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Rebuilding Haiti in the Time of Cholera

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International NGOs are working flat out to try and contain the cholera outbreak in Haiti, which by November 22 has killed at least 1,344 people and threatens hundreds of thousands more already traumatized by January's devastating earthquake.

The epidemic adds yet another layer of misery on the Haitian population and poses additional challenges for aid workers who have been working tirelessly since the January 12 earthquake to try and get people back on their feet.

How the cholera outbreak began is uncertain and the United Nations estimates there could be 200,000 cases in the next six months to a year. What we do know is that the outbreak is completely unrelated to the response to the earthquake -- the area initially hit by cholera was not affected by the quake. The spread of the disease was made worse by the flooding caused by hurricane Tomas and the latest violence has impeded the efforts of aid workers seeking to contain the disease.

Some groups have suggested NGOs could have done more to prevent the spread of the disease, and that if we had spent all the money so generously donated by the American people to cope with the aftermath of the earthquake, this would have lessened the chances of an outbreak.

But cholera did not start because of the earthquake disaster or from NGOs not burning through donations at a more rapid rate. Its roots are in Haiti's poverty, dirty waterways and garbage-clogged canals. NGOs are implementing hundreds of water projects across Haiti and most of these are focused on the camps for disaster victims. But to get clean water to the entire country will take years.

Even before the earthquake, Haiti was ranked the poorest country in the Western Hemisphere with 80 percent living below the poverty line.

What many don't realize is that responsible NGOs are not only focused on disaster management and keeping people alive, but also on projects such as building homes and schools as well as agriculture and micro-finance projects. Of nearly a billion dollars raised by our members immediately after the earthquake, a little over half was set aside at a U.N. conference last March for reconstruction and development projects. It is essential we do this longer-term work so that we can build up better systems to deal with another calamity when it strikes.

More funds need to go to fighting the cholera epidemic. The United Nations led an appeal last week for $164 million more to tackle the epidemic. Unfortunately the response has been woefully inadequate and donations are trickling in, filling less than 10 percent of the request so far. We urge international donors to meet this appeal. Critical supplies are needed as well as more doctors, nurses and other staff to cope with the scale of this epidemic. There is no time to waste.

The epidemic has not, thankfully, been seen in the sprawling tented camps in the capital where hundreds of thousands have sought shelter since the earthquake. The effort to get clean water into camps, the distribution of hygiene kits and tent-by-tent visits by health education workers have helped prevent a major outbreak.

What has not helped is the violence against aid workers as we seek to contain this epidemic. Some election candidates in the November 28 poll have also used the cholera issue to stoke up antagonism towards our community.

We understand the anger and frustration of the Haitian people who have endured trauma after trauma, both man-made and natural. Certainly, as president of the largest alliance of U.S.-based international NGOs working in Haiti, I find it especially painful to see hundreds of thousands of people still living in temporary shelters nearly a year after the disaster.

While the pace of recovery is frustrating, international NGOs have made a difference in people's lives. Schools have been built, jobs programs initiated and tens of thousands more now have access to clean water than before the quake.

In Haiti, what may seem like a simple task is never the case. There are logistical logjams everywhere. It can take 90 minutes to drive just a few miles, making it particularly difficult for cholera patients to get to treatment centers. Quick identification and treatment of the disease is critical.

The Haiti earthquake and now the cholera crisis underscores a challenge to the entire aid community -- how to respond to urban disasters of this scale, particularly in a densely-populated, poor capital like Port-au-Prince.

An effective response in urban environments depends on having a strong, engaged partner on the ground. When a new government is in place after this month's elections, we hope it will move quickly to cut some of the bureaucratic tape that has often hindered our efforts in Haiti. At times, life-saving medicines have been held up in customs for months, along with shelter materials. This is unacceptable and serves only to slow down our work.

It is unrealistic to expect overnight miracles in Haiti, which has suffered from decades of poverty. The problems are simply too big to be solved in the next few years. But as international NGOs, we are ready to work alongside the new Haitian government to ensure a more integrated rebuilding process. Many of us are in for the long haul.

Approximately half of InterAction's almost 200 members are doing work in Haiti.