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Rebuilding a Future for Haiti
Américas / June 2010

By Larry Luxner

Albert Ramdin has traveled to Haiti more than 60 times in the past 10 years.

But no trip was like the one he took there in early February, three weeks after a 7.0-magnitude earthquake devastated Port-au-Prince, killing an estimated 217,000 people, injuring over 300,000, leaving 1.9 million people homeless and destroying the country's already struggling economy.

"We knew the situation was not great, but those images on TV are nothing compared to actually being there, and seeing a country completely collapsed and the devastation on the faces of its people," said Ramdin, assistant secretary-general of the Organization of American States and chairman of the OAS Haiti Task Force. "I knew many people who died in the earthquake — ministers, policymakers, friends, family members, their kids. They did not even have time to grieve."

Ramdin, interviewed at his Washington office, told Américas that it was a miracle OAS headquarters in the Port-au-Prince suburb of Petionville was left untouched by the quake. So he immediately offered it for use by the Haitian Ministry of Foreign Affairs.

"We are now establishing a Haiti coordinating office. My next visit to Haiti will be to make our OAS office fully operational," Ramdin explained. "We are not going to be able to finance hundreds of millions in reconstruction. Our role instead will be to assist in strengthening governance and building technical capacity. We will support the electoral process and civil registry, which becomes even more important because so many people have died or moved out of Port-au-Prince. And hundreds of thousands of people have lost their national identity cards."

Ramdin said the OAS had already registered 5.6 million people — or 96% of Haiti's adult population. "They were all provided a unique national ID card for the first time in Haiti's history, and we were in the process of registering the entire population below 18, a project worth $15 million, when the quake hit."

That's a pittance compared to the nearly $14 billion the Inter-American Development Bank estimates it'll cost to rebuild Haiti's homes, schools, roads and other infrastructure. That makes the Jan. 12 earthquake the most destructure natural disaster in modern times, when viewed in relation to the size of Haiti's population and economy.

"Haiti can recover, but it will require enormous courage from policymakers," said Ramdin. "Are we going to have a country where every five years you have 15 elections taking place? It's about time to look at that, and maybe have one election for president and legislative bodies. This is the time for structural changes in Haiti. The world cannot spend $14 billion and see everything collapse again because of wrong decisions."

As such, he said, Haiti is at the top of the OAS political agenda and will remain there for some time.

"Our role is three-fold," explained Ramdin, who is from Suriname. "Right after the quake, we had to mobilize member states to provide immediate assistance in the search-and-rescue phase, then later in short-term emergency humanitarian relief followed by long-term assistance. The second role we played was to mobilize financial resources with our partners, and third, to facilitate coordination among the various inter-American institutions."

The earthquake struck at 4:53 p.m. on Jan. 12, and "the next morning, at 9 a.m., five inter-American institutions were sitting here in my office, talking about how we could respond."

Along with the OAS, those were the Pan American Development Foundation (PADF), the Pan American Health Organization (PAHO), the Inter-American Institute for Agriculture (IICA), the Inter-American Defense Board and the IDB.

"Beyond the physical and economic damage, the Haitian people will require a lot of mental and psychological assistance to overcome this," he said, The Haitian people will need beyond all the damage and rebuilding the economy, it will require a lot of mental and psychological assistance to overcome this. But Haiti can recover. And we must keep Haiti very high on the agenda."

One of the most crucial agencies on the ground in Haiti right now is PAHO, which was immediately designated as the lead coordinator for all health issues.

"The quake devastated United Nations headquarters as well as PAHO's office in Port-au-Prince, so we set up camp at the Promess compound near the airport," said Dr. Jon K. Andrus, PAHO's deputy director, in a phone interview. "Fortunately, that building did not incur major damage, so all our staff could move there. They basically camped out there from the very start. People were sleeping on the ground."

At 4:00 every afternoon, "cluster" meetings convened, bringing in 200 representatives of NGOs who had arrived in Haiti to offer assistance. Work was divided into subgroups for specific tasks like the management of mobile clinics, damaged hospitals and clinics in the 600 or so new settlement areas that had sprung up literally overnight because people were afraid to go back into their homes.

