The situation in Haiti as of January 2011 | GiveWell

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The situation in Haiti as of January 2011

This page summarizes the information we've found on the progress of the relief effort one year after the 2010 Haiti earthquake.

When possible, we use sources that are independent of any particular nonprofit, such as the Inter-Agency Real-Time Evaluation published by the Global Public Policy Institute1 ("Inter-Agency Evaluation") and publications by the United Nations Office for the Coordination of Humanitarian Affairs.2

This information is oriented toward donors, not relief organizations. We focus on what has been spent, what progress has been accomplished, and what the major obstacles to progress have been, rather than on how well the relief effort was run and what has been learned for future efforts. Readers interested in the latter should consult the sources referenced on this page, particularly the Real-Time Evaluation.

A summary/discussion of this page is available on our blog.

Funds spent by sector

To get some additional context, we've made a rough estimate of how much has been spent in different categories of aid. We've found very little information on the allocation of funding (particularly funds spent as opposed to raised/pledged) by category. Here we choose to use the breakdown of the American Red Cross as a proxy for the breakdown of overall spending. Note that the American Red Cross (a) appears fairly general in its mission, not focused on particular sectors; (b) accounts for over 15% of the total aid money spent, by our estimate.3

The table below shows the breakdown of American Red Cross spending by category, then estimates total spending by category by applying the same percentages to our estimate of about $1.6 billion spent as of January 2011

Sector ARC funds % ARC funds Total funds (our est.) Per-person affected (base: 3 million) Per-person-left-homeless (base: 1.25 million)
Total $245,000,000 100% $1,600,000,000 $533 $1,280
Food & emergency services $63,700,000 26% $416,000,000 $139 $333
Shelter $73,500,000 30% $480,000,000 $160 $384
Water/sanitation $36,750,000 15% $240,000,000 $80 $192
Health $31,850,000 13% $208,000,000 $69 $166
Livelihoods/host families $24,500,000 10% $160,000,000 $53 $128
Risk reduction $14,700,000 6% $96,000,000 $32 $77

Relief effort & situation in Haiti

Here we focus on the relief effort's progress in terms of shelter, water & sanitation, food, and health.

Cholera Outbreak

As of January 2011, the most prominent and volatile feature of the Haiti situation is the outbreak of cholera that began in October4 and has led to over 3000 deaths and 171,000 infections nationwide.5

"As of 1 January, the Ministère de la santé publique et de la population (MSPP) has reported 3,651 deaths due to the cholera epidemic and 171,304 infections nationwide." UNOCHA, "Haiti: Cholera situation report #31 - 6 January 2011", Pg 1. (Most recent cholera update at this writing)

This outbreak appears relevant to all the areas we discuss below.

Shelters and camps

The earthquake is estimated to have left 1-1.5 million people homeless.6 The aid effort has included both immediate shelter (consisting of tarp/tent distribution and camp management) and transitional shelter (construction of higher-quality, though still temporary, living spaces).

Immediate shelter

Within three months of the earthquake, tents and tarpaulins had reached what the Inter-Agency evaluation considered "good coverage," though the evaluation also criticized the relief effort for "an initial slow start and many paralyzing technical debates in January/early February."7 One such debate appears to have involved the decision to emphasize distribution of tarps rather than tents.8

The quality of settlement camps seems to vary widely;9 one study involving visits to over 100 camps10 concluded that

seven months following the earth-quake, 40 percent of IDP camps do not have access to water, and 30 percent do not have toilets of any kind. An estimated 10 percent of families have a tent; the rest sleep under tarps or even bed sheets. In the midst of the hurricane season with torrential rains and heavy winds a regular occurrence, many tents are ripped beyond repair. Only a fifth of camps have education, health care, or psycho-social facilities on site.11

A July news article cited the UN Office for the Coordination of Humanitarian Affairs (OCHA) as stating that "Tens of thousands of Haitians risk becoming homeless for a second time, as weary landowners clear their properties of makeshift refugee camps in order to build new homes or sell their land on Haiti's booming real-estate market. Of 1,241 refugee camps here, only 206 are officially recognized ... Only the official camps are monitored by NGOs, meaning that the majority lack protection."12 However, a more recent account by OCHA states that "95 per cent of camps are monitored regularly with the Data Tracking Matrix to track levels of service and raise awareness on difficulties."13 It is unclear to us whether this represents an increase in officially recognized camps between July 2010 and January 2011 or simply a distinction between two levels of monitoring.

