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Haiti: Relief and Reconstruction

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As Cholera Cases Increase, Statement from 44 Experts Outlines a Possible Way Forward Print
Friday, 03 June 2011 10:53

It is now officially hurricane season. Rains have picked up over the previous weeks and this is already causing a surge in the number of new cholera cases. The most recent data from the MSPP (Ministere de la Sante Publique et da la Population) show that there have been over 320,000 cases, 170,000 hospitalizations and that 5,337 people have died as a result of the disease. In a statement on June 1, the Pan American Health Organization (PAHO) noted that:

During the last days the MSPP and PAHO/WHO have observed an increase in the number of alerts of cholera cases, mainly in the Departments of South-East, Grand-Anse, South, Center and West. New cholera cases have been reported in IDP camps.
Also pointing out that, "due [to] lack of resources numerous NGOs have been withdrawing from these areas and interrupting their water-trucking programs. This situation makes more vulnerable the health of the IDP populations." The Health Cluster vulnerability analysis shows that the West department, because of the high concentration of IDPs, is the most at-risk part of the country. Yesterday, Oxfam reported an increase in cholera cases in the area of Carrefour where, according to the IOM, over 60,000 IDPs are spread between 124 sites. Oxfam public health promoter Mimy Muisa Kambere said:

The current cholera outbreak in the Carrefour area is far worse than the one registered in November. At that time, there were a maximum of 900 reported cases of cholera per week. Now, over 300 new cases are registered every single day. However, the number of casualties is far lower than we saw in November as people are able to get help faster.

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Over One Million Living in "Extremely Dangerous" Houses According to USAID Report Print
Thursday, 02 June 2011 12:39

A draft report produced for USAID has been circulating online and has generated controversy as a result of its estimates of the death toll numbers from last year's devastating earthquake in Haiti which don’t match up with previously published figures. While media outlets have latched onto this sensational story and tied it in to the discussion over continued assistance to Haiti, there are other aspects of the paper that appear much more relevant to the current situation of relief efforts in Haiti.

To begin with, the report – even if its results are only partially reliable – makes it clear that there are an extremely large number of people living in damaged and dangerous housing. According to the report, many people have returned to housing once slated for destruction, a phenomenon we have written about previously.

As Timothy Schwartz, the lead author of the study, writes:

It means that as many as 570,178 people (114,493 residential groups or families) are living in 84,951 homes that may collapse in foul weather or in the event of another tremor. That’s yellow buildings. For Red buildings it means that 465,996* people (100,430 residential groups) are living in 73,846 buildings that might collapse at any moment.  Discussing the growing problem of people returning to unsafe yellow and red buildings, Dr. Miyamoto emphasized the gravity of the situation,

"Occupied yellow and red houses are extremely dangerous since many are a collapse hazard.  People occupy these houses despite communications and warnings from MTPTC engineers since they have nowhere to go but the camps. People do not want to stay in these tents. Security is poor and they are exposed to diseases. I see little children sleeping next to the heavily cracked walls every day."

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GAO: U.S. Efforts in Haiti Have Begun Print
Thursday, 26 May 2011 12:11

As we previously mentioned, last week the U.S. Government Accountability Office (GAO), the independent government agency tasked with evaluating the performance of the federal government in selected areas, released their assessment of U.S. efforts in Haiti.  The report – which bears the less-than-optimistic title “Haiti Reconstruction: U.S. Efforts Have Begun, Expanded Oversight Still to be Implemented” – offers more a description of the general framework of the relief effort than a critical examination of its results to date.  For those not aware of where and how hundreds of millions of dollars of federal funding are being channeled in Haiti, the report has a number of useful pie charts, flow charts and bar graphs that provide a clearer picture of where U.S. funds are being spent, and where they aren’t.  Although the report offers no examination of whether the programs implemented by the U.S. Agency for International Development (USAID) are actually effective, it does shine a light on some of the structural problems affecting the international relief mission.

The four broad sectors receiving U.S. funding are 1) Infrastructure and Energy (46% of total funds); 2) Governance and Rule of Law (16%); Health and other basic services (13%); and Food and Economic Security (7%).  The breakdown of spending within each sector provides evidence of misplaced priorities.  For instance, while significant funds are being channeled towards improving Haiti’s energy infrastructure, roads and permanent housing, only a comparatively small amount of allocations are going to rubble removal ($25 million), although the continued presence of rubble throughout Port-au-Prince remains the biggest obstacle to the reconstruction of Haiti’s devastated capital city.

Though the U.S. has allocated over $98 million to health care, only $10 million is being channeled to education (or approximately 1% of total U.S. spending on Haiti’s reconstruction).   Haiti’s education sector was in crisis well before the earthquake – with over 60% of students dropping out of school before the sixth grade and the literacy rate hovering around 50%.  There are now heaps of rubble where many schools stood and the vast majority of the hundreds of thousands of children in tent camps have no access to any form of education.  Given the crucial role that education must play in Haiti’s reconstruction, it’s difficult to understand why this “sub-sector” is receiving so little funding.

