Friday, December 31, 2010


(The Globe and Mail) - By Nicholas Galletti and Marc Lemieux

The election-related violence in Haiti that made headlines recently was, sadly, all too predictable. The record amount of money pledged to Haiti following a devastating earthquake was not enough to get the country back on its feet. The absence of a sustainable democracy is the root of the problem in Haiti – not poor construction or lack of funds. Everyone knows this.

But donor countries, including Canada, ignored this reality despite decades of experience. The 2006 presidential election in Haiti was marred by the same politicized electoral commission and lack of transparency. The crucial institution-building that was necessary to avoid a repeat was never completed. Food aid, reconstruction and security are doomed to failure under the weight of corruption, impunity and weak institutions.

This is exactly what Parliament’s Foreign Affairs committee recognized in 2007 when it published a landmark report aimed at advancing Canada’s role in democratic development overseas. Democracy is vital to ensuring that all other development efforts are effective. Democratic institutions and processes allow citizens to participate in the decisions that affect their lives, including economic and social development.

The Harper government followed with a promise in its Throne Speech in 2008 to create “a new, non-partisan democracy promotion agency … to support the peaceful transition to democracy in repressive countries and help emerging democracies build strong institutions.” Whether or not Canada needs a new agency to do this while many already exist with similar mandates is a topic of much debate. But the idea of making Canada a leader in democratic development abroad was welcome by all in this field.

This noble new foreign policy direction was short-lived. Instead of building up and strengthening Canada’s democracy support architecture, our government has been systematically dismantling it.

The Canadian International Development Agency’s Office of Democratic Governance, which channelled much of Canada’s democracy funding, was disbanded. The Department of Foreign Affairs’ Democracy Unit was folded into the Francophonie and Commonwealth division.

The Democracy Council, a forum for discussion and collaboration among Canadian democracy promotion agencies, disappeared despite interest from both government and non-government actors to see it expand.

The Parliamentary Centre’s Sudan and Haiti programs were “de-prioritized.” And our former organizations, Rights & Democracy and the Forum of Federations, have been rendered impotent by partisan and ideological board appointments and de-funding respectively.

And what of the new agency that was to make Canada a world leader in democracy promotion? Some say it was the victim of the disaster imposed on Rights & Democracy by its board; others cite the focus on austerity sweeping Ottawa. Either way, it has been put on the “back burner”.

One of the reasons stated for establishing this new agency was that many Canadian democracy experts were working for American agencies, instead of employing their talents on Canada’s behalf. Far from repatriating our home-grown expertise, we are in the process of exporting whatever is left.

And this is happening at exactly a time when Canada has an opportunity to fill a void in democracy support. In the wake of George W. Bush’s failed “freedom agenda,” which included using democracy promotion as the ex post facto justification for the invasion of Iraq, the Obama administration has been lukewarm to further adventures in promoting democracy. There is a shift back to a pragmatic concern for stability in U.S. foreign policy.

But the desire for democracy, for a choice in how one is governed and by whom, for basic human rights, will not disappear. The Haitians protesting a flawed election are proof of this universal desire.

This presents a clear opportunity for Canada to play a greater role in strengthening NGOs, political parties, electoral commissions, parliaments, federal-provincial frameworks, and other pillars of democracy. Canada’s approach of assisting developing countries and their citizens in building lasting democracies was viewed positively by many in our partner countries.

Unfortunately, following our embarrassing loss of a UN Security Council seat, the dismantling of our democracy support capacity is another missed opportunity for Canada on the world stage.

Nicholas Galletti was the former senior policy adviser to the president of Rights & Democracy. Marc Lemieux was a former director at the Forum of Federations and visiting professor at the University of Ottawa.


( - Source - CEPR -

WASHINGTON - An independent recount and review of 11,171 tally sheets from Haiti’s November 28 election shows that the outcome of the election is indeterminate. The review, conducted by the Center for Economic and Policy Research (CEPR), found massive irregularities and errors in the tally. A report detailing the recount’s findings, and methodology, will be made available next week.

“With so many irregularities, errors, and fraudulent vote totals, it is impossible to say what the results of this election really are,” said Mark Weisbrot, economist and CEPR Co-Director.

“If the Organization of American States certifies this election, this would be a political decision, having nothing to do with election monitoring,” said Weisbrot. “They would lose all credibility as a neutral election-monitoring organization.”

Among the preliminary findings:

While OAS Assistant Secretary General Albert Ramdin was quoted by the Associated Press as saying that “Nearly 4 percent of polling place tally sheets used to calculate the results were thrown out for alleged fraud at the tabulation center,” the actual number is closer to 12 percent. CEPR found that 11.9 percent (1,324) of the tally sheets were either never received by the CEP (Haiti’s Provisional Electoral Council) or were quarantined by the CEP due to irregularities. These tally sheets added up to more than 15 percent of the total votes counted.

In addition to the 11.9 percent of tally sheets not counted by the CEP, CEPR found that 6.4 percent of the tally sheets were irregular. These tally sheets contained vote counts that were so far outside the distribution of votes that they would not be considered valid. If we add these to the tally sheets not counted by the CEP, there are more than 18 percent of tally sheets – representing more than 22 percent of votes counted -- that are invalid.

In addition, there were widespread clerical errors – mis-recorded numbers – on the tally sheets: 5.4 percent of tally sheets had numbers that were obvious clerical errors. Although these errors did not necessarily affect the distribution of votes among the candidates, they add another element of uncertainty to the vote count. It is clear that with so many mistakes in recorded totals in the tally sheets, there would have to be errors in the candidate vote counts in addition to those that CEPR detected.

Turnout was extremely low: an estimated 22.3 percent of the electorate participated, as compared with 59.3 percent in the last (2006) presidential election. This was partly due to the fact that more than 12 political parties were arbitrarily excluded from participating in the election, including the country’s most popular political party.

Internally displaced people (IDP’s), who have been made homeless by the earthquake, were especially disenfranchised. In the cities of Port-au-Prince, Carrefour, Delmas and Petionville – which contain 20 percent of Haiti’s registered voters – the average participation rate was just 12.4 percent (11.25 percent if we remove additional irregular tally sheets).

“This election was of questionable legitimacy to begin with because the electoral authorities banned over a dozen political parties, including the country’s most popular political party,” said Weisbrot. “But with this massive level of irregularity, fraud, and disenfranchisement, it can hardly be considered a legitimate election.”

The Center for Economic and Policy Research (CEPR) was established in 1999 to promote democratic debate on the most important economic and social issues that affect people's lives. In order for citizens to effectively exercise their voices in a democracy, they should be informed about the problems and choices that they face. CEPR is committed to presenting issues in an accurate and understandable manner, so that the public is better prepared to choose among the various policy options.


(AFP) - By Clarens Renois

PORT-AU-PRINCE — International monitors began Thursday a drawn-out vote verification process aimed at breaking the political impasse in Haiti following last month's disputed presidential elections.

The team of 10 from the Organization of American States comprised statisticians and electoral and legal experts from the United States, Chile, Canada, France and Jamaica.

"The work will start today and the objective is to work through the weekend," OAS assistant secretary-general Albert Ramdin told AFP, speaking in Washington.

Ramdin predicted no public statements would be made during a behind-closed-doors process that will culminate in a report being presented to President Rene Preval, probably next week.

"They will be at the tabulation centers to understand the whole system as it has operated, which procedures were followed, how it was executed and then they will look at the result sheets and how it was counted," he said.

Preliminary results of the November 28 polls had former first lady Mirlande Manigat in the lead with 31 percent of the vote, followed by ruling party candidate Jude Celestin with 22 percent.

If those results hold, the two should advance to a run-off scheduled for January 16, but the count was rejected by popular singer Michel Martelly, who trailed Celestin in third by less than 7,000 votes.

Martelly's supporters and others took to the streets after the preliminary results, torching cars and government buildings and clashing with rival supporters and UN peacekeepers in violence that killed at least five people.

Preval, who stands accused of rigging the elections in favor of Celestin, has delayed the announcement of definitive results until after the OAS team has reported its findings.

Election day was a mess. Polling stations were trashed and thousands were unable to vote, either because they were not on the register or because they lacked identification papers lost in the earthquake.

The chaotic vote further destabilized a desperately poor Caribbean nation that is still trying to recover from the quake in January that killed a quarter of a million people.

Since mid-October, Haiti, whose recent history has been plagued by violent dictatorships and political upheaval, has also been battling a cholera outbreak that has claimed almost 3,000 lives and infected.

Many of the 19 presidential candidates have rejected the OAS verification mission and are calling for the first round to be scrapped and re-run, accusing Preval of orchestrating blatant rigging in favor of Celestin.

The front-runner, 70-year-old Manigat, urged the the international community last week not to impose its own political solution on the quake-hit nation.

"The OAS fancies itself the great fixer of the crisis, but how much time will it need to complete its work?" she asked, expressing concern that a prolonged verification process could delay the run-off.

Preval has warned it would be unwise to replace him with a transitional government if the political uncertainty is not sorted out before his mandate expires on February 7.

His comments raised the possibility he may seek an emergency three-month extension to his presidency -- through to mid-May -- a course mooted by his government earlier this year.

Increasingly unpopular and facing growing blame for the limp recovery as the first anniversary of the quake approaches, Preval is barred by the Haitian constitution from seeking a third term.

Before any actual recount, Ramdin said OAS experts may want to examine the benchmarks used by Haiti's Provisional Electoral Council (CEP) in determining valid tally sheets.

"The focus today and tomorrow is really to look into all the systems and then agree on how they are going to proceed. I am sure the experts will stay on until next week," Ramdin said.

Asked if the run-off might need to be delayed because of the protracted recount and verification process, Ramdin said that was a matter for the Haitian authorities and the CEP.

"They have their own benchmarks in terms of how many days they need to prepare for the second round, so they will have to be the ones speaking on this," he told AFP.

