Kids forced into domestic servitude in Haiti

[doug]

Kids forced into domestic servitude in Haiti

'Restavek' system thrives as impoverished families have little choice

•Lost children of Haiti
Amid widespread poverty, thousands of kids are forced to become indentured servants in Haiti

Port Au Prince, Haiti- Tablita washes dishes out side her guardian family house March 30, 2005. At the age of 14, illustrates the complexity of the restavek phenomenon. She is one of seven children, but she fears the imminent return to her biological parents. Tablita had never been to school at age nine when she moved to the city to live with her distant relative Ronald. Five years later, she is on the verge of completing elementary school, and she doubts she can finish her education if returned to her rural home. She also fears her biological mother, who she said beats her, unlike her urban hosts. Ronald her man host wants to keep Tablita because he thinks that, like most restaveks, she will wind up on the streets if let go, but his wife said Tablita is at an age where she is likely to become difficult to control. She wants to trade Tablita for her younger sister. In Haiti, a country that is proud to be the first black nation to free itself from slavery, it is ironic that thousands of children are living in near slavery conditions. Children are often taken from their families in rural villages at an age as young as six. Given up by desperately poor parents for the promise of a better life, children are moved to Port-au-Prince, but the promise of a better life is rarely kept. Instead, the children are often abused, forced to fetch water, mop floors, wash dishes, care for babies not much younger than they are. At times they are forbidden to eat at the table and sleep on concrete or dirt floors. They rarely get any schooling. These children become an integral part of the family without being adopted but rather play the role of the domestic worker. These children are called "restavek," meaning, "to stay with" in Kreyol.
By Carmen Russell and Dane Liu
Special to MSNBC.com
PORT-AU-PRINCE, Haiti - Evans Antoine wakes at 7 a.m. and dusts himself off from his night on the floor. While other children in his middle-class neighborhood overlooking the Haitian capital head to school, the 15-year-old puts on toeless sneakers and gets to work washing dishes, scrubbing floors and running errands at the market. He also works in the yard and sometimes wields a scythe in the family's fields.

There is little reward for his toil, except for food and a roof over his head. And often, the quality of his work isn't good enough; his caretakers sometimes hit him with a switch or slap him on the back of the scalp. Once they tied his hands and put a bag over his head before beating him with a stick.

This has been his life for the past three years.

"They tell me that I'm useless," Antoine said, speaking softly at a meeting secretly arranged by a teacher who taught him briefly and who fears for his future. "They yell at me and tell me about all the things they do for me and how easy I have it."

During the interview, Antoine never smiled. He also kept looking away while answering questions, clearly uncomfortable with the subject: his unforgiving life.

Antoine is a restavek, a Haitian term derived from the French for "stay with." But, he would rather be described by the more genial-sounding Creole phrase meaning "one who lives with people." He is among 300,000 children, 10 percent of Haitians under 18, who serve as domestics for other families, a tradition in Haiti dating back to the country's independence more than 200 years ago.

Haiti revolted against French colonial rule and became the first "black republic" in 1804. With newly emancipated slaves in power, it also became the first nation to outlaw slavery. Dependent on coffee and sugar, however, Haiti kept the plantation system after the revolution, requiring "mandatory labor" of many citizens. The masters were no longer white, but working conditions improved only marginally.

Children were particularly susceptible. The sons and daughters of slaves remained house servants following the revolution, indentured to newly rich army officers who took over the plantations.

Key to the economy
Today child workers remain an important part of Haiti's economy, a system that barely sustains a nation of 8.7 million that is wracked by poverty and lawlessness.

Haiti is the poorest country in the Western hemisphere. A little over half of primary school-age children are enrolled in school, according to UNICEF, and less than 2 percent finish secondary school.

Children become restaveks in a variety of ways. Some, like Antoine, are orphaned and taken in by family friends. Others are runaways pulled off the street. Most are given up by parents from depressed rural areas who can't afford to care for them and hope that another family will do better and send them to school.

Evans Antoine

Antoine's case is an example of what so often goes wrong. His adoptive family promised to pay his tuition, but when it came time to do so, his adoptive father reacted harshly. "He said I was lying and he beat me," he said.

In fact, the majority of families are only slightly better off than restaveks' parents, despite living in the capital.

"It is not in Haitian culture to send children away," said Guerda Constante, a child-rights activist in the small coastal city of Jacmel. "Parents do this because they do not have the means to provide for their needs. It seems strange, but the parents are acting with love."

Promises by host families to feed, educate and take care of the children are just too alluring to poor parents, Constante said. In some cases, the new family meets those promises, but in most cases, she says, "the difference between the promise and reality is seen on the first day they arrive."

Rural poverty
It takes a bumpy four hours in a 4x4 to make the 60-mile trek from Port-au-Prince to the rural village of Fond des Blancs, where electricity and running water are scarce. The center of activity — a foreign foundation-funded hospital, a church and an outdoor meeting hall — sit in the middle of the valley.

Over the treeless mountains to the south lies the Caribbean Sea. Single-room, thatched-roof huts dot the landscape, many housing families with 10 children or more.

Fond des Blancs has little communication with Port-au-Prince and the capital's political system has nearly no influence on the area. Lack of police has made it a favorite destination for Colombian planes to drop drugs for local Haitian runners to send onto the United States.

While some families farm or make charcoal, most have no regular means of support. In the most depressed areas, fortunate children are those that are fed once a day.

Children in places like these, activists say, are most at risk of winding up in the restavek system. A group of Fond des Blancs residents formed the Committee to Promote the Rights of Children of Fond des Blancs (COSEDERF) last year in an effort to keep children in the community.

The committee circulated a petition which asks Haitian leaders to "fulfill Haiti's obligations to provide free and compulsory education," believing fewer parents would send their children away if they had access to schooling.

"More than 50 percent of the children in Fond des Blancs don't have the chance to go to school," said Briel Leveille, a community leader and member of COSEDERF. "It is said that education is the foundation of development. It is through education that Haitians will one day come out of this misery."

One U.S. community gets involved
Hearing about the lack of education, one American school has become involved with the Haitian community.

At the Seth Boyden Elementary school in Maplewood, N.J., the PTA is trying to set up a sister-school relationship with those in Fond des Blancs. Students have been collecting school supplies and attended a Haitian Flag Day celebration.

•U.S. school helps
Haitian children use supplies brought by Tamara Thompson from New Jersey.
MSNBC.com

"I hope we can do a lot more than this," said Tamara Thompson, a former U.N. observer in Haiti who now resides in Maplewood and has a 9-year-old son who attends Seth Boyden. "Education is a key to ending the restavek system and it is their right."

For now, however, many parents in Fond des Blancs see the restavek system as the only hope for their children.

"I'm afraid to send them, but I really don't have any choice," said Rodette Clermanceau, a mother of 10 in Fond des Blancs. She is sending two of her children to Port-au-Prince to work for other families. Clermanceau has been raising her children alone since the father was sent to prison.

"If I had the financial means, I would not give them away," she said.

© 2007 MSNBC Interactive

[doug]

updated 9:31 p.m. ET Jan. 14, 2010
Armed, resolute, church group heads for Haiti
Pa. church members set off on dangerous relief mission to Haiti orphanage

Members of the Lifechurch of Allentown, Pa. tie supplies atop their SUV on Thursday before leaving on a desperate relief mission to the orphanage in Port-au-Prince, Haiti, that their congregation supports.
By Bill Dedman
Investigative reporter
msnbc.com
ON THE ROAD TO PORT-AU-PRINCE, Haiti - What would Jesus do? Well, in these circumstances, he'd probably pull strings at three embassies, stock up on machetes, put yellow police lights on his vehicles and find a quiet place to cross the border into Haiti.

At least that’s how Randy Landis interpreted his likely course of action.

“Our emphasis is to witness, to be the hands and the feet of Jesus,” said the 50-year-old senior pastor and founder of the Lifechurch in Allentown, Pa., who is leading a desperate relief mission to the Haitian orphanage the church sponsors. “If Jesus were here, what would he do? I don't think he would be in America sitting and watching the television. If he had a way to get to Port-au-Prince, he would get here. He would be a first-responder.”

It was nearly dusk on Thursday when Landis and three other members of the nondenominational church left the Dominican Republic city of Santo Domingo for the Rescue Children's Orphanage in the Haitian capital Port-au-Prince. Already, the 11 children and four staff members there have spent two nights sleeping outside, afraid to risk the collapsed walls of their home amid continuing aftershocks.

After loading the SUV with as many supplies as possible, Landis and the others paused for a minute of prayer, forming a small circle by the side of the highway, before beginning the journey. The trip to the border, on good highways through the mountains, was expected to take about four hours.

But the group wasn't certain it would be allowed to cross, and safety on the other side was uncertain. The State Department warned Americans not to visit Haiti and not to travel after dusk in the capital, Port-au-Prince. The church members aren’t afraid to use guns, but they weren’t willing to try and take any firearms across the border. Machetes and police lights would have to do.

"How many of you got a knife?" mission director Ramon Crespo asked as the workers finished tying down the two stories of supplies: 25 gallons of gasoline, sacks of potatoes, vegetable oil, bananas.


He then handed out hunting knives like boarding passes as the others clambered into the SUV. But he held onto “Johnny,” his 10-inch serrated knife. “If you throw this, it nearly always sticks,” he said.

The border guards from the Dominican side were said to be turning back many vehicles, particularly rental vehicles like the group’s Mitsubishi, the last vehicle available at the Santo Domingo airport.

But the pastor had in his pocket a lucky card to play.

On the flight down from Newark, N.J., church handyman Ramon Morales sat next to a Haitian living in New Jersey, Hubermann Debrosse, who said he has not heard from his wife or children — a 2-year-old son and a 20-year-old daughter — in Haiti since Tuesday’s killer earthquake. Debrosse, who said he was a doctor who speaks three languages, was trying to make his way to Port-au-Prince, so he was immediately hired on as translator/fixer. It turned out that Debrosse's roommate from the Haitian medical college he attended works in the Haitian Embassy in Santo Domingo.

So on Thursday, before heading out, the doctor and the pastor visited the embassy.

"There were maybe 70 (or) 80 Haitians “frantically trying to communicate with embassy officials, notes, pieces of paper, can you find so and so,” Landis said. “And inside it was just jam-packed, trying to get in to see an official. Wall-to-wall people. Very orderly. You could see despair on their face."

Hubermann talked to the guard, and "we were immediately walked right through the crowd that took us to the back of the embassy into an office where the doctor was. He immediately embraced him. He said everything in Creole. All I know is he gave us his business card, wrote his number on the back. I'm hoping we won't have to use it."

If they are turned back by border guards, there is a plan B, Landis said. "Our driver knows another way in without a checkpoint," which they hope will enable them to enter Haiti unnoticed.

The group had been offered a charter flight to Haiti from Santo Domingo. The pastor's wife, Maribel, has a second cousin who works at the American Embassy in the Dominican Republic, and the cousin's husband works for the Dutch Embassy. But a charter flight wouldn't have allowed the group to bring all the gasoline, propane, food and crates of medical supplies.