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As Hurricane Season Nears, Bottlenecks Increase Dangers to IDP’s Print
Tuesday, 24 May 2011 16:25

The U.S. Government Accountability Office released a report last week noting, among other things, that the Interim Haiti Reconstruction Commission (IHRC) is still not operational, although it still has several months to do so before its mandate ends:

although the commission's mandate ends in October 2011, IHRC is not fully operational due to delays in staffing the commission and defining the role of its Performance and Anticorruption Office--which IHRC officials cited as key to establishing the commission as a model of good governance.

The GAO goes on to note a significant disconnect between what the Haitian government has identified as priorities, and what IHRC has green-lighted:

although the Haitian government identified nearly equal 18-month funding requirements for debris removal and agriculture, IHRC has approved about 7 times more funding for agriculture projects.

This is perhaps not surprising considering the IHRC’s problems in ensuring involvement of Haitian partners in decision-making.

The debris removal, of course, is necessary in part to clear space for new shelters, and getting displaced persons out of IDP camps, where cholera – abetted by a severe lack of adequate sanitation – can be a serious danger. (Deutsche Presse-Agentur reported this weekend on a new milestone in post-quake tragedy: 5,200 cholera deaths and 300,000 infections over the past seven months.) Yet just 20 percent of the rubble has been removed, according to various officials. USAID has not made rubble removal much of a priority either, according to the USAID Office of the Inspector General.

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Members of Congress Want Answers on Lack of Results from U.S. Assistance Effort Print
Wednesday, 11 May 2011 15:44

An editorial in the New York Times today describes the findings of a UN report that shows the cholera outbreak “may have originated” at a MINUSTAH camp, and says “The fact that the disease is still spreading is a reminder of how much more help Haiti needs and the consequences of continued neglect.”

The editorial concludes:

Even as relief agencies are winding down their presence in Haiti, about 680,000 people are still living in camps and waiting for permanent shelter. Life in this setting is precarious, without adequate access to latrines and safe drinking water.

The United Nations’ overall appeal to respond to the epidemic, for $175 million, is 48 percent financed. Haiti’s continuing health emergency may have been overlooked in a crush of world events, but while the sick and dying are waiting for the world to respond, the disease is not.

The editorial was, unfortunately, all too well-timed, as the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) and the Pan-American Health Organization issued a new warning today of expected "(fresh) outbreaks of cholera in the West, including Port-au-Prince, South and Southeast Departments" accompanying heavy rains and possible flooding.

As we have recently noted, the ongoing cholera epidemic – which now seems to be entering a deadly resurgence, and could kill as many as 11,000 people this year, is closely linked to inadequate sanitation in the IDP camps. This is a theme also addressed in OCHA's warning today: "More water means more cholera and the sanitation in the country is still very weak," Reuters reported OCHA spokesperson Emmanuelle Schneider as saying.

Poor sanitation, a lack of suitable transitional housing, and the poorly funded cholera appeal are all markers of the international community’s failings to come through for the people of Haiti. Now, members of the U.S. Congress are demanding answers. Yesterday, the House passed, by voice vote, bill HR 1016, which, the Miami Herald reports, requires the Obama administration to send to Congress

a report to assess the overall progress of relief, recovery, and reconstruction of Haiti and requires the president to assess within six months the effectiveness of U.S. assistance to Haiti.

…according to the Rep. Frederica Wilson (D – FL), who added an amendment to the bill regarding deportees.

Also covering the bill’s passage, AP's Jim Abrams reported that:

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Killed by Bureaucracy: A Story of Neglect in a USAID/OFDA Supported Camp Print
Friday, 06 May 2011 15:55

Earlier we reported on an Inspector General report that is extremely critical of USAID/OFDA and their grantees’ efforts in providing housing to displaced Haitians. The audit, however, also raised a separate issue, based on the fact that “USAID/OFDA’s mandate is to save lives, alleviate suffering, and reduce the economic impact of the recent earthquake in Haiti.”

The audit reported that:

As part of the audit, the audit team visited a camp where USAID/OFDA was funding the construction of 800 shelters. There we met a resident who was dying of breast cancer. The woman’s entire right breast was an open wound, and she was suffering great pain. Concerned for the welfare of this person, the audit team alerted grantee officials that the woman needed immediate medical help. The audit team members asked whether the grantee could use their knowledge of local community resources to seek help. However, the auditors were told that many people were sick in Haiti and that helping one person would lead to others asking for help.

The audit team informed USAID/OFDA of the situation, but was told by a USAID/OFDA official in Haiti that USAID could not do anything and that the issue should be taken up with the grantee.

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Inspector General Slams USAID on Provision of Housing in Haiti Print
Friday, 06 May 2011 15:51

An audit by the USAID Office of the Inspector General (OIG) that looked at USAID efforts to provide transitional housing in Haiti was published a few weeks ago and has yet to receive any attention from the media. The report, however, is extremely damning in its assessment of US government efforts to provide housing and represents the first real attempt at accountability in the failure to adequately provide housing for those displaced by the earthquake.

The audit looks at progress on 16 grants, totaling $139 million that were awarded from January 2010 through June 2010. The biggest recipients of these funds were CHF International, Catholic Relief Services, World Vision and GOAL Ireland. The full list of grantees is available in the report.