The US embassy called the election results "inconsistent," but the international community as a whole has stopped short of discrediting the vote, urging only that the will of the Haitian people is respected.



The prime minister of Haiti has criticised the international community for not allowing his country to play a bigger role in its own reconstruction following last January's earthquake.

Jean-Max Bellerive told the BBC his government had too little influence because aid money was channelled through outside agencies.

He added that only 20% of the aid pledged had been received so far.

Nearly one year on, more than one million Haitians still live in camps.

Mr Bellerive said donors and the international community were not working with Haitians to find solutions when channelling aid to those who need it. He said greater control of non-governmental organisations (NGOs) was needed.

"Let's be clear, I have nothing against NGOs - we need them. What I need is to have control over what they do in my country, where they do it and with whom they are doing it, and at what cost," he said.

Mr Bellerive said he was constantly being asked why there were no visible results from donated money.

"It's very difficult for me to give explanation for the use of money that I never receive," he said.


(Latin American Herald Tribune) -

SANTO DOMINGO – The Organization of American States removed its special representative in Haiti, Ricardo Seitenfus, from his post, a diplomat said on condition of anonymity.

The move came after the publication in a Swiss newspaper of remarks attributed to the diplomat in which he questioned the role of the U.N. Stabilization Mission for Haiti, or Minustah, which has been in the country since 2004, and the policy of the international community toward the Caribbean nation.

Seitenfus said in the interview published Dec. 20 that the U.N. had “imposed” the presence of its troops in Haiti despite the fact that the country was not involved in a civil war.

“Haiti is not an international threat. We’re not in a situation of civil war. Haiti is neither Iraq nor Afghanistan. However, the (U.N.) Security Council, given the lack of any alternative, has imposed the blue helmets since 2004, after the exit of the president (Jean-Bertrand Aristide),” the OAS diplomat told Switzerland’s Le Temps.

The Brazilian diplomat, who had been scheduled to leave the post anyway in the coming months, also said in the interview that Haiti “is on the international stage mainly due to its great proximity to the United States. Haiti has been the object of negative attention on the part of the international system. For the U.N., this is about freezing power and transforming the Haitians into prisoners on their own island,” namely Hispaniola, which Haiti shares with the Dominican Republic.

“The Haitians committed the unacceptable in 1804 (the year of their independence): a crime of lese majesty for an anxious world. The West (was) then a colonial, slave-holding and racist world that based its wealth on the exploitation of conquered lands. So, the Haitian revolutionary model made the great powers afraid,” Seitenfus said.

The OAS official also analyzed the role of non-governmental organizations in Haiti, in particular after the Jan. 12 earthquake, and he said that “the cooperative (organizations) that arrived after the quake are not very old; they came to Haiti without any experience ... (and) after the earthquake, the professional quality fell a great deal. There exists a maleficent or perverse relationship between the NGOs’ strength and the Haitian state’s weakness.”

Seitenfus, in addition to his responsibilities with the OAS, was that organization’s delegate to the Interim Haiti Reconstruction Commission, or IHRC.



In an interview published Monday in the newspaper "Le Temps" in Switzerland, the representative of the Secretary General of the OAS, Ricardo Seitenfus explains the causes and errors which led to the failure of the international community in Haiti.

Ten thousand peacekeepers in Haiti. In your opinion, a counter-productive presence?

Ricardo Seitenfus: The system of prevention of disputes within the UN system "cadre" is not adapted to the Haitian context. Haiti is not an international threat. We are not in a civil war situation. Haiti is neither Iraq nor Afghanistan. And yet the Security Council, lacking another alternative, have imposed peacekeepers since 2004, after the departure of President Aristide. Since 1990, we are here in our eighth UN mission. Haiti has seen since 1986 and the departure of Jean-Claude Duvalier what I call a "low intensity conflict". We are confronted with power struggles among political actors who do not respect the "democratic game". But it seems to me that Haiti, on the international scene, pays essentially for its' proximity to the United States. Haiti has been the subject of negative attention on the part of the international system. It can be said that the UN has "frozen power" and transforms Haitians into prisoners on their own island. The anguish of boat people explains many of the international decisions concerning Haiti. We want at any price that they stay home.

What prevents the normalization of the Haitian case?

Ricardo Seitenfus: For two hundred years, the presence of foreign troops has alternated with that of dictators. It is force which defines international relations with Haiti and never dialogue. The original sin of Haiti, on the world scene is its' liberation'. The Haitians committed the unacceptable in 1804: a crime of "self-majesty" for a troubled world. The West has always been a colonial world. Slavery and racism are the foundation of its' wealth on the exploitation of conquered lands. Therefore, the Haitian revolutionary model scares the superpowers. The United States did not recognize Haiti's independence until 1865. France required payment of a ransom to accept its' liberation. From the beginning, independence is compromised and the development of the country hampered. The world has never known how to deal with Haiti, so it ended up ignoring it. Thus began two hundred years of solitude on the international scene. Today, the UN has blindly applied Chapter 7 of its' charter. It deploys troops to impose its' peace operation. Nothing is solved, only made worse. We want to make Haiti a capitalist country, an export platform for the American market. It is absurd. Haiti must return to what it is, that is to say, a predominantly agricultural country still fundamentally imbued with customary rights. The country is continually described in terms of its violence. But without a state, the level of violence reaches only a fraction of that of Latin American countries. There are elements that exist in this society that have prevented the violence from spreading beyond measure.

Is not a resignation to see a nation unassimilable in Haiti, whose only horizon is a return to traditional values?

Ricardo Seitenfus: There is a part of Haiti that is modern and urban. It is estimated that 4 million Haitians live beyond its' borders. It is a country open to the world. I do not dream of a return to the 16th century, to an agrarian society. But Haiti lives under the influence of the world, the NGOs, and universal charity. More than 90% of the education and health systems are in private hands. The country does not have the public resources to be able to operate a minimal state system. The UN fails to take account of cultural features. Condensing Haiti to a peace operation is making challenges to the country's economy. The problem is socio-economic. When the unemployment rate has reached 80%, it is not supportable to deploy a stabilization mission. There is nothing to stabilize and everything to build.

Haiti is one of the most subsidized countries in the world and yet the situation has only deteriorated over the past twenty-five years. Why?

Ricardo Seitenfus: The emergency aid is effective. But when it becomes structural, when it replaces the state in all its missions, it leads to a collective lack of responsibility. If there exists a proof of the failure of international aid, it is Haiti. The country has become a Mecca. The earthquake of January 12th and then the cholera epidemic only accentuate this phenomenon. The international community has the feeling of having to repeat every day what it ended up doing the previous day. Haiti fatigue begins to emerge. This small nation has startled the world's conscience with disaster after disaster. I had hoped that in the distress of January 12th, the world would understand what they had done wrong with Haiti. Unfortunately, it has reinforced the same policy. Instead of taking stock, we send more soldiers. We must build roads, erect dams, participate in the organization of the State, the judicial system. The UN says that it does not have the mandate for that. Its' mandate in Haiti "is to keep peace in the cemetery".

What role do NGOs play in this bankruptcy?

Ricardo Seitenfus: Since the earthquake, Haiti has become a crossroads. For the international NGOs, Haiti has become "a place of forced passage". I would say even worse that it is a "training ground". The age of those who arrived after the earthquake is very young; they landed in Haiti without any experience. And Haiti, I can tell you, is not suitable for amateurs. After Jan. 12, because of massive recruitment, the professional quality has declined significantly. There is a sad relationship between the strength of the NGOs and the weakness of the Haitian state. Some NGOs exist only because of the misfortune of Haiti.

What mistakes were made after the earthquake?

Ricardo Seitenfus: Faced with the massive importation of consumer goods to feed the homeless, the situation of Haitian agriculture has deteriorated further. The country offers an open field to all humanitarian experiences. It is unacceptable from a moral standpoint to consider Haiti as a laboratory. The reconstruction of Haiti and the promise of $ 11 billion inflames lust. It seems that a lot of people come to Haiti, not for Haiti, but to do business. For me as an American it is a disgrace, an affront to our conscience. An example: the Haitian doctors that Cuba trained. More than 500 have been educated in Havana. Nearly half of them, though they should be in Haiti, are working today in the United States, Canada or France. The Cuban revolution is currently financing the training of human resources for its capitalist neighbors...

We constantly describe Haiti as the margin of the world, you feel rather that the country is a concentrate of our contemporary world?

Ricardo Seitenfus: It is the concentration of our tragedies and failures of international solidarity. We do not rise to the challenge. The world press comes to Haiti and describes the chaos. The reaction of public opinion is not unexpected. For public opinion, Haiti is one of the worst countries in the world. We must go to the Haitian culture, we must go local. I think there are too many doctors at the bedside and the majority of these doctors are economists. But in Haiti, we need anthropologists, sociologists, historians, political scientists and even theologians. Haiti is too complex for people who are in a hurry. Nobody takes the time or tries to understand what I might call "the Haitian soul". The Haitians have well grasped, that we are considered, we the international community as "a milk cow". They want to take advantage of this presence and they do so with extraordinary mastery. If the Haitians consider us only for the money that we bring it is because we are presenting ourselves like that.

Beyond the admission of failure, what solutions do you offer?

Ricardo Seitenfus: In two months, I will complete a two-year mission in Haiti. To stay here and not be overwhelmed by what I see, I had to create a number of psychological defenses. I wanted to remain an independent voice despite the weight of the organization that I represent. I have taken this view because I wanted to express my profound doubts and tell the world that it is enough. It is enough of playing with Haiti. January 12th taught me that there exists a potential of extraordinary solidarity in the world. Also, we should not forget that in the first days, it was the Haitians themselves, with bare hands, who tried to save their loved ones. Compassion has been very important in this emergency. But charity can not be the driving force in international relations. It is autonomy, sovereignty, fair trade, respect for others which must be. We need to think simultaneously of providing export opportunities for Haiti but also protect the "family farm" which is essential for the country. Haiti is the last untapped Caribbean paradise for tourism, with 1700 kilometers of pristine coastline and we need to encourage cultural tourism and avoid paving the way for a "new Eldorado" of mass tourism. The lessons that we have given have been ineffective for too long. The reconstruction and the accompaniment of a rich society is one of the last great human adventures. For 200 years, Haiti has illuminated the history of mankind and of human rights. We must provide an opportunity for the Haitians to confirm their vision.