"The orphanage has food for maybe 10 more days," Crespo said. "They have rice, but not much else. Without this food, they're not going to make it."


Earlier in the day, the load on top of the SUV came loose, spilling medical supplies packed by former Bronx paramedic and church volunteer Frank Andino onto the side of the road. The driver screeched to a halt and the load was retied more securely.

Now, passing a Burger King on the highway out of the city, the roads were smooth and the view serene: beautiful mountain peaks reaching into the clouds.

“Right now, this is all the easy part," Landis said. "Once we get near that city. … I hope we get there. If we can't reach our destination, it's not like there's a Motel Cinco.”

© 2010 msnbc.com

[doug]

updated 3:49 p.m. ET Jan. 15, 2010
Painful limbo for parents adopting Haitian kids
For hundreds in U.S., fears about food, water — and even more red tape

Janelle and Bryan Benedict have been in the process of adopting a little Haitian girl named Lovely for a year and a half. Pictured with the family in this July photo is Ashton, 9, the Benedicts' oldest biological child.
By By Laura T. Coffey
TODAYshow.com contributor
Parents who make the foray into international adoptions often endure a peculiar form of purgatory that involves waiting, and waiting, and waiting some more. Janelle Benedict thought she’d have escaped her purgatory by Tuesday, the day of her soon-to-be-adopted daughter’s second birthday. Instead, she sat in her California home eating birthday cake alone.

Then news of the earthquake in Haiti hit. Benedict’s 2-year-old little girl lives in Haiti, and Benedict — already dejected — came unglued.

“I was just shaking,” Benedict recalled. “Just hysterical. Just — I don’t think there’s any way I can describe it.”

As the vicious earthquake roiled the impoverished island nation and communication with Haitian orphanages evaporated, Benedict, her husband and hundreds of other adoptive parents in the United States found themselves adrift in a sea of helplessness.

Unlike adoptions in many other countries, where parents learn the identities of their children rather late in the process, Haitian adoptions typically match parents up with children near the beginning. That gives parents the opportunity to travel to Haiti multiple times during the adoption process to spend time with their children and bond with them.

The waiting game had been hard enough before Tuesday’s earthquake, with parents worrying daily about malnourished sons and daughters they had already come to know quite well. But since the earthquake, many have no way of knowing whether their children are alive or dead.

For parents who have gotten word that their children are still alive, the worries are far from over. They’re terrified that food and water supplies will run out for their already compromised kids, and they’re filled with dread that the lengthy and cumbersome adoption process in Haiti is about to become much longer.

“Unfortunately a lot of adoption paperwork has been lost,” said Heather Breems, who coordinates adoptions from Haiti for the Illinois-based agency Adoption-Link. “If we can’t find another way around this process, my guess is [adoptions] will be on hold until all the agencies get back up and running. That could be a very, very long time.”

Cutting through the red tape?

The U.S. State Department told msnbc.com that it is working with the Department of Homeland Security to determine how to handle the cases of the 254 Haitian children who are in the process of being adopted into U.S. homes. (Adopting parents are encouraged to send pertinent information to AskCI@state.gov; see box for additional details.)

Members of the House and Senate are taking up the causes of constituents who have been waiting to bring their legally adopted children home; some have been arguing for emergency visas and passports for adopted kids affected by the earthquake.

Benedict, the mother of the little Haitian girl who turned 2 on the day of the quake, had completed the entire adoption process, but had been waiting for the Haitian government to issue a passport for her daughter, whose name is Lovely. Once she had a passport, the U.S. government could grant a visa that would allow Lovely to relocate to the States.

“Of course, it’s impossible to obtain a passport for her from Haiti right now with the infrastructure there,” Benedict explained, spotlighting one of her deepest fears.

But on Thursday, Benedict received word from the State Department that the possibility of issuing humanitarian visas to children in her daughter’s situation is being explored.

“It’s really hopeful, hopeful news,” she said, bursting into tears of relief and exhaustion. She had learned only two hours earlier that her daughter and other children at her daughter’s orphanage were still alive.

Lovely is a cutie who has absolutely smitten her parents. She is the first child that Benedict, 33, and her husband Bryan Benedict, 39, have tried to adopt. The Torrance, Calif., couple have four biological children; they began the adoption process about a year and a half ago.

“I’ve gone and spent a week with her three times,” Benedict said. “She is just the sweetest little thing. She’s beautiful. She cuddles. And when you play music she likes to dance, which is so cute.”

But Lovely is lagging behind developmentally because of malnutrition and parasites.

“She’s 2, but she’s just recently started crawling and barely started standing and taking a few steps,” Benedict said. “She’s very tiny ... She only weighs 15 pounds because of malnutrition. But I think she will grow quickly once she gets home and gets proper food and medical attention.”

Waiting for word

Other parents caught in adoption limbo have no idea whether their Haitian children are still living. For days, Jan Schumacher, 52, a registered nurse at a wound clinic in Wilmington, Ohio, was desperate to receive information about her 11-year-old son Charly in Port-au-Prince. She’s been so frantic that she’s been struggling to travel to Haiti as a nurse with a relief organization.

“I don’t even know how he is now,” Schumacher said Thursday night. “I don’t know if he’s alive. ... I haven’t been able to find out if anyone’s hurt at his orphanage.”

It wasn’t until Friday that she finally got word from the orphanage that Charly and the other children there are alive. The people who work at the orphanage have been overwhelmed trying to find food, fuel and water at a very high cost as they deal with a crush of people coming to them for help.

Schumacher and her husband Paul, 55, have two biological daughters as well as one adopted child from Haiti, a 10-year-old boy named Ely.

“We take in kids healing from surgeries and give them a place to stay while they recover,” she explained.

Ely’s adoption went relatively smoothly; Charly’s did not. Charly, who was burned in a kerosene-lamp fire as a young boy, came to the States at age 5 for treatment at the Shriners Hospital in Cincinnati. He lived with the Schumachers for a year, then returned to Haiti when his medical visa expired.

“That was a nightmare, sending him back,” Schumacher recalled. “He was screaming and clinging and didn’t want to leave with the Haitian stewardess.”

The Schumachers have been trying to finalize Charly’s adoption since 2005, when he was 6. Their efforts have been blocked by one paperwork glitch after another, one technicality after another. Schumacher last saw Charly in March 2009, in Port-au-Prince.

“He can’t speak English anymore,” she said. “He spoke English when he lived with us ... We talk on a cell phone every now and then, and he just says, ‘I love you, Mama,’ and he cries.

“They’re just a tough people. They’re used to disappointment day after day after day. But this?”

‘We’ve been very emotional tonight’

Haiti was estimated to have 380,000 orphans in 2007, and that number is expected to skyrocket in the wake of the earthquake. Such tragic statistics can make the 254 adoptions in the pipeline for U.S. families sound minuscule. But one family in Kansas has a different perspective.

Tim and Alecia O’Byrne have been trying for years to adopt four children — two sets of siblings — from Haiti. Initially they set out to adopt only one child, but once they heard the siblings’ stories, they decided to try to take them all home.

Tim O’Byrne, 55, pastor of the First Baptist Church in Holton, Kan., said the children were 1, 3, 10 and 11 when the adoption process began.

“In our minds we were thinking [of the 11-year-old] that we’ll have this young man when he’s about 12 or maybe 13. But now he’s 16,” O’Byrne said. “Same thing with our little girl — she was 1 when this began and now she’s 5.

“Since November 2008, all four of them have had our last name and have officially been our children. It’s just been one holdup after another.”

But late Thursday night, the O’Byrnes were stunned to get this news: The U.S. Embassy in Haiti has approved allowing all four children to be flown to the States, possibly as soon as this weekend.

“We’ve been crying,” O’Byrne said. “We’ve been very emotional tonight ... We’re excited, ecstatic.

“All these children have all got their passports and they have all been to the embassies but had not had their visas approved yet, and then the earthquake hit. Everything had been pretty much done but the visas ... I never would have thought that an earthquake would be what it would take to push this through.”

TODAYshow.com producer Sarika Dani contributed to this report.

© 2010 MSNBC Interactive\

[doug]

updated 2:13 p.m. ET Jan. 15, 2010
Earthquake disrupts key payments lifeline
Cash is king in Haiti and system to distribute remittances is 'in shambles'

The earthquake that struck Haiti Tuesday destroyed much of its telecommunications infrastructure. A few Western Union locations in Haiti had sporadic service by Friday, but the vast majority of them were inoperable.
By Allison Linn
Senior writer
The earthquake in Haiti has disrupted a key economic lifeline for many in this impoverished nation: Money sent from family members working elsewhere in the world back to their native country.

Such remittances, as they are called, totaled around $1.2 billion in 2009, according to estimates from the World Bank, and have equaled about 20 percent of the country’s GDP in recent years.

“In a sense it helps people keep their heads above the water,” said Robert Maguire, a Haiti specialist at Trinity Washington University in Washington, D.C.

Maguire estimates that about one-third of Haitian households receive remittances, which are used for everything from paying school fees to providing families with food and medicine.

The earthquake that struck Haiti Tuesday destroyed much of its telecommunications infrastructure, bringing down the systems many financial services companies use to transfer remittances. It’s not clear when such service will be restored.

“The current payment infrastructure is basically in shambles,” said Manuel Orozco, an expert on remittances with Inter-American Dialogue, a Washington, D.C. policy group.

Remittances can be especially important in a time of crisis, Orozco said, because cash can be used to buy commodities ranging from water to rice. Prices for such basic necessities will tend to naturally rise in a disaster, he noted, making extra money even more important.

The money could also be used for families who are seeking to flee hard-hit Port–au-Prince, Maguire said.

“Even people who are trying to leave the city, they don’t have money to get out of the city,” Maguire said.

Jean-Marc Piquion, vice president of sales and marketing for the money transfer service Unitransfer USA, said Friday that the company was working diligently to restore service in Haiti.

The company may even be able to resume operations as early as Saturday, he said, although it was too early to make any promises.

“We know that money transfers are an integral part of the community,” Piquion said. “It’s pretty much the lifeblood for most (families).”

A spokesman for Western Union, Daniel Diaz, said Thursday that a few of its locations in Haiti had sporadic service but the vast majority was inoperable.

The problems extended beyond just telecommunication infrastructure.

Katleen Felix, a project director with the U.S. operations of Fonkoze, which provides money transfers and microfinance services in Haiti, said the institution has generators and satellite technology at some of its offices. That means transfers could potentially go through to rural areas, though perhaps with some delay.


But the company’s headquarters in Port-au-Prince were badly damaged and some staff was injured, making it difficult to facilitate daily business.

In addition, Felix said Fonkoze was concerned about the safety of employees distributing cash amid the devastation and potential lawlessness, especially in Port-au-Prince.

“The problem is more insecurity, I would say,” she said.

