

I have worked in international development throughout my career, but was staggered by the incredible outpouring of generosity. The Jewish community can be proud that it came together to raise more than half a million pounds, the most raised by an emergency appeal in many years. This was greatly assisted by the support of many communal organisations (including The Office of the Chief Rabbi, The United Movement, Board of Deputies of British Jews, United Synagogue, Assembly of Masorti Synagogues, Tzedek, The Movement for Reform Judaism, Liberal Judaism, Union of Jewish Students, B'nai B'rith UK, The Federation of Synagogues, Spanish & Portuguese Jews’ Congregation, Zionist Youth Council and London Jewish Forum).

The funds allowed WJR to provide food, clean water, shelter and health services to more than 90,000 people. This is a world full of tragedy, but the community’s response demonstrated that the concept of Tikkun Olam – healing the world – is still at the core of our Jewish identity. To the whole community: thank you.

The international community has already given more than £1.5bn in humanitarian aid in response to the quake, though this is barely half of the nearly £3bn pledged in the immediate wake of the disaster. In the UK, the Disasters Emergency Committee raised a staggering £107 million.

It was always obvious from the scale of the work to be done that the clear-up would not happen overnight. Almost 300,000 houses were destroyed or badly damaged, along with 80 per cent of the capital's schools and 60 per cent of hospitals. Before the earthquake hit, Haiti was already ranked 145th out of 169 countries on the UN Human Development Index, making it the poorest country in the western hemisphere.

Despite the vast sum of money available for the recovery, there are limited success stories and many lessons to learn. For the international humanitarian agencies, of which WJR is a part, response was rapid and massive. Medical, surgical and rescue teams were on the ground within days and resources mobilised and in the pipeline immediately. Working closely with local community groups there is no doubt that with the outpouring of billions of dollars, Working closely with local community groups there is no doubt that with the outpouring of billions of dollars, thousands of lives were saved in the initial aftermath both. through individual charitable organisations and the myriad of international aid groups that rushed to Haiti in the days and weeks after the 7.0 quake. If simply saving lives on a day to day basis was the objective then these agencies do indeed deserve great credit. 

But the slow pace of recovery, disorganised, donor-driven projects, scattered development and lack of investments in creating jobs have many questioning whether the money was smartly spent. The quake offered an opportunity for Haiti to pull itself out of the economic and political morass that has existed for decades. But even that possibility was quickly beset with problems.

Lack of decision making in the early days after disaster led to problems. Non-government organisations (NGO’s) that wanted to chart their own course for recovery and international community with its own spending priorities all hampered Haiti from the start of the recovery. Few organisations, if any, had experience of working in a country almost completely without government leadership and particularly in a francophone setting. The UN and the NGO network willingly sought to provide a framework against which recovery could be based but it was vastly inexperienced and inept at doing so and created what some commentators referred to as Haiti becoming a "Republic of NGO's". In addition, the scale of funds mobilised, particularly in the US, created an incentive for almost every NGO under the sun to "give it a go" in Port au Prince and help out. The recovery required a smart, coordinated and almost single minded leadership to avoid a renowned Haitian bureaucracy getting in the way. 

At a local level the international and Haitian agencies' response delivered results. Working with Merlin, WJR's mobile health clinic programme has been at the forefront of rebuilding a primary health care service to tens of thousands that required support, making sure that vulnerable communities have received the vital health care they need. The clinics have had an incredible impact, allowing tens of thousands of people to access basic healthcare. A cholera outbreak, frightening as it was, never turned into the mass casualty scenario envisaged. Thousands of people from remote areas who previously had no access to primary health care, have been seen by health professionals.

Each clinic carries out up to 1,000 consultations every month, and targets those with limited access to health care services, displaced communities, women and children. Two vehicles are kitted out with medical equipment, drugs and staff that are able to provide health care services. The Cholera Treatment and Prevent programme funded the sixty-bed Cholera Treatment Centre (CTC) in Port-au-Prince serving 600 cholera patients a month and delivering prevention activities in the centre and in the community. Women whose lives would have been endangered in pregnancy and childbirth have been able to access medical assistance in places where there was no support before. 

November saw the completion of the rebuilding of the Caravelle Health Centre which was damaged in the earthquake, leaving part of the building unusable and no reliable water or electricity supply.  The clinic remained open during its rehabilitation, serving on average 1,380 a month with antenatal and postnatal care and advice on preventing the spread of sexually transmitted diseases. With the funds raised by the community, WJR contributed to the funding for the reconstruction and repair work required. The building has been constructed to earthquake safety standards to reduce further risk of damage.

