CHAPTER 1INTRODUCTIONThe2010 Haiti earthquakewas acatastrophicmagnitude 7.0Mwearthquake, with anepicenternear the town ofLeogane(Ouest Department), approximately 25 kilometers (16mi) west ofPort-au-Prince,Haiti'scapital. The earthquake occurred at 16:53 local time (21:53UTC) on Tuesday, 12 January 2010. By 24 January, at least 52aftershocksmeasuring 4.5 or greater had been recorded.An estimated three million people were affected by the quake. Death toll estimates range from 100,000to 159,000to Haitian government figures from 220,000 to 316,000 that have been widely characterized as deliberately inflated by the Haitian government. The government of Haiti estimated that 250,000residencesand 30,000commercial buildingshad collapsed or were severely damaged.The earthquake caused major damage in Port-au-Prince,Jacmeland other settlements in the region. Many notable landmark buildings were significantly damaged or destroyed, including thePresidential Palace, theNational Assemblybuilding, thePort-au-Prince Cathedral, and the main jail. Among those killed wereArchbishop of Port-au-PrinceJoseph Serge Miot, and opposition leaderMicha Gaillard.The headquarters of theUnited Nations Stabilization Mission in Haiti(MINUSTAH), located in the capital, collapsed, killing many, including the Mission's Chief,Hdi Annabi.Many countries responded to appeals forhumanitarian aid, pledging funds and dispatching rescue and medical teams, engineers and support personnel. Communication systems, air, land, and sea transport facilities, hospitals, and electrical networks had been damaged by the earthquake, which hampered rescue and aid efforts; confusion over who was in charge, air traffic congestion, and problems with prioritisation of flights further complicated early relief work. Port-au-Prince's morgues were overwhelmed with tens of thousands of bodies. These had to be buried inmass graves.As rescues tailed off, supplies, medical care and sanitation became priorities. Delays in aid distribution led to angry appeals from aid workers and survivors, andlootingand sporadic violence were observed. On 22 January theUnited Nationsnoted that the emergency phase of the relief operation was drawing to a close, and on the following day the Haitian government officially called off the search for survivors.

CHAPTER 2BackgroundThe island ofHispaniola, shared by Haiti and theDominican Republic, isseismicallyactive and hasa history of destructive earthquakes. During Haiti's time as a French colony, earthquakes were recorded by French historianMoreau de Saint-Mery(17501819). He described damage done by an earthquake in 1751, writing that "only onemasonrybuilding had not collapsed" in Port-au-Prince; he also wrote that the "whole city collapsed" in the1770 Port-au-Prince earthquake.Cap-Haitien, other towns in the north of Haiti and the Dominican Republic, and thePalace were destroyed during anearthquake on 7 May 1842.Amagnitude 8.0 earthquakestruck the Dominican Republic and shook Haiti on 4 August 1946, producing atsunamithat killed 1,790 people and injured many others.Haiti is the poorest country in theWestern Hemisphere, and is ranked 149th of 182 countries on theHuman Development Index.The Australian government's travel advisory site had previously expressed concerns that Haitianemergency serviceswould be unable to cope in the event of a major disaster, and the country is considered "economically vulnerable" by theFood and Agriculture Organization.Haiti is no stranger to natural disasters. In addition to earthquakes, it has been struck frequently by tropical cyclones, which have caused flooding and widespread damage. The most recent cyclones to hit the island before the earthquake wereTropical Storm Fayand HurricanesGustav,HannaandIke, all in the summer of 2008, causing nearly 800 deaths.

CHAPTER 3.Geology

USGS intensity map

Map showing regional tectonic setting of theEnriquillo-Plantain Garden fault zone

Tiny dots of white against the plant-covered landscape (red in this image) are possible landslides, a common occurrence in mountainous terrain after large earthquakes. The Enriquillo-Plantain Garden fault zone runs along the two linear valleys at the top of the imageThemagnitude7.0Mwearthquake occurred inland, on 12 January 2010 at 16:53 (UTC-05:00), approximately 25km (16mi) WSW from Port-au-Prince at a depth of 13km (8.1mi) onblind thrust faultsassociated with theEnriquillo-Plantain Garden fault system.There is no evidence of surface rupture and based on seismological, geological and ground deformation data it is thought that the earthquake did not involve significant lateral slip on the main Enriquillo fault.Strong shaking associated with intensity IX on the Modified(MM) was recorded in Port-au-Prince and its suburbs. It was also felt in several surrounding countries and regions, including Cuba (MM III inGuantnamo), Jamaica (MM II inKingston), Venezuela (MM II inCaracas), Puerto Rico (MM IIIII inSan Juan), and the bordering Dominican Republic (MM III inSanto Domingo). According to estimates from theUnited States Geological Survey, approximately 3.5million people lived in the area that experienced shaking intensity of MM VII to X, a range that can cause moderate to very heavy damage even to earthquake-resistant structures. Shaking damage was more severe than for other quakes of similar magnitude due to the shallow depth of the quake.The quake occurred in the vicinity of the northern boundary where theCaribbeantectonic plateshifts eastwards by about 20mm (0.79in) per year in relation to theNorth American plate. Thefault system in the region has two branches in Haiti, theSeptentrional-Oriente faultin the north and the Enriquillo-Plantain Garden fault in the south; both its location andfocal mechanismsuggested that the January 2010 quake was caused by a rupture of the Enriquillo-Plantain Garden fault, which had been locked for 250years, gatheringstress.However, a study published in May 2010 suggested that the rupture process may have involved slip on multiple blind thrust faults with only minor, deep, lateral slip along or near the main EnriquilloPlantain Garden fault zone, suggesting that the event only partially relieved centuries of accumulated left-lateral strain on a small part of the plate-boundary system. The rupture was roughly 65km (40mi) long with mean slip of 1.8 metres (5ft 11in).Preliminary analysis of the slip distribution found amplitudes of up to about 4m (13ft) using ground motion records from all over the world.A 2007 earthquake hazard study by C. DeMets and M. Wiggins-Grandison noted that the Enriquillo-Plantain Garden fault zone could be at the end of its seismic cycle and concluded that a worst-case forecast would involve a 7.2Mwearthquake, similar in size to the1692 Jamaica earthquake. Paul Mann and a group including the 2006 study team presented a hazard assessment of the Enriquillo-Plantain Garden fault system to the 18th Caribbean Geologic Conference in March 2008, noting the large strain; the team recommended "high priority" historical geologic rupture studies, as the fault was fully locked and had recorded few earthquakes in the preceding 40years. An article published in Haiti'sLe Matinnewspaper in September 2008 cited comments by geologist Patrick Charles to the effect that there was a high risk of major seismic activity in Port-au-Prince.

CHAPTER 4Aftershocks

History of the main shock and aftershocks with magnitudes larger than 4.0, data from USGSThe United States Geological Survey (USGS) recorded eightaftershocksin the two hours after the main earthquake, with magnitudes between 4.3 and 5.9. Within the first nine hours 32 aftershocks of magnitude 4.2 or greater were recorded, 12 of which measured magnitude 5.0 or greater, and on 24 January USGS reported that there had been 52 aftershocks measuring 4.5 or greater since 12 January quake.On 20 January at 06:03 local time (11:03UTC) the strongest aftershock since the earthquake,measuring magnitude 5.9Mw, struck Haiti.USGS reported its epicenter was about 56km (35mi) WSW of Port-au-Prince, which would place it almost exactly under the coastal town ofPetit-Gove. A UN representative reported that the aftershock collapsed seven buildings in the town. According to staff of theInternational Committee of the Red Cross, which had reached Petit-Gove for the first time the day before the aftershock, the town was estimated to have lost 15 percent of its buildings, and was suffering the same shortages of supplies and medical care as the capital.Workers from the charitySave the Childrenreported hearing "already weakened structures collapsing" in Port-au-Prince, but most sources reported no further significant damage to infrastructure in the city. Further casualties are thought to have been minimal since people had been sleeping in the open. There are concerns that 12 January earthquake could be the beginning of a new long-term sequence: "the whole region is fearful"; historical accounts, although not precise, suggest that there has been a sequence of quakes progressing westwards along the fault, starting with an earthquake in the Dominican Republic in 1751.TsunamiThePacific Tsunami Warning Centerissued atsunamiwarning immediately after the initial quake, but quickly cancelled it. Nearly two weeks later it was reported that the beach of the small fishing town of Petit Paradis was hit by a localized tsunami wave shortly after the earthquake, probably as a result of an underwater slide and this was later confirmed by researchers. At least three people were swept out to sea by the wave and were reported dead. Witnesses told reporters that the sea first retreated and a "very big wave" followed rapidly, crashing ashore and sweeping boats and debris into the ocean.

CHAPTER 5Damage to infrastructure

Damaged buildings in Port-au-PrinceEssential servicesAmongst the widespread devastation and damage throughout Port-au-Prince and elsewhere, vitalinfrastructurenecessary to respond to the disaster was severely damaged or destroyed. This included all hospitals in the capital; air, sea, and land transport facilities; and communication systems.The quake affected the threeMedicines Sans Frontiers(Doctors without Borders) medical facilities around Port-au-Prince, causing one to collapse completely. A hospital inPtionville, a wealthy suburb of Port-au-Prince, also collapsed, as did the St. Michel District Hospital in the southern town ofJacmel, which was the largest referral hospital in south-east Haiti.

