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Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation CONTENTS Executive Summary 2 Report Focus 2 Report Findings 2 Methodology 3 One year later, lack of reconstruction, aid and work opportunity has led to desperation 4 The rising cholera epidemic demonstrates the inadaptability and late response of aid agencies 6 Drink and use safe water 7 Wash hands often with soap and safe water 7 Use latrines or bury feces; do not defecate in any body of water 7 Cook food well, keep it covered, eat it hot, and peel fruits and vegetables; Clean up safely 8 Recommendations 8 One year after the earthquake – Haitians still living in crisis Copyright © 2011, All rights reserved !e LAMP for Haiti Foundation P.O. Box 39703, Philadelphia, PA 19106 Tel: +1 267 295 2822 admin@lampforhaiti.org | www.lampforhaiti.org Institute for Justice & Democracy in Haiti (IJDH) Bureau des Avocats Internationaux (BAI) 666 Dorchester Avenue, Boston, MA 02127 Tel: +1 617 652 0876 | Info@ijdh.org | www.ijdh.org 2Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation EXECUTIVE SUMMARY This report provides results from a December survey that is part of a longitudinal analysis of conditions in six of Haiti’s over 1000 camps for Internally Displaced Persons (IDP). The !rst survey of camp residents was conducted in February, the second one in July, both yield- ing reports measuring living conditions in the camps and the on-the-ground impact of relief efforts from the international community. 1 Report Focus With the outbreak of cholera in October 2010, Haitians living in camps became extremely concerned about their vulnerability to contamination given the close quarters and unsanitary conditions in the camps. Our December survey sought to gauge the resources available to families living in IDP camps to prevent cholera and the level of cholera prevention assistance from international aid agencies. Report Findings !e survey results indicate that aid assistance is sparse in the six IDP camps surveyed, and has not improved signi"cantly since the cholera outbreak. Residents generally did not have the resources they needed to prevent cholera. „Limited access to safe drinking water. Only 8% of the families we interviewed received all or most of their drinking water from aid agencies. Most families could not a#ord to purchase treated water on a regular basis and therefore were drinking non- potable water, making them susceptible to water- borne illnesses such as cholera. 1. See Neglect in the Encampments, available at http:// ijdh.org/archives/10671 and We’ve Been Forgot- ten, available at http://ijdh.org/archives/14633. „Unsanitary conditions. Sanitation in the camps was severely lacking, with little soap available and only a few toilets to be shared by hundreds of residents. Fifty-seven percent of families felt the toilet facilities were unclean, unsafe or overcrowded. „Little control over conditions. Residents did not have access to separate cooking facilities from their bathing facilities. !e lack of aid assistance is consistent with our "ndings in the July and February surveys. Also consistent was the lack of work opportunities available. Sixty percent of respondents were living on less than $1 a day and struggling to feed and provide clean drinking water to their family. Also worrying was the widespread hunger of camp residents, which had not improved since the July survey. In both July and December, one in two families reported not being able to feed their children for a full day the previous week. A quarter of families scrounge for food by either asking other families or by going and looking for food. One-year after the earthquake, camps lack basic infrastructure such as toilets, water treatment facilities, cooking facilities, and sturdy housing (beyond tents) - making families sitting ducks to cholera. !e lack of preparation to prevent cholera is an illustration of the failure of donor states, aid agencies and the Haitian government to provide the basic resources needed to earthquake victims living in IDP camps. !e inadaptability and late response of aid organization to the cholera epidemic needs to be corrected immediately to prevent rampant spread in the camps. IDP camps are homes to over a million Haitians, and children are born and raised in them every day. More long-term investment must be made in camps to provide life-saving infrastructure so that Haitians can raise their families without constant vulnerability to hunger, disease, $ood, and hurricanes. 3Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation METHODOLOGY !is report presents the results of an ongoing survey of Haitian families displaced by the January 12, 2010 earthquake. In February 2010, a team of human rights observers from LAMP for Haiti surveyed 90 families selected at random from six IDP camps in and around Port-au-Prince. !e purpose was to document the earthquake’s impact on individual families while measuring the international community’s e#ectiveness in delivering aid. „Six Weeks Later. An initial survey was conducted at each camp in February 2010. It found that the overwhelming majority of respondents lacked adequate access to shelter, water, food, sanitation, and medical care. !e resulting report, Neglect in the Encampment, was presented to the Inter-American Commission on Human Rights in Washington, D.C. on March 23, 2010. 