A cholera outbreak is killing Haitians by the hundreds, and hospitalizing them by the thousands. The country is mired in short-term responses to a ten-month-old earthquake. The time is long overdue for Haiti, and those helping Haiti, to rebuild and reorient its government institutions, so that they can work on the long-term challenges facing the country. Despite a focus on day-to-day survival - and it may have been difficult to choose otherwise - day-to-day survival is still in question for many Haitians.
Cholera is an indignity. Dr. Basim Khan, a San Francisco physician, last week treated 10 patients in Port-au-Prince suffering from diarrhea and vomiting. "They were pretty much in shock," says Dr. Khan. "They couldn't walk. Their eyes were sunken." If it is not treated on the spot, a quick and painful death ensues.
At least 1.5 million Haitians are living in temporary shelter, and others are constantly on the move. "Most of the cases are in shantytowns or spontaneously created camps," says Robert Fox, executive director of Oxfam Canada. And much of Haiti remains a physical mess, the rubble remaining where it fell.
It is in these squalid conditions that fetid water collects and the bacteria that leads to cholera flourishes.
And it did not have to be this way. Throughout the year, authorities have lacked the administrative capacity, or the ability to make major decisions, that could have lead Haiti down a different path.
Lands are not being reassigned for new housing developments, and there is no central responsibility for rubble-clearance. One Red Cross official says that 46 per cent of homes survived the earthquake, but Haitians have not been convinced to move back into damaged but safe dwellings. Latrines are being built, but without good information about ground conditions, it is impossible to build functioning water systems.
The lack of good governance also leads to disputes with NGOs, slowing decision-making further. Some have blamed the distractions on politics, as Haitians electioneer now and will vote on Nov. 28. But the governance crisis long predates the campaign.
More effort and money should have spent from the beginning to bring the Haitian diaspora into reconstruction, and to spend hard aid dollars on people: the engineers, planners, and accountants essential to rebuilding the government.
A UN appeal for cholera-related aid is, of course, entirely appropriate, and donor governments should respond to this crisis. But only with investments in governance can the reconstruction for tomorrow proceed, and that is the best way to avert the next crisis.