Haiti: One Year Later
The January 12 Earthquake
U.S. Response to the Earthquake
Multilateral Partnership, Haitian Lead
United States Strategy on Haiti
The Need, the Response, Constraints
--Pillar I: Infrastructure and Energy
--Pillar II: Food and Economic Security
--Pillar III: Health and Other Basic Services
--Pillar IV: Governance and Rule of Law
Haiti: One Year Later summarizes U.S. efforts in the aftermath of the devastating January 12, 2010 earthquake. Over the past year the United States helped lead a global effort that saved countless lives, rallied support for Haiti’s reconstruction, and began to build Haiti’s capacity to deliver basic services and provide for Haiti's future. From the first post-earthquake moments, the tremendous generosity and compassion of the American people have supported public and private humanitarian assistance. One of every two U.S. households contributed in some way to Haitian relief and Haitian rebuilding. Working with the Government of Haiti and the United Nations system, the U.S. Government has been able to support many critical tasks. The response of the international community to that natural disaster reflects an unprecedented level of bilateral and multilateral cooperation, in which the United States has been a key partner in working together with Haitians and other international partners – public and private – to make progress in rebuilding Haiti. In total, more than 140 nations supported the rescue and relief efforts in Haiti, from Cuba to China and from Israel to Colombia.
Much of the rebuilding lies ahead; overcoming challenges unique to Haiti will require resolve. Even before the catastrophe, Haiti suffered for decades as the most impoverished nation in the Western Hemisphere. The country exhibited one of the widest income inequalities in the world. Eighty percent of Haiti’s inhabitants lived in poverty, with more than half the population living on less than $2 per day. Haiti suffered the lowest life expectancy, highest infant mortality and highest tuberculosis rates in the region; and an estimated 40 % of the population lacked access to basic health services. Half of Haiti’s children were not vaccinated. Less than 53% of Haiti’s adult population was literate, and half of its school-age children attended no form of school. Inadequate infrastructure reflected years of government corruption or neglect. Only 12% of Haitians had formal access to electricity.
In March 2009, Secretary of State Hillary Clinton identified Haiti as a foreign policy priority and called for a whole-of-government review of U.S. engagement and assistance. In 2011, Haiti remains a priority, its challenges and needs even greater. The United States is making the long-term commitment essential to helping Haiti rebuild on a strong foundation able to sustain its people and assume its role in the region.
THE JANUARY 12 EARTHQUAKE
At 4:53 p.m. local time on January 12, 2010, a powerful earthquake measuring 7.0 on the Richter scale struck Haiti just 16 miles from the capital city of Port-au-Prince, home to an estimated 2.35 million people. More than fifty significant aftershocks followed over the next ten days.
In the scale of its humanitarian impact, the earthquake was the most severe natural disaster Haiti had ever recorded. According to Government of Haiti estimates, 230,000 people died and another 300,000 were injured. Hundreds of thousands of buildings were destroyed or damaged, and, according to Haitian authorities' estimates, as many as one million people were left homeless. Infrastructure losses included 28 out of 29 government ministries buildings, 50 hospitals and health centers, and 1,300 educational institutions. The human losses among Haiti’s civil service were also devastating. The quake crippled seaports and the Port-au-Prince airport, and millions of cubic yards of rubble choked the capital. By Red Cross estimates, the earthquake directly affected as many as three million Haitians.
U.S. RESPONSE TO THE EARTHQUAKE
The United States reacted swiftly to the news of the catastrophic earthquake, continues to assist the Haitian government and people with life-saving and sustaining programs, and has committed long-term support. President Obama directed a “swift, coordinated and aggressive” U.S. Government response under the leadership of U.S. Agency for International Development (USAID) Administrator Rajiv Shah. The morning following the earthquake, President Obama pledged U.S. Government help, and on January 14 announced a $100-million initial commitment of aid.
The U.S. Government response has grown to be the largest international humanitarian response to a natural disaster in U.S. history. The whole-of-government effort ultimately encompassed a wide range of agencies. Their combined efforts provided humanitarian assistance that saved and sustained the lives of millions of Haitians nationwide. Early response actions and actors included the following.
- USAID deployed a Disaster Assistance Response Team (DART), whose first members arrived on the ground within hours of the earthquake. Including urban search and rescue team members, the DART comprised more than 540 people at the height of the response, and consisted of experts in the fields of health, shelter, nutrition, and water and sanitation, among other specialties.
- USAID immediately established a 24-hour, Washington-based Response Management Team whose disaster relief experts provided support to the DART as it identified relief priorities.
- The DART assessed humanitarian conditions initially and maintained continuous operations on the ground for three-and-a-half months – providing recommendations on humanitarian assistance needs to ensure that the U.S. Government helped fill needed gaps. The DART then transitioned to the USAID Office of Foreign Disaster Assistance (USAID/OFDA) program office that continues to coordinate U.S. Government humanitarian assistance in Haiti.
- The embassy chancery became a surgery unit. By January 29, over 100 surgeries and 4 amputations occurred there.
- State Department officers made their way to the to the Haiti-Dominican Republic border to address the humanitarian needs of earthquake victims who had fled to that region. State programs assisted the Haitian government to prevent dangerous outmigration by sea and to reintegrate those who did attempt the voyage after the earthquake and whom the U.S. Coast Guard (USCG) and other countries interdicted and returned to Haiti.
- The State Department oversaw the evacuation of more than 16,000 American citizens, the largest modern peacetime evacuation.
- The USCG also conducted damage assessments and ensured the safe navigation necessary to land relief materials.
- The Department of Homeland Security (DHS) deployed staff from the Federal Emergency Management Agency (FEMA), which provided search and rescue teams, a communication team, and an interagency response team to support USAID planning.