Damaged buildings in JacmelThe quake seriously damaged thecontrol toweratToussaint L'Ouverture International Airport. Damage to thePort-au-Prince seaport rendered the harbor unusable for immediate rescue operations; itscontainer cranesubsided severely at an angle because of weak foundations.Gonaivesseaport in northern Haiti remained operational.Roads were blocked withroad debrisor the surfaces broken. The main road linking Port-au-Prince withJacmelremained blocked ten days after the earthquake, hampering delivery of aid to Jacmel. When asked why the road had not been opened, Hazem el-Zein, head of the south-east division of the UNWorld Food Programmersaid that "We ask the same questions to the people in charge...They promise rapid response. To be honest, I don't know why it hasn't been done. I can only think that their priority must be somewhere else."There was considerable damage to communications infrastructure. Thepublic telephone systemwas not available,and two of Haiti's largestcellular telephoneproviders,Digicel andComcel Haiti, both reported that their services had been affected by the earthquake.Fibre-optic connectivitywas also disrupted.According toReporters Sans Frontires(RSF), Radio Lumiere, which broadcasts out of Port-au-Prince and reaches 90 percent of Haiti, was initially knocked off the air, but it was able to resume broadcasting across most of its network within a week. According to RSF, some 20 of about 50 stations that were active in the capital region prior to the earthquake were back on air a week after the quake.

CHAPTER 6General infrastructure

Large portions of theNational Palace collapsed

In February 2010 Prime MinisterJean-Max Belleriveestimated that 250,000residencesand 30,000commercial buildingswere severely damaged and needed to be demolished. The deputy mayor of Logne reported that 90 percent of the town's buildings had been destroyed. Many government and public buildings were damaged or destroyed including thePalace of Justice, theNational Assembly, theSupreme CourtandPort-au-Prince Cathedral. TheNational Palacewas severely damaged,thoughPresidentRen Prvaland his wifeElisabeth Delatour Prvalescaped injury. The Prison Civiler de Port-au-Prince was also destroyed, allowing around 4,000 inmates to escape.

Leogane, close to the earthquake epicenterMost of Port-au-Prince's municipal buildings were destroyed or heavily damaged, including the City Hall, which was described by theWashington Postas, "a skeletal hulk ofconcreteandstucco, sagging grotesquely to the left." Port-au-Prince had no municipal petrol reserves and few city officials had working mobile phones before the earthquake, complicating communications and transportation.Minister of EducationJoel Jean-Pierrestated that the education system had "totally collapsed". About half the nation's schools and the three main universities in Port-au-Prince were affected. More than 1,300 schools and 50 health care facilities were destroyed.The earthquake also destroyed a nursing school in the capital and severely damaged the countrys primarymidwiferyschool. Theworld suffered great losses; artworks were destroyed, and museums and art galleries were extensively damaged, among them Port-au-Prince's main art museum,Centre d'Art,College Saint PierreandHoly Trinity Cathedral.The headquarters of theUnited Nations Stabilization Mission in Haiti(MINUSTAH) atChristopher Hoteland offices of theWorld Bankwere destroyed. The building housing the offices ofCitibankin Port-au-Prince collapsed, killing five employees. The clothing industry, which accounts for two-thirds of Haiti's exports, reported structural damage at manufacturing facilities.The quake created alandslide damon theRivire de Grand Gove. As of February 2010the water level was low, but engineer Yves Gattereau believed the dam could collapse during the rainy season, which would floodGrand-Gove12km (7.5mi) downstream.

CHAPTER 7Conditions in the aftermath

Assistance camp set up by theBrazilian Army.In the nights following the earthquake, many people in Haiti slept in the streets, on pavements, in their cars, or in makeshiftshanty townseither because their houses had been destroyed, or they feared standing structures would not withstand aftershocks. Construction standards are low in Haiti; the country has nobuilding codes. Engineers have stated that it is unlikely many buildings would have stood through any kind of disaster. Structures are often raised wherever they can fit; some buildings were built on slopes with insufficient foundations or steel supports. A representative ofCatholic Relief Serviceshas estimated that about two million Haitians lived assquatterson land they did not own. The country also suffered from shortages of fuel and potable water even before the disaster.President Prval and government ministers used police headquarters near theToussaint L'Ouverture International Airportas their new base of operations, although their effectiveness was extremely limited; several parliamentarians were still trapped in the Presidential Palace, and offices and records had been destroyed. Some high-ranking government workers lost family members, or had to tend to wounded relatives. Although the president and his remaining cabinet met with UN planners each day, there remained confusion as to who was in charge and no single group had organized relief efforts as of 16 January. The government handed over control of the airport to the United States to hasten and ease flight operations, which had been hampered by the damage to the air traffic control tower.

Urban Search and Rescue specialists work at theHotel MontanaAlmost immediately Port-au-Prince'smorguefacilities were overwhelmed. By 14 January, a thousand bodies had been placed on the streets and pavements. Government crews manned trucks to collect thousands more, burying them in mass graves.In the heat and humidity, corpses buried in rubble began to decompose and smell. Mati Goldstein, head of the IsraeliZAKAInternational Rescue Unit delegation to Haiti, described the situation as "Shabbatfrom hell. Everywhere, the acrid smell of bodies hangs in the air. Its just like the stories we are told of theHolocaust thousands of bodies everywhere. You have to understand that the situation is true madness, and the more time passes, there are more and more bodies, in numbers that cannot be grasped. It is beyond comprehension."Mayor Jean-Yves Jason said that officials argued for hours about what to do with the volume of corpses. The government buried many in mass graves, some above-ground tombs were forced open so bodies could be stacked inside, and others were burned. Mass graves were dug in a large field outside the settlement ofTitanyen, north of the capital; tens of thousands of bodies were reported as having been brought to the site bydump truckand buried in trenches dug byearth movers. Max Beauvoir, aVodoupriest, protested the lack of dignity in mass burials, stating, "... it is not in our culture to bury people in such a fashion, it is desecration".

The Haitian government began a programme to move homeless people out of Port-au-Prince on a ferry toPort Jeremieand in hired buses to temporary campsTowns in the eastern Dominican Republic began preparing for tens of thousands of refugees, and by 16 January hospitals close to the border had been filled to capacity with Haitians. Some began reporting having expended stocks of critical medical supplies such as antibiotics by 17 January. The border was reinforced by Dominican soldiers, and the government of the Dominican Republic asserted that all Haitians who crossed the border for medical assistance would be allowed to stay only temporarily. A local governor stated, "We have a great desire and we will do everything humanly possible to help Haitian families. But we have our limitations with respect to food and medicine. We need the helping hand of other countries in the area."Slow distribution of resources in the days after the earthquake resulted in sporadic violence, withlootingreported. There were also accounts of looters wounded or killed by vigilantes and neighborhoods that had constructed their own roadblock barricades.Dr Evan Lyon ofPartners in Health, working at the General Hospital in Port-au-Prince, claimed that misinformation and overblown reports of violence had hampered the delivery of aid and medical services.

One of the firstparachuteair dropsafter the quake, 18 JanuaryFormer US presidentBill Clintonacknowledged the problems and said Americans should "not be deterred from supporting the relief effort" by upsetting scenes such as those of looting.Lt. Gen. P.K. Keen, deputy commander of US Southern Command, however, announced that despite the stories of looting and violence, there was less violent crime in Port-au-Prince after the earthquake than before.In many neighbor hoods, singing could be heard through the night and groups of men coordinated to act as security as groups of women attempted to take care of food and hygiene necessities. During the days following the earthquake, hundreds were seen marching through the streets in peaceful processions, singing and clapping.The earthquake caused an urgent need for outside rescuers to communicate with Haitians whose main or only language isHaitian Creole. As a result, a mobileprogram to translate between English and Haitian Creole had to be written quickly.