Longer-term shelter

After initial distribution of tents and tarps, the relief effort aimed to build transitional shelters, "simple timber or steel frame structures that provide better protection than tents or tarps."14 It appears that only a small percentage of displaced people were housed in transitional shelters within the first 9 months of the earthquake, but that progress has recently accelerated on this front:

  • The Inter-Agency Evaluation stated that "the lack of transitional shelter was glaring at the time of the evaluation [April to May 2010] with only about 400 transitional shelters built."15
  • As of October 2010, the Pan American Health Organization stated that "Roughly 12,300 transitional-shelters have been built which house over 60,000 people on newly developed land."16
  • A one-year update by OCHA stated that 31,656 transitional shelters had been built, housing 158,000 families.17

OCHA cited issues with rubble (discussed below) and property rights (lack of clarity about who owns what land) as obstacles to construction of transitional shelters.18

Water and sanitation

The Inter-Agency evaluation stated that " the need for drinking water was covered reasonably well and quickly ... One month after the earthquake, the [[water, sanitation and hygiene] Cluster lead agency reported that over 900,000 people received approximately five liters of safe water per person per day in Port-au-Prince, Léogâne and Jacmel."19

Sanitation efforts continue to be a disappointment, especially in light of the cholera outbreak discussed above.

Reports cite a number of major challenges with water and sanitation, particularly the fact that traditional approaches to sanitation were ill-suited to a densely populated urban area built on concrete.20 The Haitian government was also criticized for its work in this area.21

The Inter-Agency Evaluation was particularly harsh (despite being published well before the cholera outbreak began), stating that "The [Humanitarian] sector does not have urban solutions to sanitation issues," arguing that the chemical latrines used were overly expensive, and criticizing the relief effort for paying insufficient attention to existing cultural practices and needs for privacy.22

Medical care

The medical care appears to have mobilized quickly, treating over 250,000 cases in the 3 months after the disaster.23

We have seen very little information about patient outcomes. The Inter-Agency Evaluation states that "after the end of January, many of the treated patients had either begun to experience complications following their earlier treatment";24 a report by Merlin, a health-focused nonprofit, argued that amputations were excessive.25

Food

We have seen little criticism of the food distribution effort. According to the United Nations Office of Humanitarian Affairs,

"Having provided emergency food rations to 3.5 million people in the months following the earthquake, WFP is now transitioning its programme to support recovery effort through long term food security and investments in human capital."

26 The United Nations Office for the Coordination of Humanitarian Affairs stated in October 2010 that

Since the January earthquake, there has been no reported increase in acute malnutrition rates in Haiti, though 65,000 children are estimated to be in need of nutritional assistance. Still, across Haiti 52 per cent of households are food insecure in earthquake-affected areas which includes 494,600 children under five and 197,840 pregnant and lactating women.27

Rubble

Rubble removal appears to have been very slow, and a major ongoing issue for the relief effort. The United Nations Office for the Coordination of Humanitarian Affairs stated that as of a year after the earthquake, between 10 and 15% of the rubble was "managed";28 stories in the media gave lower estimates.29

An October article from the Associated Press outlines some of the potential obstacles to rubble management:

Government officials and outside aid groups say rubble removal is the priority before Haiti can rebuild. But the reasons why so little has been cleared are complex. And frustrating.

Heavy equipment has to be shipped in by sea. Dump trucks have difficulty navigating narrow and mountainous dirt roads. An abysmal records system makes it hard for the government to determine who owns a dilapidated property. And there are few sites on which to dump the rubble, which often contains human remains.