- The Department of Defense helped evacuate Americans and provided support on humanitarian, shelter, transportation, communication, and security issues.
- The Treasury Department, in partnership with other U.S. agencies, assisted two remittance transfer agencies with cash replenishment and deployed a senior representative to advise Haitian officials on the immediate need to promote a functioning banking sector, cash availability, and remittances.
- With USAID support, the Department of Health and Human Services (HHS) provided emergency medical response teams and public health planning support.
- Technical assistance teams of the Department of Energy and the Federal Communications Commission conducted assessments of the electrical grid and communications infrastructure.
- The Federal Aviation Authority recertified Port-au-Prince airport for commercial operations once it was restored.
Just four days after the earthquake, Secretary of State Hillary Clinton, meeting with President René Préval and Prime Minister Jean-Max Bellerive in Haiti, reiterated the United States’ commitment to support Haiti. President Préval asked Secretary Clinton to provide comprehensive U.S. Government assistance. At the conclusion of the Secretary’s trip, President Préval and Secretary Clinton issued a communiqué outlining the Government of Haiti’s request and the U.S. Government’s commitment. Following the communiqué, the U.S. military began to assist with disaster relief operations and allowed the U.S. Government to manage the airport and ports during the emergency, to ensure greatest efficiency in meeting the most immediate needs of the Haitian people until the Government of Haiti could resume control.
The goal in the immediate term was to save and protect lives, and in-country resources continued to grow to meet this goal. The USAID DART and a 72-member Urban Search and Rescue (USAR) team from Fairfax County, Virginia, were on the ground with 24 hours of the earthquake, bringing emergency relief and rescue tools and expertise. The U.S. teams rescued 47 individuals, contributing to the international USAR team total rescues of 134, the largest number of known rescues in an international disaster response. The conference room in the U.S. Embassy became a surgical ward, and Embassy grounds became home to hundreds of responders in tents. The U.S. Coast Guard was also on the scene within 24 hours of the earthquake, providing medical assistance and evacuating American citizens and earthquake victims requiring critical cases.
Between January 17 and February 22, the 1,100 deployed medical staff from the Department of Health and Human Services’ twelve disaster medical assistance teams and three international medical surgical teams attended more than 31,300 patients, performed 167 surgeries and delivered 45 babies. They also provided critical medical supplies and equipment, such as medicines and mobile medical tents, to the response effort. Medical teams aboard the USNS Comfort treated hundreds of the most critically injured trauma victims, including performing more than 840 surgeries.
By the end of January, U.S. efforts in Haiti included more than 15,400 troops afloat and 6,800 on the ground, 113 aircraft, and 23 Navy ships, present at the request of the Government of Haiti. Working in coordination with USAID relief programs and priorities identified by disaster response experts on the scene, U.S. military forces distributed more than 2,600,000 liters of water, almost 2,300,000 meals, and over 17,000,000 pounds of bulk food. Operation Unified Response was the U.S. military’s longest and largest contribution to a foreign disaster relief operation, covering a wide range of missions: air and seaport operations, medical airlift, medical assistance, transport and delivery of medical commodities, evacuations of American citizens, logistics support, and support for the World Food Program surge.
The U.S. Government supported the delivery of emergency shelter to earthquake victims at an unprecedented rate, and was part of an international effort that provided 1.5 million people with basic shelter materials before May 1, the onset of the rainy season. By July, the six-month mark, the United States, through USAID and its partners and in coordination with Haitian authorities and humanitarian organizations, had been providing safe drinking water to approximately 1.3 million people daily since early May, providing the most economically vulnerable Haitians with more access to safe water than before the earthquake. The United States, through USAID, the Department of Energy, and the Department of Defense, collaborated to restore the fuel supply to Haiti, without which the distribution of relief supplies would have been severely delayed.
On January 23, USAID Administrator Dr. Rajiv Shah traveled to Haiti to assess ongoing earthquake relief efforts and meet with local officials. Administrator Shah met with Haitian President René Préval and discussed recovery efforts and Haiti’s urgent needs. Administrator Shah, together with FEMA Administrator Craig Fugate, also visited the site of the Hotel Montana in Port-au-Prince, where USAR teams had been working around the clock since the hotel’s collapse in the earthquake trapped hundreds of people in the rubble.
By the one-year anniversary of the earthquake, the United States had contributed significantly to an international effort that fed more than four million people. Together with the Haitian government, the United States assisted 80% of children who had been attending school before the earthquake to return to school. U.S. relief programs prioritized activities that benefit the local Haitian economy by promoting short-term job generation – funding cash-for-work programs employing over 8,000 people per day at sites nationwide for projects from rubble removal to, more recently, cholera response.
A significant undertaking post-earthquake was ensuring that those Haitians displaced by the quake were not at risk from the impending hurricane season. The U.S. Government, through USAID and the Department of Defense, led efforts to prevent loss of life due to flooding from tropical storms in and around Port-au-Prince. USAID funded the clearing of 95 kilometers of drainage canals and over 263,500 cubic meters of garbage and sludge that cause flooding and loss of life each year in Haiti. Additional flood mitigation efforts in internally displaced person (IDP) camps included the digging of drainage ditches to ensure the smooth flow of water, terracing, digging retaining ponds and walls, sandbagging, and building safety fences. Additionally, in advance of hurricane season, USAID pre-positioned a range of supplies throughout the country, including water containers, blankets, hygiene kits, and kitchen sets, which allowed for rapid response to storms. Twenty-one people were killed by Tomas which passed by Haiti on November 5. In contrast, there were more than 1,000 dead or missing after Tropical Storms Hanna and Fay and Hurricane Gustav hit Haiti in 2008.