2 „Six Months Later. A follow-up survey was conducted in July 2010, primarily through on-site interviews. Of the 90 original families, 52 could be located. !e team found widespread evidence of ongoing violations of economic and social rights, con"rming that aid had slowed and even stopped in each of the six camps surveyed. A second report, We’ve Been Forgotten, was released calling on donor countries and international aid agencies to allocate more of their resources to meet the basic needs of Haitians living in camps and adopt a rights-based approach to relief and reconstruction. „One Year Later. A follow-up survey was conducted in December 2010, primarily through telephone interviews. Of the original 90 families, 37 families participated. !e team encountered signi"cant di%culty contacting respondents: at least 35 phone numbers now belonged to di#erent people or were no longer working. 3 Lost families: Tracking the families has become increasingly di%cult; the earthquake’s economic dislocations have made it di%cult for people to maintain their phone numbers. !e respondents we were able to locate may represent families who are relatively better o# because their living circumstances were more stable – the fact that they were reachable at the same phone number may indicate more economic security and access to electricity to charge phones. Alternately, it is possible that the reachable respondents represent the families who are relatively worse o#, or less stable, because they still live in camps. Either way, the inability to locate a large percentage of the families, without knowing why they were unreachable, is not viewed as conclusive evidence that their lives have improved. !ey may simply have slipped through the cracks. 2. See Neglect in the Encampments, available at http://ijdh.org/archives/10671. 3. See We’ve Been Forgotten, available at http://ijdh.org/archives/14633. IDP Camp February 2010 July 2010 December 2010 Place St. Pierre in Pétionville 22 families 11 families (50%) 9 families (41)% Acra camp in Delmas 23 families 12 families (52%) 9 families (39)% Diquini / Adventist University of Haiti (ADUH) in Carrefour 11 families 8 families (73%) 6 families (55)% Champ de Mars in Port-au-Prince 12 families 9 families (75%) 7 families (58)% Bouzi camp in Croix-des-Bouquets 9 families 5 families (56%) 2 families (22)% Parc La Couronne in Cité Soleil 13 families 7 families (54%) 4 families (31)% Total Respondents 90 families 52 families (57%) 37 families (41%) 4Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation ONE YEAR LATER, LACK OF RECONSTRUCTION, AID AND WORK OPPORTUNITY HAS LED TO DESPERATION IN THE CAMPS !e results from our December survey indicate that one year after the earthquake, Haitians are still living in a state of crisis. Despite the global promise of 11 billion dollars in assistance from donor countries and several billions more donated to non-governmental aid organizations, over 1 million internally displaced persons (IDPs) continue to su#er from inhumane housing conditions as they struggle to "nd shelter, clean water and food in displacement camps. State of crisis. As !e Economist recently described, “!e tent camps that dot the city look ever-shabbier, and their inhabitants thinner and more bedraggled.” 4 Our survey results indicated that families living in camps often go without any food or safe drinking water because they cannot a#ord to buy it and aid organizations are not providing it. One out of two families had at least one child in their family go a full day without eating the prior week. Twenty-six percent of families regularly scrounged for food by either asking other families (16%) or by “going and looking for food” (11%). Only 39% of families had daily access to clean drinking water. Just over one-half of families had a tent to live in, the rest survived under makeshift shelters. !e results on the lack of access to food are nearly identical to the results in July. !e Haitians we interviewed still live in camps one year after the earthquake because they have no other place to go – either their homes are still destroyed or they cannot a#ord any other options. Only two of the respondents live in the same home as before the earthquake; over 50% of families stated they still live in camps because they do not have money or resources to move; 74% of families stated their home is still destroyed. To make matters worse, 40% of families have been threatened with eviction since the earthquake. Evictions pose a serious threat. !e UN estimated in September 2010 that 29% of 1,268 camps studied had been closed forcibly, meaning the often violent relocation of tens of thousands of people. 