The audit found that USAID/OFDA grantees completed just 6 percent of planned transitional shelters by the onset of last year's hurricane season (June 2010). By November 2010, just 22 percent of shelters had been completed. The audit notes that grantees will not be able to complete all the shelters they had planned due to “rising costs and unrealistic initial cost estimates.” There is also a 65 percent shortfall in the efforts to repair “14,375 homes minimally damaged in the earthquake.”

The inspector general made a series of recommendations to USAID, however they note that, “No management decisions have been reached on Recommendations 1, 3, 5, 6, and 7.” There are only seven recommendations.

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UN Panel Links Cholera to MINUSTAH Base; MINUSTAH Continues to Shift Blame Print
Thursday, 05 May 2011 15:16

Yesterday, the UN “independent panel” released their long awaited report (PDF) on the origin of cholera in Haiti. Although the ultimate conclusion of the panel was that “the Haiti cholera outbreak was caused by the confluence of circumstances…and was not the fault of, or deliberate action of, a group or individual,” the report is a serious indictment of MINUSTAH, specifically the base in Mirebalais. The report finds that the cholera outbreak began in a tributary near the MINUSTAH base and that the “sanitation conditions at the Mirebalais MINUSTAH camp were not sufficient to prevent fecal contamination of the Meye Tributary System of the Artibonite River.” (Check out the picture of the sewage pit on page 22 of the report).

The report does find that cholera “strains isolated in Haiti and Nepal during 2009 were a perfect match”. The MINUSTAH troops at the base were from Nepal. And the disease was introduced “as a result of human activity.” But, as Colum Lynch asked today:

In the end, the panel echoed the U.N.'s talking points throughout the cholera crisis: that the battle to end the scourge should take priority over determining how it got there. "The source of cholera in Haiti is no longer relevant to controlling the outbreak," he said. "What are needed at this time are measures to prevent the disease from becoming endemic," the report concluded.

Surely, no one would quibble with that sentiment. But wasn't the panel's primary mission to do just that?

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Sacrificing Food Sovereignty for Food Aid Print
Wednesday, 04 May 2011 09:53

The AP’s Trenton Daniel put a spotlight on rising food prices in Haiti over the weekend. Daniel writes:

Soaring food prices aren't new in Haiti, the poorest country in the Western Hemisphere and heavily dependent on imports. Now those prices are rising again, mirroring global trends, while the cost of gasoline has doubled to $5 a gallon. Haitians are paying more for basic staples than much of Latin America and the Caribbean, an Associated Press survey finds.

A number of factors have led to the most recent surge in prices. As we reported in early March:

The FAO warned that, “The low-income food deficit countries are on the front line of the current surge in world prices.” Haiti, which imports nearly 50 percent of its food, according to the WFP, could be especially vulnerable.

International factors have exacerbated the negative effects of the cholera epidemic and last year’s Hurricane Thomas, both of which greatly affected agricultural regions. All of this comes at a particularly bad time for Haiti, where the months of April and May are generally the least food secure months of the year. FEWS Net has warned “The size of the food insecure population will be larger than usual, peaking in April/May.”

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Will the International Community Stand Idly By While Over 11,000 Haitians Die from Cholera? Print
Tuesday, 26 April 2011 13:32

In the wake of last week’s letter by 53 members of the U.S. Congress urging prioritizing the needs of IDP’s, Georgianne Nienaber underscores the urgency of the situation in a new piece for Haiti Live News and other publications. Likening the looming disaster of an expected spike in cholera deaths with the sinking of the Titanic, Nienaber suggests that the current international response is akin to that of the SS Californian, which, although having been less than 10 miles away from the Titanic on April 15, 1912, made no attempt to rescue the doomed voyagers.

Nienaber writes that the number of cholera cases is already growing quickly with the onset of the rainy season:

The country-wide fatality rate is 1.7 percent, but rural Sud Est department stands at a disastrous 7.9 and Grande Anse is not far behind with a 5.4 percent death rate. The Ministere de la Sante Publique et de la Population (MSPP) provides statistics that usually lag behind real time, but you can find them on the webpage.

In a better assessment from the ground in Mirebalais, the epicenter of the outbreak, PBS reports that the Partners in Health cholera center saw 500 cases in the three weeks prior to the recent rains. They have seen 1,000 cases in the last two weeks.

While the UN has offered estimates of up to 400,000 total cases by October 2011, a new study in the British medical journal, The Lancet, predicts nearly 800,000 cases and over 11,000 deaths from the cholera outbreak.

While millions of dollars collect interest in the bank accounts of large NGO’s, and while pledges by various foreign governments go unfulfilled, treatment for cholera remains greatly underfunded. Nienaber notes that UN Secretary General Ban Ki-moon spoke about the urgent, but still neglected needs earlier this month:

[T]he withdrawal of some humanitarian agencies from cholera treatment centres and camps risks creating a shortage in the provision of services. The Cholera Appeal is 45 per cent funded, and the overall Haiti Appeal received only 10 per cent of the requested funds.

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