CHAPTER 8Casualties

A Haitian boy receives treatment at a MINUSTAH logistics base

Israeli and U.S. medical personnel coordinate relief efforts.The earthquake struck in the most populated area of the country. TheInternational Federation of Red Cross and Red Crescent Societiesestimated that as many as 3million people had been affected by the quake. In mid February 2010, the Haitian government reported the death toll to have reached 230,000. However, an investigation by Radio Netherlands has questioned the official death toll, reporting an estimate of 92,000 deaths as being a more realistic figure.On the first anniversary of the earthquake, 12 January 2011, Haitian Prime Minister Jean-Max Bellerive said the death toll from the quake was more than 316,000, raising the figures from previous estimates.Several experts have questioned the validity of the death toll numbers;Anthony Penna,professor emeritusinenvironmental historyatNortheastern University, warned that casualty estimates could only be a "guesstimate",and Belgian disaster response expert Claude de Ville de Goyet noted that "round numbersare a sure sign that nobody knows." Edmond Mulet, UNAssistant Secretary-GeneralforPeacekeeping Operations, said, "I do not think we will ever know what the death toll is from this earthquake, while the director of the Haitian Red Cross, Jean-Pierre Guiteau, noted that his organization had not had the time to count bodies, as their focus had been on the treatment of survivors.While the vast majority of casualties were Haitian civilians, the dead included aid workers, embassy staff, foreign touristsand a number of public figures, includingArchbishop of Port-au-PrinceMonsignorJoseph Serge Miot,aid workerZilda Arnsand officials in the Haitian government, including opposition leaderMichel "Micha" Gaillard. Also killed were a number of well-knownHaitian musicians and sports figures, including thirty members of theFederation Hatienne de Football.At least 85 United Nations personnel working with MINUSTAH were killed,among them the Mission Chief,Hdi Annabi, his deputy,Luiz Carlos da Costa.,and police commissionerDouglas Coates. Around 200 guests were killed in the collapse of theHotel Montanain Port-au-Prince.On 31 May 2011, an unreleased draft report based on a survey commissioned by theUS Agency for International Development(USAID) challenged the Haiti earthquake death toll and several damage estimates. The unpublished report put the death toll between 46,000 and 85,000 and put the number of displaced persons at 895,000, of which only 375,000 remained in temporary shelters. The unreleased report, which compiled its figures from a door-to-door survey, was done by a Washington consulting firm, LTL Strategies. A US State Department spokesperson said the report had inconsistencies and would not be released until they were resolved.As of January 2012, USAID has not released the report and states at its website that 1.5 million people were displaced, of which 550,000 remain without permanent shelter.

CHAPTER 9Early responseHumanitarian response to the 2010 Haiti earthquake,Humanitarian response by national governments to the 2010 Haiti earthquake,Humanitarian response by non-governmental organizations to the 2010 Haiti earthquake, andHumanitarian response by for-profit organizations to the 2010 Haiti earthquake

Heavy-lift helicopters ferry water from the offshore flotilla, 15 JanuaryAppeals forhumanitarian aidwere issued by many aid organizations, the United Nations and president Ren Prval.Raymond Joseph, Haiti's ambassadorto the United States, and his nephew, singerWyclef Jean, who was called upon by Prval to become a "roving ambassador" for Haiti,also pleaded for aid and donations. Images and testimonials circulating after the earthquake across the internet and through social media helped to intensify the reaction of global engagement.Many countries responded to the appeals and launched fund-raising efforts, as well as sending search and rescue teams. The neighboringDominican Republicwas the first country to give aid to Haiti, sending water, food and heavy-lifting machinery. The hospitals in the Dominican Republic were made available; a combined effort of the Airports Department (DA), together with the Dominican Naval Auxiliaries, the UN and other parties formed the Dominican-Haitian Aerial Support Bridge, making the main Dominican airports available for support operations to Haiti. The Dominican website FlyDominicanRepublic.com made available to the internet, daily updates on airport information and news from the operations center on the Dominican side. The Dominican emergency team assisted more than 2,000 injured people, while the Dominican Institute of Telecommunications (Indotel) helped with the restoration of some telephone services. The Dominican Red Cross coordinated early medical relief in conjunction with the International Red Cross. The government sent eight mobile medical units along with 36 doctors including orthopaedic specialists, traumatologists, anaesthetists, and surgeons. In addition, 39 trucks carrying canned food were dispatched, along with 10 mobile kitchens and 110 cooks capable of producing 100,000 meals per day.

Having lost their homes, many Haitians now live in precarious campsOther nations from farther afield also sent personnel, medicines,materiel, and other aid to Haiti. The first team to arrive in Port-au-Prince wasICE-SARfromIceland, landing within 24hours of the earthquake.A 50-member Chinese team arrived early Thursday morning. From the Middle East, the government ofQatarsent a strategic transport aircraft (C-17), loaded with 50 tonnes of urgent relief materials and 26 members from the Qatari armed forces, the internal security force (Lekhwiya), police force and the Hamad Medical Corporation, to set up a field hospital and provide assistance in Port-au-Prince and other affected areas in Haiti. A rescue team sent by theIsrael Defense Forces'Home Front Commandestablished a field hospital near the United Nations building in Port-au-Prince with specialized facilities to treat children, the elderly, and women in labor. It was set up in eight hours and began operations on the evening of 16 January. A Korean International Disaster Relief Team with 40 rescuers, medical doctors, nurses and 2k-9s was deployed to epicenters to assist mitigation efforts of Haitian Government.TheAmerican Red Crossannounced on 13 January that it had run out of supplies in Haiti and appealed for public donations. Hope worked to get much-needed medicines and supplies on the ground. Partners in Health(PIH), the largest health care provider in rural Haiti, was able to provide some emergency care from its ten hospitals and clinics, all of which were outside the capital and undamaged. MINUSTAH had over 9,000 uniformed peacekeepers deployed to the area.Most of these workers were initially involved in the search for survivors at the organization's collapsed headquarters.

Haitian survivors were transferred to rescue ships for medical aidTheInternational Charter on Space and Major Disasterswas activated, allowing satellite imagery of affected regions to be shared with rescue and aid organizations. Members ofsocial networkingsites such asTwitterandFacebookspread messages and pleas to send help. Facebook was overwhelmed byand blockedsome users who were sending messages about updates.The American Red Cross set a record for mobile donations, raising US$7million in 24hours when they allowed people to send US$10 donations by text messages. TheOpen Street Mapcommunity responded to the disaster by greatly improving the level of mapping available for the area using post-earthquake satellite photography provided byGeoEye,and tracking websiteUshahidi coordinated messages from multiple sites to assist Haitians still trapped and to keep families of survivors informed. Someonline pokersites hosted poker tournaments with tournament fees, prizes or both going to disaster relief charities. Google Earthupdated its coverage of Port-au-Prince on 17 January, showing the earthquake-ravaged city.Easing refugee immigration into Canada was discussed by Canadian Prime MinisterStephen Harper, and in the US Haitians were grantedTemporary Protected Status, a measure that permits about 100,000 illegal alien Haitians in the United States to stay legally for 18months, and halts the deportations of 30,000 more, though it does not apply to Haitians outside the US.Local and state agencies inSouth Florida, together with the US government, began implementing a plan ("Operation Vigilant Sentry") for a mass migration from the Caribbean that had been laid out in 2003.Several orphanages were destroyed in the earthquake. After the process for the adoption of 400 children by families in the US and the Netherlands was expedited,UNICEFandSOS Childrenurged an immediate halt to adoptions from Haiti.Jasmine Whitbread, chief executive ofSave the Childrensaid: "The vast majority of the children currently on their own still have family members alive who will be desperate to be reunited with them and will be able to care for them with the right support. Taking children out of the country would permanently separate thousands of children from their familiesa separation that would compound the acute trauma they are already suffering and inflict long-term damage on their chances of recovery."However, several organizations were planning an airlift of thousands of orphaned children to South Florida on humanitarian visas, modelled on a similar effort with Cuban refugees in the 1960s named "Pedro Pan". The Canadian government worked to expedite around 100 adoption cases that were already underway when the earthquake struck, issuing temporary permits and waiving regular processing fees; the federal government also announced that it would cover adopted children's healthcare costs upon their arrival in Canada until they could be covered under provincially administered public healthcare plans.

CHAPTER 10Rescue and relief effortsRescue efforts began in the immediate aftermath of the earthquake, with able-bodied survivors extricating the living and the dead from the rubble of the many buildings that had collapsed. Treatment of the injured was hampered by the lack of hospital and morgue facilities: theArgentine military field hospital, which had been servingMINUSTAH, was the only one available until 13 January. Rescue work intensified only slightly with the arrival of doctors, police officers, military personnel and firefighters from various countries two days after the earthquake.

MINUSTAH troops meet a relief flight on 16 JanuaryFrom 12 January, theInternational Committee of the Red Cross, which has been working in Haiti since 1994, focused on bringing emergency assistance to victims of the catastrophe, in close cooperation with its partners within the International Red Cross and Red Crescent Movement, particularly the Haitian Red Cross and the International Federation of Red Cross and Red Crescent Societies.Medecins Sans Frontieres(Doctors without Borders; MSF) reported that the hospitals that had not been destroyed were overwhelmed by large numbers of seriously injured people, and that they had to carry out many amputations. Running short of medical supplies, some teams had to work with any available resources, constructing splints out of cardboard and reusing latex gloves. Other rescue units had to withdraw as night fell amid security fears. Over 3,000people had been treated by Medecins Sans Frontieres as of 18 January. Ophelia Dahl, director ofPartners in Health, reported, "There are hundreds of thousands of injured people. I have heard the estimate that as many as 20,000 people will die each day that would have been saved by surgery."

