World Report 2015: Haiti

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World Report 2015: Haiti

The Haitian government and international community made limited progress in 2014 to address the devastating impact of recent natural disasters and a deadly cholera epidemic. Political stalemates, resource constraints, and weak government institutions continued to hinder the Haitian government’s efforts to meet the basic needs of its people and address long-standing human rights problems, such as violence against women and inhumane prison conditions.

For the fourth consecutive year, Haiti failed to hold constitutionally mandated elections, leading to a deteriorating political environment. The terms of another one third of the Senate and a number of deputies were due to end in early 2015, leaving almost all elected national and local positions in Haiti (with the exception of a remaining one third of senators and the president) open or filled by appointees.

As of June, 103,565 internally displaced persons (IDPs) were living in camps established in the aftermath of the 2010 earthquake, according the International Organization for Migration, down more than 90 percent since 2010. The United Nations estimates that some 70,000 of the remaining IDPs have no prospect of a durable solution.

The cholera epidemic has claimed more than 8,500 lives and infected over 700,000 people in four years. Nevertheless, 2014 marked a significant decrease in the number of suspected cases and a dramatic reduction in deaths, down to 51 deaths for the year as of September, compared to over 4,100 deaths in the first three months of 2010.

Criminal Justice System and Detention Conditions

Haiti’s prison system remains severely overcrowded, in large part due to high numbers of arbitrary arrests and prolonged pretrial detentions.

The weak capacity of the Haitian National Police (HNP) contributes to overall insecurity in the country. While the government and the United Nations Stablization Mission in Haiti (MINUSTAH), the UN peacekeeping operation in the country, have made police reform a priority, there have been difficulties training sufficient numbers of entry-level cadets. The latest report of the UN secretary-general on MINUSTAH estimated the police-to-population ratio by the end of 2014 would likely be half the minimum recommended number.

Accountability for Past Abuses

Former President Jean-Claude Duvalier returned to Haiti in January 2011 after nearly 25 years in exile. He was charged with financial and human rights crimes allegedly committed during his 15-year tenure as president. From 1971 to 1986, Duvalier commanded a network of security forces that committed serious human rights violations, including arbitrary detentions, torture, disappearances, summary executions, and forced exile.

In 2012, the investigating judge in the case found, contrary to international standards, that the statute of limitations prevented prosecuting Duvalier for his human rights crimes. An appellate court heard testimony in a challenge to the ruling in 2013, with Duvalier appearing in court and answering questions posed by the court and victims’ attorneys. In a historic ruling on February 20, the Port-of-Prince Court of Appeal found that the statute of limitations cannot be applied to crimes against humanity and ordered additional investigation into charges against Duvalier. However, Duvalier died on October 4 without having been brought to trial for his crimes. At time of writing, a reopened investigation into crimes committed by Duvalier’s collaborators was still pending.

Violence against Women

Gender-based violence is a widespread problem. A draft law on combatting violence against women that would bring Haiti’s criminal code in line with international standards has been discussed among members of parliament, but not officially introduced for debate.

A council of advisers to the president was reviewing two pending draft revisions to Haiti’s criminal code that include acts of gender-based violence, such as rape and sexual assault, not currently in the code, with the expectation that a conciliated version would be presented to parliament in early 2015.

Children’s Domestic Labor

Use of child domestic workers—known as restavèks—continues. Restavèks, the majority of whom are girls, are sent from low-income households to live with wealthier families in the hope that they will be schooled and cared for in exchange for performing light chores.

Though difficult to calculate, some estimates suggest that 225,000 children work as restavèks.These children are often unpaid, denied education, and physically or sexually abused. Haiti’s labor code does not set a minimum age for work in domestic services, though the minimum age for work in industrial, agricultural, and commercial enterprises is 15. Most of Haiti’s trafficking cases are restavèks. In May, Haiti passed legislation outlawing many forms of trafficking, including hosting a child for the purpose of exploitation.

Human Rights Defenders

Human rights defenders continue to face threats of violence. Malya Vilard Apolon, co-founder of Komisyon Fanm Viktim Pou Viktim (KOFAVIV), a women’s rights organization, left Haiti in March after repeated death threats, harassment, and the poisoning of her family dogs. Marie Eramithe Delva, KOFAVIV’s other co-founder, reported to police in May that she received death threats by text message from a woman in police custody, and provided screenshots of the threats and phone number. To her knowledge, there was no further investigation into her claims and she received no protection from police, prompting her also to leave Haiti in June.