MULTILATERAL PARTNERSHIP, HAITIAN LEAD
Support to Haiti’s reconstruction continues the unprecedented multilateral cooperation begun during the emergency response. In Haiti as elsewhere, the United States recognizes that multilateral partnerships offer opportunities to pool political, military and humanitarian assets while sharing the costs and burdens of the international response.
The United Nations Stabilization Mission in Haiti (MINUSTAH)’s human and other resources were decimated by the Haitian earthquake. As MINUSTAH recovered, the U.S. Government deployed national assets to help bolster the depleted mission. The U.S worked with the Haitian government and the UN to define the respective roles in the immediate aftermath of the earthquake and created international partnerships to provide needed assets such as transportation, logistics, medical, and rule of law expertise. With this and other support from the United States, Brazil, and others, MINUSTAH recovered and today continues to play a critical role, including by securing the logistical routes to enable an effective response to the cholera crisis and supporting the Haitian National Police as they work to uphold the rule of law in Haiti.
Humanitarian organizations on the ground in Haiti were severely affected by the earthquake in terms of loss of capacities, resources and staff that seriously undermined their ability to respond effectively and swiftly. UN humanitarian agencies nonetheless moved quickly to establish a coordinated humanitarian response after the earthquake. The UN launched an interim flash appeal for emergency relief funding on January 15, and followed up with a $1.5 billion revised appeal on February 18. The U.S. Government was by far the largest bilateral donor to the 2010 UN appeal, providing over $242 million in response. Over the course of 2010, UN relief effort provided life-saving support to millions, including:
- Food rations provided to some 4.3 million people;
- Emergency shelter provided to 1.5 million people;
- Provision of basic health services to 90 percent of the displaced population in Port-au-Prince;
- 11,000 latrines installed and maintained;
- Short-term employment provided to 116,000 people;
- 4,372 separated children registered, and 1,101 reunited with families and primary caregivers;
- Supplementary feeding to children and pregnant/lactating mothers reached 500,000 people;
- Contingency plans for ensuring ongoing emergency services for rainy and hurricane seasons prepared and implemented;
- Emergency-level malnutrition was prevented altogether, and more than 11,000 children received additional malnutrition treatment; and
- Over one million children benefited from provision of basic learning materials, temporary learning spaces, and school tents; over 8,400 new teachers trained.
In December 2010, the UN launched the 2011 Consolidated Appeal for Haiti, requesting approximately $907 million to provide ongoing humanitarian and early recovery assistance. Priorities for the 2011 UN humanitarian response will include supporting the Government of Haiti’s efforts to treat and prevent cholera, creating durable conditions for many of the estimated one million who still reside in camps and spontaneous settlements to return and reintegrate into their communities, enhancing disaster preparedness and contingency planning, and building government and local community capacity to ensure access to basic social services.
Following the cholera outbreak, the Pan American Health Organization (PAHO) led the UN health cluster's efforts in the overall cholera response. PAHO ensures that adequate medical supplies are on hand, working with MINUSTAH, World Food Program and other partners to distribute life-saving supplies to a network of cholera treatment centers, treatment units, and oral rehydration points established across the country. PAHO has trained over 500 health workers in cholera case management and has worked with Centers for Disease Control (CDC) to improve surveillance and reporting of cholera cases and fatalities. PAHO, MINUSTAH, and others continue to assess and evaluate the cholera situation and measures to manage it.
In the aftermath of the earthquake, the Government of Haiti convened approximately 250 local and international experts to conduct a post-disaster needs assessment, which mapped and quantified the colossal destruction that Haiti’s social, economic, and administrative structures had suffered. The study estimated that overall damage and losses totaled approximately $7.9 billion, which amounted to 120% of the country’s GDP in 2009. On the basis of the assessment, the Government of Haiti produced an “Action Plan for National Recovery and Development” that concentrated on four areas: 1) territorial rebuilding (estimated cost: $1.5 billion), 2) economic rebuilding (estimated cost: $.8 billion), 3) social rebuilding (estimated cost: $1.6 billion), and 4) institutional rebuilding (estimated cost: $1.1 billion). This analysis placed the country’s assistance needs at an estimated $3.86 billion in the eighteen months following the earthquake. At a UN-sponsored conference on March 31, 2010, more than 140 countries and international organizations pledged a total of $5.3 billion towards Haiti’s recovery. Total assistance pledges, including those that stretch beyond 2011, have since risen to more than $10 billion.
The Government of Haiti followed up with important steps to facilitate donor coordination for its recovery and development.
Interim Haiti Recovery Commission
- In important demonstrations of unity on the part of the Haitian people, in April 2010 Parliament approved, and in May President Préval signed into law, the formation of the Interim Haitian Recovery Commission (IHRC). Adapted from the coordinating body established to rebuild Aceh in wake of the December 2004 tsunami there, the IHRC’s mission is to ensure that bilateral and multilateral donors, as well as non-governmental organizations (NGOs) and the private sector, are planning and implementing reconstruction activities in a coordinated manner that effectively carries out Haiti’s vision for its future. The IHRC opened its doors in June. Co-chaired by Haitian Prime Minister Bellerive and former U.S. President Bill Clinton, with representatives from Haitian civil society, the private sector, the Haitian Diaspora and the international community, the IHRC held its most recent board meeting December 14. These board meetings provide a forum for Haitians to articulate their development priorities, and to align the plans, and proposed projects of donors accordingly. The IHRC has already approved $3 billion in projects, while helping ensure transparency and accountability of donor investments. The U.S. Government has funded over $330 million of these recovery projects.