Fonkoze’s 800 local employees also are dealing with tragedies of their own, including losing loved ones and homes to the earthquake, and Felix said it wasn’t clear how many would even be able to get to the company’s offices.

“Our staff is incurring major distress,” Felix said. “How can they go to work and do their work?”

Nevertheless, Felix said the hope was to get operations running normally by next week.

“It’s just a matter of getting out of this crisis,” she said. “There’s so much out of our hands … but we really want to serve the population.”


Orozco, the remittance expert, said the devastation also was likely making it more difficult — and more dangerous — for people to get remittances in through more informal arrangements, such as the border crossing with the Dominican Republic.

And even once the technology is operational again, Orozco said there was good reason for people to be concerned about their safety if they go to a money transfer operation to pick up cash.

“The crisis has exacerbated, like in many other places, the problem of insecurity,” he said.

© 2010 msnbc.com\

[doug]

updated 7:53 p.m. ET Jan. 15, 2010
Next wave of misery? Infection, illness loom
Quake victims who survived face daunting health problems in coming days

An injured girl waits for medical attention in front of a damaged hospital in Carrefour, in the outskirts of Port-au-Prince. Children are especially vulnerable to secondary health problems including dehydration and infection in the aftermath of the devastating earthquake.
By JoNel Aleccia
Health writer
As soon as the shaking stopped, the first wave of misery began.

For badly injured victims of Haiti’s massive earthquake and the crews who rescued and treated them, the early days have been all about survival.

“From a patient’s point of view, you’ve got about 48 hours,” said Dr. Jerry L. Mothershead, a Norfolk, Va., emergency room physician and a disaster response consultant. “A few might make it longer.”

But in the days and weeks ahead, public health experts say Haiti can expect new rounds of health problems to emerge and worsen, challenging even the best efforts of a global humanitarian response.

Thousands of deaths likely will be added to the estimated toll of 50,000 as infections from untreated or poorly treated injuries set in, said Dr. Thomas Kirsch, co-director of the Johns Hopkins Center for Refugee and Disaster Response. Victims crushed beneath falling buildings and other debris would have required the skills of entire trauma teams in a developed nation. In Port-au-Prince, medical crews are running short on staff, pain medication and bandages.

“Haiti has no surge capacity at all,” said Kirsch, who is also the national physician adviser for the American Red Cross and a veteran of hurricanes and the Sept. 11 terror attacks. “The issue now is the lack of resources.”

Even as foreign medical crews begin to make their way into the capital city hit hardest by the magnitude-7 quake, more basic problems loom in a nation that has long struggled with poverty and hunger, said Dr. Curtis E. Cummings, an associate professor in Drexel University’s School of Public Health and an expert in public health readiness.

“A destroyed infrastructure means no clean water or food,” he said. “There are already high levels of diarrheal disease, respiratory disease and malnutrition. Bad will go to very much worse.”

Mild illnesses pose deadly threat

Outbreaks of cholera, dysentery and other illnesses are expected to skyrocket. With people congregating in refugee-like conditions, mingling at aid sites, contagious diseases will spread rapidly. Even simple illnesses like colds and flu — including the H1N1 swine flu, now the dominant strain — could threaten immune-compromised people.

“Those are the things in refugee camps that nail people,” Mothershead said. “What they need is water, plastic sheeting and moving the porta-potties away from where the people are.”

After the 2004 tsunami in Indonesia, acute cases of diarrheal illness in Thailand nearly doubled from the previous year, according to a report in the Journal of the American Medical Association. Wound infections jumped, including a scourge of hard-to-treat drug-resistant infections. And some people developed a disabling or deadly type of pneumonia called "tsunami lung," caused by swallowing saltwater.

Earthquakes pose different dangers. Tens of thousands of victims in Haiti have suffered crush injuries, which harm victims not only through the initial trauma, but also later, when damaged muscles pour toxins into the bloodstream, often leading to kidney damage.

The situation is especially dire for children, who make up an estimated 40 percent to 50 percent of the Port-au-Prince population. They're smaller and more vulnerable to injury than adults, but they also suffer faster from dehydration, blood loss and shock. Their immature immune systems also make it harder to fight back against illness and infection than adults, health experts said.

In the meantime, medical teams on the ground will continue to grapple with the aftermath of early triage, which postponed treatment for those whose injuries may have been serious, but not life-threatening.

Victims with arm or leg fractures, for instance, wouldn't have been a top priority, Cummings said. But the untended wounded remain ripe for infections and shock and they're more vulnerable to other illness.

It’s a no-win choice for health workers who have to make hard decisions about who gets care — and who doesn’t.

In a catastrophic situation, doctors will exclude “expectant” patients — people they know are going to die — and they’ll defer care for survivable injuries. That reserves life-saving effort for the worst injured with the best chance of surviving.

“We have only so many resources. We have to look at who we can save here,” said Cummings.

Rescuers and public health officials shouldn't spend much time worrying about the health risk of the corpses piling up on the city's streets, Cummings added. Contrary to common belief, dead bodies don't spread disease, especially when they've likely died of trauma and not infection.

"They're just not the problem people think," he said.

Intervening in a disaster of such magnitude — whether it’s a massive earthquake in a country of nearly 9 million, the series of hurricanes that slammed Haiti last year, or the tsunami in Indonesia — is not for the inexperienced, Kirsch and Mothershead emphasize.

Help is needed, but it must be the right kind

Volunteer crews of doctors, nurses and other health workers are clamoring to fly to Haiti, motivated by compassion, adrenaline or even a sense of adventure, said Kirsch.

“You take all these rich Westerners who want to fly down there and help,” Kirsch said. “They become more a burden than they are help.”

Organizers on the ground in Haiti are calling for trained surgeons with experience in battlefield or disaster conditions. Medical crews with little training in working in developing nations would do better to send money — and stay home, Kirsch said.

In past catastrophes, Kirsch saw well-meaning volunteer medical crews show up, only to become overwhelmed by rugged demands of the job and the lack of resources for their own comfort.

“The best way to help is to give money to the experts who know what the needs are," he said. "That’s the way you help the world.”

© 2010 msnbc.com

[doug]

updated 9:04 p.m. ET Jan. 15, 2010
Groups raise doubts about Jean’s charity group
Tax returns, audits show Yele Haiti intertwined with musician’s businesses

Haitian-born musician Wyclef Jean backs the Yele Haiti Foundation, which groups are now raising doubts about.
The Associated Press
LOS ANGELES - Groups that vet charities are raising doubts about the organization backed by Haitian-born rapper Wyclef Jean, questioning its accounting practices and ability to function in earthquake-hit Haiti.

Even as more than $2 million poured into The Wyclef Jean Foundation Inc. via text message after just two days, experts questioned how much of the money would help those in need.

“It’s questionable. There’s no way to get around that,” said Art Taylor, president and chief executive of the Better Business Bureau’s Wise Giving Alliance, based in Arlington, Va.

Taylor reviewed Internal Revenue Service tax returns for the organization also known as Yele Haiti Foundation from 2005 through 2007. He said the first red flag of poor accounting practices was that three years of returns were filed on the same day — Aug. 10 of last year.

In 2007, the foundation’s spending exceeded its revenues by $411,000. It brought in just $79,000 that year.

“Here’s the bottom line: for an earthquake of catastrophic proportions, do people really believe that this organization is in a position to do anything right now?” he said.

Jean, a 37-year-old Grammy-winning artist, has been imploring followers to text “Yele” to 501501 to donate $5 to his foundation in support of Haitian earthquake victims.

The foundation, founded in January 2005, intends to airlift supplies using a FedEx plane into Haiti early next week carrying medical supplies, water and Clif Bars, according to foundation president Hugh Locke.

Intertwined with businesses

An Associated Press review of tax returns and independent audits provided by Jean’s foundation showed that it was closely intertwined with Jean’s businesses.

Three of the five foundation board members — Jean, Jerry Duplessis and Seth Kanegis — are involved in his personal music and business endeavors.

According to an IRS tax return from 2006 reviewed earlier by the Web site The Smoking Gun, the foundation paid $250,000 to buy airtime from Telemax S.A., a for-profit TV station in Haiti that is majority owned by Jean and Duplessis.

Part of that money went to pay for a concert in Haiti put on by Jean himself, Locke said.

Another $160,000 that year was spent on a concert in Monte Carlo that Jean participated in, of which $75,000 paid for backup singers and $25,000 went to Jean through a company he owns with Duplessis, Platinum Sound Recording Studios Inc., Locke said.

“I’m not saying he didn’t benefit from it,” said Locke, who says his own salary is $8,100 a month after taxes. “We were paying that to Platinum Sound because that covered the cost of him participating in the event.”

Locke argued that the foundation took in “several hundred thousand” dollars in exchange for Jean’s work through the proceeds of an auction.

The foundation also rents office space from Platinum Sound, paying about $2,600 a month in New York. Locke said the foundation also plans to partner with Jean’s Sak Pase Records to build a music studio to provide vocational training to Haitian children.

‘We have a niche’

Sandra Miniutti, vice president of marketing for Charity Navigator, an organization that evaluates charities, said the foundation was too small to have been examined recently, although the current flood of goodwill may change that. Its revenue in 2008 was $1.9 million.

“My concern is it goes against our first tip, and that is to give only to groups with experience with disaster relief,” Miniutti said. “I think it’s very hard for a new organization even with the best intentions to handle something on this magnitude.”

Locke said the foundation has been directly involved in delivering food and providing clean-up services in many disasters, including the hurricanes that devastated Haiti in late 2008. Jean’s standing among Haitians can help the foundation gain access to gang-controlled or other troubled regions, he said.

“We have a niche which no one else occupies,” Locke said.


He said the foundation is now seeking bridge financing to allow it to use money that has been pledged in unprecedented volumes by text message.

It could take at least a month for donors’ money to flow in because it is not released until they pay their phone bills.

That delay presents a challenge and an opportunity, the Better Business Bureau’s Taylor said.

“The challenge is they can’t do anything until they get the money,” Taylor said. “The opportunity is that some people may change their minds and decide that $10 or whatever they text to him might be better used somewhere else.”

© 2010 The Associated Press. All rights reserved.

[doug]

updated 3:53 a.m. ET Jan. 16, 2010
Dead U.N. workers were ‘very happy’ in Haiti
Stories of those who lost their lives in a troubled nation they served, loved

The heavily damaged U.N. headquarters in Port-au-Prince is seen from the air on Thursday, two days after Haiti's devastating earthquake.
By Amy Goldstein and Colum Lynch
The Washington Post
She had fallen in love with Haiti during the heady days when she was fresh out of Smith College and Jean-Bertrand Aristide was the fledgling president of a poor country seemingly filled with promise. By Tuesday afternoon, as she sat in a meeting in a basement room of the U.N. headquarters there, Lisa Mbele-Mbong had worked in Port-au-Prince as a human rights specialist for 3 1/2 years. When the trembling began, she was the first out of the meeting to find out why.