5 Without any other housing options, eviction would be disastrous for many families. Lack of Reconstruction. One reason for the desperate conditions in the camps is the lack of reconstruction. United Nations Special Envoy to Haiti, President Bill Clinton, projected after the earthquake that Haiti could “build back better.” Donor countries in March 2010 pledged $5.6 billion for recovery and reconstruction through 2011. But less than half of the money has been disbursed, and 20% will go to debt relief rather than recovery. 6 Meanwhile, only "ve percent of the rubble has been cleared and only 15% of the planned temporary houses have been built (about 31,000 temporary shelters and 1,000 permanent shelters). 7 One-third of Port au Prince’s population remains in IDP camps with very few options for alternative housing. Haiti needs a stable, legitimate government to address the political issues at the heart of rebuilding, including land tenure, property rights and spending priorities. Unfortunately the $awed elections on November 28, 2010, which were funded, organized and monitored KEY FINDINGS: FOOD, WATER, SHELTER z71% had at least one family member go at least 1 day without eating the prior week z53% had at least one child go at least 1 day without eating the prior week z74% had a member in their household who has lost weight since the earthquake z39% have access to clean drinking water daily, 21% had no access to drinking water at all z55% of families have soap z80% still live in a makeshift shelter z55% have a tent 5. Haiti homeless caught between eviction and storm, Jonathan Katz, Associated Press, November 4, 2010, available at http:// news.yahoo.com/s/ap/20101104/ap_on_bi_ge/tropical_weather. 6. Http://s3.amazonaws.com/haiti_production/assets/23/ NY_pledge_total_opt_2_6_Jan_2011_original.pdf. 7. Oxfam, From Relief to Recovery: Supporting good governance in post-earthquake Haiti, January 6, 2011, available at http://www.reliefweb.int/rw/rwb.nsf/db- 900sid/MUMA-8CU2M7/$File/ full_report.pdf. 8. See IJDH, Haiti’s November 28 Elections: Trying to Legitimize the Illegitimate, November 22, 2010, available at http://ijdh.org/ archives/15456, and IJDH, !e International Community Should Pressure the Haitian Government for Prompt and Fair Elec- tions, June 30, 2010, available at http://ijdh.org/archives/ 13138. 5Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation by the international community, undermined Haiti’s chances for a legitimate government. 8 In the meantime the country remains a “republic of NGOs,” with international non-governmental organizations (NGOs) receiving billions of dollars in donations to provide Haitians with basic social services such as food, water, shelter, and education. !e NGOs providing these critical life-saving services must be accountable to the people they are trying to help. 9 Lack of work opportunities. Another large contributor to the desperate conditions is the lack of economic opportunities for families living in camps. Almost all the families surveyed were unemployed or underemployed. Only 44% of respondents had any income. !ose 44% made on average $1.30 per day (average family size was 8 people). In addition to work, families reported surviving through loans (14%) and gifts from friends and family (11%). Over 60% of the families interviewed were trying to survive on less than $1 a day. Families seemed to have less work in December than in July, where 63% of families reported having some form of work and 35% earned about $1 a day. In July, only one of the respondents reported having a cash-for-work job, which lasted two weeks. !ere were no reports of cash- for-work employment in December. With only $1-$1.30 a day, an average family of 8 cannot a#ord to buy basic life-sustaining such as water and food. !e respondents of all ages expressed a strong desire to "nd work. Laziness is not the culprit; lack of economic opportunity is. Lack of aid. !e survey results indicate that aid organizations are not providing the much-needed relief assistance either. Only a quarter of families had received any food aid in the last month. Only 8% of families received all or most of their drinking water from aid agencies; 20% received some of their drinking water from aid agencies; 50% received no potable water at all. KEY FINDINGS: WORK AND INCOME z44% of families received income from work. (14% had full-time work, 14% had part-time work, and 16% were self-employed.) z19% of the 44% with work had work in December when the survey was administered. zOne person per family had work (the average family had 8 people, 5 of whom were adults) zAverage hours worked for the 44% with work was 22 per week zAverage earnings were $1.30 per day z60% of families made less than $1 a day KEY FINDINGS: RECEIPT OF AID z24% received some food aid in the last month z61% never receive food from aid agencies z3% received all of their drinking water from aid agencies z5% received some of their drinking water from aid agencies z50% receive no drinking water from aid agencies z39% of families receive no water (drinking or other) from aid agencies 9. See We’ve Been Forgotten, available at http://ijdh.org/archives/14633. 6Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation THE RISING CHOLERA EPIDEMIC DEMONSTRATES THE INADAPTABILITY AND LATE RESPONSE OF AID AGENCIES A cholera outbreak was con"rmed in Haiti on October 21, 2010. 10 Starting o# in the countryside, the disease quickly began claiming lives. As of December 31, 2010, over 3,000 people were dead, 11 130,000 people infected and 71,000 people hospitalized. 12 While cholera has not yet fully spread to the camps, given the extremely unsanitary conditions and the thousands living on top of each other, the results would be disastrous. 13 !e Pan American Health Organization warned that 400,000 Haitians could be infected within a year. 14 Despite the signi"cant risk, 50% of respondents surveyed stated that they have not received any cholera preventive aid, not even education. Completely missing the mark of their obligations under Haitian law and international human rights law and standards, donor states, aid agencies and the Haitian government continue to fail to adequately respond to the growing cholera epidemic. !e UN continued to push a massive campaign against cholera on December 30, 2010, over two months after the outbreak was con"rmed and over 3,000 lives taken. 15 !e late response to the epidemic is telling of the aid agencies’ inability to adapt to changing situations and to successfully implement a plan to transition the 1 million in camps into long-term housing. !e UN complains that it is has only received 20% of the funds it requested to address the epidemic as a reason for the tardy prevention measures. 16 Others claim that the lack of funds is not the issue – it is the lack of coordination among UN agencies and NGOs. 17 Cholera is relatively treatable and preventable; it is most commonly contracted through drinking contaminated water/food or ingesting the bacteria from unclean hands or eating utensils. 18 !e prevention for cholera is simple: drink treated water, dispose of waste property and routinely wash and disinfect hands. Contaminated water is easily treatable through treatment tablets, boiling water or more sophisticated measures like reverse osmosis. 19 Most residents in the six camps surveyed did not have the resources they needed to prevent cholera. !e December survey echoed the "ndings from July that safe drinking water was not being su%ciently distributed in the camps by aid organizations even after the outbreak of cholera. Sanitation in the camps was severely lacking with 57% KEY FINDINGS: DECEMBER ACCESS TO WATER z39% have access to clean drinking water daily z21% have access to it weekly z21% never have access to clean drinking water z61% of families purchase their drinking water z50% of families receive no drinking water from aid groups z39% of respondents receive no water at all from aid groups KEY FINDINGS: JULY ACCESS TO WATER z44% of families primarily drank untreated water z9% of families received water relief in the last 30 days z91% had not received drinking water z73% of families paid for drinking water at least once a week 10. Center for Disease and Control, 2010 Haiti Cholera Outbreak available at http://www.cdc.gov/haiticholera/, last accessed, January 3, 2011. 11. Moni Basu, Cholera death toll in Haiti rises to more than 3,000, December 31, 2010, available at http://articles.cnn.com/2010- 12-31/world/haiti.cholera_1_cholera-cases-cholera-outbreak-health-ministry?_s=PM:WORLD, last accessed, January 3, 2011. 12. UN urges massive campaign in Haiti to boost cholera prevention measures, December 20, 2010, available at http:// www.un.org/apps/news/story.asp?NewsID=37180&Cr=Haiti&Cr1=, last accessed January 3, 2010. 13. During the December third phase survey, only one family reported having a family member with Cholera, who eventually recovered. 14. http://www.reliefweb.int/rw/rwb.nsf/db900SID/VVOS-8CUSM8?OpenDocument&RSS20=02-P 15. http://www.un.org/apps/news/story.asp?NewsID=37180&Cr=Haiti&Cr1= 16. http://www.reliefweb.int/rw/rwb.nsf/db900SID/VVOS-8CUSM8?OpenDocument&RSS20=02-P 17. http://www.doctorswithoutborders.org/publications/article.cfm?id=4939&cat=op-eds-articles 18. Center for Disease and Control, Cholera: Prevention & Control, available at http://www. cdc.gov/haiticholera/preventionandcontrol.htm, last accessed January 3, 2011. 19. Center for Disease and Control, Cholera Prevention Message, available at http://www.cdc.gov/ haiticholera/pdf/cholera_preventionmessages.pdf, last accessed January 3, 2011. 7Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation of families stating that they felt the toilet facilities were unclean, unsafe or overcrowded. !e Figure below demonstrates that the few resources given to the respondents to prevent cholera do not match their direct needs. Using the !ve CDC recommendations for preventing the transmittal of Cholera, 20 the following sections outline the many shortcomings of the aid response: Drink and use safe water !e majority of distributed aid water is non-potable, and the overwhelming majority of respondents obtain potable water by purchasing it. !e frequency of access or means to purchase potable water greatly $uctuates. Access to clean drinking water seems to have improved slightly since July, but not by much. With only 39% of the population in December having access to clean drinking water, even after the cholera outbreak, it is clear that families are vulnerable to cholera and other water-borne bacteria and parasites. Wash hands often with soap and safe water Since the outbreak only 16% of families reported receiving soap and 3% reported receiving hand sanitizer, 28% of families reported needing both treated water and soap. Use latrines or bury feces; do not defecate in any body of water In July, the families surveyed reported horrifyingly unsanitary conditions. Nearly one third reported that they defecate in plastic bags rather than use the camp facilities because the conditions of the toilet facilities were so unsanitary and unsafe. Many camps lack of latrines or pit toilets altogether, and the toilets that do exist often KEY FINDINGS: DECEMBER ACCESS TO SANITATION z38% used camp’s portable toilets z22% used a container or plastic bag to defecate z11% used open camp ground to defecate into a container or plastic bag z27% complained the camp’s toilets were unsanitary z13% complained the camp’s toilets posed safety risks from violence z16% said toilets are less sanitary since the cholera outbreak z29% said camp toilets are in the same condition pre and post outbreak KEY FINDINGS: JULY ACCESS TO SANITATION z69% had access to latrines or pit toilets z27% used a container, a plastic bag, or open camp ground to defecate z28% owned toilet paper z57% felt that toilet facilities were unclean or unsafe 8Institute for Justice & Democracy in Haiti (IJDH) The LAMP for Haiti Foundation are only emptied a few times a month, allowing urine, feces and parasites to accumulate. Since July, the majority of people responded that the conditions had stayed the same or become worse. In December, even fewer residents were using the latrines or pit toilets because they are not cleaned often enough and pose a sanitary or safety danger. !e lack of latrines or pit toilets in the camp continues to be a large problem. With IDP camps considered “temporary”, many aid agencies do not want to invest long term in building pit or compost toilets. Cook food well, keep it covered, eat it hot, and peel fruits and vegetables; Clean up safely—in the kitchen and in places where the family bathes and washes clothes. !ere are limited cooking facilities in camps, making it di%cult to cook food properly in a stove and keep it hot. !ere are also few places to bath and wash clothes cleanly and safely. In fact, given the constraints of the camps all bathing, washing and defecation often occur in the same clustered area. !ese unsanitary conditions make it extremely challenging for families to maintain adequate sanitation to prevent cholera. 20. Center for Disease and Control, Cholera Prevention Mes- sage, available at http://www.cdc.gov/haiticholera/pdf/chol- era_preventionmessages.pdf, last accessed January 30, 2010. 42% OF FAMILIES REPORTED NEEDING TREATED WATER; ONLY 16% REPORTED RECEIVING WATER TREATMENT TABLETS OR FILTERS SINCE THE CHOLERA OUTBREAK AND 13% REPORTED RECEIVING POTABLE WATER. RECOMMENDATIONS 1. The inadaptability and late response of aid organizations to the cholera epidemic should be corrected immediately to prevent an outbreak in the camps. Access to safe water, soap and sanitary latrines must be provided. 2. Aid should be planned and coordinated to advance self-sufficiency and permanence. This includes investing in water treatment facilities rather than distributing bottled water; installing compost toilets in lieu of portable toilets that require regular emptying; and building sturdy housing rather than handing out more tarps. 3. Families living in IDP camps cannot become self-sufficient without permanent housing. The government and donors must prioritize clearing rubble from the earthquake to help people return home. A resettlement plan must be adopted and implemented to allocate land and resources to build permanent communities or, where possible, convert IDP camps into permanent settlements. 4. The Government of Haiti should stop all evictions from IDP camps until it adopts and implements a resettlement plan that provides alternative shelter to those evicted. 5. Haitians need more economic opportunities to foster independence. Job training and work opportunities at living wages should be a priority of all aid and reconstruction projects. 6. To encourage the protection of the rights of Haitians, the UN Guiding Principles on Internal Displacement should be consulted and integrated into all policies and procedures relating to aid distribution, resettlement and disaster reconstruction.