Haiti Reconstruction Fund:
- The donors’ conference also led to the establishment of the Haiti Reconstruction Fund (HRF), a multi-donor fund managed by the World Bank. The HRF has received $267 million as of November. The U.S. has provided a $120 million contribution to the HRF, from funds appropriated by the FY10 Supplemental Appropriations Act, which will fund projects in housing, rubble removal, education, and a partial credit guarantee fund to support finance for small and medium-size enterprises. The HRF mobilizes, coordinates, and allocates contributions from bilateral and other donors to finance high-priority reconstruction projects. All proposals for HRF financing must be endorsed by the IHRC as consistent with the Action Plan for the Recovery and Development of Haiti.
In July, the Treasury Department announced that the United States, the International Financial Institutions (IFIs), and other donors together reached the goal of eliminating the total debt stock of $800 million that Haiti owed to the IFIs at the time of the January earthquake. This represented one of the fastest multilateral debt reductions in history. As part of this effort, the U.S. Government disbursed $212 million of new money to provide Inter-American Development Bank and International Fund for Agricultural Development debt relief, freeing up money for the Government of Haiti to use to meet their highest and most urgent priorities.
UNITED STATES STRATEGY ON HAITI
The U.S. Government had been working on a comprehensive strategy to support Haiti since March 2009. The earthquake necessitated careful review and revisions to meet the needs of the post-earthquake nation. In close coordination with the Government of Haiti and other donors, the State Department and USAID led the planning and development of a whole-of-government comprehensive strategy to support Haiti’s long-term reconstruction.
The strategy is built upon the principle of sustainability. The strategy seeks not only the benefits to individuals generated by human development and economic growth, but also the overall sustainability and development of a Haitian state and society. A crucial part of the strategy therefore is for the Government of Haiti to be fully capable of providing the services expected of the public sector and the infrastructure needed by the private sector. Toward this rebuilding of Haiti's capacity in both public and private spheres, a guiding principle of U.S. assistance to Haiti is that the recovery process be Haitian-led. Monitoring of projects and evaluation of results hold the implementers of the strategy accountable to the Haitian people and the American people.
The strategy identifies four priority pillars of U.S. investment – areas upon which Haiti’s reconstruction, sustainable development, economic growth, and long-term stability depend. These pillars are:
- infrastructure and energy;
- food and economic security;
- health and basic services; and
- governance and rule of law.
The strategy focuses on three regional development corridors. To promote the Government of Haiti’s goal of decentralization, U.S. Government assistance will focus on the greater Port-au-Prince area, the corridor between Port-au-Prince and St. Marc, and in the north around Cap Haitien.
The earthquake in Haiti called for an urgent international response in the short term and a long-term commitment to help put that country on a more solid and sustainable foundation for the future. Efforts by the U.S. Government have operated within both time frames. The United States has provided more than $1.1 billion in humanitarian assistance to address most pressing needs, many of which extended beyond the four priority pillars. Additionally, the U.S. Government has provided $406 million from existing appropriations to lay the groundwork for long-term reconstruction efforts.
The U.S. Government also identified longer-term goals and planned for the necessary resources. Of the $5.3 billion pledged at the March 31 donors’ conference, the United States pledged $1.15 billion in new assistance through 2011 toward Haiti’s reconstruction. In March 2010, the Obama Administration submitted a Supplemental Budget Request seeking additional funds for Haiti. In May Congress appropriated $1.75 billion in supplemental funding for State, USAID, and Treasury for recovery and reconstruction activities in that country. Prudent planning is crucial to achieve maximum impact and ensure accountability. As of January 12, 2011, the U.S. Government will have spent an estimated $332 million of the supplemental reconstruction funding.
THE NEED, THE RESPONSE, CONSTRAINTS
The earthquake created immediate and long-term needs in each of the four pillars of investment, and generated significant challenges in addressing these needs.
Pillar I: Infrastructure and Energy
- The earthquake displaced more than 1.3 million persons within Haiti. Many of these internally displaced persons (IDPs) required temporary shelter.
- It produced millions of cubic meters of rubble, which would have to be removed before reconstruction could begin.
- It damaged or destroyed an estimated 400,000 buildings.
- It weakened Haiti’s already fragile power system.
- The proximity of the earthquake to Port-au-Prince, which dominates Haiti’s economic, administrative and political life, meant that the impact of the disaster reached far beyond the capital.
- Many living an already economically marginal existence lost their livelihoods.
- State and USAID plan to spend $425.8 million for reconstruction efforts on energy and infrastructure.
- The United States has removed more rubble than any other donor.
- U.S. Government funds have cleared over 1.2 million cubic meters of rubble through programs including cash-for-work. This rubble has been removed from areas prioritized by local authorities, communities, and the Government of Haiti.
- The U.S. Government has spent more than $100 million on rubble removal through projects funded by USAID and the Department of Defense.
- In collaboration with the international community and the Government of Haiti, the U.S. Government is implementing a multi-pronged strategy to move those Haitians displaced by the earthquake into dignified shelter as rapidly as conditions on the ground permit.
- The U.S. Government and the World Bank led the international effort to assess the structural soundness of housing and other buildings. Through U.S. Government and World Bank funding, teams of engineers from the Government of Haiti Ministry of Public Works, Transport, and Communication; the U.N. Office for Project Services; and the Pan American Development Foundation (PADF), with assistance from Miyamoto International, worked to conduct habitability assessments on many buildings in earthquake-affected areas. Buildings are examined by engineers and rated “green,” or safe for immediate habitation, “yellow,” indicating that houses could be made safe with relatively minimal repairs, or “red,” meaning that they are unsafe for habitation or require major repairs or demolition.
- As of December 2, trained engineers had assessed more than 380,000 of 400,000 targeted structures, tagging 54 % green as they are safe to inhabit and marking another 26 % yellow.