UN forces took to patrolling the streets of Port-au-PrinceAn MSF aircraft carrying a field hospital was repeatedly turned away by US air traffic controllers who had assumed control at Toussaint L'Ouverture International Airport. Four other MSF aircraft were also turned away.In a 19 January press release MSF said, "It is like working in a war situation. We dont have any more morphine to manage pain for our patients. We cannot accept that planes carrying lifesaving medical supplies and equipment continue to be turned away while our patients die. Priority must be given to medical supplies entering the country."First responders voiced frustration with the number of relief trucks sitting unused at the airport.Aid workers blamed US-controlled airport operations for prioritizing the transportation of security troops over rescuers and supplies; evacuation policies favoring citizens of certain nations were also criticized.

AnIsrael Defense ForcesSearch and Rescue team extracts a Haitian government employee, trapped in the ruins of the customs office inPort-au-Prince. The man was trapped under the rubble for 125 hours before being rescued by the team and was then taken to an Israeli field hospital for treatment.

A USAFpararescuemansearching through demolished buildings in Port-au-Prince for survivors

Helicopters transfer injured earthquake victims to hospital shipUSNSComfortoff the coast of HaitiThe US military acknowledged the non-governmental organizations' complaints concerning flight-operations bias and promised improvement while noting that up to 17 January 600 emergency flights had landed and 50 were diverted; by the first weekend of disaster operations diversions had been reduced to three on Saturday and two on Sunday. The airport was able to support 100 landings a day, up from the 35 a day that the airport gets during normal operation. A spokesman for the joint task force running the airport confirmed that though more flights were requestinglanding slots, none were being turned away.Brazilian Foreign MinisterCelso Amorimand French Minister of State for CooperationAlain Joy and et criticized the perceived preferential treatment for US aid arriving at the airport, though a spokesman for the French Ministry of Foreign Affairs said that there had been no official protest from the French government with regard to the management of the airport. US officials acknowledged that coordination of the relief effort is central to Haitian recovery, and President Prval asked for calm coordination between assisting nations without mutual accusations.US Air Force logs documenting activity at the airport obtained by theAssociated Presslargely disprove the claim that the US held up aid in favor of military flights. The US military initially did give priority to military units needed to secure the airport, distribute aid, and provide security, but after that, incoming relief flights were cleared or rejected on a first come, first serve basis. According to a US Air Force Captain who had coordinated flight schedules, nearly all groups sending aid insisted their shipment was urgent. Those flights that were rejected were diverted to the Dominican, where their cargoes were unloaded and taken to Haiti by land.At the peak of the relief efforts, the airport was in a state of chaos. Normally, the airport, with a single runway and 10 spaces for large planes, handled 20 flights a day. After the earthquake struck, hundreds of planes rushed to Haiti without designated landing time. On average, a plane would land or take off every two minutes. The situation was further complicated by the fact that there was no room on ramps for planes to unload their cargo, and some planes did not have enough fuel to leave.

While international efforts received significant media coverage, much of the rescue effort was conducted by Haitians themselvesWhile the Port-au-Prince airport ramp has spaces for over a dozen airliners, in the days following the quake it sometimes served nearly 40 at once, creating serious delays.The supply backup at the airport was expected to ease as the apron management improved, and when the perceived need for heavy security diminished.Airport congestion was reduced further on 18 January when the United Nations and US forces formally agreed to priorities humanitarian flights over security reinforcement.By 14 January, over 20 countries had sent military personnel to the country, with Canada, the United States and the Dominican Republic providing the largest contingents. Thesuper carrierUSSCarl Vinsonarrived atmaximum possible speedon 15 January with 600,000 emergency food rations, 100,000 ten-litre water containers, and an enhanced wing of 19helicopters; 130,000litres ofdrinking waterwere transferred to shore on the first day.The helicopter carrierUSSBataansailed with three largedock landing shipsand two survey/salvage vessels, to create a "sea base" for the rescue effort. They were joined by theFrench NavyvesselFrancis Garnieron 16 January, the same day the hospital shipUSNSComfortand guided-missile cruiserUSSBunker Hillleft for Haiti. Another large French vessel was later ordered to Haiti, theamphibious transport dockSiroco.

A woman is rescued alive from rubble several days after the initial quakeInternational rescue efforts were restricted by traffic congestion and blocked roads. Although US Secretary of Defense Robert Gates had previously ruled out dropping food and water by air as too dangerous, by 16 January, US helicopters were distributing aid to areas impossible to reach by land.In Jacmel, a city of 50,000, the mayor claimed that 70 percent of the homes had been damaged and that the quake had killed 300 to 500 people and left some 4,000 injured. The small airstrip suffered damage that rendered it unusable for supply flights until 20 January. The Canadian navy vessel HMCSHalifaxwas deployed to the area on 18 January; the Canadians joined Colombian rescue workers, Chilean doctors, a French mobile clinic, and Sri Lankan relief workers who had already responded to calls for aid.About 64,000 people living in the three adjacent agricultural communities ofDurissy,Morne a Chandelle, andLes Palmeswere relatively unharmed because most of the people were working in the fields; but all churches, chapels and at least 8,000 homes were destroyed.British search and rescue teams were the first to arrive in Logane, the town at the epicenter of the quake, on 17 January. The Canadian shipHMCS Athabaskanreached the area on 19 January, and by 20 January there were 250300 Canadian personnel assisting relief efforts in the town. By 19 January, staff of the International Red Cross had also managed to reach the town, which they described as "severely damaged... the people there urgently need assistance, and by 20 January they had reachedPetit-Goveas well, where they set up two first-aid posts and distributed first-aid kits.

A Haitian child is treated aboard a hospital shipOver the first weekend 130,000 food packets and 70,000 water containers were distributed to Haitians, as safe landing areas and distribution centers such as golf courses were secured. There were nearly 2,000rescuers present from 43 different groups, with 161search dogs; the airport had handled 250tons of relief supplies by the end of the weekend.Reports from Sunday showed a record-breaking number of successful rescues, with at least 12 survivors pulled from Port-au-Prince's rubble, bringing the total number of rescues to 110.The buoy tenderUSCGOakandUSNSGrasp(T-ARS-51)were on scene by 18 January to assess damage to the port and work to reopen it, and by 21 January one pier at the Port-au-Prince seaport was functional, offloading humanitarian aid, and a road had been repaired to make transport into the city easier.In an interview on 21 January,Leo Merores, Haitis ambassador to the UN, said that he expected the port to be fully functional again within two weeks.The US Navy listed itsresourcesin the area as "17 ships, 48 helicopters and 12 fixed-wing aircraft" in addition to 10,000 sailors and Marines. The Navy had conducted 336 air deliveries, delivered 32,400 US gallons (123,000L) of water, 532,440 bottles of water, 111,082 meals and 9,000lb (4,100kg) of medical supplies by 20 January. Hospital shipComfortbegan operations on 20 January, completing the arrival of the first group of sea-base vessels; this came as a new flotilla of USN ships were assigned to Haiti, including survey vessels, ferries, elements of themaritime prepositioningandunderway replenishmentfleets, and a further three amphibious operations ships, including another helicopter carrier,USSNassau(LHA-4).

Landing ships move supplies onshore from the rescue fleetOn 22 January the UN and United States formalized the coordination of relief efforts by signing an agreement giving the US responsibility for the ports, airports and roads, and making the UN and Haitian authorities responsible for law and order. The UN stated that it had resisted formalizing the organization of the relief effort to allow as much leeway as possible for those wishing to assist in the relief effort, but with the new agreement "were leaving that emergency phase behind". The UN also urged organizations to coordinate aid efforts through its mission in Haiti to allow for better scheduling of the arrival of supplies. On 23 January the Haitian government officially called off the search for survivors, and most search and rescue teams began to prepare to leave the country.However, as late as 8 February 2010, survivors were still being discovered, as in the case of Evan Muncie, 28, found in the rubble of a grocery store.On 5 February, tenBaptistmissionaries fromIdaholed byLaura Silsbywere charged withcriminal associationandkidnappingfor trying to smuggle 33 children out of Haiti. The missionaries claimed they were rescuing orphaned children but investigations revealed that more than 20 of the children had been taken from their parents after they were told the children would have a better life in America. In an interview, theHaiti Kenneth Merten, stated that the US justice system would not interfere and that "the Haitian justice system will do what it has to do." By 9 March 2010, all but Silsby were deported and she remained incarcerated.Social networking organizations such asCrisis Camp Haitiwere developed to aid in the structure and coordination of relief efforts in Haiti and future catastrophic events as well.On 10 April, due to the potential threat of mudslides and flooding from the upcomingrainy season, the Haitian government began operations to move thousands of refugees to a more secure location north of the capital.

CHAPTER 11Recovery

Haitians await the opening of a supply depot, 16 JanuaryUS PresidentBarack Obamaannounced that former presidentsBill Clinton, who also acts as the UN special envoy to Haiti, andGeorge W. Bushwould coordinate efforts to raise funds for Haiti's recovery. Secretary of StateHillary Clintonvisited Haiti on 16 January to survey the damage and stated that US$48million had been raised already in the US to help Haiti recover. Following the meeting with Secretary Clinton, President Prval stated that the highest priorities in Haiti's recovery were establishing a working government, clearing roads, and ensuring the streets were cleared of bodies to improve sanitary conditions.US Vice PresidentJoe Bidenstated on 16 January that President Obama "does not view this as a humanitarian mission with a life cycle of a month. This will still be on our radar screen long after it's off the crawler at CNN. This is going to be a long slog."