She walked onto a veranda. A large slab of concrete struck her head, killing her instantly, according to her supervisor, who was nearby. As he did every day after school, her 10-year-old son, Nady, was outside the complex with their driver, waiting for his mother to leave work.

Mbele-Mbong's death in the earthquake -- even as her colleagues in the basement of the U.N. complex's human rights section survived, her family has been told -- has not been officially announced. At 38, she was a woman of penetrating intellect and many cultures, as comfortable grilling gang members about genocide in Congo as nurturing her son's passion for soccer. She is one of nearly 400 U.N. workers listed as missing or killed, a toll certain to eclipse by far the organization's previous worst losses.

This week's casualties come to a U.N. mission that has endured more than its share of trauma since U.N. peacekeepers arrived in force in 2004, the main security presence in Haiti amid the chaos that followed a coup against Aristide. In 2006, the peacekeeping force's commander, a Brazilian general, was found dead with a self-inflicted gunshot wound to the head. Two years after that, the U.N. mission was overwhelmed when the Caribbean island country was struck, in rapid succession, by two hurricanes and two tropical storms.

"This is a humanitarian catastrophe of a scale that is beyond the capacity of the government, [or] of the U.N. stabilization mission here," the mission's special representative, Hédi Annabi, a Tunisian bureaucrat who mentored a generation of U.N. peacekeepers, said after the 2008 storms. Now, Annabi is missing. Haiti's president said he died. U.N. officials have not confirmed his death, but say they do not expect him to survive.

'A tough decade'

The events in Port-au-Prince are a microcosm of the spasms of tragedy that have struck the United Nations in the past decade -- including deadly attacks in Baghdad, Algiers and Kabul.

"It's been a tough decade for U.N. staff everywhere: We've faced trauma after trauma after trauma," said Ahmad Fawzi, who was the U.N. spokesman in Baghdad when the U.N. headquarters there was bombed in 2003.

In Haiti, the United Nations had set up its headquarters in the converted Christopher Hotel and surrounding buildings in the hills near Pétionville, a Port-au-Prince suburb of interspersed mansions and slums that was favored by diplomats and other expatriates. The earthquake collapsed the hotel.

Annabi had an office on the top floor. A consummate U.N. insider, he had spent a decade running the largest foreign expeditionary force outside the United States -- nearly 20 U.N. peacekeeping missions -- from a corner office in the organization's glass and marble headquarters in New York. Aides recalled him as the "schoolmaster" who marked up poorly edited reports with a bright blue pen. He started his U.N. career as the desk officer during the Rwandan genocide. It was, colleagues say, a defining moment for him. "He was a man who had seen a lot of cynicism but who did not become a cynic, but became a realist," said Jean-Marie Guéhenno, the U.N. undersecretary general for peacekeeping from 2000 to 2008.

Annabi had "blossomed" in Haiti, Guéhenno said, with his first chance to lead a field mission. In a New Year's e-mail, Annabi told his former colleague that he was preparing for challenging elections. "I must tell you I'm very happy to be here," he wrote in French. "This is a very difficult task, but it's very fulfilling."

The mission's second-in-command is missing, too. A Brazilian national, Luiz Carlos da Costa, has been a larger-than-life figure in the U.N. peacekeeping department, where he was responsible for hiring most of the civilian peacekeeping officials. Da Costa was sent to Kosovo in 2000 to help restore order to the U.N. operation there and later to Liberia.

Most of the United Nations' confirmed dead -- 37 as of Friday -- were less well-known. The body of a peacekeeper, a member of the Royal Canadian Mounted Police, was found under his house. Other peacekeepers who were killed came from Brazil and Argentina, China and Jordan.

'She fought to go back'

Mbele-Mbong was the daughter of a mother from Minneapolis and a father from Cameroon who grew up on three continents. After graduating from Smith, she moved to Washington, but gravitated to Haiti again and again. She volunteered twice as an election monitor and later worked there as a consultant for the National Democratic Institute, trying to foster civic education. She had a romance with a Haitian economist, her parents said, and gave birth in 1999. She moved to a U.N. job in Geneva to be closer to her parents in France and eventually left her son, Nady, with them to go to Congo as a humans rights officer.

"She fought to go back to Haiti," said her younger sister, Leontyne Mbele-Mbong, because "she had this built-in warm community" there, that would enable her to bring her son.

She had returned to Port-au-Prince on Jan. 6, after a three-week Christmas visit with her family in France. "Her last days, she was . . . very discouraged" about Haiti, her father, Samuel Mbele-Mbong, said. "She could see where the country was going, contrary to the hopes she had."


After she was killed Tuesday, a peacekeeper from Cameroon, a friend to whom she rented a room, raced to the U.N. complex and found Nady outside. His father, the economist, gave permission for him to leave the country, as soon as an embassy can transport him to his grandparents.

And in the middle of the tragedy, a small but crucial fragment of good news materialized. Nady can leave Haiti because he knew that his mother usually carried his passport in her pocketbook. A U.N. worker picked through the rubble and found the pocketbook. Nady's passport was inside.

Lynch reported from the United Nations. Research director Lucy Shackelford contributed to this report.

© 2010 The Washington Post Company

[doug]

updated 5:46 a.m. ET Jan. 16, 2010
A world away, foster parents hold out hope
Fates unknown for medically fragile kids restored in U.S., returned to Haiti

Angeline Gammons-Reese, 3, left, talks with her adoptive mother, Sarah Gammons-Reese, as her mom holds Berlange, 1, at the Gammons-Reese family home in Ferndale, Wash. Sarah Gammons-Reese is the co-director of the Medical Advocacy Team, an organization that connects Haitian children with U.S. medical care and foster families. She is hosting Berlange as he receives medical treatment for spina bifada and club feet in Seattle. Sarah has not heard from Berlange's family since the recent earthquake.
By Linda Dahlstrom
MSNBC.com Health editor
FERNDALE, Wash. - Little Berlange doesn’t know that his country has crumbled into dust and despair.

Snug in his high chair Friday morning having a breakfast of peanut butter on toast, he has no idea that the fate of his parents and younger brother, who live in the hills outside of Port-au-Prince, is in question.

He has no comprehension that the land he left a year ago when he came to the United States on a medical visa is no more.

The 14-month-old, who is being treated in Seattle for spina bifida and club feet, has been living for the past year with Sarah and Robert Gammons-Reese in the northern corner of Washington state — a world away from his home in Haiti, and the thousands of abandoned bodies and a million homeless.

Sarah Gammons-Reece is the co-director of The Medical Advocacy Team, a non-profit organization that help arrange care for medically fragile children from Haiti. The group that she formed in 2007 with Salem Richards of Athens, Ohio, has so far brought to the U.S. about 20 sick children who otherwise would likely have little chance of surviving in that poorest of poor countries.

While in the U.S., the children stay with foster families while they undergo surgery and receive medical care donated by doctors and hospitals. The Gammons-Reeces have fostered four children from Haiti so far, including the now chubby baby with enormous brown eyes they call “Baby Bear.”

Loving — and letting go

Sarah Gammons-Reece, 36, knows the kids who come are only hers for a little while — children on loan. Loving and letting go, even if it breaks your heart, comes with the mission of The Medical Advocacy Team. She understands that for these kids, recovery means they’ll be leaving her and returning to their families, healthy at last — some for the first time — to go on to what she always dreamed would be long, full lives.

Until Tuesday, when the magnitude-7 earthquake decimated Haiti, it never occurred to her that now she’d be wondering if those children she loved and mothered still walked the face of the earth.

She’s especially desperate for one particular child, 4-year-old Isaac who the couple has adopted from a Haitian orphanage but hasn’t been able to bring home yet due to paperwork delays in getting the visa and passport. She has learned he survived the quake without injury but worries if he’ll have enough food and water in the coming days.

As for the three children she's helped to mend and send back home, she’s only heard so far that one is safe.

“It all feels so in vain,” she said, standing in her kitchen while readying her children for school Friday morning. “You take a child away from their mom for a year and send them back — and then they’re in an earthquake. It’s like ‘Why?’”


Immediately after the earthquake, she spent her days scrutinizing the pictures she saw on TV and online, yearning to see the little faces she once washed and kissed. Now she tries to keep the TV off, in part to spare her children from seeing the stacks of bodies.

“Somehow whatever channel it’s on, it always ends up back on a news station,” she says.

The Gammons-Reeces have a blended family that includes five biological children and nine adopted, including Isaac — ranging in age from 3 to 24.



Three years ago, they adopted Angeline, who will turn 4 on Feb. 1, from Haiti. Like Baby Bear, Angeline has spina bifida, and when she first arrived in the U.S., she was also gravely ill with bacterial meningitis and given a less than 5 percent chance to live.

Today, she’s a vibrant little girl who loves the color pink and Goldfish crackers, just learned in preschool that her name starts with the letter “A,” and, with the aid of her walker, recently went ice skating for the first time and loved it.

“I didn’t want to leave,” she says. “I cried.”

Robert Gammons-Reece, 47, who supports the family by working in construction, says Angeline inspired the family to found The Medical Advocacy Team.

“If you take this little girl, who had virtually no chance of survival and look at her now and she’s OK, that makes you think about the other kids and maybe they have hope too,” he says.

Health care ‘desperate’ even before quake hit

In the best of times, medical care in Haiti is almost non-existent, says Dr. John Lawrence, a pediatric surgeon at Swedish Medical Center in Seattle. Lawrence has traveled to Haiti several times to volunteer at clinics there and donated his time last year perform surgery on a little girl named Saintana who the Medical Advocacy Team brought to Seattle for surgery.

Lawrence says he doesn’t know Saintana’s fate since the quake.

“It was terribly desperate [in Haiti] before the earthquake,” he said. “You can hardly imagine how resource-poor it was.”

Kimberly Smith, a 33-year-old mom in nearby Bellingham, Wash., helps coordinate foster care for the Medical Advocacy Team, and stayed in the hospital to care for a little girl named Christella who came to the U.S. to be treated for spina bifida when she was less than a year old.

But after Christella recovered and was reunited with her family in Haiti, she died 56 days later of a bowel obstruction.


She became ill on a weekend, Smith says, and her parents desperately tried to find an open clinic to care for her. When they finally did, they had to leave her to go buy blood for a transplant. “They came back and she had passed,” Smith says.

Smith, who is in touch with aid workers in Haiti, says one scene she heard about keeps replaying in her head: Workers were trying to help a man, totally buried in the rubble, alive, but unreachable and trapped next to the bodies of his family. “They asked him what he needed,” she said. “He told them ‘A gun.’”

Across the country, Tanya Borlase of Mooresville, N.C., fears for the two little girls she cared for in 2008 when they came to the United States for urinary surgeries. “They were such brave little girls,” she remembers. She has not heard if they survived the earthquake.

Borlase, who is so worried that an entire day sometimes goes by before she remembers to eat, says she remembers vividly the day the girls, then 3 and 4, left to return home.

“It was heartbreaking,” she says. “They called me Momma Tonya.”