Thursday, December 30, 2010


Christmas here in Haiti was a difficult one for people with all that has happened over the year; especially for those living in the camps. To see a news video follow the link to:


(ReliefWeb) - Source: Pan American Health Organization (PAHO); World Health Organization (WHO)

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The evolution of an epidemic cannot be defined with precision. Past experience has shown that an epidemic does not follow a uniform pattern but consists of multiple outbreaks in different areas that may peak in a few weeks in some places, a few months in others. For planning purposes, the Haitian government is using an estimate of 400,000 cases over the first 12 months, with half of those cases in the first 3 months. There are concerns that in some rural areas the case fatality rate is still very high.

At present, there are enough supplies of medicines for the treatment of estimated cases in the near future, with more supplies continuously arriving. The distribution of these supplies in the departments remains a complex logistic operation, which is sometimes made worse by the security situation.

All partners should build a network of community health workers around the treatment centers with the goals of having every family knows how to recognize, prevent and treat cholera, providing every community with a cholera rehydration post, and of engaging every sector of society in the response.

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PAHO/WHO, co-chairs the Health Cluster with the MSPP, and provides a range of support to the government and population.

Among the main activities that support the MSPP cholera strategy has been the establishment of Cholera Treatment Centers, Cholera Treatment Units, and Oral Rehydration Posts with the MSPP and partners. Over 500 CTU health workers have been trained by PAHO/WHO in cholera case management.

Mobilisation of the community has been strengthened by training courses for various audiences such as community and religious leaders on how to manage cholera in their community. In addition, the MSPP has trained over 1000 community health workers so far.

MINUSTAH has produced a protocol - Concept of Supporting Operations, Cholera –which provides an informative guide on the MINUSTAH operational approach and its capacities to provide support to post earthquake and the cholera crisis.

The Lutheran World Federation (LWF) in collaboration with Fin Church Aid (both members of ACT Alliance) continues its support in various locations in Leogane, Gressier, Petit Goave, Grand Goave and St Mark. The LWF Primary Health Promotion (PHP) team initiated awareness raising campaigns and distributed material in 5 Nerette camps in Petion-Ville, reaching 987 families.

LWF has also supported its local partner NGO (Oganizasyon Santé Popile/OSAPO) in St Mark by providing large tents and provided funds for a 3 months Emergency project for prevention and treatment service to infected people.

The International Federation of Red Cross and Red Crescent Societies (IFRC) continue to support Haitian Red Cross (HRC) and Partner National Societies (PNSs) in their response to cholera. The IFRC is supporting the development and implementation of the Haitian Red Cross’ Cholera Plan of Action with a reach beyond the earthquake-affected areas. This Plan of Action is in line with the Ministere de la Santé Publique et Population’s (MSPP) strategy. The IFRC and PNSs have deployed Basic Health Care Emergency Response Units (ERUs) to set up CTC/CTU, support the overall response and assist the vulnerable population.

IFRC is supporting the HRC and PNSs and Bureau of Delmas, Medecins du Monde-Canada, Medecins du Monde-France, and other health partners in their efforts in the field. IFRC provides assistance and hygiene supplies to IDP camps through organizations working in them. ORS posts are to be established.

Supported by the British, Canadian and Spanish Red Cross, the IFRC has provided 6 pick-up trucks for the Haitian Red Cross ambulance service for the cholera patients. This service operates 24/7. Between 1 – 26 December, 706 cholera patients have been transported by Haitian Red Cross ambulances.

The main needs can be summarized as followed:

(1) Community mobilization for preventive behaviors and prompt treatment, this is the most urgent: many deaths can be avoided if people learn how to prevent cholera and to take simple steps to initiate treatment.

(2) The control of the epidemic will depend on access to safe water, basic sanitation and application of hygiene promotion measures. The Haitian government has begun to chlorinate all public water systems, which is a big advance for the country. PAHO/WHO is working with other partners in Water, Sanitation and Hygiene Cluster to monitor water quality, provide technical support to CTCs and CTUs for safe water and safe disposal of waste and to provide policy guidance to the Government.

(3) Access to care: Only about 40% of the population has access to health care. The health partners active in Haiti, including those working outside the UN’s Health Cluster system -- such as MSF and the Cuban cooperation -- are working with Haitian authorities to set up various types of facilities to care for all stages of cholera treatment.

(4) Coordinated action is vital. With so many partners active in the response, it is important that resources are distributed to where they are most needed. PAHO/WHO works closely with the government to coordinate the response and is the leader of a UN mechanism called the Health Cluster. The Cluster involves 27 partners that are active in setting up healthcare centers, distributing medicines and running public education campaigns.

More needs include:

Additional doctors, nurses, support staff and local community health workers.

Training for local health staff in cholera case management.

Medical supplies must be pre-positioned in sufficient quantities to be able to be sent to any area that needs them quickly.

These needs reflect the necessity to respond to treatment needs. The problems of infrastructure (lack of clean water, poor sanitation, illiteracy) have been Haiti’s reality for decades and are barriers to the response.


On December 29, The Ministry of Health of Haiti (Ministère de la Sante Publique et de la Population, MSPP) reported that the cumulative number of cholera cases was 148,787 and deaths due to cholera was 3,333, as of December 26. Of the total cholera cases, 83,166 patients have been hospitalized. The overall case fatality rate was 2.2%.

Although epidemics tend to follow a certain pattern, we cannot predict exactly how they will evolve. The mortality rate will depend on the response. Without access to treatment (either at home or in a health facility) the mortality rate rises from 1% to as high as 25-50% for severe cases.

As of 18 December, all ten departments of Haiti have reported cases and deaths due to cholera. During the previous three epidemiological weeks, the highest cumulative incidence was observed in the departments of Artibonite followed by Nord Ouest, Nord and Centre.

In the North department, cholera epidemic has entered a "second phase": New foci of patients in remote areas are seen, which makes the response more difficult in terms of logistics, mobilization of human resources and introduction of oral rehydration points.

In the Central Department / Haut-Plateau (Cerca La source, Thomassique, Boc Banic et Los Cacaos) have reported a high number of cases.


PAHO/WHO is supporting an alert system that works in conjunction with the national surveillance system. Alerts are raised, for example, when there is a sudden peak in cases, unexpected deaths, or a community is identified that is completely unsupported. Once an alert is received, a team may be sent to investigate and conduct needs assessment. The teams comprise epidemiologists, risk assessment specialists, logistics specialists, and environmental health consultants who are in the field across the country and liaise with the MSPP.


Save the Children runs 6 CTUs functioning 24/7 with a total bed capacity of 80-100, in Carrefour, Delmas, Bainet, and Maissade. The number of cases admitted in CTUs in all locations has increased last week. Save the Children plans to open 4 more CTUs this week in Belle Anse, Carrefour, Delmas, and Grande Riviere, functioning 24/7 and will continue service during the holiday season.

The French Red Cross (FRC) continues its work regarding the installation and reinforcement of CTC and CTU in more than 30 sites (material, staff, training). FRC has developed an "emergency reactive approach", consisting of the installation of emergency CTU, temporary if needed, in order to provide a quick response close to populations and to prevent the spread of the epidemic. The installation of a new CTU in Ducrabon, by helicopter as the village is in the mountains, 50km from PaP, responds to this strategy. Additionally, consistent support is given to the Département sanitaire de l`Ouest (DSO) in the management of dead bodies, training activities and staff.

FRC has installed 17 CTU - 12 in Port au Prince, 1 in Kenskoff, 1 in Ducrabon and 3 in Petit Goave - and 15 are already operational. Specific zones have been habilitated to receive sick people, staff has been trained and material has been delivered. The CTU of Chapi, in Cité Soleil, is open 24/7. More than 1 600 cholera cases have been treated up to day in FRC’s CTUs. The Haitian Red Cross has been contacted to explore the possibility of working with HRC volunteers in order to increase the number of disinfection agents in this centre.

FRC trainings, needs assessments, supervision visits and works linked to CTUs and CTCs have continued:

Trainings have been provided in the CTC of Gheskio Bicentenaire, the health center of Fondeph (PaP) and in the new CTU installed in Ducrabon. Since the beginning of the epidemic, 688 medical staff has been trained in Port au Prince.

Needs assessments have been conducted in three new CTUs in the health centers of Saint Martin 1 (Delmas), Saint Antoine and Solino (PaP).

Reinforcement of the CTC of Gheskio IMIS and Ste Philomene hospital in PaP (installation works).

The CTU in La Piste, run jointly by British Red Cross, Finnish Red Cross, and Partners in Health has received more than 1,000 patients. It has 70 beds capacity, with plans to scale up to 90 beds. Oral Rehydration points will be set up in surrounding camps, which will refer serious cases to the CTU in La Piste. Hygiene promotion activities with a special focus on cholera continue in La Piste, Automeca, Delmas 19 and Annex de la Mairie.

In Port-a-Piment (Sud department), the British Red Cross and part of the Japanese Red Cross Society ERU support a CTU

In the South East Department, in Léogâne and Jacmel, the Canadian Red Cross will establish Oral Rehydration Posts (ORPs) as follows: 12 in the shelter sites in Jacmel; 12 in the Leogane commune; and 29 in les Nippes. 10,000 prevention kits are in place in these locations.