- USAID partners have trained local communities and construction workers how to return homes that suffered limited damage to structural soundness, to date resulting in home repairs to 1875 households. This approach ensures that Haitians have the capacity themselves to build back better, repairing their own homes and other buildings.
- This "safe shelter on safe sites" emphasis has proven successful in mitigating the effects of future hazards in other post-disaster situations, most recently in post-earthquake responses in Indonesia (2009), Peru (2007), Indonesia (2006), and Pakistan (2005).
- The United States is committed to supporting the international community’s effort to build transitional shelters (t-shelters) and core homes for those who cannot return to their homes even after repairs.
- The U.S. Government had completed more than 12,000 t-shelters, representing more than 48% of the international total.
- Faced with numerous obstacles including the Government of Haiti’s limited capacity, delays in getting land for building, slow start up by implementers and delays in rubble disposal, the international community did not attain a previous goal of 47,500 t-shelters by year’s end.
- Donors have continued t-shelter construction, as rubble removal and disposal efforts increase and additional land becomes available.
- The U.S. Government and other donors are, however, shifting their focus to assessment and repair of damaged structures, a more rapid and cost-effective means of providing shelter.
- The U.S. is also working aggressively to identify appropriate locations that will provide permanent relocation options for displaced Haitians.
- To do this in a sustainable way, the United States is carrying out assessments to ensure that proposed areas of resettlement have adequate access to sources of water, income, and opportunities, are relatively accessible and not unduly susceptible to flooding, landslides or other risks.
- Accurate information about property occupancy, tenancy, and ownership claims is essential for informed, responsible decisions regarding urban planning, land readjustment, and delivery of basic services.
- As much as 70% of Port-au-Prince’s pre-quake population lived in informal settlements, and many of the estimated one million displaced Haitians still living in spontaneous settlements presumably lived in these communities.
- The United States, through USAID and the international community, is using a process known as community enumeration, a participatory, community-based means of gathering and verifying statistical information.
- As part of the post-earthquake response in Haiti, the U.S. Government began funding short- and medium-term temporary employment activities that support community revitalization, laying the foundation for longer-term development efforts.
- To date, cash-for-work has cumulatively employed over 350,000 people, creating nearly 3.3 million person-days of work.
- On average 50% of these jobs, many of which are for rubble clearance, are filled by women.
- Cash-for-work has injected over $19 million into the local economy.
- The United States is working with the Government of Haiti, the International Development Bank (IDB) and the EU to develop Haiti’s North, one of the country’s poorest regions, by establishing a globally competitive industrial park. The United States has dedicated $124 million from its infrastructure funds to this effort for port, housing and energy investments that render this region attractive for local and foreign investors.
- The industrial park spans 75 hectares in its first phase and is expected to attract one of the world’s largest garment manufacturers as anchor tenants, who propose to create 20,000 permanent jobs and are anticipated to pay about $500 million in salaries to their workers over ten years, effectively doubling exports from Haiti’s biggest industry.
- This historic regional development project harnesses the northern region’s untapped economic opportunities and creates sustainable livelihoods in line with the Government of Haiti’s priority of decentralization. This effort promotes a more prosperous, stable and economically viable Haiti, where private investors partner with donors to generate long-term growth in incomes.
- Responsibility for shelter issues is divided among multiple Government of Haiti agencies, and capacity in these entities has suffered. This has affected issues ranging from shortages of heavy equipment to clearing necessary materials through customs to identifying rubble disposal sites. Those complications slowed the delivery of t-shelters.
- Rubble removal and land tenure affect not only rebuilding, but also resettlement of displaced Haitians and provision of services.
- Rubble removal is an inherently time-, resource-, and labor-intensive process; millions of tons of rubble remain.
- There is a need to identify sites for rubble disposal. Only one rubble disposal area has been approved to date, limiting the pace of removal.
- Many occupants of displacement camps have been reluctant to return home or otherwise leave the camps due to concerns about safety of structures, crime, and lack of humanitarian assistance or economic opportunities outside the camps.
- Land ownership records are nonexistent or ambiguous. Lack of clear title to a plot of land or written approval from a verified owner can make it difficult to supply a potential beneficiary with a t-shelter or to support re-occupancy of prior homes.
- We will need to continue working with the Government of Haiti to strengthen its capacity, for example in expediting the registration of NGOs and the importation of shelter material, and in identifying land for new settlement sites for permanent relocation. In the absence of a central entity responsible for planning and ensuring implementation of the critical shelter functions, delays and inefficiencies arise.
Pillar II: Food and Economic Security
- Agriculture is central to the Haitian economy, employing over 60% of the population and generating nearly 25% of GDP. Improving economic productivity is essential to help fund economic recovery.
- Farmers need improved access to markets and to value chains that offer higher returns on their crops.
- Deforestation has left Haitian agriculture disproportionately vulnerable to erosion and flooding from rains and hurricanes.
- Unemployment levels are extremely high and Haitian small and medium-sized businesses face enormous challenges to growth, some policy-related and others a result of limited business skills and workforce quality.
- State and USAID plan to spend $63.6 million for reconstruction efforts on food and economic security.
- Haiti is one of 20 focus countries in Feed the Future (FTF), the U.S. Government’s global hunger and food security initiative. FTF seeks to promote food security through improving nutrition and accelerating inclusive agriculture sector growth through increased agricultural productivity, expanded markets and trade, and increased economic resilience in vulnerable rural communities.
- United States agriculture development efforts, implemented mainly by USAID and Department of Agriculture, are now aligned with the Government of Haiti’s National Food Security Plan which was finalized in June 2010. The U.S. Government strategy will focus investment in four well-defined fertile plain areas located at the bottom of major watersheds that represent untapped potential to increase production in selected high-value crops (mango and cacao for export) and staple crops (mainly rice and horticulture crops for domestic consumption).