But she knew that was part of the deal. Her yearning heart meant two other mothers were about to get their daughters back.

For now, Sarah Gammons-Reece desperately hopes that a half a world away her son and the many other children she has loved and cared for are safe, with someone to watch over them and a place to rest at night. At the same time, she cares for the child of another woman who may or may not be alive.

© 2010 msnbc.com

[doug]

updated 12:22 p.m. ET Jan. 16, 2010
Former presidents to lead a relief fund to help earthquake-ravaged country
msnbc.com staff and news service reports
WASHINGTON - President Barack Obama on Saturday enlisted the help of his two predecessors, George W. Bush and Bill Clinton, to lead a national drive to raise money for earthquake-ravaged Haiti.

"By coming together in this way, these two leaders send an unmistakable message to the people of Haiti and to the people of the world," Obama said in the Rose Garden, standing between Bush and Clinton. "In these difficult hours, America stands united. We stand united with the people of Haiti, who have shown such incredible resilience, and we will help them to recover and to rebuild."

Bush and Clinton have created a Web site, http://www.clintonbushhaitifund.org, to begin collecting donations. They said potential donors should know that their money will be spent wisely.

Bush said the best way for people to help in Haiti is by sending money.

"I know a lot of people want to send blankets or water. Just send your cash," said Bush, who made his first visit to the Oval Office since leaving the White House in January 2009.

Dined with victims

Clinton, who also is the special U.N. envoy to Haiti, said he had stayed in Haitian hotels that collapsed during Tuesday's earthquake and dined with people who were killed in the disaster.

"It is still one of the most remarkable, unique places I have ever been," he said.

"Right now, all we need to do is get food and medicine and water and a secure place for them to be. But when we start the rebuilding effort ... we want to be a place where people can know their money will be well spent," Clinton said.

Haitian authorities believe tens of thousands of people — and perhaps as many as 200,000 — died in Tuesday's earthquake that devastated the Caribbean nation.

Copyright 2009 The Associated Press. All rights reserved.

[doug]

updated 7:22 p.m. ET Jan. 19, 2010
A week after Haiti quake, aid for all is elusive
Amid estimated 200,000 dead, several thousand Americans missing

Soldiers from the 82nd Airborne land at the garden of the damaged presidential palace in Port-au-Prince on Tuesday.
The Associated Press
PORT-AU-PRINCE, Haiti - The world still can't get enough food and water to the hungry and thirsty one week after an earthquake shattered Haiti's capital. The airport remains a bottleneck, the port is a shambles. The Haitian government is invisible, nobody has taken firm charge, and the police have largely given up.

Even as U.S. troops landed in Seahawk helicopters Tuesday on the manicured lawn of the National Palace, the colossal efforts to help Haiti are proving inadequate because of the scale of the disaster and the limitations of the world's governments. Expectations exceeded what money, will and military might have been able to achieve so far in the face of unimaginable calamity.

"God has abandoned us! The foreigners have abandoned us!" yelled Micheline Ursulin, tearing at her hair as she rushed past a large pile of decaying bodies.

Three of her children died in the quake and her surviving daughter is in the hospital with broken limbs and a serious infection.

Time is running out

Rescue groups continue to work, even though time is running out for those buried by the quake. A Mexican team created after that nation's 1985 earthquake rescued Ena Zizi, 69. She had survived a week buried in the ruins of the residence of Haiti's Roman Catholic archbishop, who died. Other teams pulled two women from a collapsed university building.

But most efforts are focused on getting aid to survivors.

"We need so much. Food, clothes, we need everything. I don't know whose responsibility it is, but they need to give us something soon," said Sophia Eltime, a 29-year-old mother of two who has been living under a bedsheet with seven members of her extended family. She said she had not eaten since Jan. 12.

It is not just Haitians questioning why aid has been so slow for victims of one of the worst earthquakes in history — an estimated 200,000 dead, 250,000 injured and 1.5 million homeless. Officials in France and Brazil and aid groups such as Doctors Without Borders have complained of bottlenecks, skewed priorities and a crippling lack of leadership and coordination.

"TENS OF THOUSANDS OF EARTHQUAKE VICTIMS NEED EMERGENCY SURGICAL CARE NOW!!!!!" said press a release from Partners in Health, co-founded by Dr. Paul Farmer, the deputy U.N. envoy to Haiti. "Our medical director has estimated that 20,000 people are dying each day who could be saved by surgery." No details were provided on how the figure was determined.

The reasons are varied:

Both national and international authorities suffered great losses in the quake, taking out many of the leaders best suited to organize a response;
Woefully inadequate infrastructure and a near-complete failure in telephone and Internet communications complicate efforts to reach millions of people forced from homes turned into piles of rubble;
Fears of looting and violence keep aid groups and governments from moving as quickly as they'd like;
Pre-existing poverty and malnutrition put some at risk even before the quake hit.
Tons of aid shipped

Governments have pledged nearly $1 billion in aid, and thousands of tons of food and medical supplies have been shipped. But much remains trapped in warehouses, diverted to the neighboring Dominican Republic, or left hovering in the air. The nonfunctioning seaport and impassable roads complicate efforts to get aid to the people.

Aid is being turned back from the single-runway airport, where the U.S. military has come under criticism for poorly prioritizing flights, although the U.S. Air Force said Tuesday it had raised the facility's daily capacity from 30 flights before the quake to 180 on Tuesday.


"We're doing everything in our power to speed aid to Haiti as fast as humanly possible," said Gen. Douglas Fraser, head of U.S. Southern Command.

The World Food Program said more than 250,000 ready-to-eat food rations had been distributed in Haiti by Tuesday, only a fraction of the 3 million people thought to be in desperate need. There have been anecdotal stories of starvation among the old and infirm, but apparently no widespread starvation — yet.

The WFP said it needs to deliver 100 million ready-to-eat rations in the next 30 days. Based on pledges from the United States, Italy and Denmark, it has 16 million in the pipeline.


So far, international relief efforts have been unorganized, disjointed and insufficient to help a people in need of such basics as food, water and medical care. Doctors Without Borders says urgently needed surgical equipment and drugs have been turned away five times, even though the agency received advance authorization to land.

"It's frustrating to see planes landing, officials coming in and military planes coming in, carrying military personnel and their supplies," Marie-Noelle Rodrigue, the group's deputy operations manager, said from Paris. "We see there are priorities being given but don't understand on what grounds."


Defending U.S. aid efforts

French Cooperation Minister Alain Joyandet went as far as demanding a U.N. investigation into U.S. aid efforts, although his boss, President Nicolas Sarkozy, defended the U.S. on Tuesday, as did the United Nations. U.N. spokeswoman Elisabeth Byrs credited the U.S. with bringing in great amounts of aid and expertise, and said the airport wouldn't be working without U.S. military help.

U.S. defense officials acknowledged bottlenecks, but said they have been working aggressively to eliminate them. They note that many military flights also carry aid, and White House spokesman Tommy Vietor said that by Monday, fewer than a third of flights into Haiti were U.S. military.

About 2,200 Marines established a beachhead west of Port-au-Prince on Tuesday to help speed aid delivery, in addition to 9,000 already on the ground. Lt. Cmdr. Walter Matthews, a U.S. military spokesman, said helicopters were ferrying aid from the airport into Port-au-Prince and the nearby town of Jacmel as fast as they can.

The U.N. was sending in reinforcements as well: The Security Council voted Tuesday to add 2,000 peacekeepers to the 7,000 already in Haiti, and 1,500 more police to the 2,100-strong international force.

"The floodgates for aid are starting to open," Matthews said at the airport. "In the first few days, you're limited by manpower, but we're starting to bring people in."

The WFP's Alain Jaffre said the U.N. organization was starting to find its stride after distribution problems, and hoped to help 100,000 people by Wednesday.

"The problem is the logistics: getting the food to the people," he said. "We're challenged by trucks, staff, roads and security, in declining order of importance."


A U.S. military official told NBC News that the hospital ship USNS Comfort was due to arrive off the coast of Haiti on Wednesday and will begin flying in to Port-au-Prince to evacuate critically injured people.

The effort was also hampered by a lack of leadership.

Haitian government invisible

With its seat of power destroyed and many officials dead, the Haitian government has largely disappeared. President Rene Preval hasn't addressed the nation, beyond sending one taped message to a radio station. He is only known to have toured briefly one of the thousands of sites where people are dead or dying.

First lady Elisabeth Debrosse acknowledged that Preval "is limited in his capacity to act," but insisted: "The president is in control and is trying to focus on what the priorities are and those priorities are changing every minute."

The U.N., which itself lost its Haiti headquarters, its top two officials and many others inside, has tried to fill the void but has struggled to bring the international relief effort together. The United States has taken charge of pieces of the operation but coordination has been uneven.

"Is the U.N. going to run it or is the military? Somebody needs to take charge here," said Robert Kind of CMC Construction. He was at the airport looking for somebody to get a generator that his company donated to a University of Miami field hospital. It took three days to fly the generator in, he said, and it has sat on the grass since Monday.

Rodrigue, of Doctors Without Borders, said it would have been helpful if immediately after the quake, all the aid donors and governments responding to the crisis had had a discussion "to know who's in charge, what are the procedures, when everyone knew that bringing material into Haiti was going to be an issue."

"We didn't see that," she said.


Security a concern

Hanging over the entire effort was an overwhelming fear among relief officials that Haitians' desperation would spill over into violence.

"We've very concerned about the level of security we need around our people when we're doing distributions," said Graham Tardif, who heads disaster-relief efforts for the charity World Vision. The U.N., the U.S. government and other organizations echoed such fears.

Occasionally, those fears have been borne out. People rampaged through part of downtown Port-au-Prince on Tuesday, just four blocks from where U.S. troops landed at the presidential palace.

Hundreds of people fought over bolts of cloth and other goods with broken bottles and clubs.

"That is how it is. There is nothing we can do," said Haitian police officer Arina Bence, who was trying to keep civilians out of the looting zone for their own safety.

U.S. officials insisted they had no plans to take on a policing role in Haiti, and the arriving Marines are allowed to use force only in self-defense, according to U.S. Maj. Gen. Cornell A. Wilson Jr. But troops of the 82nd Airborne took up positions outside the General Hospital on Tuesday when the crowd grew too large.

Haitian Police Chief Mario Andersol said he can muster only 2,000 of the 4,500 officers in the capital and said even they "are not trained to deal with this kind of situation."

Some police are urging citizens to take the law into their own hands, and neighborhoods are creating their own security forces, forming night brigades and machete-armed mobs to fight bandits. "If you don't kill the criminals, they will all come back," one officer shouted over a loudspeaker in the Cite Soleil slum.

Despite the criticism, some aid officials defended their efforts and said the world is judging them too harshly.


"The aid is never fast enough for the armchair aid workers sipping their lattes," said Steve Matthews, a Haiti-based spokesman for World Vision. "Despite the slowness, aid is flowing. Things are happening. We understand the race against time. Everyone's working 16-hour days.