In Arcahaie, the German Red Cross manages a CTC and supports MSPP’s activities in Carrefour. 929 cases of cholera have been treated in the 24 beds CTC in Arcahaie. The German Red Cross mobile health team is visiting villages (reaching over 10,000 so far) to promote hand washing, water disinfection, ORS use and proper sanitation.

In Grand Anse, the German Red Cross WASH project supports the CTC run by MDM with sanitation facilities (latrines and showers). Safe water is supplied to 2 CTCs and 1 CTU (Jeremie, Moron, Rousseau). 250 HRC volunteers were trained and 200 beneficiaries were reached during a one-day sensitization activity held in Rousseau.

In Petit Goave and Grand Goave. Norwegian Red Cross supports the Medicines du Monde Spain CTC in Petit Goave, Finnish Red Cross and Norwegian Red Cross have deployed an advance team to assess possible sites for establishing new CTCs. Assessments have been carried out in Jeremie (Grand Anse department) and Miragoane, Anse a Veau (Nippes department). The Advanced assessment team from Norwegian Red Cross is going to the North East for a new assessment.

An updated list of CTCs and CTUs has been published and can be found on the Haiti Health Cluster site at:

A new list of ORPs has also been created and can be found at the same address:


Management of dead bodies continues to present challenges to health authorities and agencies involved in cholera response.

The responsibility for managing cadavers lies with the Ministry of Health and the Mayors’ offices. Guidance has been prepared on proper disposal of dead bodies, and training for those who are handling the corpses is ongoing. There are protocols of disinfection of the areas from where the dead bodies are picked up (CTCs, homes and public places such as streets, sidewalks, etc), for disinfection of bodies, proper transportation and ensuring proper disposal in previously prepared areas.

PAHO/WHO and partners are working with the government on a training program for community leaders (civic leaders, religious leaders, etc) that explains how to manage cholera, including how to manage dead bodies. The training will be delivered by the government.

Direct support with vehicles and staff is given to the DSO by PAHO/OMS, French Red Cross and NGOs.

Only one mass grave has been prepared for dead bodies in metropolitan Port-au- Prince, This issue remains a serious problem in other areas of the country affected by cholera.


PROMESS has created a simplified procedure to obtain cholera medical supplies for organizations that are not registered with the Ministère de la santé publique et de la population (MSPP). This procedure can be found at

For those who are registered with the MSPP in the country, go directly to PROMESS or write to

A new warehouse in Tabarre (6km from the Haitian Red Cross / IFRC Base Camp) is now operational with transfer of cholera supplies an ongoing activity.


Training in LSS-SUMA software was provided to DINEPA personnel and OXFAM-Quebec. The training aimed at improving their inventory management and distribution systems with a main focus on WASH. SUMA was installed in both institutions and customized with the names of the departments and communes for easy users` registration.


PAHO/WHO, the WASH cluster, UNICEF, UNOPS, MSF and DINEPA finalized a protocol on excreta management `Protocole pour l’évacuation des excrétas par les entreprises de vidange/nettoyage et les ONG.

This protocol includes information on personnel protection, vehicles equipment, procedures for toilet evacuation, procedures at the disposal site, what to do with an accidental spill, maintenance and upkeep of equipment and reports that need submission. It also has a section on human waste management at cholera treatments units and centers. The protocol has been developed in light of the changed circumstances due to the cholera outbreak. The protocol, in French only, can be found at:

This new protocol will be disseminated by training of trainers: Formations des formateurs sur la Protocole pour l'Evacuation des Excrétas par les Entreprises de Vidange/ Nettoyage et les ONG in PaP and in the departments. The new trainers will provide cascade training in their organizations/structures in the country.

For more information, contact Moustapha Niang ( ) and WASH Cluster, Kelly Ann Naylor ( ). The deadline for registration is Tuesday 4 January 2011.

PAHO/WHO is working with Action Contre la Faim and the WASH cluster in looking for more long term durable solutions for providing water to communities. In addition, monitoring of water quality is ongoing in both water truck filling stations and in water providers and bladders across the metropolitan area.

The IFRC and Haitian Red Cross continue to provide water services to 220,000 people and also support PNS in-country. Water is distributed to IFRC-supported camps and other distribution sites using a concentration of residual chlorine of 0.7 milligrams per litre as a preventive measure against cholera.

The IFRC team conducts regular monitoring to verify how the water treatment process takes place and to test the chorine level before water reaches people at the tap stands. Safe water is supplied to CTCs and CTUs in Arachaie, Port-a-Piment, Grand-Goave and Port-au-Prince (La Piste and Carrefour). The IFRC also supported Haitian water authorities (Direction Nationale de l’Eau Potable et Assainissement –DINEPA) and Movement partners through the provision of 14 millions aqua tabs.

IFRC currently manages 206 latrines. 38 clean up kits were distributed and 175 showers are in place.

In Bas Artibonite, the French Red Cross continues its water distribution. Three primary health centers (in Desdunes and Grandes Salines), two CTCs (Marchand Dessalines and Petite Riviere) and a dispensary (Petite Riviere) have been supplied in drinking water by water-trucking. Distributions were also conducted in several villages of Desdunes, Saint Marc and Grandes Salines. This week, 84 000 gallons were distributed. Six bladders have been installed in different villages. In Duclos (Desdunes, Bas Artibonite) FRC is rehabilitating the water network of the village.

The Spanish Red Cross together with Haitian Red Cross have been working in the Earthquake operation since the beginning supporting an average of 95.000 beneficiaries in PAP. They have been using a community volunteer approach in order to assure the maintenance of the infrastructures in the camps (water, latrines, cleaning activities, waste removal, etc).

Moreover, since 8 November, the Spanish Red Cross is working in cholera activities such as disinfection, rehydration community points. The activities are also carried out by volunteers from the camps.

Other examples of partners work in the communities include:

In Bas-Plateau, the Mercy Corps sensitized 2054 persons and distributed 70.000 AQUATABS and 1245 SRO (one per family).

In Mirebalais, the Mercy Corps with DINEPA distributed chlorine tablets to 7392 families in 4 communal sections. Each family received a month’s supply of 212 tablets.

In coordination with MSPP, assessments are taking place in the department of Nord-Est to determine the need for the deployment of a Massive Sanitation Module (MSM 20) and an additional CTC.

The Haitian government is chlorinating all public water systems, which is a big step for this country. PAHO/WHO is working with partners in the Water, Sanitation and Hygiene Cluster to monitor water quality, increase access, providing technical collaboration to CTCs and CTUs and provide policy guidance to government.


Hundreds of volunteers from Haitian Red Cross branches are receiving training from IFRC on preventive health and hygiene promotion, and are taking part in cholera prevention awareness-raising activities in schools, communal areas and markets throughout the country.

IFRC training was provided to vacuum truck operators on the use of personal protective equipment for handling both the chlorine as to limit contact with cholera. These vacuum truck operators spray the interior of the latrines with chlorine after emptying them and the area around the latrines. The spray of 206 latrines is assured twice a week since mid-November.

Training is also being provided to improve HRC volunteers’ ability to facilitate group discussion as part of the cholera psychosocial support response strategy: group discussion, with both children and adults, are being used to address stress, fear, rumours, stigma related to the cholera outbreak.


A series of key health promotion materials developed by PAHO/WHO and the Ministry of Health have been approved for production and distribution throughout the country by the Government. The materials include:

Brochures on cholera prevention in agricultural and farming settings and salt fields developed with the Agriculture Cluster;

A guide for relatives and/or friends caring for cholera patients in CTCs, CTUs and other health facilities;

Posters to be included in the treatment kit (bucket, ORS, soap, aqua tabs,) given to each patient, demonstrating what do at home during the days following recovery and what to do in case of not feeling well again;

Posters about the importance of rapidly seeking help at the nearest health facility, immediate use ORS (oral rehydration salts) treatment and better hygiene practices;

A guide for community leaders with the 12 official cholera prevention messages and;

Posters about the importance and practice of hand washing.

All materials have been produced in Creole, with the assistance of experienced Haitian graphic artists, assuring the audience will related with the characters used and the way the messages are conveyed.

The PAHO/WHO Haitian expert participated in a one-hour radio show at MINUSTAH-FM. The show included answering phone-calls regarding the cholera outbreak from concerned listeners from across the country. Questions focused on prevention measures, treatment at home, and treatment and handling of family members with cholera.

Save the Children activities related to public on hygiene promotion messages, provision of hygiene supplies (soap, aquatab, jerrycans), water quality testing, and ORPs (in more than 20 points) are ongoing in Dessalines, Maissade, Port-au-Prince, Jacmel, and Leogane.

The Emergency Bureau of Haiti Participative initiated a National Caravan called "Karavan Zewo-Kolera". This collective project is owned and operated by several humanitarian partners with the objective to promote massively cholera preventive measures and combat discriminative behavior. From 17 to 19 December, the "Zero-Cholera Caravan", 3 convoys of mobilization and sensitization held several activities among which a competition of Poems against cholera between primary-schools pupils and the Red-Ink Votes where children and adults voted for Zero-Cholera Objectives. The "Karavan Zewo-Kolera" reached 97 schools and approximately 23,000 families. 1,350 families received hygiene kits and ORS. T-shirts of sensitization were also distributed to lactating women.

The Lutheran World Federation (LWF), in partnership with Finn Church Aid/ACT Alliance, distributed hygiene kits, soaps and Aquatabs to 6 schools in Petit-Goave (3,437 beneficiaries). Along with distributions there were awareness raising sessions on hygiene and cholera disease prevention done by the Primary Health Promotion team. The activity is ongoing targeting 75 schools until end of March 2011.

From the onset of the cholera outbreak the IFRC and the Haitian Red Cross increased the preventive health and hygiene promotion activities to palliate the epidemic:

46,778 beneficiaries in camps have been sensitized by HRC volunteers on cholera treatment and prevention messages.

Distribution of aqua tabs in IDP camps and communities is taking place in coordination with CASEC, camp presidents and hygiene promoters.