"We are now re-establishing primary-care services so that patients with chronic diseases such as tuberculosis, diabetes and HIV/AIDS can receive the necessary treatment they would have received without the earthquake. We're also providing vaccines now, particularly to pregnant women. Reproductive health services are very important at this point. We know that before the earthquake struck, about 20% of babies were born prematurely. And now, with this kind of stress, we estimate premature births will go up to 30% to 35% of the total."

Andrus told Américas that PAHO is extremely worried about water- and food-borne diseases.

"The big concerns now, given the upcoming rainy season, are malaria and dengue fever, particularly in the 600 resettlement camps. When the rains start, hygiene and sanitation make it very challenging to sustain what were already vulnerable conditions."

In addition, "meningitis in any crowded situation is a concern. Any infectious disease you can name is a hypothetical concern in Haiti. That's why establishment of surveillanc for rapid detection of outbreaks is so very important."

On Feb. 19, PAHO — in conjunction with the World Health Organization — issued an urgent appeal for $1.44 billion in donor funds for Haiti earthquake relief over the next 12 months.

As part of the new humanitarian appeal, PAHO/WHO and health-sector partners are seeking $134 million to support a range of projects aimed at meeting priority health needs, supporting the Haitian Ministry of Public Health and Population, and making the country's health system functional again.

Included in the appeal are PAHO/WHO projects to make essential medicines and supplies available; ensure surveillance of and response to communicable diseases outbreaks; reeactivate basic health services; coordinate, assess and reduce disaster risks; address environmental health concerns; support the Dominican Republic's health response to Haiti; provide rehabilitation services for amputees and other injured; control vaccine-preventable diseases, and reactivate specialized health care in the Port-au-Prince metropolitan area

PAHO Director Mirta Roses said that, to succeed, these and other efforts to rebuild Haiti will require more funds as well as a greater focus on supporting and empowering Haiti’s leadership and people.

"We know that the coordination of humanitarian relief efforts — in the health sector and other sectors — has been a major challenge and has affected the success of our efforts," Roses said in a prepared statement. "Going forward, our greatest challenge will be to resist any tendency to assume the leadership function that properly belongs to the Haitian people and government. Our job must be to help Haitians restore their own authority over their country."

Roses noted that Haiti's Ministry of Health lost some 200 staff members when its offices collapsed in the quake. Many Haitian doctors and nurses were killed or injured in the quake, and many health facilities damaged or crippled.

Over the longer term, Roses said, "Haiti will need help to rebuild its damaged health infrastructure, to build institutional capacity to improve the health system in affected areas, and to lay the foundation for a permanent, sustainable national health system."

Overcrowded living conditions in settlements are a major concern, as is the need to provide adequate shelter and sanitation services. Diarrhea and water-borne diseases are both an immediate and a longer-term threat, and displaced people could also face a higher risk of vector-borne diseases as a result of their increased exposure to insects.

The UN's Office for the Coordination of Humanitarian Affairs (OCHA) estimates that more than 1.2 million Haitians are still in need of emergency shelter. Some 600,000 to 700,000 are living in spontaneous settlements in Port-au-Prince and need sanitation and hygiene assistance as well as shelter. At least two million need food assistance. Host families and communities supporting displaced people have also been seriously affected.

Amy Coughenour is deputy director of PADF, which has been active in Haiti for over 30 years and currently has 155 staffers working out of seven regional offices in addition to its Port-au-Prince country office.

"We were very fortunate in that about 80% of our buildings were OK, and the 20% that was damaged was repaired, so we are fully operational," she told Américas, explaining that PADF's portfolio in Haiti ranges from $12 million to $14 million a year.

"Our mission in Haiti is to empower Haitians to carry out their own longterm sustainable development. So our focus is on long term results, empowering communities Hatician civil society and the Haitian government to build capacity. That shows in the way we work, and with whom we work."

An OAS affiliate, PADF is nonetheless a registered Section 501(c)(3) nonoprofit, which makes it financially independent of the OAS — unlike PAHO, which is an international organization.