Planes loaded with aid supplies crowd the tarmac atPort-au-Prince airport, waiting to be unloaded, 18 JanuaryTrade and Industry MinisterJosseline Colimon Fethiereestimated that the earthquake's toll on the Haitian economy would be massive, with one in five jobs lost. In response to the earthquake, foreign governments offered badly needed financial aid. The European Union promised 330million for emergency and long-term aid. Brazil announced R$375million for long-term recovery aid, R$25 million of which in immediate funds.The United Kingdom's Secretary of State for International DevelopmentDouglas Alexandercalled the result of the earthquake an "almost unprecedented level of devastation", and committed the UK to 20million in aid, while France promised 10million. Italy announced it would waive repayment of the 40million it had loaned to Haiti, and the World Bank waived the country's debt repayments for five years. On 14 January, the US government announced it would give US$100million to the aid effort and pledged that the people of Haiti "will not be forgotten".

TheUN Development Programme employed hundreds of Haitians to clear roads and to make fuel pellets in a cash-for-work schemeIn the aftermath of the earthquake, the government ofCanadaannounced that it would match the donations of Canadians up to a total of C$50million. Canadians were able to donate through theHumanitarian Coalitionwhich distributed funds to partner organizations working in the field. During this time the Humanitarian Coalition raised over C$15 Million. After a United Nations call for help for the people affected by the earthquake, Canada pledged an additional C$60million in aid on 19 January 2010, bringing Canada's total contribution to C$135million. By 8 February 2010, the federal International Co-operation Department, through theCanadian International Development Agency(CIDA), had already provided about C$85 million in humanitarian aid through UN agencies, theInternational Federation of Red Cross and Red Crescent Societiesand to organizations such as CARE, Medicine du Monde,Save the Children, Oxfam Quebec, the Centre for International Studies and Co-operation, andWorld Vision. On 23 January 2010, Canadian Prime MinisterStephen Harperannounced that the federal government had lifted the limit on the amount of money allocated for matching individual donations to relief efforts, and that the federal government would continue to match individual donations until 12 February 2010; by the deadline, Canadians had privately raised C$220 million. On top of matching donations, International Co-operation MinisterBev Odapledged an additional C$290 million in long-term relief to be spent between 2010 and 2012, including C$8 million in debt relief to Haiti, part of a broader cancellation of the country's overall World Bank debt.The government's commitment to provide C$550 million in aid and debt relief and Canadians' individual donations amount to a total of C$770 million.In addition to Canada's federal government, the governments of several of theprovinces and territories of Canadaalso announced that they would provide immediate emergency aid to Haiti. On 18 January 2010, the province ofQuebec, whose largest city Montreal houses the world's largest Haitian Diaspora, pledged C$3 million in emergency aid. Both the provincial government of Quebec and the Canadian federal government reaffirmed their commitment to rebuilding Haiti at the 2010Francophonie Summit; Prime Minister Harper used his opening speech to "tell the head of the Haitian delegation to keep up their spirits" and to urge other nations to continue to support recovery efforts.PresidentAbdoulaye WadeofSenegaloffered interested Haitians free land in Senegal; depending on how many respond to the offer, this could include up to an entire region.

A US mobile air traffic control tower is moved to Haiti by anAntonov An-124Prime Minister Bellerive announced that from 20 January, people would be helped to relocate outside the zone of devastation, to areas where they may be able to rely on relatives or better fend for themselves; people who have been made homeless would be relocated to the makeshift camps created by residents within the city, where a more focused delivery of aid and sanitation could be achieved. Port-au-Prince, according to an international studies professor at theUniversity of Miami, was ill-equipped before the disaster to sustain the number of people who had migrated there from the countryside over the past ten years to find work.After the earthquake, thousands of Port-au-Prince residents began returning to the rural towns they came from.On 25 January a one-day conference was held inMontrealto assess the relief effort and discuss further plans. Prime Minister Bellerive told delegates from 20 countries that Haiti would need "massive support" for its recovery from the international community. A donors' conference was expected to be held at the UN headquarters inNew Yorkin March, however, took more than three months to hold the UN conference. The 26-member international Interim Haiti Reconstruction Commission, headed by Bill Clinton and Haitian Prime Minister Jean-Max Bellerive, convened in June 2010. That committee is overseeing the US$5.3billion pledged internationally for the first two years of Haiti's reconstruction.The Netherlands sponsored a project, called Radio555. The Dutch radio channels3FM,Radio 538andRadio Veronicaall broadcast under the name of Radio555, funded by a contribution of 80million.Several organizations of the US building industry and government, such as theDepartment of Homeland Securityand theInternational Code Council, among others, reported that they were compiling a "Haiti Toolkit" coordinated by theNational Institute of Building Sciences. The toolkit would comprise building technology resources and best practices for consideration by the Haitian government with the goal of creating a more resilient infrastructure to prevent future losses of life.Immediately following the earthquake,Real Medicine Foundationbegan providing medical staffing, in-kind medical supplies and strategic coordination to help meet the surging needs of the health crisis on the ground. Working in close partnership with other relief organizations, Real Medicine organized deployments of volunteer medical specialists to meet the needs of partner hospitals and clinics at the HaitiDominican Republic border and in Port-au-Prince, provided direct funding, medical supplies and pharmaceuticals to local health facilities and partner hospitals, provided advisory services and coordination to local health facilities, including physical therapy support, and coordinated mobile health outreaches, field clinics and food supplies to outlying villages overlooked in the relief effort.On 15 January 2011, theCatholic Relief Servicesannounced a US$200million, five-year relief and reconstruction program that covers shelter, health, livelihoods, and child protection among its program areas.

CHAPTER 12 Status of the recoverySix months after the quake as much as 98 percent of the rubble remained unclear. An estimated 26million cubic yards (20million cubic meters) remained, making most of the capital impassable, and thousands of bodies remained in the rubble. The number of people in relief camps of tents and tarps since the quake was 1.6million, and almost no transitional housing had been built. Most of the camps had no electricity, running water, or sewage disposal, and the tents were beginning to fall apart. Crime in the camps was widespread, especially against women and girls. Between 23 major charities, US$1.1billion had been collected for Haiti for relief efforts, but only two percent of the money had been released.According to aCBSreport, US$3.1billion had been pledged for humanitarian aid and was used to pay for field hospitals, plastic tarps, bandages, and food, plus salaries, transportation and upkeep of relief workers. By May 2010, enough aid had been raised internationally to give each displaced family a cheque for US$37,000.In July 2010,CNNreturned to Port-au-Prince and reported, "It looks like the quake just happened yesterday", and Imogen Wall, spokeswoman for the United Nations office of humanitarian affairs in Haiti, said that "six months from that time it may still look the same." Land ownership posed a particular problem for rebuilding because so many pre-quake homes were not officially registered. "Even before the national registry fell under the rubble, land tenure was always a complex and contentious issue in Haiti. Many areas of Port-au-Prince were settled either bytonton makout Duvalier's death squads given land for their service or by squatters. In many cases land ownership was never officially registered. Even if this logistical logjam were to be cleared, the vast majority of Port-au-Prince residents, up to 85 percent, did not own their homes before the earthquake."In September 2010 there were over one million refugees still living in tents, and the humanitarian situation was characterized as still being in the emergency phase, according to theApostolic Nuncioto Haiti,ArchbishopBernard Auza. He went on to say that the number was rising instead of diminishing, and reported that the state had decided to first rebuild downtown Port-au-Prince and a new government center, but reconstruction had not yet begun.In October 2010,Refugees Internationalcharacterized the aid agencies as dysfunctional and inexperienced saying, The people of Haiti are still living in a state of emergency, with a humanitarian response that appears paralyzed". It was reported that gang leaders and land owners were intimidating the displaced and that sexual, domestic, and gang violence in and around the camps was rising. They claimed thatrape of Haitian women and girlswho had been living in camps since the January earthquake was increasing, in part, because theUnited Nationswasnt doing enough to protect them.In October, acholera epidemic broke out, probably introduced by foreign aid workers. Cholera most often affects poor countries with limited access to clean water and proper sanitation. By the end of 2010, more than 3,333 had died at a rate of about 50 deaths a day.