The IFRC has also created the following media messages:

300,000 SMS sent per day on the correct use of aqua tabs and disinfection, addressing cholera stigma and fear of cholera treatment centers.

The sound truck continues delivering messages through Port-au-Prince.

One edition of Radio Croix Rouge was broadcast on Radio 1 (90.1FM) and streamed live at:

Cholera continues to be the main topic discussed during the show, sharing experiences and giving live saving messages to the population. The last show focused on CTCs.

Radio stations across Haiti are running the 3 minute Red Cross cholera prevention advert for free (including the 4 biggest stations in Haiti, Metropole, Caraibes, Ginen and Radio 1).

Information and the list of the CTCs in Haiti will be uploaded to the Red Cross free information line *733. This service, which offers pre-recorded messages in Creole, will be promoted through the SMS platform.

American Red Cross conducts hygiene promotion activities through the deployment of promoters to camps. Messages focus on cholera prevention, transmission, symptoms, vulnerable populations, how to prepare ORS, and demonstrations on proper hand-washing. From 16 to 22 December, American Red Cross cholera prevention activities included:

8,275 people in 17 camps from Port-au-Prince received hygiene promotion and cholera prevention information and materials. 5,929 people participated in tent-to-tent hand-washing demonstrations.

161 people were reached through a hygiene promotion and cholera prevention information session in Laboule. 200 cholera prevention flyers were distributed.

In the North-east, promoters provided hygiene promotion and cholera prevention messages to 155 community members in Acul Samedi (Locality of Fort-Liberte) and Nappe (locality of Trou du Nord).

In Les Cayes, British Red Cross is coordinating with Danish Red Cross for the distribution of soap and information, education and communication (IEC) materials with cholera messages in schools and in public place.

Finnish Red Cross, in coordination with Swedish Red Cross and Icelandic Red Cross continue supporting HRC volunteers to respond to the cholera outbreak. The security situation was hindering the volunteers from running their activities, yet they managed to reach people with their cholera prevention messages.

The four PS teams of Leogane (Lafferonay), Petit-Goâve, Canapé Vert (Sainte-Marie) and Carrefour are participating in the prevention campaign together with hygiene promoters. PS volunteers are addressing the resistance to prevention messages by organizing discussion groups where fear, rumours, stigma are being addressed. Volunteers are working in schools and in the community with both children and adults.

Hygiene promotion and cholera prevention activities continue in Place Jerome, De Louise, Saint Marie and Park Harry supported by the 62 volunteers. There are not yet cholera cases in these camps but many in their vicinity. HRC volunteers are placed in each of the subcamps Kau Mango, Akaba Kafe, Font Brasch and Larousse/KauLaman including surrounding areas.

Cleaning campaigns have been planned in different places around De Louise and Saint Marie.

Cleaning materials has been provided to Delouise.

Netherlands Red Cross, together with the HRC, is responding with prevention measures in the South East department:

176 volunteers were trained on cholera and health education.

12,879 people reached through hygiene promotion sessions with specific messages on cholera prevention and treatment in the communes of Jacmel, Marigot, Cayes Jacmel and La Valee.

So far 11,128 families have been identified as most vulnerable have received non-food items (NFIs) to contain the spread of cholera; of these 2,439 families have each received:

1 jerry can (10 litres), 2 bars of soap, 180 (33mg) tablets of aqua tab (chlorine), 2 information flyers with messages on cholera prevention/treatment, and 2 ORS sachets.


(ReliefWeb) - Source: United States Agency for International Development (USAID)

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The U.N. Office for the Coordination of Humanitarian Affairs (OCHA) notes that the overall decrease in recent weeks of the cholera case fatality rate (CFR) may be a result of the impact of the humanitarian response to the outbreak, but may also be due in part to underreporting of cases in rural areas.

The CFR is currently 2.1 percent countrywide and has declined by 0.2 percent since November 27. OCHA highlights that the CFR remains particularly high in Grand Anse Department.

USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) recently committed funding to grantee Catholic Relief Services (CRS) to provide health interventions in Grand Anse Department.

On December 29, USAID/OFDA also provided more than $400,000 to the Center for International Studies and Cooperation (CECI) to support WASH projects in Artibonite Department. USAID/OFDA funds will help reduce the vulnerability of approximately 250,000 people to cholera through the promotion of safe hygiene practices.

Map: Haiti: USAID Humanitarian Assistance for Cholera Outbreak (as of 29 Dec 2010)

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Overall Cholera Caseload: 130,534 ................MSPP1 – December 18, 2010

Hospitalized Cases: 70,865 .................MSPP – December 18, 2010

Deaths Due to Cholera: 2,761...............MSPP – December 18, 2010

Overall Case Fatality Rate: 2.1 percent MSPP – December 18, 2010


USAID/OFDA Assistance to Haiti for Cholera.......................................................................$39,212,495

USAID/OTI2 Assistance to Haiti for Cholera............................................................................$505,079

USAID/Haiti Assistance to Haiti for Cholera3 .....................................................................$2,015,000

Total USAID Humanitarian Assistance to Haiti for Cholera.......................................................................$41,732,574


 On October 22, U.S. Ambassador Kenneth H. Merten issued a disaster declaration due to the cholera outbreak. On October 26, USAID deployed a Disaster Assistance Response Team (DART) to work closely with staff from USAID/Haiti, USAID/OTI, and the U.S. Centers for Disease Control and Prevention (CDC) to coordinate emergency response efforts, provide technical assistance to the MSPP, and support longer-term health systems. USAID also stood up a Response Management Team in Washington, D.C., to support the USAID/DART in Haiti and coordinate with the USAID Haiti Task Team (HTT) in Washington, D.C.

 USAID/OFDA’s response plan focuses on preventing cholera cases, reducing the number of cases requiring hospitalization, and reducing the CFR. The plan outlines four elements: provision of chlorine to increase availability of safe drinking water; expansion of national hygiene education outreach; provision 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/Haiti continues to work with the MSPP and Pan American Health Organization (PAHO) to plan and respond to the cholera outbreak. USAID/Haiti grantees are distributing educational materials, conducting hygiene trainings, and broadcasting prevention messages. In addition, USAID/Haiti grantees have procured and consigned commodities—including ORS, water purification materials, intravenous sets, Ringer’s lactate (an intravenous solution), and bleach—to USAID-supported health sites and other sites treating cholera cases.

 In response to the outbreak, USAID/OTI is conducting direct cholera prevention activities; all ongoing and new USAID/OTI activities responding to the earthquake now also include cholera prevention and education elements. An initiative launched in late December aims to improve public health by increasing the supply of affordable, safe, and clean water for Cité Soleil residents by providing cost-effective water purification systems to six existing water kiosks.

 In addition to ongoing work to strengthen and rebuild Haiti’s basic public health infrastructure, CDC is contributing scientific leadership and technical guidance in response to the outbreak in four key areas: treating patients in health facilities; preventing illness and deaths in communities; monitoring the spread of disease; and improving laboratory and diagnostic capacity. CDC currently has a total of 183 staff providing support to the MSPP cholera response.

A total of twelve staff members remain deployed specifically for the cholera response, including eight staff members in Haiti, two staff members in the Dominican Republic, one staff member in Washington, D.C., and one staff member in Miami, Florida. Among those involved in the cholera response are medical officers, epidemiologists, laboratory scientists, environmental health specialists, public health advisors, communication specialists, planners, information
technology specialists, and support staff.

 The MSPP’s approach to the cholera outbreak has focused on community-level primary response to provide rehydration, disinfect affected sites, and promote good health practices; cholera treatment facilities (CTFs) at health service sites where patients can receive oral rehydration and basic intravenous therapy; and CTFs dedicated to treatment of severe cases.

 The attached CTF Distribution for Haiti Cholera Outbreak Map identifies the approximate locations of Cholera Treatment Units and Cholera Treatment Centers based upon data received from the U.N. Health Cluster. The information presented in the map is representative of data reported thus far to the Health Cluster and may not reflect the total number of CTFs operational in Haiti.


 On December 27, the Health Cluster—the coordinating body for health activities—announced a simplified procedure for non-governmental organizations (NGOs) not currently registered with the MSPP to obtain medical supplies from the Program on Essential Medicine and Supplies (PROMESS) warehouse, the GoH-and PAHO-managed warehouse and distribution system for medical commodities. NGOs can provide required information—including documentation from the NGO’s country of origin, proof of NGO status, and a project work plan—to receive immediate temporary authorization to operate in Haiti and request medical supplies from PROMESS.

 The Health Cluster reported 249 operational CTFs as of December 22. The updated figure represents a significant increase from December 13, when the Health Cluster reported a total of 183 CTFs. Several of the CTFs maintain operations 24 hours per day and can expand to accommodate additional patients, if necessary. USAID/OFDA is funding a total of 33 CTFs.


 According to OCHA, the number of cholera cases may be decreasing in urban areas, while the number of cases continues to increase in rural areas, where limited access to safe drinking water and more limited awareness of cholera and hygiene practices continue to present challenges.

 On December 22, the GoH National Direction for Potable Water and Sanitation (DINEPA) outlined its commune level procedure for distributing water purification tablets. The procedure involves two meetings per commune between GoH officials, local civil society groups, and relief agencies to determine areas of need, create a distribution plan, and train personnel on product use. DINEPA has distributed the equivalent of a one-month supply of water purification tablets to approximately 400,000 families.

 On December 23, USAID/OFDA grantee Action Contre la Faim (ACF) submitted results of a bacterial and chemical analysis of 31 wells in the Tabarre and Cité Soleil neighborhoods of Port-au-Prince. Results indicated that the majority contained potable water, with only two registering saline levels too high for drinking.

Logistics and Relief Commodities

 On December 28, USAID/OFDA transported 170,000 catheters to Haiti for use with the lactated Ringer’s intravenous solution that USAID/OFDA continues to deliver for treating severe dehydration associated with cholera.