- Production interventions will be complimented with the introduction of innovations in value addition (certification, packaging, processing) and pro-active market access linkages to ensure increased production is converted to income after household consumption needs are met.
- Concerted efforts to improve soil and water management within the fertile plain area will be fully integrated into the U.S. Government strategy to demonstrate the importance of natural resource management as a core, sustainable business practice.
- Earlier implementation (prior to alignment with National Food Security Investment Plan) has generated important lessons-learned and effective approaches that will be incorporated into the new U.S. Government strategy. For example, successful small farmer training investments that promote soil conservation, use of organic fertilizers and introduction of new seed varieties demonstrated a 75% increase in overall production by participating farmers. Scaling up of these tested interventions in the selected fertile plains will be made a priority.
- U.S. support will assist farmers and farmers’ organizations, entrepreneurs and food industries to develop management and marketing capabilities and improve reporting and market information. These are crucial to translating improved productivity into improved market access and improved rural incomes.
- Investments in management and capacity building will create new jobs and businesses, increase dietary diversity, reduce loss from food spoilage, and improve harvesting, storage, and packaging techniques.
- U.S. Government funds will also provide for technical training and deployment of extension agents.
- Treasury Department’s Office of Technical Assistance is supporting the Government of Haiti and relevant ministries in structural reorganization, modernized legislation and regulation, and more efficient administration in debt issuance and management, public budgeting, banking and insurance regulation, and financial law enforcement.
- The U.S., in partnership with the World Bank and the Inter-American Development Bank, has provided $12.5 million in funding and technical assistance for the establishment of a partial credit guarantee fund to restart credit and support small- and medium-sized enterprise (SME) lending.
- The Ministry of Agriculture is in the process of launching their new National Food Security Investment Plan that includes a commitment to decentralize services to more effectively meet the needs of small farmers in rural areas well beyond greater Port-au-Prince. This will take a significant institutional capacity building effort in the areas of extension, research, and food safety standards and regulations.
- The Ministry of Agriculture has the responsibility to develop inter-ministerial coordination to ensure investments in public infrastructure such as roads, irrigation, power, and natural resource management are properly prioritized to support the overall success of Haiti’s National Food Security Investment Plan and meet the needs of other productive sectors.
- Managing natural resources in a way that protects the environment, contributes to improved production, and increases rural income is key to Haiti’s economy. However, such change is generational and will require long-term investment to ensure lasting impact.
- Elected officials must demonstrate sufficient political will to enact necessary reforms that improve governance, improve public services, attract business investment and spur much needed economic growth.
- Haiti’s environment presents physical challenges for agriculture, including a mountainous terrain and significant land erosion that leaves agricultural areas vulnerable to flooding.
- The history of economic centralization in Port-au-Prince is an ingrained habit that must be overcome if economic opportunities are to improve in other regions of the country.
Pillar III: Health and Other Basic Services
- Even before the earthquake, Haiti’s health indicators were the worst in the Western Hemisphere. According to Ministry of Public Health and Population (MSPP) estimates, a significant portion of the population (40%) had no access to basic health services and access to tertiary care was extremely limited.
- Only one in four pregnant women has skilled attendance at delivery, and maternal mortality rates have risen since 1999. One in 14 Haitian children dies before his or her fifth birthday. Immunization coverage, at just over 50%, is well below the WHO goal of 90%.
- The earthquake posed dramatic additional challenges to the healthcare sector and a traumatized population.
- Approximately 4,000 amputees need ongoing support, particularly devastating in a country where the majority of the population travels by foot or bicycle.
- The outbreak of cholera, which appeared first in the central part of the country and subsequently spread to the capital and throughout Haiti, is a major public health tragedy with significant consequences in terms of lives and health of the population. Cholera, which had not been seen in Haiti in more than a generation, has also placed additional burdens on an already strained health care sector by diverting both human and financial resources for the response. However, several agencies responding to the earthquake were quickly able to enhance health, water, sanitation and hygiene programs to address cholera-related needs.
- State and USAID plan to spend $118.1 million on reconstruction efforts for health and other basic services.
- USAID and CDC have contributed to PAHO and the Ministry of Health’s campaign to immunize over one million people Haitians against highly communicable diseases, including polio and diphtheria.
- Through targeted food aid, U.S. assistance is working to counter malnutrition, distributing food to approximately 1.9 million Haitians.
- While data are not exactly comparable, the latest nutritional survey of earthquake-affected zones, released in late July, suggest that post-earthquake malnutrition levels were the same or slightly lower than pre-earthquake levels in children under five.
- To prevent malaria and other insect-borne disease, USAID partners have provided 800,000 insecticide-treated mosquito nets to earthquake-affected Haitians.
- In preparation for the rainy and hurricane seasons, U.S. assistance pre-positioned sufficient emergency relief supplies (including food, medicine, and blankets) for 100,000 individuals, with more available through our partners.
- Child protection work with orphans and vulnerable children affected by HIV/AIDS and the earthquake helped in identifying and tracking unaccompanied children in IDP camps and in health centers in the aftermath of the earthquake. Support and care was rendered to victims of sexual violence identified in IDP camps.
- Besides responding to and containing the cholera outbreak (discussed below), the U.S. Government continues to provide focused support for disease prevention. Other efforts are underway to ensure that cholera not contaminate sources of drinking water.
- New investments through USAID and CDC will construct or renovate and equip important health facilities such as the Haitian State University Hospital and 15 to 20 health facilities at the decentralized commune unit level, strategically selected to establish services in new settlements for those displaced by the earthquake.
