Following up on my summary of last week, here is more information on how help is flowing, or in some cases failing to flow, to the unnumbered victims of the earthquake in Haiti; on government competence and fecklessness; and on the world's systematic unpreparedness for disasters on this scale.
- There is food, but no organized system for distributing it.
- There is medical care, but no coordination in providing care or bringing in supplies.
- There are tents for refugees, but a significant number were stolen.
- Huge amounts of assistance have been pledged or donated outright, but little can be delivered.
- The communications network was devastated, and has not been restored.
- The Haitian government is not used to having resources, and is not prepared to deal with them, particularly in the context of offices destroyed, people killed, maimed, or missing, and communication disrupted, all on top of endemic corruption.
- After the Asian tsunami, the Burmese storm, Katrina, and this earthquake, among other recent large-scale disasters, there is no political will to create the systems and institutions necessary for rapid, co-ordinated, effective response to such needs.
As usual, there is more information than any one person can follow, so if you find bits that I missed, please add them in comments. Also as usual, the Mainstream Media continue to focus on miracle rescues and on everything that is going wrong in Haiti, and not on trying to give us a clear picture.
Yes, there was a girl freed from the rubble after fifteen days. Some people can last that long without food and water if they cannot move and are protected from dehydrating under the rubble. In every major disaster, the very last rescue is almost unbelievable. And yes, those fifteen days were rough on the girl. As was being above ground during those fifteen days with an untreated crush injury that was threatening to go gangrenous. There are uncounted thousands of such cases in the absence of organized communication, transportation, and medical care. These and many others have not known from one day to the next whether they would live or die.
There is good news and bad news. Behind every piece of good news is heroic coping with unimaginable difficulties. Today, I'm starting with the bad.
By some measures, things are as bad as on the first day, particularly in infrastructure--electricity, the water system (plant and pipes, not emergency deliveries), roads. Others are somewhat improved, but still far from normal functioning--government, coordination of aid, transportation, seaport, airport.
- The phone and Internet connections that were cut have not been repaired.
- Switching stations that collapsed have not even been excavated, much less restored to functioning.
- Some hospitals are functioning in part, but often without supplies, including antibiotics and anesthetics; without equipment, most of which was damaged or destroyed; without regular electricity; without security; without coordination, and without the possibility of getting in another surgical team to relieve those on duty.
- The utterly inadequate electricity generation systems are still mostly down.
- The water system is still down where plants have been destroyed and pipes broken.
- The port is so damaged that it can hardly be used at all. There is another port nearby, but it can only handle 10 containers an hour.
- There are not enough camps for the displaced, and existing camps lack sufficient shelter, sanitation, and other facilities.
- There is little amateur radio in Haiti, unlike in Kobe, Japan, where hams provided most of the communications for the first several days after the 1995 earthquake. Additional equipment and operators coming into Haiti must register with the government. One team from the Dominican Republic set up a system and then left Haiti due to security concerns.
- There is little Internet in Haiti, and much was damaged. This makes it impossible to set up fully effective information exchanges.
- It is impractical to distribute dry milk and powered infant formula where sanitation and clean water are lacking. Ready-to-use infant formula (RUIF) is recommended, and is being supplied. Sadly, donations of breast milk are being discouraged. The logistics would be impossible.
- Debris removal, rebuilding, and microfinance support have begun. The scale of the need is staggering.
- Many assessment teams only operate by day, but people return to spontaneous settlements only at night.
- When the USNS Comfort had a staging point on the lawn of the Presidential Palace, it was ordered off, and wasted a whole day finding another place to operate.
- Transport of Haitian orphans to adoptive parents has been delayed by additional red tape, including a requirement for Prime Minister Preval to sign off on each one individually.
Water, electricity, and phone systems, inadequate as they were before the earthquake, will take months to bring back, and much longer to make adequate (even assuming political and donor will to fund the repairs and enhancements). Food for work will also be needed for months before the economy gets back even to the dreadful pre-earthquake level, where many lived on less than a dollar a day.
But there is good news, more every day.
- Coordination is much improved. There are formalized Clusters of organizations for several important services, including the Water, Sanitation and Hygiene (WASH [sic]) Cluster, and others for Health, Nutrition, and Protection. There remain significant difficulties in coordinating newly arrived medical personnel, and medical supplies in general.
- About 75% of radio and a third of TV stations have come back on the air.
- The four mobile phone providers are largely functional, but the system is continuously congested.
- Food and water are getting to most of the population on a somewhat regular basis at more than a hundred sites, and everybody has received some. Capacity and organization increase. Food aid is switching from individual meals to 15-day rations for cooking, including oil, rice and beans. Thousands of kitchen sets have been handed out. Food and water distribution to towns outside Port-au-Prince is increasing.
- There are 160 organizations involved in health care of one kind or another in Haiti, with increasing coordination. Attention can be turned to infectious diseases, rape, pregnancies, HIV/AIDs, and other issues. Epidemiologists are tracking relatively small outbreaks of cholera and other diseases in order to contain them.
- USNS Comfort, a US Navy hospital ship, has treated several thousand patients and performed hundreds of surgeries. Work is going on to organize post-operative care locations in order to free up more surgical beds.
- Other health organizations have treated tens of thousands of victims, performed hundreds of operations, and delivered a number of babies.
- On January 24, it was reported that diesel fuel was no longer a limiting factor for deliveries and other transportation needs.
- A team of structural engineers is in Haiti to advise on temporary emergency construction and on rebuilding.
So what do we need next?
- More communications of all kinds
- Plasting sheeting for shelters (preferred to tents)
- Sanitary facilities
- More health care: people, facilities, equipment, supplies, transportation
- Temporary buildings
- Experts, especially those who can teach locals
- Political will
- Money
What do we learn from this disaster and others on this scale? Mostly that we do not learn enough from the disasters that occur every few years. There is no serious international program to design and develop systems adequate to the scale of the need for sufficiently fast coordinated deployment. Search and Rescue Teams (REST) are closest to adequate both in numbers and in speed of deployment.
- The first unmet need, and one of the last to be supplied when needed, is adequate communications for assessing damage and injuries; informing the population of what is being done; contacting friends, families, and colleagues; and coordinating aid. We have the technology to create emergency communications systems with broadcast, phone, radio, and Internet not only for relief personnel but for entire populations. As at 9/11, we still have no plans anywhere to link diverse communication systems together.
- Nobody has a stock of telephone switching centers ready to airlift.
- Several organizations, mostly governmental, have portable hospitals. There are not enough of them in the whole world for one such disaster, and they are all designed differently.
- The supply of temporary buildings more generally has been woefully inadequate.
- In World War II, the Allies floated in Mulberries to Normandy. These were seaport sections that could be filled with water and set on the bottom wherever needed. There are apparently no such devices anywhere in the world today.
- There is a stock of portable toilets, but it is not organized on a large enough scale for delivery.
- There are not enough portable water systems.
- There has been no thought to using local renewable energy in most of the vulnerable areas so that recovery from electrical system disruption will not depend only on scarce and expensive diesel fuel.
This is just off the top of my head. Admittedly, I have thought about this a lot in the context of providing education worldwide, even to villages without electricity or Internet, and from there meeting the rest of the UN Millennium Development Goals. A systematic analysis of various other kinds of disaster (fire, flood, tsunami, war, volcano...) could find other elements to plan for, design, develop, and keep at the ready. I will follow up on the technologies available for dealing with these requirements, and estimate the costs of doing it right. Then we can talk about building a real economy in Haiti.