 OCHA reports that health agencies continue planning for potential periods of unrest and that the Haitian population is also stocking supplies, including fuel, food, and water. PAHO staff recently met with the Joint Operations and Tasking Centre (JOTC)—a platform established by the U.N. Stabilization Mission in Haiti (MINUSTAH), OCHA, and others—to discuss arrangements for future security scenarios. Discussion topics included protection for warehouses and commodity transportation and distribution.

 From October 21 to December 20, the GoH-and PAHO-managed PROMESS warehouse distributed sufficient oral rehydration sachets and Ringer’s lactate intravenous solution to treat nearly 102,000 cholera cases. Additional stocks and supplies currently in Haiti or en route are sufficient to treat an additional 107,000 cases. USAID/OFDA recently consigned 100,000 liters of Ringer’s lactate solution to the warehouse, sufficient to treat 12,500 cases.

Grantee/ Activity/ Location/ Amount


ACF - WASH - Artibonite, Northwest Departments - $925,000

American Refugee Committee (ARC) - Health, WASH - West Department -$1,144,166

CRS - Health - Artibonite, Grand Anse, Nippes, North, Northwest, South, West Departments - $1,417,527

CDC - Health Affected Areas - $275,000

CECI - WASH - Artibonite - $400,096

Concern - WASH - Center, West Departments - $624,942

U.S. Department of Health and Human Services (HHS) - Logistics and Relief Commodities Affected Areas - $500,000

International Medical Corps (IMC) - Health, WASH - Artibonite, Center, North, Northeast, Northwest, South, Southeast, West Departments - $7,285,583

International Organization for Migration (IOM) - Health, Logistics and Relief Commodities - Artibonite, North, Northeast, Northwest, Southeast, West Departments - $4,600,000

IOM - Logistics and Relief Commodities - Affected Areas - $7,800,000

Management Sciences for Health (MSH) - Health - Affected Areas - $825,617

Mercy Corps - WASH - Center Department - $925,013

Partners in Health (PIH) - Health, WASH - Artibonite, Center, and West Departments -

Samaritan's Purse - Health, Logistics and Relief Commodities, WASH - West Department -$2,869,431

Save the Children/U.S. (SC/US) - Health, WASH - West Department - $825,000

World Concern Development Organization (WCDO) - Health - West Department - 364,180

OCHA - Humanitarian Coordination and Information Management - Affected Areas -$1,000,000

U.N. World Health Organization (WHO)/PAHO - Health - Affected Areas - $635,580

Logistics and Relief Commodities - Affected Areas - $5,163,259

Administrative Costs - $132,101

TOTAL USAID/OFDA - $39,212,495

Implementing Partners - Health, Logistics and Relief Commodities, WASH - Affected Areas -$505,079

TOTAL USAID/OTI - $505,079

FY 2010
Program / Activity / Location / Amount


Community Health and AIDS Mitigation Project (CHAMP) - Community Health Services - Countrywide - $198,000

Leadership, Management, and Sustainability Program (LMS)- Logistics and Relief Commodities - Countrywide - $185,000

PROMARK - Health, Public Outreach - Countrywide - $232,000

Supply Chain Management System (SCMS) - Logistics and Relief Commodities -Countrywide - $600,000

Health for the Development and Stability of Haiti (SDSH)- Essential Health Services -Countrywide - $800,000

TOTAL USAID/HAITI - $2,015,000


1 USAID/OFDA funding represents anticipated or actual obligated amounts as of December 29, 2010.

2 USAID/Haiti has pre-existing, long-term health programs that have been an integral part of the cholera response; these programs have also continued normal activities. The USAID/Haiti funding levels represent estimated amounts for one month of FY 2010 resources expended on the cholera response. The funding is based on an estimate of the program spending rate and percentage of resources expended on the cholera response.

Information on relief activities of the humanitarian community can be found at:

USAID/OFDA bulletins appear on the USAID web site at:


(ReliefWeb) - Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

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As of 18 December 2010, the Ministère de la santé publique et de la population (MSPP) has reported 2,761 deaths and 70,865 hospitalized cases due to the cholera outbreak.

There is an increase of cholera cases and fatality rates in the South-East department.

The major gaps and constraints identified by the Health Cluster include community mobilization for cholera prevention and prompt treatment; access to clean water and latrines; access to health care; and coordination.

Map: Haiti: Cholera Treatment Centers (CTCs) and Units (CTUs) Snapshot (as of 29 Dec 2010)

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This report was issued by OCHA Haiti. The next report will be issued on or around 2 January 2011.


The MSPP has reported 2, 761 deaths and 70 865 hospitalized cases, with an overall fatality rate of 2.1 per cent nationwide.

The fatality rates have decreased in most departments since 1 December, except in South-
East where it went from 12,9 per cent to 13,8 per cent between 11 and 18 December.


The Panamerican Health Organization/World Health Organization (PAHO/WHO) continues to provide support to health, hygiene promotion and social mobilization activities. It has supported the development, printing and distribution of 97,000 posters and 150,000 laminated pages containing guidance on cholera prevention and treatment in Creole. These documents were developed in conjunction with the Ministry of Health. A course on cholera management has also been developed for community and religious leaders and will be delivered by the Government of Haiti. Over 500 health professionals have already been trained by PAHO/WHO in cholera
case management.

In the Artibonite department, the Association of Mayors, with the support of the Ministry of Interior, has set up communal brigades to assess the cholera situation due to an increase in cholera cases that has been reported in the mountainous area of the Mornes. Due to a decrease in cholera cases, MSF Spain is reducing its presence in the Lower Artibonite.

Gaps and constraints
The major gaps and constraints identified by the Health Cluster include:

1) community mobilization for cholera prevention and prompt treatment of the disease;

2) access to clean water and latrines in health facilities including cholera treatment centers and units CTCs/CTUs);

3) access to health care; and

4) coordination.

There is an urgent need for massive mobilization activities to promote prevention and early treatment. In addition, controlling the epidemic will depend on the level of access to safe water and basic sanitation and implementation of hygiene measures.

With only 40% of the population having access to health care, health partners, including those working outside the UN Health Cluster system, are working with Haitian authorities to set up various types of facilities to care for all stages of cholera treatment.

Considering the number of partners active in the response – 27 partners in the Health Cluster –, coordination is crucial.

The mission of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is to mobilize and coordinate effective and principled humanitarian action in partnership with national and international actors.

Water, Sanitation, Hygiene (WASH)
The Ministère des travaux publics et de l’intérieur is preparing a 30-day plan to improve the water, sanitation and hygiene conditions in public markets throughout Port-au-Prince. These activities will be coordinated with Health Cluster and WASH Hygiene & Sanitation sub-clusters. Two to six sanitations agents will conduct hygiene promotion activities and supervise water and sanitation activities, including cleaning of market areas, removal of solid waste and management of public latrines.

Information collection for the localization of additional septage disposal sites is on-going at the departmental level while collection of information about access to sanitation at CTCs in Port-au-Prince has resumed by the Direction nationale de l’eau potable et de l’assainissement (DINEPA) after data collection was stopped due to fuel shortages.

Training activities are also ongoing and 963 people, mainly sanitation agents, have been trained in eight departments from 20 to 24 December by the Institut national de santé communautaire en Haïti (INSCAH).

Gaps and constraints
MSF-Holland has identified a critical link between power outages, disruptions in water supply and increased cholera cases in Mariani, Bertil, Bizoton, Archachon and Riviere Froid areas of Carrefour, which warrants four emergency interventions:

· Placement of emergency fuel stocks in pumping stations to ensure continuity of water supply in the event of electrical malfunctions.

· Increased hours of pumping to maintain higher water levels in the reservoirs.

· Adjustment of the chlorination dosage to achieve an appropriate level of free residual chlorine at the end-user points of the water network.

· Ensuring the availability of an emergency repair team to address breakdowns quickly, minimizing the duration of any interruptions in water supply.

As of 1 January 2011, the Italian NGO COOPI, which is providing 20,180 liters of water per day to 17,091 people, will discontinue water trucking to seven camps in the Port-au-Prince metropolitan commune of Tabarre. The WASH Cluster is requesting support from other WASH actors and donors to ensure provision of drinking water in Tabarre.

In the South Department, the management of dead bodies remains a huge challenge, particularly in Les Cayes where at least 64 corpses remained several weeks at the hospital because the population was opposed to the burial of the corpses in a mass grave.

Camp Coordination/Camp Management (CCCM)
Camp Management Agencies (CMAs) and Camp Management Operations (CMO) teams continue to monitor the situation in camps.

Awareness campaigns are also on-going. A cholera prevention day organized by the AMI Foundation focused on environmental sanitation, rubbish collection and disposal, hand-washing demonstrations, coloring books and painting activities for children, theatre and music. The camp population showed great interest and engagement in the activities while appreciating the initiative.

Needs and constraints
WASH items, awareness activities, installation and desludging of latrines, and provision of drinking water remain an urgent need in IDP sites.

Cholera cases continue to be reported in residential centers (orphanage, day-care center, and transitional center). An orphanage in Arcahaie reported 30 cases of cholera among children with disabilities, of whom six died, or a fatality rate of 20%. Another residential center in Croix de Bouquets reported one cholera death and 10 cases currently being treated in CTCs.

A new phase of supply distributions in residential care centers has started in Kenskoff and Croix de Bouquets.

During the last three days, UNICEF, with the support of the Logistics Cluster, has distributed soap, Clorox, water purification tablets, education and communication materials to 98 centers hosting more than 6,000 children. UNICEF also organized a training on cholera for 50 civil agents of the Child Protection Brigade who will be deployed at border areas, the airport and camps.

Separation of children due to the cholera epidemic continues to be reported. Efforts to raise awareness on the issue are being stepped up by child protection partners.