"Critics want a two-hour movie with a happy ending."

Missing Americans

The U.S. Embassy told NBC News an estimated 45,000 Americans were thought to have been in Haiti before the quake. Many of those people are married to Haitians or involved in aid missions and are not looking to leave.

The State Department said 5,200 Americans had been evacuated and 500 more were cleared to go as of late Tuesday. Twenty-eight Americans were confirmed dead, including one diplomat, Victoria Delong, and 24 others were presumed dead. "Several thousand" Americans were missing or unaccounted for, the State Department said.

NBC News contributed to this report.

© 2010 MSNBC.com

[doug]

updated 3:08 a.m. ET Jan. 20, 2010
NYT: Normally wary Haitians welcome U.S.
‘We can’t do it without them,’ survivors say amid ‘vacuum of government’

Soldiers from the 82nd Airborne land at the garden of the damaged presidential palace in Port-au-Prince on Tuesday.
By Marc Lacey
The New York Times
PORT-AU-PRINCE, Haiti - American military helicopters landed on Tuesday at Haiti’s wrecked National Palace, and troops began rolling through the capital’s battered streets, signs of the growing international relief operation here. But the troops’ presence underscored the rising complaints that the Haitian government had all but disappeared in the week since a huge earthquake struck.

Haiti’s long history of foreign intervention, including an American occupation, normally makes the influx of foreigners a delicate issue.

But with the government of President René Préval largely out of public view and the needs so huge, many Haitians are shunting aside their concerns about sovereignty and welcoming anybody willing to help — in camouflage or not.

“It is not ideal to have a foreign army here, but look at the situation,” said Énide Edoword, 24, a waitress who was standing in a camp of displaced people. “We are living amid filth and hunger and thirst after a catastrophe.”

When Mr. Préval asked religious and business leaders at a meeting on Saturday whether they supported the intervention of the United States Marines, the response came with a caveat.

“They said, ‘Yes — as long as it’s temporary,’ ” said Bishop Jean-Zache Duracin of Haiti’s Episcopal Church, who attended the meeting. “We have no choice because the government has collapsed.”

‘Where is the state?’

At the international airport, where the United States Air Force now controls incoming and departing planes, Haitian officials are on hand and insist that it is still theirs, even if it more resembles a military base.

“We are like a country whose capital has been hit by two atomic bombs,” said Patrick Elie, a presidential adviser and former defense minister.

“We are obviously in a moment of disarray, if not pain, and we have to regroup,” he added. “But let no one point a finger and say, ‘Where is the state?’ People who say that don’t understand the extent of the damage.”

But many were still pointing fingers.

“We have a vacuum of government,” asserted Michèle Pierre-Louis, who had been Mr. Préval’s prime minister until she was ousted a few months ago. “The big question is, Who’s in charge? We don’t feel as though there is someone organizing all this.”

Aloof leader

Mr. Préval, an aloof leader even in the best of times, huddled with advisers on Tuesday at a compact police station that has become the government’s de-facto headquarters. Aides described him as being as traumatized by the recent events as every other Haitian but still fully engaged in the nation’s recovery.

They said he and his ministers were engaged in a furious effort to organize all the outside aid, find refuge for the hundreds of thousands of people living in the streets and bury bodies, thousands and thousands of which have been collected and put in mass graves so far as of Tuesday morning. (There is still no widely accepted death toll.)

They said the president would soon address the nation for the first time since the quake struck on Jan. 12.

But the international effort has far outpaced anything Haiti could manage: supply flights from around the world continued to arrive in numbers, though aid groups complained of being turned away.

In New York, the United Nations secretary general, Ban Ki-moon, said that the United Nations’ food agency had distributed rations for 200,000 people so far, and other officials said the aim was to quickly supply 4.2 million rations of high-nutrition food for children.

Mr. Ban said the agency was aiming to feed one million people by the end of this week and two million by the end of next week — though three million or more people are estimated to need food.


Dying due to lack of care

In Port-au-Prince, the capital, foreign rescue teams scoured buildings for survivors under the rubble. A joint New York City Police-Fire rescue team on Tuesday pulled out two children from the rubble of a collapsed building in the capital, The Associated Press reported. A police spokesman, Paul J. Browne, said that the 8-year-old boy and the 10-year-old girl were taken to an Israeli tent hospital for treatment, The A.P. reported. Foreign doctors provided medical care and carried out scores of life-saving amputations.

But the demand for medical care far outstripped the supply of doctors. Debarati Guha-Sapir, a professor of epidemiology and the director of the Center for Research on the Epidemiology of Disasters at the University of Louvain in Belgium, said that deaths in large earthquakes generally declined after the first day or two.

“Haiti, I think, is going to be a little different,” she said. “They will die simply because there is no care. People will die of wounds. They will die of lack of surgical care. They will die of simple trauma that in almost any other country would not lead to death.”

Elisabeth Delatour Préval, Haiti’s first lady, insisted that the country’s sovereignty remained intact, although she acknowledged that there was widespread concern among the population about whether the government was functioning, especially given the heavy damage sustained by the palace and other highly visible government buildings.

“Visually, people can’t see what they used to recognize as the symbols of the state,” she said in an interview. “That has generated some kind of panic. ‘Are they there or aren’t they there?’ ”


U.S. reassures Haitians of support role

The American military, which began patrolling in Humvees up and down Boulevard Jean-Jacques Dessalines, the capital’s main commercial strip, took pains to reassure Haitians that the United States was in the country in a support role.

Meanwhile, 125 Marines arrived in helicopters in the damaged farming town of Léogâne, south of the capital, delivering cases of water and food.

Col. Gregory Kane of the United States Army told reporters at the Port-au-Prince airport that the Haitian government remained in charge. He said that United States forces were on the ground only to assist with the relief efforts.

“There have been some reports and news stories out there that the U.S. is invading Haiti,” Colonel Kane said. “We’re not invading Haiti. That’s ludicrous. This is humanitarian relief.”

Most Haitians seemed to see it that way, despite deep historic concerns about American troops in particular.

History of intervention

President Woodrow Wilson sent American Marines to Haiti in 1915 to restore public order after six different leaders ruled the country in quick succession, each killed or forced into exile. Opposition was intense, but it would be nearly two decades before the Marines would leave, in 1934.

When President Bill Clinton ordered troops into the country in 1994 to restore Jean-Bertrand Aristide, who was ousted as president by a group of former soldiers, Haitian critics raised that earlier intervention.

A decade later, Mr. Aristide was forced out of office, and he accused the United States of orchestrating his ouster.


Video: Despite dimmed hopes, search for survivors continues

But on Tuesday, as American troops in combat fatigues bounded out of the helicopters and moved across the palace grounds, hundreds of Haitians who had gathered at the white-and-green palace gates erupted in cheers and called out in Creole for food and water.

“We can’t do it without them,” said Ms. Pierre-Louis, the former prime minister. “This country has been mismanaged for the last 50 years, and if we can’t run the country well in normal times how can we do it now?”

Other troops are on the way. The United Nations Security Council on Tuesday unanimously approved sending 3,500 more police officers and peacekeeping troops to Haiti to maintain public order and to guard deliveries as the aid effort gathers steam.

The forces will augment the roughly 9,000 United Nations troops already here.

Fears of violence, signs of hope

So far, violence has been scattered in Port-au-Prince. But senior United Nations officials said it might boil over at any moment as the difficulties of living without water, food and shelter mounted.

Mrs. Préval said that she and the president were about to enter their private residence when the earthquake struck. They stepped back from the home, she said, and it collapsed before them. For hours, rumors circulated around the capital that she had been killed.

She said that Mr. Préval quickly jumped onto the back of a motorcycle taxi to tour hospitals and damaged areas with top aides, and that he had been in nonstop emergency meetings ever since. Government ministers, she added, initially held meetings in the yard of the president’s home.

The streets of Port-au-Prince contained scenes of commerce and activity on Tuesday morning, instead of just devastation and death. Merchants sold fruits and vegetables amid the rubble of destroyed businesses. More cars were winding through the debris-strewn streets.

Ray Rivera and Ginger Thompson contributed reporting from Port-au-Prince, and Neil MacFarquhar from the United Nations.

This story, "U.S. Troops Patrol Haiti, Filling a Void," originally appeared in The New York Times.

Copyright © 2010 The New York Times

[doug]

updated 10:14 a.m. ET Jan. 20, 2010
People flee as strong aftershock hits Haiti
‘I've seen the situation here, and I want to get out,’ survivor says

Residents leave Port-au-Prince by bus after a 6.1 magnitude aftershock on Wednesday.
The Associated Press
Video: 6.1 magnitude aftershock rocks Haiti

PORT-AU-PRINCE, Haiti - The most powerful aftershock yet struck Haiti on Wednesday, shaking more rubble from damaged buildings and sending screaming people running into the streets eight days after the country's capital was devastated by an apocalyptic quake.

The magnitude-6.1 temblor was the largest of more than 40 significant aftershocks that have followed the Jan. 12 quake. The extent of additional damage or injuries was not immediately clear.

Wails of terror rose from frightened survivors as the earth shuddered at 6:03 a.m. U.S. soldiers and tent city refugees alike raced for open ground, and clouds of dust rose in the capital.

The U.S. Geological Survey said Wednesday's quake was centered about 35 miles northwest of Port-au-Prince and 6.2 miles below the surface — a little further from the capital than last week's epicenter was.

"It kind of felt like standing on a board on top of a ball," said U.S. Army Staff Sgt. Steven Payne. The 27-year-old from Jolo, West Virginia was preparing to hand out food to refugees in a tent camp of 25,000 quake victims when the aftershock hit.

Last week's magnitude-7 quake killed an estimated 200,000 people in Haiti, left 250,000 injured and made 1.5 million homeless, according to the European Union Commission.

'I want to get out'

The strong aftershock prompted Anold Fleurigene, 28, to grab his wife and three children and head to the city bus station. His house was destroyed in the first quake and his sister and brother killed.

"I've seen the situation here, and I want to get out," he said.

A massive international aid effort has been struggling with logistical problems, and many Haitians are still desperate for food and water.

Still, search-and-rescue teams have emerged from the ruins with some improbable success stories — including the rescue of 69-year-old ardent Roman Catholic who said she prayed constantly during her week under the rubble.

Ena Zizi had been at a church meeting at the residence of Haiti's Roman Catholic archbishop when the Jan. 12 quake struck, trapping her in debris. On Tuesday, she was rescued by a Mexican disaster team.

Zizi said after the quake, she spoke back and forth with a vicar who also was trapped. But he fell silent after a few days, and she spent the rest of the time praying and waiting.

"I talked only to my boss, God," she said. "I didn't need any more humans."

Doctors who examined Zizi on Tuesday said she was dehydrated and had a dislocated hip and a broken leg.

Elsewhere in the capital, two women were pulled from a destroyed university building. And near midnight Tuesday, a smiling and singing 26-year-old Lozama Hotteline was carried to safety from a collapsed store in the Petionville neighborhood by the French aid group Rescuers Without Borders.

