The GiveWell Blog

What is the situation in Haiti a year after the earthquake? What have and haven’t charities accomplished so far?

Yesterday we discussed how much has been raised and spent for Haiti relief. Today we’ll summarize what we know about how the relief effort has progressed over the last year.

Our detailed and sourced account of the relief effort as a whole will be available by the end of today, and linked here when it is. Update: this page is now available. (Our take on individual organizations will be published tomorrow.) For now, the big picture as we see it is that the relief effort has reached a lot of people with some basic necessities, but that conditions in the camps are still extremely poor, and that there is a dire need to halt the ongoing outbreak of cholera and clear more of the rubble.

  • The relief effort provided immediate shelter assistance, mostly in the form of tarps, within three months of the earthquake, although there has been some criticism that this was slower than it needed to be due to coordination issues. There has also been criticism of the emphasis on tarps as opposed to tents.
  • Conditions in settlement camps, while varied, have generally been extremely poor. One study involving visits to over 100 camps concluded that

    seven months following the earth-quake, 40 percent of … camps do not have access to water, and 30 percent do not have toilets of any kind. An estimated 10 percent of families have a tent; the rest sleep under tarps or even bed sheets. In the midst of the hurricane season with torrential rains and heavy winds a regular occurrence, many tents are ripped beyond repair. Only a fifth of camps have education, health care, or psycho-social facilities on site.

  • Construction of transitional shelters (higher-quality living spaces compared to camps) has been far slower than hoped. 9 months after the earthquake, only about 60,000 people were living in such shelters (out of likely over 1 million people left homeless by the earthquake). The number of transitional shelters has reportedly tripled since then, so things may be improving on this front. Rubble and confusion over land rights have been major obstacles to transitional shelter construction.
  • Water and sanitation efforts have been hampered by the difficulty of operating in a crowded urban area, and have generally been poor, especially in terms of sensitivity to privacy. A massive outbreak of cholera began in October and has led to over 3000 deaths and 171,000 infections nationwide, and is ongoing.
  • A large number of people have been reached with medical assistance and food aid, and we have not seen major criticisms of the relief effort on these fronts. We have also seen no assessments of the quality of medical care or of medical outcomes after the earthquake (i.e., deaths/complications not directly related to the earthquake itself or the cholera outbreak).
  • Rubble removal has been a major problem, and at least 80% (possibly much more) of rubble remains un-managed. Property rights and coordination issues have been obstacles on this front; the difficulty of navigating narrow roads has been an issue as well.

Overall, we’d say that the progress of relief has been disappointing.

One of the questions we’ve been thinking about is whether relief in a situation like this is over- or under-funded relative to everyday aid. I see a few possible interpretations of the disappointing relief effort in Haiti:

  1. Relief organizations aren’t spending money fast enough – they are selfishly/irrationally holding money for later projects that they should be spending now. If they would spend more, the above problems would be alleviated.
  2. Relief organizations are wisely conserving their funds for necessary later rebuilding efforts. If donors gave more generously, relief organizations would be spending more now, and still have enough left over for later rebuilding.
  3. Relief organizations are wisely withholding funds because money isn’t the bottleneck to better outcomes. The logistical and political problems can’t be solved simply by spending more money, and any spending above current levels could be wasteful and even harmful.

Although #1 seems to be the most common narrative in the media, I find it the hardest to believe. All of the public pressure seems to be on nonprofits to spend faster and get quicker, more tangible results. Spending money now seems to be the best move from a public relations standpoint; if it were also the best move from an outcomes standpoint, I don’t see what motivation relief organizations would have for doing otherwise.

#2 seems possible. We have acknowledged that rebuilding Haiti could take all the money that’s been given and more.

However, given the direness and urgency of the current needs – particularly the cholera outbreak and the rubble situation – it seems to me that any effective investment in getting better outcomes now ought to more than pay off later. (Haiti can’t be rebuilt without clearing the rubble or stopping the cholera outbreak; the sooner these are done, the better.) Because of this, and in view of the large amounts given/spent in the context of Haiti’s economy, I lean toward explanation #3: Haiti earthquake relief doesn’t have immediate room for more funding (though this would not preclude having significant needs for more long-term rebuilding funds).


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