Over the last week, the Logistics Cluster supported DINEPA country-wide distribution plan of water purification tablets by air and road to eight departments.

The Logistics Cluster also offered to relevant authorities to establish a customs bonded warehouse dedicated to incoming medical supplies for cholera response in Port-au-Prince airport. This offer was not accepted and and similar proposals will be discussed with harbour authorities to expedite incoming sea shipments in the near future. Organisations expecting sea consignments should contact the Logistics Cluster team at the following email address :

Port operation actors will participate in the next Logistics Cluster meeting on 4 January.

Upon request from the Centre des operations d’urgence nationale (COUN), the Logistics Cluster made its GIS capacity available to the Office for the Coordination of Humanitarian Affairs (OCHA) and WHO/PAHO in order to coordinate the mapping of cholera treatment sites throughout the country. A country-wide map of CTCs and CTUs has been produced and is available on Reliefweb ( and

Since 16 December, the Logistics Cluster provided road transportation services and delivered 348 metric tons of health and WASH items by trucks. The United Nations Humanitarian Air Service (UNHAS) airlifted 77.5 metric tons of health and WASH items on behalf of multiple partners to fourteen different locations in the country.

There is an increased demand for storage from various humanitarian actors. The storage site in Croix des Bouquets, which is used by 18 organisations, will remain open for three additional months until the end of March 2011.

In addition, the earthquake response support is still ongoing with deliveries of 135 metric tons of rehabilitation material, food and storage equipment to remote locations in the Nippes department and the mountains of the Ouest Department.

In its support to hygiene promotion activities, IOM has published three editions of the Chimen Lakay newspaper and circulated over 100,000 copies nationwide. The fourth edition is on cholera stigmatisation and scheduled to be published in January.

Contact Information:

Head of OCHA Haiti (a.i.) Jolanda Vand Dijk

Head of Communications (a.i), Maurizio Giuliano
Email: /

OCHA Haiti Spokesperson: Emmanuelle Schneider
Email :

Reports Officer: Abdourahmane Diallo
Email: /

United Nations Office for the Coordination of Humanitarian Affairs, (OCHA Haiti), Boulevard
Toussaint Louverture et Clercine 18, Port-au-Prince, Haiti.


(UN) -

United Nations humanitarian officials are calling for “massive mobilization activities” in Haiti to promote prevention and early treatment in the cholera epidemic which has already killed more than 2,760 people and infected over 130,000 others, nearly 71,000 of whom were hospitalized.

Major gaps and constraints in fighting the epidemic since it broke out in October include access to clean water and latrines in health facilities and cholera treatment centres, access to health care, and coordination, according to the latest update by the UN Office for the Coordination for Humanitarian Affairs (OCHA).

“There is an urgent need for massive mobilization activities to promote prevention and early treatment,” it said of a disease that is spread by contaminated water and food. “In addition, controlling the epidemic will depend on the level of access to safe water and basic sanitation and implementation of hygiene measures.”

The UN World Health Organization (WHO) through its regional arm, the Pan-American Health Organization (PAHO), continues to provide support for hygiene promotion and social mobilization activities with the development, printing and distribution of 97,000 posters and 150,000 laminated pages containing guidance on prevention and treatment in Creole, the local language.

A course on cholera management has also been developed for community and religious leaders and will be delivered by the Government, with over 500 health professionals already trained by PAHO/WHO in case management.

Fatality rates have decreased in most departments, or administrative regions, since 1 December to an overall 2.1 per cent nationwide, except in the south-east where it went from 12.9 per cent to 13.8 per cent between 11 and 18 December.

In the South Department, the management of dead bodies remains a huge challenge, particularly in Les Cayes where at least 64 corpses remained several weeks at the hospital because the population was opposed to burying them in a mass grave.

Earlier this month Secretary-General Ban Ki-moon called for more funds to fight the epidemic, noting that a $164 million appeal launched in November was only 21 per cent funded.

He also announced the creation of an independent scientific panel to investigate the source of the outbreak amid widespread media reports that Nepalese peacekeepers from the UN Stabilization Mission in Haiti (MINUSTAH) were the likely source, with infected water spreading from their base into a nearby tributary of the Artibonite River.


(The National) - AFP

PORT-AU-PRINCE - Haiti's cholera death toll has risen to 2,901 with official figures Thursday showing a record high for the daily number of fatalities since the outbreak erupted in mid-October.

The number of confirmed cholera deaths on December 19, the second most recent day on record, was just under 100, the data from the Haitian health ministry showed, far higher than previous peaks around 80 in mid-November.

As the total number of infections soared towards 150,000 in Haiti, there was also growing concern in the neighboring Dominican Republic where more than 100 cases have now been recorded including one suspected fatality.

Haiti's first cholera outbreak in more than a century has poured further misery on a poor and politically dysfunctional country trying to recover from a devastating January earthquake that killed some 250,000 people.

The epidemic spawned deadly anti-UN riots last month as some turned their anger on peacekeepers from Nepal accused of bringing the disease into the country.

Experts say the outbreak was likely sparked by a human source from outside the region and the United Nations has promised a thorough investigation into the origin of the epidemic.

Angry mobs in the deeply superstitious nation have stoned or hacked to death at least 45 people - most of them voodoo priests - accusing them of spreading the water-borne bacterial infection.

The epidemic comes against the backdrop of deep political uncertainty.

Flawed first round elections to find a successor to President Rene Preval are to be the subject of a recount monitored by international observers.


(Montreal Gazette) - AFP

A significant part of the rice harvest in Haiti is likely to be lost as farmers increasingly fear cholera contamination from the water in their paddies, the UN food agency FAO said yesterday.

Many farmers in northwestern Haiti are avoiding the harvest because they are worried that the water that irrigates their fields may be infected, the Rome-based Food and Agriculture Organization said.

"The important thing is not to stop harvesting," said Annika Kaipola, operations officer at the FAO.

"The farmers are afraid of catching the disease because it is waterborne, but our investigations so far have shown there's no danger in cultivating the rice as long as basic hygiene measures are followed," she said.

The cholera outbreak has so far killed more than 2,500 people across the country.

The FAO also said consumers were reportedly unwilling to purchase produce from regions directly affected by the cholera outbreak.

The Haitian Ministries of Agriculture and Health have launched a campaign to provide health and sanitation information to farmers.

But the messages are not reaching some areas, and advice needs to be given to rural low-income communities in person through hands-on training and outreach, the FAO said.

"Avoiding the disease is a question of basic hygiene. We need to tell farmers that it's about washing hands properly, cooking food, boiling and purifying the water used in the home," said Kaipola.

Cholera, which first appeared in mid-October in the north, led to deadly anti-UN riots last month as a desperate populace turned its anger on peacekeepers from Nepal accused of bringing the disease into the country.

Angry Haitian mobs have since lynched at least 45 people accused of spreading cholera with a magical substance


(Bloomberg) - AP - By Jonathan M. Katz

PORT-AU-PRINCE — The silhouetted bodies moved in waves through the night, climbing out of crumbled homes and across mounds of rubble. Hundreds of thousands of people made their way to the center of the shattered city by the thin light of a waning crescent moon. There was hardly a sound.

It took a few moments to recognize the great white dome bowing forward into the night. Another had fallen onto itself, its peak barely visible over the iron gate. The white walls of the 90-year-old mansion were crushed, the portico collapsed. Haiti's national palace was destroyed.

It was clear from the first, terrible moments after the quake, when I ran out of my broken house to find the neighborhood behind it gone, that Haiti had suffered a catastrophe unique even in its long history of tragedy.

But it was not until reaching the Champ de Mars plaza at the center of the capital, more than six hours later, that I understood what it meant. Not just homes and churches had succumbed. Haiti's most important institutions, the symbols and substance of the nation itself, had collapsed atop the shuddering earth.

The people came to the palace in droves seeking strength and support. Some wondered if President Rene Preval might emerge — or his body. They were looking for a leader, a plan, some secret store of wealth and aid.

But there was no news, no plan, no help that night. The president was not there. Nobody was in charge.

In the year since, crisis has piled upon crisis. More than 230,000 are believed to have died in the quake, and more than a million remain homeless. A cholera epidemic broke out in the fall, and in its midst a dysfunctional election was held, its results still unclear.

There was hope that the quake would bring an opportunity to break the country's fatal cycle of struggle, catastrophe and indifference. But promises were not kept, and no leader emerged, within Haiti or outside.

What little center there had been simply disappeared, and the void was never filled.
Among those gazing at the collapsed palace that night was Aliodor Pierre, a 28-year-old church guitarist and father of two. Until that moment, he had lived in the slum of Martissant. His friends called him "Ti-Lunet," little glasses, for the wire-rimmed pair he wore.

He was drinking beer at a corner store when the earth began to move. He tried to walk into the street but the force knocked him down. A roar filled the air, like a thousand trucks crashing through a mountain forest. A friend tried to bolt but Aliodor shouted "No!" and held him back. They lay together on the ground until it stopped.

Aliodor picked up his head. His apartment, a five-story building, was flat. Everything he owned was buried inside. He didn't know where his wife and children were.

Then the screaming began all around him.

Aliodor ran to his parent's house a few blocks away. It had fallen. He shouted and an answer came from inside. He smashed a window and pulled out his mother, hurt but alive. Neighbors rushed to help rescue other relatives. Still his wife and children were missing.

His heart raced. He and a friend ran through the neighborhood, pushing off concrete and slicing through barbed wire with pliers. In one doorway, they found a young girl who had nearly escaped before the house fell forward onto her lower leg. "Save me!" she screamed. Aliodor looked for a hacksaw to cut her free, but she died in front of him.

Dazed, he followed the crowd through the falling light to the central plaza. People were shouting: The national palace, Roman Catholic cathedral and Episcopal cathedral — where Aliodor sometimes played guitar — were gone. He looked for the white domes, but couldn't see them.