2011In January 2011, one year after the quake,Oxfampublished a report on the status of the recovery. According to the report, relief and recovery were at a standstill due to government inaction and indecision on the part of the donor countries. The report stated, "One year on, only five percent of the rubble has been cleared and only 15 percent of the required basic and temporary houses have been built. House building on a large scale cannot be started before the enormous amount of rubble is cleared. The government and donors must prioritize this most basic step toward helping people return home".Robert Fox, executive director of Oxfam Canada, said "The dysfunction has been aided unabated by the way the international community has organized itself, where pledges have been made and they haven't followed through [and] where they come to the table with their own agendas and own priorities. Most donors provided funds for transitional housing but very little money for clearing rubble or repairing houses". Fox said that in many instances rubble removal "means it was [moved] off someone's property onto the road in front of the property". According to aUNICEFreport, "Still today more than one million people remain displaced, living in crowded camps where livelihoods, shelter and services are still hardly sufficient for children to stay healthy". Amnesty Internationalreported that armed men were preying with impunity on girls and women in displacement camps, worsening the trauma of having lost homes, livelihoods and loved ones.On the first anniversary of the earthquake, Haitian-bornMichelle Jean, who served as theGovernor General of Canadaat the time of the disaster and who becameUnited Nations Educational, Scientific and Cultural Organization(UNESCO)Special Envoy for Haition 8 November 2010, voiced her anger at the slow rate of aid delivery, placing much of the blame on the international community for abandoning its commitments. In a public letter co-authored with UNESCO headIrina Bokova, Jean said, "As time passes, what began as a natural disaster is becoming a disgraceful reflection on the international community." The Interim Haiti Recovery Commission, led by former US PresidentBill Clintonand Haitian Prime MinisterJean-Max Bellerive, had been set up to facilitate the flow of funds toward reconstruction projects in April 2010, but as of January 2011, no major reconstruction had started.2012In January 2012, two years since the quake, figures released by the United Nations show that of the nearly US$4.5 billion pledged for reconstruction projects in 2010 and 2011, only 43 percent has been delivered.Venezuela and the US, which promised the major share of reconstruction funds, have disbursed only 24 percent and 30 percent, respectively. Japan and Finland are among the few donors to have fully met their pledges. The data shows that some crucial sectors face particularly large funding gaps. In 2010 and 2011, for example, donors disbursed just US$125 million of the US$311 million in grants allocated to agriculture projects, and only US$108 million of the US$315 million in grants allocated to health projects. Only 6 percent of bilateral aid for reconstruction projects has gone through Haitian institutions, and less than 1 percent of relief funding has gone through the government of Haiti.A January 2012Oxfamreport said that a half a million Haitians remained homeless, still living under tarps and in tents. Watchdog groups have criticized the reconstruction process saying that part of the problem is that charities spent a considerable amount of money on "soaring rents, board members' needs, overpriced supplies and imported personnel". TheMiami Heraldreports. "A lot of good work was done; the money clearly didn't all get squandered," but, "A lot just wasn't responding to needs on the ground. Millions were spent on ad campaigns telling people to wash their hands. Telling them to wash their hands when there's no water or soap is a slap in the face."The Institute of Justice & Democracy in Haiti, Let Haiti Live, and The Center for Constitutional Rights have recommended immediate changes to recovery efforts to ensure that critical human rights concerns are addressed. A report found that, "The conditions in the displaced persons camps are abysmal, particularly for women and girls who too often are victims of genderbased violence". They call for more oversight of accountability of reconstruction plans, asking, "Why have only 94,000 transitional shelters been built to date despite a stated goal of 125,000 in the first year?On 25 August 2012, recovery was hampered due toTropical Storm Isaacimpacting Haitis southern peninsula. There it caused flooding and 29 deaths according to local reporting. As a result of the 2010 earthquake, more than 400,000 Haitians continue to live in tents and experienced the storm without adequate shelter. In late October, with over 370,000 still living in tent camps, a second tropical storm,Hurricane Sandy, killed 55 and left large portions of Haiti under water.At the 2012 Consultative Group meeting of the Global Facility for Disaster Reduction and Recovery (GFDRR), the Haitian delegation shared a "bottom-up" approach to disaster reduction and management based on community integration and sustainable development with a group of experts from approximately 38 nations.

2013According to the International Monetary Fund, more than half of the 10,000,000 cubic metres (13,000,000cuyd) of debris have been removed, and 20 percent of it has been recycled.The cholera outbreak which began in October 2010 has continued. According toU.S. Centers for Disease Control and Preventionit is considered the worst epidemic of cholera since the 1994 outbreak in theDemocratic Republic of the Congo. By August 2013, it had killed over 8,231 Haitians and hospitalized hundreds of thousands more. More than 6% of Haitians have had the disease. Care of cholera patients remains inadequate with much now done in tent facilities with rows of cots for patient treatment.TheUnited Nationspeace keeping force, widely believed responsible for the cholera outbreak, continues to refuse to accept responsibility, however, they have launched a $2.2 billion initiative to combat cholera and the construction of a $17 million teaching hospital in Mirebalais which will employ 800 Haitians and treat 185,000 people.By the beginning of the year only a small part--$215 millionof the total funds collected for aid had been spent on permanent housing, with most of it--$1.2 billiongoing for short-term solutions including tent camps, temporary shelters, and cash grants that paid a years rent.A 2013 survey disclosed that of the 1.5 million Haitians living in camps following the quake, about 279,000 remained in a total of 352 camps. Fifteen percent of the camps had no basic protection servicesand 48% no health services.While 20% lacked functioning toilets, this is higher than the population outside tent cities, where 50% lack toilets. Many camps remained at a risk for flooding and more than a third of the camps (108) were at risk for evictions. In a 2013 statement, the American Red Cross reported that almost all of the money collected for quake relief has been spent or is scheduled for making progress permanent by ensuring people can leave camps and return to stable communities, which includes building new homes, repairing homes, completing a new hospital and clinic, and signing an agreement for a second hospital.

CHAPTER 13Current ConditionsThe largest earthquake ever recorded in Haiti devastated parts of the country, including the capital, on January 12, 2010. The quake, centered about 15 miles southwest of Port-au-Prince, had a magnitude of 7.0. A series of strong aftershocks followed.1 Witnesses are describing the damage as severe and catastrophic. Communication services were cut off by the quake, so detailed information is difficult to come by. Initial reports indicate that thousands of buildings collapsed, leaving unknown numbers of people trapped, and tens of thousands of people homeless in the streets. Early estimates of casualties are constantly being updated, but already reach into the hundreds of thousands. According to the Secretary General of the United Nations, [o]f Haitis 9 million people, initial reports suggest roughly a third may be affected by the disaster.2 About 45,000 U.S. citizens live in Haiti, and the Embassy has been asked to help account for about 3,000 of them. Aftershocks have the potential to cause further damage, especially to structures weakened by the initial large earthquake; 14 aftershocks greater than magnitude 5 and 36 greater than magnitude 4 were felt within one day, and they could continue for weeks. In addition, steep slopes and rugged topography near the epicenter increase the chances for earthquake- and aftershock-triggered landslides, which pose a further hazard to structures and people down slope from landslide-prone regions.3 Recovery efforts will be made extremely difficult by the loss of personnel and infrastructure that would be part of a recovery effort. Among the missing and dead are Haitian government officials and international aid personnel, including many United Nations personnel. Housing, hospitals, schools, and many government buildings have collapsed. Basic services such as electricity and water are almost completely disrupted. Major transportation routes are damaged and/or blocked. Although the airport continues to function, the control tower was destroyed. The main port suffered heavy damage. The roof of the Presidential Palace collapsed; President Preval is safe, but was initially unable to communicate with his Cabinet. The Parliament building collapsed, with some Members trapped inside and others dead. Buildings of the Ministries of Finance, Public Works, and Justice are also damaged or destroyed, and government officials report having difficulty finding places to meet. The United Nations, which has a strong presence in Haiti, and would be at the forefront of on-the ground response for security and humanitarian assistance, suffered heavy losses as well. Its headquarters collapsed, and about 300 U.N. personnel are unaccounted for, including the head of the U.N. Stabilization Mission in Haiti (MINUSTAH), Special Representative Hedi Annabi, his deputy, Luiz Carlos da Costa, and other civilian staff and peacekeepers. U.N. Secretary General Ban Ki-moon sent Assistant Secretary General Edmond Mulet to Haiti on January 13 to direct the U.N.s immediate response efforts; Mulet is a former Special Representative of the Secretary General for MINUSTAH. All of this damage is sustained in a country that already was socially and ecologically at risk. Haiti suffers massive and deep poverty. Over one-half of the population (54%) lives in extreme poverty, living on less than $1 a day; 78% live on $2 or less a day, according to the World Bank. Hunger is also widespread: 81% of the national population does not get the minimum daily ration of food defined by the World Health Organization. Haiti was already in an acute environmental crisis. Following the hurricanes of 2008, the President of the Inter-American Development Bank (IDB), Luis Moreno, called Haiti the most fragile of IDB's member countries, saying that no other nation in Latin America and the Caribbean is as vulnerable to economic shocks and natural disasters as is Haiti. The United Nations already designated Haiti as one of the 50 least developed countries in the world, facing a higher risk than other countries of failing to come out of poverty, and therefore needing the highest degree of attention from the international community. 4 Prior to the earthquake, the international community was providing extensive development and humanitarian assistance to Haiti. With that assistance, the Haitian government had made significant progress in recent years in many areas of its development strategy, including security; judicial reform; macroeconomic management; procurement processes and fiscal transparency; increased voter registration; and jobs creation. It had also made progress in providing broader access to clean water and other services. Parliamentary elections were scheduled for February 2010. These presumably will be delayed. The U.N. Secretary-General had commissioned a report, published in January 2009, that recommended a strategy to move Haiti beyond recovery to economic security.5 Indeed, the U.N.Security Council conducted a fact-finding visit to Haiti in March 2009, and concluded that there was a window of opportunity to enable the consolidation of stability and the undertaking of a process of sustainable development.6 The destruction of Haitis nascent infrastructure and other extensive damage caused by Januarys earthquake will set back Haitis development significantly. U.N. Special Envoy and former President Bill Clinton said that Haitis long-term development plans will need to be amended ... but they cannot be abandoned.