And tens of thousands of temporary shelters, camp facilities and transitional services have been, and continue to be, provided to hundreds of thousands of those still displaced. NGO’s have provided assistance to over 1.8million earthquake survivors in Haiti. They are now making the challenging shift taking the provision of basic services onto a more sustainable footing. This means supporting those who are moving back from camps to their pre-quake neighbourhoods. It means working with communities and government to hand over the provision of services such as water supply, waste management and the creation or maintenance of safe toilets. It also means that an increasing proportion of the remaining funds are being spent on helping earthquake survivors earn an income to become more self-sufficient.

Sadly, however it appears that all the small details have been worked out just leaving the big ones to be resolved! Complex historical land ownership rights have meant that rubble remains where it has fallen as arguments continue as to who actually owned the building that collapsed and who is responsible for reconstruction. And with more than a half-million people still living in squalid camps, and billions of dollars in promised aid still to arrive, much remains to be done. And some Haiti experts and Haitians worry that the country could still slide backwards without major efforts to create jobs and economic reforms. Government weakness has meant too much prevarication and the result is a city today that still resembles a huge tented camp.

Perched on a well known seismic fault in the midst of the Caribbean hurricane belt, the humanitarian agencies know that building the resilience of the Haitian population and ensuring the country is better prepared to meet future disasters is critical. It is not just a question of responding to 2010's disaster but being ready for the next one. This is no easy task in the absence of political stability and Haitian leadership willing to take responsibility. There is still a lot to do, but international aid is delivering results to thousands of Haitians.

Cresimise's story, Durissy, Petit Goave

Once a week Merlin runs a mobile clinic in Durissy, a remote community of 2,500 in Les Mornes Petit Goave. The closest health facility is the Notre Dame hospital in Petit Goave, a two and a half hour walk away, but people complain about the poor service at this facility. Each Wednesday, the mobile team (comprising two doctors, five nurses and one midwife) treat an average of 150 patients per day. The majority of patients come from the community, but many others come from far away to access Merlin's services due to the lack of health facilities in the area. 

Cresimise, a 30-year old woman living in Durissy, visited Merlin's mobile clinic with abdominal pain that had continued for several weeks. When Cresimise arrived at the clinic, she hadn't known that she was four months pregnant. "I went many times to the hospital in Petit Goave but I've never had the chance to be seen by a doctor" she said to Dr Mario Fremont, one of Merlin's doctors.

After consultation, a Merlin doctor referred Cresimise to the Notre Dame Hospital in Petit Goave for a sonogram, accompanied by a Merlin nurse. Cresimise was finally diagnosed as having an ectopic pregnancy requiring immediate surgery. However, the referral nurse discovered a day later that Cresimise was still waiting for medical attention, as the hospital lacked the necessary blood supply and no gynaecologist was available for the procedure. The referral nurse immediately called Medecins sans Frontieres (MSF) in Leogane, who accepted Cresimine for surgery in agreement with Merlin's Health coordinator. 

Cresimise recovered well thanks to the effective MSF services and the intervention of Merlin's staff. When she returned to the mobile clinic a few weeks later for a check-up, the Merlin team were delighted to see she was better. "I'm feeling good and am very grateful that Merlin was there to save my life".

Cezanne’s story

Cezanne is a nurse, and team leader for one of Merlin’s mobile clinics. Here, she talks about a life changing experience she had in a remote part of Haiti.

“Every week, our mobile clinic visits a small village about 45 minutes into the hills from Petit Goave, west of Port-au-Prince. There is no proper road to the village; instead our 4x4s take us up a stony riverbed – which will be totally impassable once the rainy season starts. Nearing the end of our clinic one week, a man ran in saying that his wife's water had broken hours ago and she was having heavy contractions in the river bed below. She had been trying to hike the three hours to the nearest hospital, but was not going to make it.

Only stopping to make sure that we had the equipment we needed, two doctors from our team and I trekked down to where she was labouring, perched on a tiny river rock. Her only company was the local birth attendant, an old man who was sitting in silence as she contracted away. He had no medical supplies or equipment with him.

Dr. Mario and I immediately strapped on gloves, lifted up her gown and felt the head crowning. At that moment the lady stood upright and screamed as she pushed her baby out. Unbelievable! Blood and fluids absolutely everywhere, baby breathing ok and mother trembling... With the infant safely placed on her mother’s stomach, I tied off the umbilical cord and cut it with my scalpel – et voila! Happy birthday, baby! Her parents were so moved that they decided on the spot to name the baby after us - Maria Cezanne Merline”