He sat down near a statue of Jean-Jacques Dessalines, the liberator and first president of Haiti.
Hours later Aliodor had still not found his wife, Manette Etienne, their 7-year-old daughter, Sama, or their 3-year-old son, Safa. Pain wrenched his stomach as he pictured them dead. He didn't know what had happened to the nursing school his wife attended.

He started walking toward his neighborhood. As he reached a gas station, suddenly there was Manette, walking toward him. The children had been saved by a teacher who ran them out of school when the shaking began. They had thought he was dead, too. They held each other and for a moment the broken city disappeared.

"It was like the earthquake never happened," he said.

By morning, people began carving up the lawns and plazas, marking space with blankets, umbrellas and bits of cardboard to sleep on. Some thought being near the government might mean being closer to the aid. But there was no government there. When Preval came out of hiding, he set up shop at a police station that backed directly onto the airport runway. Maybe he was leaving, people mused.

They wanted to leave. The Champ de Mars plaza reeked. Stagnant fountains became toilets, washing pits for clothes and wells for bath water. Bodies trapped under the rubble started to smell. Those survivors who could got surgical masks. Others painted toothpaste mustaches under their noses.

Two days after the quake, roaring gray helicopters dropped onto the rubble-strewn lawn outside the palace. American soldiers of the 82nd Airborne Division jumped out with their rifles, packs and armor — the vanguard of what President Barack Obama called one of the largest relief efforts in U.S. history.

The soldiers took over the airport and stood guard as U.N. peacekeepers handed out rice, beans and water to a desperate crowd. Fights broke out and pepper spray filled the air. Aliodor lined up once for food, then swore never to do it again.

He asked the soldiers why they had come with guns. A young private told him they had been on their way to Iraq when they were told to go to Haiti instead. Aliodor asked why he wasn't carrying food, water or something to help people build houses.

"He said to me, 'I'm just a sharpshooter. I'm very good at shooting,'" Aliodor recalled. "But I said, 'Haiti's not at a war.'"
On the last day of March, donors at a United Nations conference pledged nearly $10 billion for the reconstruction of Haiti, with its almost 10 million people. The United States alone promised $1.15 billion for 2010, the largest one-year pledge.

Days later, word spread that the national palace would be torn down. Radio reports said the government of France had agreed to help build a new one. On April 8, people came to see the demolition begin.

The palace was the backdrop for the famous statue of the Neg Mawon, the escaped slave blowing a conch shell to call others to fight for freedom. But the palace's history, like Haiti's, was never simple.

The Beaux Arts mansion, designed in 1915, was torched while still under construction by a mob bent on assassinating the president, Vilbrun Guillaume Sam. It was completed under the U.S. occupation that followed his death, and was the scene of successive coups and ousters.

Eventually, it became a symbol of terror under the father-son dictatorship of Francois and Jean-Claude Duvalier.

Presidents ceased living in the palace after Jean-Claude's 1986 overthrow, but it continued to host world leaders in its salons — and protests and coup attempts on the lawn.

The people of the Champ de Mars watched as the backhoes tore down what was left of the portico and, for the first time in most of their lives, they got a glimpse of the grand salon and the crystal chandeliers inside.

Then the machines stopped. A Preval aide said there were disagreements over how reconstruction should proceed. Demolition came to a halt.

On the plaza, aid groups had handed out plastic tarps and put in portable latrines. Shacks went up across every open space. Someone tied a tarp to the side of the Neg Mawon.

Aliodor scraped together most of the money he had — about $51 — to buy wood, sheets and tarps to put up a little shack, a few feet (meters) from where he had sat down the first night.

The bonhomie and spirit of sharing that had prevailed in the days after the quake cracked, and then broke. Mugging, robbery and rape became facts of life. Aliodor sent his children to his quiet hometown in the rural south to live with relatives.

Without a government to organize them, the people began organizing themselves. In settlements all over the capital, camps set up organizing committees in an intricate bureaucracy. Aliodor's Place Dessalines was the largest. He was named spokesman for its central committee.

"I'm one of those guys who has little money but I have a lot of strength," he explained.
There was, at one point, a plan.

As the homemade camps swelled beyond 1.5 million people, the government said it would relocate 400,000 to the capital's outskirts. Officials set up card tables around the Champ de Mars to register people who talked excitedly about getting new homes, better than the slums where they had lived before.

In April the first camp was ready in the open desert north of the capital, designed by U.S. military, U.N. engineers and aid groups. About 7,500 people living on a golf course were chosen to move, encouraged by their camp's manager, actor Sean Penn.

It was a disaster. There were no trees and the site was too remote. Also, it turned out that the parcel belonged to Nabatec Development — whose president was head of the relocation commission. And so the company stood to gain government compensation for its land.

Over the summer, a storm ripped through a quarter of the camp's tents. People screamed and cried as, again, they lost their homes.

Only one more relocation camp was built. The rest of the project was abandoned.

In May, an old smell returned to the Champ de Mars: Tear gas. Parliament dissolved because an election could not be held to replace expiring seats. Its last act was to grant emergency powers to Preval and create a reconstruction commission co-chaired by Prime Minister Jean-Max Bellerive and former U.S. President Bill Clinton.

Clinton was already the U.N. Special Envoy for Haiti. Aliodor and others wondered if he was now their governor.

When Preval announced that he might extend his term beyond February 2011, opponents marched to the palace. Police and U.N. peacekeepers fired rubber bullets and tear gas at rock-throwing demonstrators and into the camp.

Then Haiti settled in for a summer break. The World Cup was on.

In July, exactly six months after the quake, big cars pulled up to the palace. The government was moving back in. News conferences, once held under a mango tree at a police station, would now be in a new wooden gazebo. A defiant Preval said the lack of massive disease outbreaks and violence was proof that the quake response had gone better than people were saying.

Then came the medals. Twenty-three honorees — including Penn and Clinton — received certificates deeming them Knights of the National Order of Honor and Merit. There was no mention of the dead, or the giant shantytown a few hundred feet (meters) away.

The officials then announced that the previous six months of grinding inaction had merely been the emergency-recovery phase. Now, they said, reconstruction would begin.
Aliodor and Manette were losing weight. Food was scarce and there was no work. The shack boiled in the summer heat.

Every day Aliodor woke up in their cramped bed and walked out to the sight of a big rubber bladder, wider than his shack, that aid groups sometimes filled with treated water. Above it stood the statue of Dessalines on a horse, waving to his left.

The sun beat down until it gave Aliodor a headache. He had an eye infection. He was starting to get angry.

"The government, the ones who are responsible for us, don't really want us to go because while we are in misery they are enjoying themselves," he said. "Every day they are making money on top of our heads."

The aid groups promised they would do this and that, fix a toilet, bring more food. Sometimes they did, sometimes they didn't. The committee squabbled. People stole what they needed.

Behind Aliodor's shack, the backhoes and bulldozers at the national palace had been sitting idle for months.

"The country needs to have a national palace. But if it's under these guys who are in power now, the palace will never be built," Aliodor said.

He looked at Dessalines again, waving on his horse. Maybe he was trying to leave, too.
Rumors had been spreading for weeks. A strange disease was killing people in the countryside: like diarrhea, but it could kill you in hours.

In mid-November, it arrived on the Champ de Mars. A woman everyone said was crazy walked into her tent one day and did not leave. In two days, the tent gave off a nauseating smell. A brave soul opened the tarp and found her lying dead in her own filth. A fight broke out between neighbors and police about who would clear her out.

The next day a young man was found dead in a toilet. Word came in from the Cite Soleil slum that dozens of children were dropping dead. The foreigners called it cholera.

Then the news spread that U.N. peacekeepers might have brought the disease to Haiti.

"I'm not supposed to be here, waiting for cholera to kill me in a public park," Aliodor said, jutting out his lower teeth.

As the year drew to a close, the international community pushed for a presidential election.

Donor countries provided $29 million, including $14 million from the United States. Black-and-white pictures of the 19 candidates were hung on the palace gates.

The Nov. 28 election was, by most measures, a failure. Hundreds of thousands who had died in the earthquake were still on the rolls, and untold thousands of survivors were turned away because of disorganization or alleged fraud. There was violence and voter intimidation. Nearly all the major candidates called for the vote to be canceled.

When results were announced days later, the city was shut down with flaming barricades.

Gunmen wearing shirts of the ruling-party candidate called for people on the Champ de Mars to come out and celebrate. Then they opened fire. Up to three people were killed and several injured. Aliodor and others took turns keeping lookout at night.

Nearly 3,000 people died of cholera and more than 100,000 were infected.

Clinton's commission had approved billions of dollars in projects, but many remained unfunded.

The United States delayed its entire donation of $1 billion in reconstruction money until 2011.

Less than $900 million of the donors' conference pledges was delivered.
The guys hanging in front of Aliodor's house still call him Ti-Lunet, but his glasses are long gone.

His hair has receded.

The afternoons are still baking hot, and tire fires from a daily protest burn black, acrid smoke nearby. Aliodor has criticism for everyone. He asks me to deliver a message to my country:

"I blame this on the United States, because the United States is the world power," he says. "Why would you accept for us to be living in poverty?"

If Dessalines were alive today, Aliodor says, he would lead the people in a revolution against the government, foreign soldiers and other foreigners who aren't helping. He hopes the spirits of the ancestors will come back and teach Haitians to be independent again.

"God is the only one we have hope in," he adds.

Aliodor pulls out a photo album from under the bed and flips through pictures taken before the quake. There is Manette, in a nursing uniform. And there he is, fit and muscular, a gold cross hanging from his neck and nearly brushing the guitar in his confident hands.

He looks down at his stringy arms. They look like someone else's.

Afternoon shadows come upon the tens of thousands of tents in the central plaza. Soon the people will be shrouded in darkness, just as they were on that night almost a year ago.

Beside them, the national palace lies cracked upon the lawn. There's a gaping hole in the middle.