Work of 125 aid agencies failed to create lasting rehabilitation services in Haiti, study shows

Two years after the devastating earthquake that left over 300 000 people injured in Haiti, international aid agencies have failed to work with the government to create rehabilitation services that will last, a study has concluded.

“Thanks to the earthquake, for the first time this country has proper rehabilitation services,” said Karl Blanchet, a coauthor of the study. “But the quality depends on the international organisations. If they leave, the services will go too.” The study was conducted by a team at the International Centre for Evidence in Disability at the London School of Hygiene and Tropical Medicine.

Haiti received a far greater rehabilitation response after the January 2010 earthquake than previous disasters such as the 2004 Indian Ocean tsunami, possibly because of its proximity to the United States. But in many ways the sheer number of organisations involved in rehabilitation alone (125, including United Nations agencies and government, international, and Haitian non-governmental organisations) led to failures, says the study.

The study, carried out over nine months and involving more than 60 interviews and analysis of 30 reports by the organisations involved, lists a series of failures, from lack of coordination among organisations to disregard of national authorities and a high turnover of volunteer workers who had neither the medical nor the language expertise needed.

International organisations held coordination meetings in English, rather than French or Creole, thus excluding many local players; and not enough was done to work with local health professionals to build long term services for people with disabilities.

“The Haitian staff just switch off because they know that the [international] team are going to be there for 5, 6 days and then . . . the next team’s going to come with a whole different way of doing things . . . It’s disastrous,” said one of the 61 people interviewed for the study.

Prosthetics received much attention in the immediate response to the earthquake, although the data available indicate that amputations accounted for only 6% of the impairments recorded after the earthquake. Aid funds were restricted to provision of prosthetics in many cases, and inappropriate donated wheelchairs were “dumped” and “distributed by NGO [non-governmental organisation] staff with little or no training in physical rehabilitation” the study found.

Many interviewees said they believed that “in some cases the rehabilitation response was driven by media rather than by real needs.”

Over 220 000 people were killed by the earthquake in January 2010, which struck the country’s most populous area. Some 1.1 million people (nearly a seventh of the population) have disabilities as a result of the disaster, government figures show.

In part because of donor requirements, international agencies focused for a long time on emergency services, despite the fact that there was soon a greater need for more general, long term services. Just five months after the disaster, clinics recorded a drop in the numbers of earthquake injured patients and a steady rise in the number of patients with new or previously untreated injuries, the study shows.

Some long term progress has been made as a result of the massive international rehabilitation effort. Before the earthquake people with spinal cord injury in Haiti were not expected to survive more than a year or two after their injury, the study says. Rapid and low cost interventions provided since the earthquake and improved training of staff mean that those patients are now likely to survive much longer.

The study recommends practical improvements to the way international organisations coordinate emergency operations in future, including simple things such as hiring staff proficient in the local language to increase cooperation with local authorities. Finally, the report recommends patience when organisations are working in countries with weak governments.

International aid organisations “must be prepared to work more slowly than they may wish if they seek to develop sustainable programmes.”

Handicap International, one of the leading international organisations working on rehabilitation in Haiti, recognised the criticisms but “provided essential emergency services in the early post-earthquake phase without developing long term approaches,” the report says.

But its UK director, Aleema Shivji, said, “HI [Handicap International] has made efforts to work with local partners right from the initial emergency response, in order to support local capacity in the longer term.” This May the agency will begin to transfer control of a physical rehabilitation centre, set up in 2010, to its local partner organisation, Healing Hands for Haiti.