Also, no single person in the Haitian government has been declared in charge of the rubble, prompting foreign nongovernmental organizations to take on the task themselves. The groups are often forced to fight for a small pool of available money and contracts - which in turn means the work is done piecemeal, with little coordination.
...
Leslie Voltaire, a Haitian architect, urban planner and presidential candidate [...] maintains that there are enough crushers, dump trucks and other heavy equipment for the job; others say that more machinery is needed....
While many private landowners and others are dumping the rubble in the streets, canals or countryside, there's only one place in all of Haiti where NGOs using U.S. money can take contaminated rubble: an approved and environmentally surveyed site.

"Not all rubble is the same," said Michael Zamba, the spokesman for the Pan American Development Foundation. "There's a lot of contaminated rubble with human remains in it. It can't go in a standard landfill."30

Sources

  • 1.

    Grünewald and Binder 2010

  • 2.

    United Nations Office for the Coordination of Humanitarian Affairs, "About Us."

  • 3.

    We estimate about $1.6 billion spent as of January 2011. The American Red Cross reports $245 million spent as of January 2011.

  • 4.

    Centers for Disease Control and Prevention 2010.

  • 5.

    See UNOCHA, "Haiti: Cholera situation report #31 - 6 January 2011" (most recent cholera update at this writing)

  • 6.

    Discussion of these figures at our blog post from January 2011.

  • 7.

    "After an initial slow start and many paralyzing technical debates in January/early February, huge efforts were made to provide most people in need with some sort of shelter. The good coverage finally reached by the end of March should not hide the fact that there will soon be a gap in emergency shelter due to the short lifespan of tents and tarpaulins in a tropical climate. This was beginning to be apparent in April 2010. In many areas, tarpaulins were already rotten and the evaluation team witnessed a lot of situations where people were no longer protected from the rain. Furthermore, the lack of transitional shelter was glaring at the time of the evaluation with only about 400 transitional shelters built. The inadequate supply of temporary shelter was of greatest concern to the affected population interviewed for the evaluation. Among other things, the difficulty to efficiently remove rubble from housing areas made it impossible to move quickly from the emergency shelter to the temporary shelter phase. Also, the fact that some donors insisted on continuing to distribute tents despite the recommendation of the shelter cluster not to do so, undermined more durable (though less aesthetic) solutions." Grünewald and Binder 2010, Pg 48.

  • 8.

    Center for Economic and Policy Research 2010, "USAID Takes Credit for Tarps Over Tents."

  • 9.
    • Center for Economic and Policy Research 2010, "NPR Contrasts Conditions in Two IDP Camps."
    • Schuller 2010.
  • 10.

    "this study covers over 100 camps for internally displaced persons (IDPs), a random sample of one in eight of the 861 in the metropolitan area. Students conducted quantitative and qualitative surveys in three inter-related areas: conditions and services within the camps, residents' level of understanding and involvement in the camp committees, and interviews with committee representatives. The author followed up with a visit to 31 camps." Schuller 2010, Pg 2. See Pgs 13-14 for details of the methodology.

  • 11.

    Schuller 2010, Pg 2.

  • 12.

    Christian Science Monitor 2010.

  • 13.

    United Nations Office for the Coordination of Humanitarian Affairs, "Haiti: One year later."

  • 14.

    United Nations 2010, "Haiti: 6 months after..." Pg 5.

  • 15.

    Grünewald and Binder 2010, Pg 48.

  • 16.

    Pan American Health Organization 2010, Pg 2.

  • 17.

    United Nations Office for the Coordination of Humanitarian Affairs, "Haiti: One year later."

  • 18.

    "The biggest challenge for cluster members is a lack of available land on which to build, either because land ownership is unclear or because plots are blocked by debris. Clarifying land rights is a major challenge. Shelter/NFI cluster agencies need clear guidelines supported by local authorities to allow legal construction of transitional shelters on land where ownership remains unclear." United Nations 2010, "Haiti: 6 months after..." Pg 5.

  • 19.

    Grünewald and Binder 2010, Pg 31.