Haitian Government ResponseDescribing conditions in his country as unimaginable following the earthquake, President Preval appealed for international assistance. The countrys top priority was to conduct search and rescue operations for survivors. Other priorities included an offshore vessel medical unit and electricity generation capability. The government also requested communications equipment so that government officials can better function and coordinate response efforts. The Haitian government, the United Nations, and donor representatives met in Haiti on January 14 to coordinate their efforts. Prior to this disaster, the World Bank and others were working with the Haitian government to incorporate disaster risk management into Haitis overall development strategy and to develop its capacity for disaster response. The capacity was still in its early stages, however, and the focus of much of its risk management efforts was not geared toward earthquakes, but toward hurricanes, which are the most common cause of natural disasters on the island. The last major earthquake in Haiti was 150 years ago, in 1860.Humanitarian Relief OperationThe massive humanitarian relief operation already underway in Haiti is hampered by a number of significant challenges, including a general lack of transportation, extremely limited communications systems, and damaged infrastructure. In many parts of Port-au-Prince, roads are ruptured or blocked by collapsed buildings,Debris, bodies, and people seeking open space, impeding rescue efforts and movement. Lack of electricity and clean water is a major problem. Hospitals that remain functioning have reached full capacity and people are also being treated inUnsanitary makeshift areas. Fuel shortages also have been reported, which affect generator power for life-saving equipment. The priority is search and rescue assistance, including teams with heavy-lift equipment and medical assistance and supplies. In addition, there is a critical need for food, clean water and sanitation, and emergency shelter. In-depth assessments are necessary to obtain a more detailed understanding of the situation on the ground. Until assessments can be completed, the humanitarian needs cannot be fully determined. The arrival of humanitarian supplies has begun, but access to Port-au-Prince and the distribution of aid to people in need is difficult. People are gathering in open spaces and some are reportedly leaving Port-au-Prince for other areas in Haiti.There are increasing concerns about security and potential for looting and violence.The relief effort is expected to last for many months, although it is anticipated that recovery and reconstruction will begin as soon as possible in a parallel effort.Status of the Relief OperationThe headquarters of the U.N. Stabilization Mission in Haiti (MINUSTAH) was reportedly very badly damaged. Thirty-six military and civilian MINUSTAH personnel have died and more than 300 staff are reported missing or remain unaccounted for. U.N. staffs are being deployed to Haiti to increase capacity. MINUSTAH is providing search and rescue operations, security, and assistance. With Mr. Hedi Annabi still missing, Secretary-General Ban Ki-moon has sent Edmond Mulet, former Special Representative to Haiti and current Assistant Secretary-General for Peacekeeping Operations, to take command of MINUSTAH and coordinate the relief effort. The United Nations typically works with government ministries on how best to provide assistance. On January 15, 2010, Mr. Mulet met with President Preval to discuss the status of the rescue operation and to address issues of law and order. The United Nations has also deployed Disaster Assessment and Coordination (UNDAC) and U.N. Office for the Coordination of Humanitarian Affairs (UNOCHA) teams. The United NationsResident/Humanitarian Coordinator, Kim Bolduc, was deployed to Haiti in November 2009. Traditionally, soon after a disaster, a Humanitarian Country Team, which includes U.N. agencies, international NGOs, national NGOs, and the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC) as observers, will be assembled. In Haiti, UNOCHA is helping to coordinate the 27 search and rescue teams and assistance effort while focusing on other humanitarian priorities. The WorldFood Program (WFP) is supporting immediate relief efforts and working on emergency logistics and telecommunications. Together with the United Nations Humanitarian Response Depot (UNHRD), they are providing food from El Salvador as well as distributing relief supplies and food from a depot in Panama. The World Health Organization (WHO) is coordinating medical assistance, particularly victim care. The U.N. Childrens Fund (UNICEF) is focusing on identifying and reuniting children with their families. Humanitarian relief sectors are typically established during humanitarian crises to enable the U.N. Humanitarian Country Team to coordinate partners, prioritize resources, and facilitate planning. To date in Haiti, relief sectors have been organized into five clusters led by various agencies, including: Emergency Shelter and Non-food Items (International Organization forMigration) Food Assistance (WFP) Health (WHO) Logistics (WFP) Water/Sanitation (UNICEF)A number of other clusters are expected to be mobilized in the coming days. Various international non-governmental organizations (NGOs) that were already operating in Haiti before the earthquake are mobilizing to respond to the crisis. Reportedly hundreds of local staff are assisting with the relief effort.In addition, the International Federation of the Red Cross and Red Crescent Societies (IFRC) is working with the Haitian Red Cross Society (HRCS) and other national red cross societies, including the American Red Cross, to provide assistance to earthquake survivors. The IFRC is coordinating efforts with the International Committee of the Red Cross (ICRC), which is focused on medical assistance, tracing the missing and helping to restore family links. The ICRC is also helping with the identification and collection of mortal remains.U.S. ResponseU.S. Humanitarian AssistanceOn January 13, 2010, U.S. Ambassador to Haiti Kenneth H. Merten issued a disaster declaration, and the U.S. Agency for International Development (USAID), through the Office of Foreign Disaster Assistance (OFDA), authorized $50,000 for the initial implementation of an emergency response program. The embassy also facilitated the evacuation of U.S. citizens and issued a travel warning.On January 14, 2009, President Obama announced $100 million in humanitarian assistance to Haiti to provide significant resources to meet the immediate needs on the ground. At present, there is reportedly some carryover funding expected from the International Disaster Assistance Account as well as the P.L. 480 food aid account. In addition, money in the FY2010 budget will be made available.The U.S. government has set up an interagency task force to coordinate and facilitate the humanitarian response to the earthquake in Haiti through the Washington, DC-based Response Management Team headed by USAID/OFDA. At this point, the overall focus of the U.S. governments response is search and rescue, logistics and infrastructure support, provision of assistance where possible, and conducting needs assessments. The activities of some of the key agenciesUSAID and DODare described below.USAIDUSAID/OFDA has deployed a 17-member Disaster Assistance Response Team (DART) to Haiti. The Washington, DC, Response Management Team is also in place to support the USAID/DART, which will focus on assessing humanitarian needs and coordinating assistance with the U.S. Embassy in Haiti, the Government of Haiti, and the international community. The Fairfax Urban Search and Rescue Team has deployed 72 staff, and Los Angeles County has also sent teams along with support staff, both including search and rescue canines and rescue equipment. Food aid through USAIDs Food for Peace Program (FFP) will come from prepositioned stocks in Texas. In coordination with the WFP, USAID has food aid for 1.2 million people over the next two weeks.Response of International Financial InstitutionsMultilateral LendingThe multilateral development banks (MDBs) have been active in Haiti in recent years, providing debt relief, loans, and grants. After the earthquake, the World Bank announced $100 million in emergency grant funding to support recovery and reconstruction, in addition to its existing $308 million portfolio of grants projects in Haiti. The existing projects are in areas including disaster risk management, infrastructure, community-driven development, education, and economic governance. The World Bank is the only international financial institution providing all of its assistance as grants, thus ensuring that Haiti does not accumulate any additional debt to it. In addition to World Bank programs, the World Bank administers several donor-funded trust funds. Since 2003, trust funds administered by the World Bank have given more than $55 million to Haiti.On January 12, 2010, Inter-American Development Bank (IDB) President Luis Alberto Moreno announced a $200,000 emergency grant for immediate relief aid. The IDB is Haitis largest multilateral donor, with a portfolio of programs worth over $700 million, as of the end of 2009.These programs include both grants and concessional loans. Of this amount, $330 million is undisbursed, of which $90 million could be quickly redirected to high-priority civil works and reconstruction projects, according to the IDB.IDB management also announced that it anticipates the approval of up to $128 million in already-planned grants, potentially providing more resources for reconstruction. Haiti receives concessional loans from the International Monetary Fund (IMF) as well as from the development banks.In response to the earthquake, the IMF announced it will provide $100 million in additional concessional loans, following approval from its member countries. This would be additional debt incurred by the country. Including the new lending, total Haiti debt to the IMF would be $277.9 million. Of this amount, close to $170 million in concessional lending to Haiti has already been disbursed. Debt ReliefHaiti completed the multilateral Enhanced Heavily Indebted Poor Countries (HIPC) Initiative in June 2009, making it eligible to receive debt relief from the multilateral and some bilateral creditors. Under the terms of their participation in the Enhanced HIPC program, the World Bank provided Haiti debt relief for debts incurred through December 2003. According to the World Bank, debt relief under the Enhanced HIPC Initiative amounts to $140.3 million. Haiti has no outstanding debt to the World Bank. The IDB, in September 2009, provided $511 million in debt relief. Debts eligible for cancellation were those incurred through 2004 (compared to 2003 in the case of IDA). According to the IDB, Haiti currently owes $429 million (principal-only) to the IDB. This includes $305 million from loans made in 2005 and 2006, after the debt cancellation cut-off date of December 31, 2004, and $124 million from undisbursed balances of loans made before the cut-off date. Beginning in 2009, Haitis payments on its debt to the IDB have been made by a U.S.-supported trust fund that currently amounts to $20 million.Haiti has also received debt relief from its bilateral creditors. Haitis completion of the HIPC program triggered debt relief of $62.7 million by the Paris Club group of official creditors. Haitis Paris Club creditors agreed to go beyond the requirements of the HIPC program, however, and provide $152 million in additional debt cancellation, thus completely cancelling Haitis external Paris Club debt of $214 million. That said, Paris Club debt relief is not automatic. Creditor nations collectively sign bilateral agreements with the debtor nation, giving effect to the multilateral debt relief agreement. On September 18, 2009, the United States cancelled $12.6 million, totaling 100% of Haitis outstanding debt to the United States. Several countries, however, have not yet completed their debt relief agreements. While most Paris Club members have implemented the sum of their Paris Club debt relief, France has only cancelled 4 million ($5.75 million) of 58 million ($83.36 million) owed to them by Haiti. The French Finance Minister asked on January 15, 2010, that debt relief be sped up, and that Taiwan and Venezuela, two of Haitis largest non-Paris Club creditors, forgive Haitis debts owed to them, $71.2 million and $112 million respectively.