"We are working simultaneously on three things right now," said Coghenour, who has been focused on Haiti for the last eight years. "Our mission there is to empower Haitians to carry out their own long-term sustainable development — so our focus is on long-term results, empowering communities, Haitian civil society and the Haitian government. That shows in the way we work, and with whom we work."

PADF's three areas of focus are its ongoing program in community development and human rights; immediate relief (which includes food, water, tents, medicine and basic supplies), and recovery and reconstruction.

"We've served over 114,000 people, and donated over 100 tons of supplies. [After the earthquake,] we couldn't just carry on our activities and act like nothing had happened. We had to mount an entire relief operation via Santo Domingo and Miami, getting things in through partners. So our first order of buseness was taking care of our partners on the ground. That will be ongoing for the next three months."

With regard to recovery and reconstruction, Coughenour said PADF has been busy offering "cash for work" programs to unemployed Haitians, clearing rubble and draining ditches to aid communities and jump-start the informal economy.

"We're also going to tag 20,000 homes with either red, yellow or green tags," she explained. "Yellow means the building can be reapired. A lot of people are still deathly afraid of going into any building. They refuse to sleep in their homes or go inside buildings, even if they haven't been damaged."

Coughenour said "that's a very valid fear," given the numerous powerful aftershocks that have terrified Port-au-Prince and its environs, "but if we can go in and structurally assess the home with an engineer, then by tagging it green it gives people the green light to live in their homes again. And that's going to be really critical once the rains start coming. The green tag won't guarantee that people will use their homes again, but at least they'll know there wasn't any damage sustained by the earthquake."

PADF's third priority, she told Américas, is its human rights program, which is focused mostly on women and children who have been victims of violence, trauma or trafficking — all common problems in Haiti.

"As a result of the earthquake, this vulnerable population has increased a lot," said Coughenour. "What we're trying to do is address this growing violence against women and children, and the growing population of unaccompanied minors. We're ramping up child protection activities to infuse more training, resources and services."

A detailed study by the IDB concludes that the cost of rebuilding Haiti's homes, schools, roads and other infrastructure could total $13.9 billion. The complex report took into consideration several variables including the magnitude of the disaster, the number of fatalities, Haiti's population and its per-capita GDP.

Viewed this way, the study confirms that the Haitian earthquake is likely to be the most destructive natural disaster in modern times, vastly more destructive than the tsunami that hit Indonesia and several other countries in 2004, or the cyclone that hit Burma in 2008. It caused five times more deaths per million inhabitants than the world's second-ranking natural killer, the 1972 earthquake that leveled Managua, Nicaragua.

"My own country, Colombia, is epxosed to various types of natural disasters," said IDB President Luís Alberto Moreno. "In 1999, two earthquakes destroyed over 100,000 buildings and left half a million people homeless in the 'coffee axis,' an area' that's key for the national economy. It was the worst disaster in Colombian history, yet the reconstruction was completed in less than four years."

Moreno suggested that the IDB can play a crucial role in Haiti as it did in Colombia, El Salvador and other countries devastated by recent disasters. al role

Shortly after the quake struck, Moreno visited Port-au-Prince and toured the district where the bank had its offices. He also inspected the site of an encampment for people left homeless by the quake, and discussed the IDB's potential role in helping turn the encampment into a neighborhood with permanent housing and basic services.

"The enormous challenge of rebuilding Haiti is beginning for the bank. Now we need the commitment of our member countries in a difficult task that will take years. The solidarity of Latin America and the Caribbean needs to stay strong long after the harrowing images of the disaster vanish from the media. But if we get to rebuild a capital worthy of Haitian pride, the effort will be worthwhile."

On that note, Ramdin of the OAS says that Port-au-Prince and its 2.5 million people must be relocated, or at least fortified against future earthquakes by making government buildings stronger.

"You cannot rebuild a city where there's a risk of a repeat disaster. If you know it can happen again, maybe the government should consider moving part of the city somewhere else," he said. "There is an international commitment to help Haiti, but it has to stick. Whatever you invest today has to meaningfully improve lives — not just for the coming few years but forever."

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