  • 20.
    • "Lack of space for sanitation services due to dense urban environment; the inability to construct pit latrines due to concreted-in sites; land tenure issues where landown-ers do not allow construction; and the issue of “ghost camps” where the number of permanent residents is un-clear, are all challenges. Ensuring consistent water quality has also been difficult." United Nations 2010, "Haiti: 6 months after..." Pg 25.
    • "Problems were also encountered in relation to sanitation. The sector does not have urban solutions to sanitation issues. WASH actors typically use pit latrines with various technical designs which are not applicable in a concrete-covered market place or in the centre of a city." Grünewald and Binder 2010, Pg 49.
    • "The lack of clean sanitation facilities was a critical problem in the devastated city, and was compounded by government and institutional failure to address public hygiene issues. An urgent public health response was required from Oxfam. Severe overcrowding and the fact that the city was built from, and on, concrete, meant that providing latrines and temporary portable toilets in sufficient numbers was out of the question. So we had to find other solutions." Oxfam 2010, Pg 9.
  • 21.
    • "It should also be noted that the limited capacity of DINEPA to take charge of the sanitation response contributed to the problem." Grünewald and Binder 2010, Pg 49.
    • "The lack of clean sanitation facilities was a critical problem in the devastated city, and was compounded by government and institutional failure to address public hygiene issues." Oxfam 2010, Pg 9.
  • 22.

    "Furthermore, WASH actors did not enquire about the sanitation habits of the urban populations before the earthquake. If they had, they would have discovered how common it was to use plastic bags to dispose of excreta and they could have based their strategy on optimizing this behavior. Instead, some started off by providing traditional latrines as they are often used in rural areas, but these rapidly got blocked. The WASH cluster supported the use of costly chemical latrines which were from Santo Domingo: in highly-populated camp situations, these chemical latrines require daily visits by gully sucker trucks to remain hygienic and are thus a very expensive solution. The low in-country maintenance capacity combined with cultural norms of privacy partly reduced the attractiveness of these collective chemical latrines which created a difficult sanitary situation in the “camps”. Women interviewed complained about the poor hygiene and the lack of privacy in and around all latrines and showers installed by the aid agencies. The evaluators found several cases of latrines and showers that were not properly separated, if at all, into female and male wash areas. " Grünewald and Binder 2010, Pg 49.

  • 23.

    "The mobilization in the health sector continued for months after the disaster. From the 12th of January to the 31st of March, MSF carried out 11,749 operations and treated 173,757 cases in total. During the same period, the International Red Cross Movement treated another 95,000 cases." Grünewald and Binder 2010, Pg 54.

  • 24.

    Grünewald and Binder 2010, Pg 54.

  • 25.

    "There have been claims that the poor working conditions and inexperience of some clinicians in treating these very specific earthquake related injuries led to too many unnecessary amputations and health complications for patients down the line ... The many amputations in the emergency phase seemed to pay litle heed to the longer term implications of such a drastic operation in a city reduced to rubble, where sanitary living conditions were scarce." Merlin 2010, Pg 10.

    Note that the Inter-Agency Evaluation (Grünewald and Binder 2010, Pg 31-32) states that "In this context of mass injuries, the absence of clear protocols for definitive injury management together with the high level of primary and secondary infection led to one of the highest rates of amputation which has ever taken place in a disaster."

  • 26. United Nations Office for the Coordination of Humanitarian Affairs 2010, "Haiti: Humanitarian bulletin issue # 1." Pg 3
  • 27.

    United Nations Office for the Coordination of Humanitarian Affairs, "Haiti Earthquake: humanitarian update."

  • 28.

    United Nations Office for the Coordination of Humanitarian Affairs 2010, "Haiti: One year later."

  • 29.
    • " Just 7.5 percent of the rubble had been cleared from Port-au-Prince according to the latest estimates." Chronicle of Philanthropy 2011.
    • " [Aid agency Trocaire] said reconstruction efforts have been hampered by weak government, with just 5 per cent of rubble from the earthquake removed to date." Irish Times 2011, "Call for leadership on Haiti homeless."
  • 30.

    Associated Press 2010.