CHAPTER 14Key strategic lessons for the next sudden-onset disasterThe magnitude of international response has increased dramatically from one disaster to the next. This growth has many positive aspects: First, many developing countries, neighbors or not, are now joining the more traditional humanitarian donors to respond to disasters. A number of specialized agencies are filling small niches neglected in the past and new NGOs are providing Collective services to other partners (communications, information, logistics, etc.). There are now numerous organizations active in a variety of health disciplines, Creating the potential for great diversity and coverage of services. This rapid growth has come with a lot of pain and changes. In the health sector, a two-fold process is emerging: On one side, the established humanitarian organizations are becoming more professional by developing their own standards and norms and training their staff. On the other side, the number of inexperienced new comers (NGOs, universities, countries, and others) is rising rapidly. Some of these new actors plan to remain in the humanitarian field, which justifies the investment made by more established agencies in guiding their first steps. In the very distinctive health vacuum of Haiti, they did contribute positively and will improve their performance. However, a rising minority of new actors, with doubtful health competence or with questionable motives, were definitely more a hindrance than help. They should be filtered out by the health authorities.Is a better organized response possible?Lack of information sharing and coordination (two intertwined concepts) is the most common criticism in the aftermath of disasters. It is easily documented by external evaluators, eagerly conveyed by mass media, and conveniently used by lead agencies to call for more resources and staff. There are two relevant questions: 1) Is it possible to significantly improve the information?2) Is it possible to effectively coordinate such an unruly world of humanitarian Organizations?Is it possible to significantly improve the information? In the health field, the response is a definite yes.The first step is to identify (conservatively and pragmatically) what must be known to improve relief and what can be collected in time for this information to have the proper impact (not what we would love to know). In matters of immediate trauma care, which is a rapidly changing field, perhaps not much can be known and disseminated before it becomes obsolete.The second step is to deploy qualified human resources in time. This implies interagency agreements and the capacity to share rosters of experts. It supposes a significant investment in deployment of human resources and logistic support at the time of the crisis and a shift of lead agencies priorities from visible delivery of hard services to soft information management.Is it possible to effectively coordinate such an unruly world of organizations? In the health field, the response is a more qualified yes.More human and financial resources and definitely more meetings are not necessarily the solution. Coordination should not be an end in itself. Some level of chaos is an integral part of the initial response to large disasters. To what extent more coordination will improve the fate of the affected population deserves scrutiny. A high-level UN official in Haiti concluded privately that the lack of coordination in the first two months may have in fact permitted meaningful, community-level contributions from the many small or marginal actors. The same actors were seen as a major burden in past disasters in countries with more National capacity. Response and coordination must be determined by the context.A particular area that may benefit from quality control and improved coordination is that of foreign medical care assistance. The next disaster may require a substantial and rapid mobilization of senior managers and thematic experts, with significant logistical support, which is very problematic in the first days when needed most. WHO and its regional offices need to seek partnerships with bilateral and other institutions to develop a roster of experts and considerably increase their surge capacity to coordinate the incoming flow of medical responders. The Global Outbreak Alert and Response Network (GOARN) may serve as a useful model. Many bilateral groups and NGOs have demonstrated a high level of technical competence and critical analysis. Their support and participation will be most valuable.The efforts of INSARAG to improve search and rescue assistance may provide some additional clues to the way forward in the health sector. An independent review of its impact in Haiti is, however, still lacking (i.e., What would have happened if this sustained investment had not been made by INSARAG?).In other words, we need to shift from outcome indicators (more coordination is better) to impact appraisal by demonstrating that diverting funds from relief activities toward coordination and quality control actually does save more lives.

CHAPTER 15Ownership of the disasterMobilizing more external coordinators will not, in itself, improve coordination. Coordination without meaningful participation and leadership of the national health authorities is ultimately doomed to fail. One of the key findings of the self-evaluation of the UN Country Humanitarian Team in Haiti was the need to ensure national ownership of the disaster response. Government, however weak, has to play a central role in humanitarian leadership and coordination of post-natural disaster. We as humanitarian leaders and actors have to accept and facilitate this.To follow up on those findings, the IASC recommended that: Wherever possible, international humanitarian actors should then organize themselves to support or complement existing national response mechanisms rather than create parallel ones which may actually weaken or undermine national efforts. Where appropriate and practical, government leads should be actively encouraged to co-chair cluster meetings with their Cluster Lead Agency counterparts. As with all co-chair arrangements, respective responsibilities should be clearly defined from the outset (IASC 2011). Sudden-onset disasters are creating a wave of generosity (and therefore a high number of volunteers who are in need of coordination and strong competition for funding and visibility among actors which is in need of arbitration). In such disasters, the cluster approach must be implemented differently to ensure national ownership. Asserting the national governments primary role in coordinating and selectively filtering external assistance is not an easy matter for national authorities even when local health resources have the capacity to respond effectively.144 The perception held by the public that the international community is better suited to coordinate response guarantees that weaker national institutions will continue to be marginalized, and further weakened. Coordination should be a key feature of national disaster preparedness. (cluster approach) should be discussed with those countries most vulnerable to large-scale, sudden-onset natural disasters. Many potential worst-case, urban earthquakes scenarios have already been identified and those countries are receiving technical cooperation in preparedness from the UN and bilateral agencies. Under this agreement: The Government will determine the number and scope of responsibility of the sectors/ clusters at the national level in order to better reflect the organization of the government and respective mandate of the line ministries. Adjusting the clusters to national structure is a requirement to facilitate the early and smooth transfer of responsibility to the government. The sector/cluster structure at national level will vary from country to country (in line with the flexibility recommended in the 2006 IASC guidelines recognizing that one size does not fit all). The Government, in consultation with the UN Humanitarian Country Team, will designate in advance one or more (co-lead) agencies to assist the national institution (line ministry) responsible for each sector. Those lead agencies may or may not be the same as those at global level (another recommendation of the IASC guidelines). It would not affect the role of the cluster lead agency at global level. It is also understood that in the immediate life-saving phase, the co-lead UN agencies may have to actually manage and coordinate the entire response in exceptional situations such as in Haiti. The agreement will endorse the existing 24-hour activation mechanism for the clusters but ensure explicit participation of the government in the UN decision making process (beyond merely informing authorities). Finally, a clear end-date (for example, three weeks) will be set for either transfer of responsibility to the national institution or a formal request for extension of the lead role of the international agencies for a specified period, should the national authorities deem that necessary.In brief, the humanitarian community must acknowledge that in order to strengthen the capacity of national authorities it is worth taking the risk, in the short-term, of having less efficient or experienced coordination. Indeed, the risk of additional chaos might be less than anticipated considering the poor performance of external coordination in the first few months in Haiti and other disasters. Instead of managing the crisis themselves, international partners should accompany and build the capacity of their counterpartsadmittedly a more demanding and difficult task.

Quality control in the medical sectorMany agencies that regularly provide medical teams and field hospitals are dedicating considerable effort to improve the quality of their performance by carrying out systematic evaluations and training. Some have gone a step further to analyze the cost effectiveness of their interventions in terms of development and relief. However, not all groups have a high standard of quality assurance.Medical care is one of the most regulated service sectors in all countries, even in less developed ones. Accrediting medical doctors, paramedical technicians, and pharmacists or licensed facilities is one of the key functions of a ministry of health in normal times. In the aftermath of a disas