Crews at the cathedral recovered the body of the archbishop, Monsignor Joseph Serge Miot, who was killed in the Jan. 12 quake.

Authorities said close to 100 people had been pulled from wrecked buildings by international search-and-rescue teams. Efforts continued, with dozens of teams hunting through Port-au-Prince's crumbled homes and buildings for signs of life.

But the good news was overshadowed by the frustrating fact that the world still can't get enough food and water to the hungry and thirsty.

"We need so much. Food, clothes, we need everything. I don't know whose responsibility it is, but they need to give us something soon," said Sophia Eltime, a 29-year-old mother of two who has been living under a bedsheet with seven members of her extended family.

The World Food Program said more than 250,000 ready-to-eat food rations had been distributed in Haiti by Tuesday, reaching only a fraction of the 3 million people thought to be in desperate need.

The WFP said it needs to deliver 100 million ready-to-eat rations in the next 30 days, but it only had 16 million meals in the pipeline.


Even as U.S. troops landed in Seahawk helicopters Tuesday on the manicured lawn of the ruined National Palace, the colossal efforts to help Haiti were proving inadequate because of the scale of the disaster. Expectations exceeded what money, will and military might have been able to achieve.

So far, international relief efforts have been unorganized, disjointed and insufficient to satisfy the great need. Doctors Without Borders says a plane carrying urgently needed surgical equipment and drugs has been turned away five times, even though the agency received advance authorization to land.


A statement from Partners in Health, co-founded by the deputy U.N. envoy to Haiti, Dr. Paul Farmer, said the group's medical director estimated 20,000 people are dying each day who could be saved by surgery.

"TENS OF THOUSANDS OF EARTHQUAKE VICTIMS NEED EMERGENCY SURGICAL CARE NOW!!!!!" the group said in the statement. It did not describe the basis for that estimate.

Nearly $1 billion pledged

Governments have pledged nearly $1 billion in aid, and thousands of tons of food and medical supplies have been shipped. But much remains trapped in warehouses, or diverted to the neighboring Dominican Republic. Port-au-Prince's nonfunctioning seaport and many impassable roads complicate efforts to get aid to the people.

Aid is being turned back from the single-runway airport, where the U.S. military has been criticized by some of poorly prioritizing flights. The U.S. Air Force said it had raised the facility's daily capacity from 30 flights before the quake to 180 on Tuesday.

About 2,200 U.S. Marines established a beachhead west of Port-au-Prince on Tuesday to help speed aid delivery, in addition to 9,000 Army soldiers already on the ground. Lt. Cmdr. Walter Matthews, a U.S. military spokesman, said helicopters were ferrying aid from the airport into Port-au-Prince and the nearby town of Jacmel as fast as they could.

U.S. Defense Secretary Robert Gates said the military will send a port-clearing ship with cranes aboard to Port-au-Prince to remove debris that is preventing many larger aid ships from docking.


The U.N. was sending in reinforcements as well: The Security Council voted Tuesday to add 2,000 peacekeepers to the 7,000 already in Haiti, and 1,500 more police to the 2,100-strong international force.

"The floodgates for aid are starting to open," Matthews said at the airport. "In the first few days, you're limited by manpower, but we're starting to bring people in."

The WFP's Alain Jaffre said the U.N. agency hoped to help 100,000 people by Wednesday.

Hanging over the entire effort was an overwhelming fear among relief officials that Haitians' desperation would boil over into violence.

"We've very concerned about the level of security we need around our people when we're doing distributions," said Graham Tardif, who heads disaster-relief efforts for the charity World Vision. The U.N., the U.S. government and other organizations have echoed such fears.

Occasionally, those fears have been borne out. Looters rampaged through part of downtown Port-au-Prince on Tuesday, just four blocks from where U.S. troops landed at the presidential palace. Hundreds of looters fought over bolts of cloth and other goods with broken bottles and clubs.

USGS geophysicist Bruce Pressgrave said nobody knows if a still-stronger aftershock is possible.

"Aftershocks sometimes die out very quickly," he said. "In other cases they can go on for weeks, or if we're really unlucky it could go on for months" as the earth adjusts to the new stresses caused by the initial quake.

© 2010 The Associated Press. All rights reserved.

[doug]

updated 2:52 a.m. ET Jan. 21, 2010
Haiti’s dying elderly say ‘nobody cares’
Dozens beg for food, medicine while relief teams are less than a mile away

An elderly woman begs for food from people passing by as she lays with other senior citizens outside their collapsed nursing home in Port-au-Prince, on Sunday.
The Associated Press
Video: Haiti MD: 'We are their only hope'

PORT-AU-PRINCE, Haiti - More than a week after their nursing home collapsed, dozens of elderly Haitians are still begging for food and medicine in a downtown Port-au-Prince slum barely a mile from the international airport where tons of aid are pouring in.

"It's as if everybody has forgotten us, nobody cares," said Phileas Julien, 78, a sometimes delirious blind man in a wheelchair who has appointed himself spokesman for the 84 surviving residents. "Or maybe they really do just want us to starve to death."

The Jan. 12 earthquake killed six residents and two more have since died of hunger and exhaustion. Several more were barely clinging to life Wednesday evening. They struggle to survive in the midst of a squalid camp that was created in the hospice's garden by people who fled the quake's destruction.

Life for the residents has improved a bit since Sunday, when some of their new neighbors pulled beds out of the home and into the open so the elderly didn't have to sleep on the ground with rats scampering by.

Some relatives and volunteers have made small food offerings and helped wash and medicate the worse-off patients. An Associated Press reporter has brought a case of bottles of water every day since discovering their plight Sunday.

On Monday, the Brazilian aid group Viva Rio brought in a large tanker of drinking water, the first large-scale aid for the 59 women and 25 men left from the nursing home.

'So, so hungry'

John Lebrun, one of the nursing home's cleaners, also brought a 110-pound bag of rice that was cooked the same day.

"I found it in a storage house nearby," he said. He wouldn't elaborate on how he secured such a costly item: that much rice now costs $60 amid shortages. Lebrun grinned and said evasively that it came from a "broken" store — one damaged in the quake.

The plain, boiled rice Monday was the pensioners' first meal since the earthquake. They have not eaten since.


"We're hungry, we're so, so hungry," lamented 77-year-old Felicie Colin, one of those who still had enough energy to speak intelligibly at sunset Wednesday.

Dying tucked away

Lebrun pointed at two pensioners who had been unconscious for days, tucked in a corner so their slow, silent departure wouldn't affect the others too much.


Video: Haiti's hobbled government gives little guidance

"My friends, they need medicine so badly," said nurse Jesula Maurice, shaking her head.

Maurice came to check on her ailing brother at the hospice and said she had worked around the clock for days stitching up wounds and cleaning cuts of all the quake victims she could help. A pharmacist gave her two suitcases of basic medicine, but the supplies quickly ran out.

"There's such a desperate need for antibiotics here," Maurice said.

She expressed anger at the seeming lack of outside interest in the residents of the nursing home, which is close to the areas around the collapsed presidential palace and Roman Catholic cathedral, which teem with journalists and international rescue teams.

Copyright 2010 The Associated Press. All rights reserved.

[doug]

updated 7:13 a.m. ET Jan. 21, 2010
Disaster do-gooders can actually hinder help
Uninvited volunteers, useless donations can cost money, time — and lives

Haitians reach out for relief supplies from the World Food Program in Port-au-Prince, Haiti. A massive wave of aid has been directed at the earthquake-devastated survivors, but disaster organizers say it must be the right kind of aid to make a difference.
By JoNel Aleccia
Health writer
No question, the two church-goers from New Jersey had the best intentions in the world when they arrived in Port-au-Prince this week to help victims of Haiti’s killer earthquake.

Trouble was, that was all they had in a land where food, water, shelter and transportation are at a desperate premium, said Laura Blank, a disaster communications manager on the ground for World Vision, a Christian humanitarian aid group with long ties to the country.

“They seemed very eager and very passionate about helping the people of Haiti, but they didn’t have a ride to get out of the airport,” said Blank, who had to direct the pair to assistance.

More than a week after a magnitude-7 earthquake devastated the country, disaster organizers say they’re seeing the first signs of a problem that can hinder even the most ambitious recovery efforts: good intentions gone wrong.

From volunteer medical teams who show up uninvited, to stateside donors who ship boxes of unusable household goods, misdirected compassion can actually tax scarce resources, costing time, money, energy — and lives, experts say.

“Everyone wants to be a hero. Everyone wants to help,” said Dr. Thomas Kirsch, co-director of the Johns Hopkins Center for Refugee and Disaster Response. “It’s not the way to do it.”

Even a medical crew from his own school — Kirsch declined to identify them — arrived in Haiti so ill-prepared they had to seek sustenance from non-governmental organizations.

“They had no bedding, supplies or food,” he said. “They ended up glomming onto some of the NGOs.”

Volunteers simply show up

What to do with well-meaning volunteers is not a new problem. In every disaster, large numbers of people simply show up to help. A handbook published by California disaster officials estimates organizers can count on 50,000 “convergent” volunteers after any severe earthquake. After the Sept. 11 terror attacks, more than 40,000 unsolicited volunteers arrived at Ground Zero in New York.

In the U.S. and around the world, aid organizations are walking a fine line, trying to encourage skilled professionals who can provide indispensable assistance — and waving off those who might not be up to the task. At the federal Center for International Disaster Information, a stern note warns the well-intentioned:

“Volunteers without prior disaster relief experience are generally not selected for relief assignments,” it reads. “Most offers of another body to drive trucks, set up tents, and feed children are not accepted.”

It’s an effort to help would-be Samaritans recognize the reality of the situation, said CIDI director Suzanne H. Brooks.

“It’s very romantic in the TV and movies,” she said. “They think it’s flying in for a weekend. They need to think of it in terms of months.”

Those best suited to help are probably already there, experts said. They’re trained crews who not only have experience working in disasters, but also in developing nations, Kirsch said. The best teams also have a command of Haitian Creole and French, if possible.

When teams arrive without those skills and without their own supplies, they drain resources that could better be used for actual victims, said Dr. Kristi L. Koenig, an emergency physician at the University of California, Irvine, who specializes in disaster response.

“Unless you’re part of a team before the disaster happens with a formal mission, you’re going to be part of the problem,” she said.

Even worse, certain volunteers have required emergency intervention themselves, Kirsch noted.

“Most people do quite well, but about 10 percent don't,” he said. “They end up totally freaking out and having to be evacuated.”

Winter coats and high-heeled shoes?

A different but equally pressing problem is the flood of ill-advised donations that aid agencies already are facing, organizers said. A handful of “Help Haiti” food and clothing drives across the country are inspiring cringes among some workers, said Diana Rothe-Smith, executive director of the National Voluntary Organizations Active in Disaster, a coalition of agencies.

“I would strongly recommend that no donation drives be conducted unless there’s an existing organization on the ground, in Haiti, that has asked for the help,” Rothe-Smith said. “It does pile up very quickly.”