- The U.S. Government will support a comprehensive package of services in U.S.-led development corridors and a core package of services in other areas.
- The U.S. Government will also invest in seven key health-related areas: technical programs, health financing, health workforce, commodities and supply chain management, health information systems, governance, and performance-based contracting.
- The U.S. Government, through the HHS, has provided coordination and consultation to a consortium of U.S. academic institutions, NGOs, and health professions organizations. The consortium has three working groups addressing the following areas: 1) undergraduate health professions education (e.g., medicine, nursing, and public health), 2) graduate medical education (residency and fellowship training), and 3) infrastructure building.
- Following the earthquake the U.S. Government, through HHS, initiated and coordinated the Haitian Health Facilities Working Group, an interagency working group that developed a comprehensive Haiti health facility database.
Over the past year, HHS agencies, including CDC and the U.S. Public Health Service, have partnered closely with USAID to work with the Haitian government and its partners to:
- Establish national and camp-based surveillance for diseases most likely to become epidemics. The newly established National Sentinel Surveillance System and Internally Displaced Persons Surveillance System provide this critical information.
- Strengthen the national public health laboratory to provide quality diagnostic tests for select reportable diseases, thus improving the quality of tuberculosis (TB), HIV/AIDS, malaria, and rabies diagnostic testing services, the reportable disease surveillance system, and the health care delivery system throughout the country.
- Along with USAID, assess and support the national TB program. Even before the earthquake, Haiti had the highest incidence and prevalence rates for TB in the Western Hemisphere.
- Control the spread of malaria, with scientists from CDC and MSPP working to improve diagnostic laboratory testing and to improve surveillance for malaria at a national level to target public health interventions.
- Strengthen the national immunization program by seconding a CDC immunization expert to work closely with MSPP to improve vaccine coverage, the introduction of new childhood vaccines and to improve surveillance for monitoring vaccine-preventable disease in children.
- Along with USAID, strengthen MSPP capacity to respond to reportable disease outbreaks; track water sanitation and hygiene (WASH) practices in IDP camps; track clean water shortages, availability of latrines, solid waste removal needs, number of hand washing sites, and signs of associated disease outbreaks.
- Establish nutritional information on the population living in camps.
- Launch a Field Epidemiology Training Program with MSPP to strengthen Haiti’s epidemiologic capacity to respond to public health priorities and emergencies.
- MSPP, the U.S. Government, non-governmental organizations, and other response partners have worked rapidly under challenging circumstances to respond to the cholera outbreak in Haiti.
- CDC is working closely with other U.S. Government agencies and international partners to assist MSPP in a concerted effort to control the outbreak.
- U.S. Government partners are working to establish and expand cholera treatment services in health facilities and communities throughout Haiti. USAID has funded a total of 33 cholera treatment facilities (CTFs) and is supporting more than 9,000 community health workers and hygiene promoters to provide hygiene education, cholera awareness and prevention training, and referral services, particularly in underserved and rural areas. USAID has provided nearly $42 million for cholera response efforts to date.
- On October 26, USAID deployed a DART to work closely with staff from the USAID Mission and CDC to coordinate emergency response efforts, provide technical assistance to the MSPP, and support longer-term health systems.
- USAID’s emergency cholera response plan focuses on preventing cholera cases, reducing the number of cases requiring hospitalization, and reducing the case fatality rate (CFR) through activities focused on the provision of chlorine to increase availability of safe drinking water; the expansion of national hygiene education outreach; the provision of sachets of oral rehydration salts (ORS) and medical supplies; and an increase in the number of cholera treatment facilities, particularly in underserved and rural areas.
USAID is also responding through the rapid procurement of relief commodities including:
- 300 metric tons (MT) of soap to prevent disease spread;
- 5.3 million sachets of ORS, sufficient to help 530,000 individuals;
- 600,000 liters of Ringer’s lactate, an intravenous saline solution to treat 75,000 individuals;
- 100,000 hard-sided, 10-liter water containers for safe household water storage;
- 30 MT of calcium hypochlorite, equivalent to providing sufficient chlorination for 100 percent of municipal water usage throughout Haiti for three months;
- 2,000 cholera beds;
- 33,180 hygiene kits, which include detergent, soap, shampoo, and toothpaste, to respond to non-governmental organization requests for the commodities; and
- Disinfection supplies and personal protection equipment to protect medical personnel working in CTFs.
- Efforts to enhance health facilities supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) will further expand treatment options in remote parts of Haiti.
- CDC epidemiologists working with partners conducted a Training of Trainers program to train health care providers on cholera treatment and management techniques in Haiti. Trainers trained in CDC’s program have already reached more than 400 Haitian clinicians providing healthcare to patients.
CDC is assisting with:
- increasing access to life-saving oral and IV rehydration therapy;
- improving access to safe water, sanitation, and hygiene supplies;
- maintaining a national surveillance system for accurate and timely identification of cholera cases;
- consulting on clinical management and treatment of patients with cholera;
- performing laboratory testing of suspected cholera cases in collaboration with Haiti’s National Public Health Laboratory;
- conducting environmental health assessments, such as testing of the water supply, in various communities throughout the country; and
- developing and translating (French, Haitian Creole, and Spanish) health education materials to encourage behaviors for effective treatment and prevention of cholera.
- CDC and partners have recommended actions to slow disease progression, reduce hospitalizations, and prevent deaths through early treatment.
- To further support these cholera relief efforts, HHS provided 25 cholera treatment kits, funded by USAID. Each kit can treat from 100 to 400 cases, depending on the severity of the cases. USAID transported the kits to all of Haiti’s ten departments to provide pre-positioned commodities throughout Haiti for the response.
