More than 1.5 million Haitians lost their homes in the Jan. 12 quake, leaving even makeshift tents in scarce supply.
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In the first week, workers handed out just 250,000 daily food rations to hundreds of thousands clamoring for them. But it's difficult to see how aid could have been distributed through a ruined Haiti much faster. Indeed, by one measure, things went better than expected: despite a security vacuum that U.S. soldiers now have to fill, fears of widespread violence seemed mostly unfounded, though there were local exceptions. As the shock of the quake receded, Haitians did what people have done throughout the world after natural disasters: they improvised, helping one another while they hoped for aid. Haitians "look more poised to come together and roll up our sleeves," says Jocelyn McCalla, a Haitian-American development consultant.
But that spirit won't be enough to keep Haiti going in the weeks and months ahead. For medium-term recovery, international aid will have to keep supplies flowing. Water will be the first priority. People can go hungry longer than they can go thirsty, and contaminated water can lead to outbreaks of diseases like cholera. Desalination will be one option — the aircraft carrier U.S.S. Carl Vinson, holding off the coast of Haiti, can donate 200,000 gal. (about 757,000 L) of fresh water a day. Steady food aid will be necessary for some time, though there are hopes that the earthquake left Haiti's agricultural sector mostly unscathed. The assistance efforts have to be visible, to assure Haitians they haven't been forgotten and to forestall rage on the ground.
There is also a pressing need for doctors and nurses who can handle traumatic injuries and provide disease care. There were more than 200,000 Haitians with HIV or AIDS before the quake. For them and people with other chronic conditions who need consistent drug treatment, interruption can mean death. Haiti's ruined public-health infrastructure will have to be rebuilt, and that will mean more than just replacing collapsed hospitals. Local talent will be needed — especially vital will be nurses and support staff. Without such a sustained effort, the "long-term ramifications could lead to more deaths than the event itself," says Tom Kirsch, the co-director of the Center for Refugee and Disaster Response at Johns Hopkins University.
Further ahead, a recovering Haiti must change the way it builds. The shoddiness of construction in Port-au-Prince made the death toll dramatically higher than it would have been had the quake struck in a sturdier place; the 1989 quake in the San Francisco Bay Area was of almost the same magnitude as Haiti's but killed only 63 people. A concrete block in Haiti might weigh an eighth of what its U.S. counterpart would, as unscrupulous contractors take kickbacks and building codes go unenforced. It wasn't only slums that tumbled, after all; grand buildings like the presidential palace and the headquarters of the U.N. mission collapsed too. Other developing countries in quake zones, like Colombia, build far more securely. "Earthquakes don't kill people," says Columbia University's Mutter. "Bad buildings kill people. And buildings are bad because people are poor."
That's exactly why recovery will never be complete unless Haiti can break out of the economic basement. The country has a per capita GDP of $1,300 — six times less than that of the Dominican Republic, with which it shares the island of Hispaniola. While the Dominican Republic has enjoyed relative political stability, Haiti's history of corruption and turmoil has helped keep the country poor. Before the quake, Haiti had begun to do better, and in the initial phase of recovery, there will be jobs in reconstruction. Consistent aid policies that include microloans for small businesses and more-liberal tariffs that would nurture a low-cost export sector could help Haiti grow sustainably. A richer Haiti would be a safer Haiti. "Part of recovery has to mean charting a new role for Haiti in the global economy," says Ben Wisner, a research fellow at Oberlin College and a disaster expert.
To someone standing in the rubble of Port-au-Prince, it may seem impossible to believe that Haiti can ever rebuild. But in the past five years, natural disasters that were just as catastrophic — the Asian tsunami, the 2008 quake in China's Sichuan province — were followed by often impressive recoveries. More than $10 billion was spent on aid and recovery for tsunami-hit nations, and though the effort was hardly problem-free — it was marred by corruption, poor coordination and the paradox of too much money chasing too few immediate uses — the Indonesian province of Aceh, ground zero for the disaster, is back on its feet. The recovery in Sichuan is even more impressive: just six months after the quake, which killed 87,000 people, homeless were nowhere to be found. Of course, China's strong central government and turbocharged economy were largely unaffected by the quake. "A place like Haiti — that's going to be a struggle," says Ramsey Rayyis, the regional representative for the American Red Cross in China. "You're going to need a lot more external intervention."
What does the world owe Haiti? Beyond the moral imperative to help save the country, there is a practical incentive. Natural disasters — earthquakes, storms, floods — are unavoidable acts of God. But it's possible to build societies, from New Orleans to Port-au-Prince, that can weather them. Doing so would save lives and the tens of billions of dollars that are spent every time a fragile community gets wiped out. "The world can't afford more of these disasters," says Roger Bilham, a seismologist at the University of Colorado. "It's worth investing in these problems now, while we can." Haiti's buried were victims of poverty and neglect, not just the quake. But we owe it to the survivors — to people like Michaud Jonas — to help build a Haiti that will never again be so vulnerable.
— With reporting by Austin Ramzy / Beijing; Ioan Grillo / Port-au-Prince; and Laura Fitzpatrick / New York
Read more in the new book TIME Earthquake Haiti: Tragedy and Hope and support TIME Haitian relief efforts