Donations of old clothes, canned goods, water and outdated prescriptions are accumulating, said Brooks. While such items sound useful, they’re actually expensive to sort, to transport and to distribute, she said. Cast-off drugs can be dangerous.

Oftentimes, the household items donated are simply not useful to the disaster victims they’re intended to help.

“I guarantee you someone is going to send a winter coat or high-heeled shoes,” Brooks said.

In fact, after the tsunami in Indonesia in 2004, aid organizers in Sri Lanka were forced to deal with donations of stiletto shoes, expired cans of salmon, evening gowns and even thong panties, according to news reports. In Florida, a truckload of mink coats showed up during the 2004 hurricane season, Rothe-Smith said, a likely tax write-off for a retailer having trouble pushing furs.

The compassion behind some donations is understandable — and laudable, she added. People see dire images on television or in news reports and they want to help.

“It seems to make logical sense to go through your own cupboard and gather those items,” Rothe-Smith said.

The reality, however, is that inappropriate donations actually do more harm than good.

“If you buy a can of peas and it costs 59 cents, it’ll cost about $80 to get it where it needs to go,” Rothe-Smith said.

Mathematics of donation favor cash

Many agencies try to motivate donors with the mathematics of the situation. Jeff Nene, a spokesman for Convoy of Hope, a Springfield, Mo., agency that feeds 11,000 children a day in Haiti, urges cash donations that allow his group to buy in bulk from large suppliers and retailers.

“When people give $1, it translates into $7 in the field,” he said. “If they spend $5 for bottled water, that’s nice and it makes them feel good, but probably it costs us more than $5 to send it. If they give us $5, we can get $35 worth of water.”

That’s a sentiment echoed by virtually every aid agency.

“I would really say at this point, honestly, right now, money is the best thing to give,” Rothe-Smith said.

Donors can find vetted agencies helping in Haiti on sites such as Charity Navigator.


Still, trying to direct the flood of compassion can be tricky, Nene acknowledged.

“Some people get a little miffed by it. They think they’re trying to help and when you don’t receive it in that attitude and spirit, they get upset,” he said.

“You just have to tread lightly. You don’t want to crush people when they’re so willing to help.”

© 2010 msnbc.com

[doug]

updated 9:15 p.m. ET Jan. 21, 2010
Haiti unveils plan to move 400,000
Suburb picked to start; aid still backed up with 1,400 flights waiting

People use water from a pothole to wash in Port-au-Prince on Thursday. Logistical problems have slowed aid efforts, and many people are still desperate for food and water.
msnbc.com news services
Video: In Haiti, burying 10,000 bodies a day

PORT-AU-PRINCE, Haiti - Haiti's government on Thursday unveiled plans to move 400,000 earthquake victims to new settlements outside the destroyed capital.

The first wave of 100,000 people were to be sent to transitional tent villages of 10,000 each near Croix Des Bouquets, a suburb north of Port-au-Prince, Interior Minister Paul Antoine Bien-Aime told reporters.

The minister did not provide a timeline, but Brazilian U.N. peacekeepers were already leveling land at a site where the Inter-American Development Bank planned to help build permanent homes for 30,000 people.

Authorities are worried about sanitation and disease outbreaks in makeshift settlements like the one on the city's central Champs de Mars plaza, said Fritz Longchamp, chief of staff to President Rene Preval.

"The Champ de Mars is no place for 1,000 or 10,000 people," Longchamp said. "They are going to be going to places where they will have at least some adequate facilities."

The plan would let displaced Haitians help build their own new homes under a food-for-work scheme, allowing them to stay close to the area where they had made a living.

Many for now were jammed into haphazard camps with no toilets, sleeping outdoors because their homes were destroyed or out of fear that aftershocks would bring down more buildings. Aftershocks of 4.8 and 4.9 magnitude shook the capital on Thursday, further stressing traumatized survivors.

The United Nations has counted nearly 450 homeless encampments in Port-au-Prince alone and urged the government to begin consolidating them to streamline food distribution.

The city's water system is only partially functional and tanker trucks are delivering water to makeshift camps where people lined up to fill their buckets.

Violence and looting has subsided as U.S. troops provided security for water and food distribution, and thousands of displaced Haitians heeded the government's advice to seek shelter in villages outside Port-au-Prince.

"We're so, so hungry," said Felicie Colin, 77, lying outside the ruins of her Port-au-Prince nursing home with dozens of other elderly residents who have hardly eaten since the earthquake hit on Jan. 12.

More than 13,000 U.S. military personnel are in Haiti and on 20 ships offshore, and the number is expected to soar to 20,000 by Sunday. Troops landed helicopters on the lawn of the destroyed presidential palace to pick up the seriously wounded and fly them to the U.S. Navy hospital ship Comfort, which has advanced surgical units.

Small grocery shops and barber shops, as well as some pharmacies, were open again in Port-au-Prince, some extending credit to regular customers short of cash.

Banks were to reopen on Friday in the provinces and on Saturday in Port-au-Prince, giving most Haitians their first access to cash since the quake hit, Commerce Minister Josseline Colimon Fethiere told Reuters.

1,400 flights waiting to land

The U.S. military on Thursday said it was tapping another airport in neighboring Dominican Republic to help bring in relief supplies and that the capital's harbor had been reopened to large ships bringing aid.

Gen. Douglas Fraser, head of Southern Command, said that while 120 to 140 flights a day are now able to land at the Port-au-Prince airport, the military has a waiting list of 1,400 flights.

In addition to alternative airfields opened this week in Jacmel, Haiti, and one in the neighboring Dominican Republic, another airport is now open in the Dominican Republic, Fraser said.

Fraser added that the U.S. military effort has cost more than $100 million so far, but he could not say whether that was just military operating costs or if it also included the physical supplies (medical, meals, etc.) that the military has provided.

At the harbor in Port-au-Prince, U.S. crews were able to move enough debris to open some dock space.

"We're on our third vessel and the structural engineers have OK'd this operation we are doing," Coast Guard Lt. Commander Mark Gibbs said Thursday.

Also Thursday, two aftershocks, one a magnitude-4.9, prompted rescue crews to briefly abandon work on ruined buildings, though there were no reports of casualties or damage.

They followed a magnitude-5.9 temblor a day earlier. At least 50 sizable aftershocks have jolted the city, sending nervous Haitians fleeing repeatedly into the streets — and keeping many sleeping in the open.

The 7.0 magnitude quake which roiled Haiti's capital, Port-au-Prince, on Jan. 12 killed an estimated 100,000 to 200,000 people and left the poverty-stricken country looking to the world for basic sustenance.

A week after the earthquake, and with fewer signs of more survivors buried under rubble, international rescue teams have begun pulling out.

A Florida search and rescue team left Haiti on Wednesday and it was reported that teams from Belgium, Luxembourg and Britain did as well.

U.S. and international teams have rescued 122 people, the White House said, while Haitians themselves rescued many others in the hours and days after the quake.

Some teams were still working with sniffer dogs at the collapsed Hotel Montana, where a whiteboard listed the names of 10 people found dead and 20 more still missing inside. Crews had treaded gingerly, shifting rubble by hand, but were switching to heavy machinery to dig up the bulk of the hotel.

"As well as being hopeful you have to be realistic and after nine days, reality says it is more difficult to find people alive but it's not impossible," said Chilean Army Major Rodrigo Vasquez.

Dying from infection

Most of the basics in Port-au-Prince are still missing or barely functional. Hospitals are overwhelmed and doctors lack anesthesia, forcing them to operate with only local painkillers.

Doctors Without Borders cited 10-to-12-day backlogs of patients at some of its surgical sites as well as infections of untreated wounds. "Some victims are already dying of sepsis," the group said.

"The next health risk could include outbreaks of diarrhea, respiratory tract infections and other diseases among hundreds of thousands of Haitians living in overcrowded camps with poor or nonexistent sanitation," said Dr. Greg Elder, deputy operations manager for Doctors Without Borders in Haiti.


Haitian government figures relayed by the European Commission put the death toll at 200,000, with 80,000 buried in mass graves. The commission now estimates 2 million homeless, up from 1.5 million, and says 250,000 are in need of urgent aid.

"Are we satisfied with the job we are doing? Definitely not," said Jon Andrus, deputy director of the Pan American Health Organization. "But progress is being made. Think of what we started with when the world came crashing down on Haiti. No roads, only rubble and dead bodies. No communication, only death and despair."


Workers are carving out mass graves on a hillside north of Port-au-Prince, using earth-movers to bury 10,000 earthquake victims in a single day.

In the sparsely populated wasteland of Titanyen, north of Port-au-Prince, burial workers said the macabre task of handling the seemingly never-ending flow of bodies was traumatizing.

"I have seen so many children, so many children. I cannot sleep at night and, if I do, it is a constant nightmare," said Foultone Fequiert, 38, his face covered with a T-shirt against the overwhelming stench.

Workers say they have no time to give the dead proper religious burials or follow pleas from the international community that bodies be buried in shallow graves from which loved ones might eventually retrieve them.

"We just dump them in, and fill it up," said Luckner Clerzier, 39, who was helping guide trucks to another grave site farther up the road.

Elderly dying

Many of the survivors are living on high-protein biscuits or dry emergency rations. The Food for the Poor charity managed to reopen its kitchens in Port-au-Prince and served up vats of rice, beans and chicken, giving thousands of people their first hot meal in more than a week.

But the need was much greater. Perhaps no one was more desperate than the 80 or so residents of the damaged Municipal Nursing Home, in a slum near the shell of Port-au-Prince's devastated cathedral. The quake killed six of the elderly, three others have since died of hunger and exhaustion, and several more were barely clinging to life.

"Nobody cares," said Phileas Justin, 78. "Maybe they do just want us to starve to death."

In the first eight days after the quake, they had eaten just a bit of pasta cooked in gutter water and a bowl of rice each. On Thursday, they had a small bowl of spaghetti, and five bags of rice and beans were delivered.

A dirty red sheet covered the body of Jean-Marc Luis, who died late Wednesday. "He died of hunger," said security guard Nixon Plantin. On Thursday, four days after The Associated Press first reported on the patients' plight, workers from the British-based HelpAge International visited and said they would help.


Americans flock to adopt

In addition to giving money, many Americans are contacting adoption advocacy groups, which reported receiving dozens of calls a day.

"The agencies are being flooded with phone calls and e-mails," said Tom Difilipo, president and CEO of the advocacy group Joint Council on International Children's Services. "The response is 'Can we help with these children by adopting them?'"

Before new adoptions can occur, officials need to establish that the children are identified by the Haitian government as orphans; there have been reports of families selling their children to adoption brokers.

UNICEF will now work to find children who are alone and determine whether they are orphans or have become separated from family, spokesman Patrick McCormick said. If they have relatives, the agency will work to reunite them. Alternative and long-term choices such as international adoption would be options only after that.

The Associated Press and Reuters contributed to this report.

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