- As of December 13, 2010, a total of 183 CDC staff are participating in the outbreak response, including medical officers, epidemiologists, laboratory scientists, environmental health specialists, communication specialists, public health advisors, planners, information technology specialists, and support staff.
- The earthquake destroyed physical infrastructure, such as hospitals, clinics, and MSPP buildings.
- Urban and community water infrastructure is degraded or non-existent, diverting those who gather water from more productive activities. The lack of infrastructure also poses a public health threat, which is made more acute now that the cholera bacterium is present and will spread throughout the country
- Deficiencies in the Haitian health system pre-earthquake continue to exist. There are shortages of community health workers, low retention of doctors and nurses, and low skill level and knowledge base at all levels.
- The roles and responsibilities of personnel at different levels of care (primary, secondary, and tertiary) are poorly defined and often overlap.
- Procurement and distribution networks for medicines and medical supplies are unreliable and fragmented.
- Despite a robust response by the U.S. Government and others, cholera will be a longer-term issue in Haiti, placing a strain on an already weak medical structure. Accessing clean water and sanitation; improving Haiti’s decrepit and damaged medical infrastructure, including emergency transportation and road access to communities; and ensuring Haitians have basic medical care will present ongoing challenges for years to come.
Pillar IV: Governance and Rule of law
- The earthquake severely undermined the already weak capacity of the Government of Haiti.
- An estimated 17% of the civil service was killed, including many in senior management; many other civil servants were unable to return to work.
- Twenty-eight of 29 ministry buildings were destroyed.
- Security has been an ongoing concern, with reports that looting and violence, particularly against women, have increased.
- State and USAID plan to spend $296.6 million for reconstruction efforts for governance and rule of law.
- The U.S. Government has supported the rebuilding of the Government of Haiti. This has included a temporary command center for the president’s top 100 staff at the National Palace, the refurbishment of the former U.S. embassy compound to house the temporary offices of the prime minister and the IHRC, a temporary building to house the parliament, the refurbishment of the former USAID headquarters to house the national courts, as well as support for technical assistance and advisors in key ministries.
- The U.S. Government provided $14 million funds to support the Government of Haiti and international community through the UNDP trust fund to prepare for the November 28 elections. As part of the support for elections, USAID supported a long-term election observation team from the OAS and CARICOM and supported the training and deployment of domestic observation groups.
- The U.S. Government sponsored presidential debates, which were attended by all political candidates and broadcast on radio and television throughout the country for the first time.
Rule of Law
- To strengthen rule of law, the U.S. Government supported the Haitian National Police (HNP) training academy by providing equipment, uniforms, hygiene supplies, classroom supplies, and food subsistence. This assistance advanced the HNP objective of building a trained force of 14,000 police by 2012.
- The U.S. Government deployed six Haitian-American New York Police Department officers to support the judicial police with their investigative techniques, monitor activities in the IDP camps, and propose training needs for existing HNP officers, to include senior management. These officers are currently on 90-day rotations for one year.
- The U.S. Government has scheduled architectural and engineering assessments at the HNP academy and two prisons in Port-au-Prince that were damaged in the earthquake in December 2010. Construction is anticipated to begin in the second quarter of FY11.
- We are also providing equipment and targeted technical assistance to reduce pre-trial detention and to strengthen key criminal justice institutions in their ability to manage cases more efficiently and provide services to the most vulnerable populations.
- The U.S. Government is also providing free legal assistance to vulnerable populations from the Cité Soleil neighborhood in Port-au-Prince, including supporting community outreach activities to increase civil and legal rights education and training court personnel and community leaders in the use of alternative dispute resolution to resolve conflicts.
- To improve security for IDPs, the U.S. Government has provided 1,000 headlamps and 500 flexible flashlights to HNP and MINUSTAH to facilitate night patrols in IDP camps. We have also supported installation of strategically placed street lights to improve security in selected camps and neighborhoods.
- The U.S. Government constructed security kiosks in six of the most at-risk camps in/around Port-au-Prince and provided temporary infrastructure (large tents, office furniture) for two security kiosks in each of 20 major IDP camps.
- The U.S. Government has scheduled deployment of additional police and corrections officers to increase the U.S. contribution in support of MINUSTAH to a total of 100 police and ten corrections officers. In close coordination with the UN, we have worked to identify additional female officers and officers with backgrounds in domestic violence, counternarcotics, management and administration to deploy in January 2011.
- The U.S. Government is improving the capacity of the Government of Haiti and NGOs to provide treatment to victims of violence and human trafficking, including medical, rehabilitation, psychosocial, and legal services, and conducting women’s support groups and messaging campaigns that raise awareness of gender-based violence’s destructive effects.
- The November 28, 2010 elections were marred by fraud and irregularities.
- Haiti’s highly centralized government structure complicates on-the-scene decision-making necessary to respond to the needs of the people.
- Lack of enforcement of existing laws can foster a sense of impunity.
- Corrupt practices discourage business formation and growth, and impede efforts to modernize government processes.
- The Haiti earthquake was an almost unprecedented urban disaster in the Western Hemisphere, striking a crowded city already struggling against crime, gangs, and other typical urban social problems. These pre-existing urban challenges will continue to complicate recovery efforts.
- Sustained criminal activity creates the perception that the Government of Haiti does not have the capacity to provide security and basic services.
January 12, 2010 will live in the world’s memory as a day of national calamity for Haiti. Twelve months after that disaster, there has been demonstrable progress in responding to immediate humanitarian needs, and in beginning the long process of rebuilding the country on a solid and sustainable foundation. Success in putting Haiti on the path to a better future depends on long-term engagement. That is the commitment the United States has made, and the American people, through their outpouring of generosity, have demonstrated their unequivocal support for Haiti.