In February, Daniel Dorsinvil, the general coordinator for the Platform of Haitian Human Rights Organizations (POHDH), and his wife Girldy Lareche were killed while walking in a Port-au-Prince neighborhood near the POHDH offices. In the days after the murders, government officials claimed that the crime occurred during an armed robbery and was unrelated to Dorsinvil’s human rights activities or criticism of the government. This claim was not substantiated by a thorough investigation, according to local civil society representatives.

Pierre Espérance, executive director of the Réseau National de Défense des Droits Humains (RNDDH), received a death threat in April accusing him of reporting false human rights claims in an effort to destabilize the government. The handwritten threat also included a bullet and stated “this time you won’t escape,” referring to an incident in 1999 when Espérance was shot but survived.

Key International Actors

The UN mission, MINUSTAH, has been in Haiti since 2004 and has contributed to efforts to improve public security, protect vulnerable groups, and strengthen the country’s democratic institutions. The UN Security Council extended MINUSTAH's mandate through October 15, 2015.

There is mounting evidence that the cholera epidemic that began in October 2010 is likely to have been introduced by UN peacekeepers. A member of the UN’s Panel of Experts on the outbreak, stated that “the most likely source of the introduction of cholera into Haiti was someone infected with the Nepal strain of cholera and associated with the United Nations Mirebalais camp.”

Responding to the UN’s dismissal of claims for compensation from 5,000 victims of the epidemic, the victims’ representative, the Institute for Justice and Democracy in Haiti and the Bureau des Avocats Internationaux filed a lawsuit before a US court. At time of writing, a motion to dismiss was pending. To date, there has been no independent adjudication of the facts surrounding the introduction of cholera and the UN’s involvement.

According to figures from the UN Office of Internal Oversight Services, at least 93 allegations of sexual abuse or exploitation have been made against MINUSTAH personnel in the last eight years, including 11 in 2014, as of September 30.

In February, the UN independent expert on Haiti, Gustavo Gallón, called for “shock treatment” to significantly reduce the number of persons in pretrial detention.


In May, the Inter-American Commission on Human Rights called on all Organization of American States (OAS) member states to make their archives and official files on the human rights abuses committed under Duvalier open for use as evidence in the investigation. It was unknown whether OAS member states had complied with the commission’s request.

Haiti sees spike in cholera deaths

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Haiti sees spike in cholera deaths

As cholera continues to spread, clinics are struggling to cope with the deluge of patients

Death toll jumps to 917 as international organisations appeal for funds to fight epidemic.

The death toll from Haiti's cholera outbreak has soared to 917 as officials struggle to contain the growing epidemic threatening the quake-ravaged country.

The previous official toll announced two days earlier was 796.

Authorities on Sunday said 14,642 people had been treated in hospitals since the disease took hold in the desperately poor Caribbean nation.

Officials fear the scale of the epidemic could increase exponentially if cholera infiltrates makeshift camps in the capital city of Port-au-Prince, where hundreds of thousands of earthquake survivors live in cramped and unsanitary conditions.

A January earthquake flattened much of the capital, leaving more than 250,000 people dead and an estimated 1.3 million of Haiti's 10 million population displaced.

Public plea

Haitian officials have taken to the airwaves with a major televised campaign to communicate information on the cholera outbreak to the public, but Al Jazeera's Cath Turner, reporting from Port-au-Prince, said it was not clear how many people were able to watch the special broadcast.

"There were communal television sets, set up at markets, on the sides of the streets, where people gather around and watch," Turner said. "The first three TV sets that were set up had no electricity, so they didn't even have any power, which speaks to the conditions here in Haiti at the moment."

The only working communal set Turner saw was broadcasting a football game.

In addition to having difficulty reaching the public, Turner also reported that officials must also tackle their image problem, as the public views any official statement with "general suspicion and distrust".

Haiti's priests and religious leaders, she said, have the most power in terms of reaching people.

"Many Haitians we spoke to say, 'Maybe Jesus will protect me from this outbreak. If Jesus was meant to give me this cholera, we will face it - we will face this adversity,'" our correspondent said.

Government officials, Turner said, have contacted religious leaders, asking them to talk about cholera in their sermons and services.

UN appeal

International organisations have stepped up appeals for funds to bring in more doctors, medicine and water purification equipment.

The United Nations is asking for $164m to fight the epidemic, which has gained strength over the past week.

"We hope we can get this, otherwise all our efforts will be over-run by the epidemic," Elisabeth Byrs, a spokeswoman for the UN office for the Coordination of Humanitarian Affairs said in Geneva on Friday.

The outbreak, the first in Haiti in more than a century, was  confirmed on October 22 in northern Haiti where the Artibonite River  is believed to the conduit of the disease.

Since then, thousands of people have been sickened, swamping tiny, overwhelmed and ill-prepared hospitals and clinics, according to the health ministry.

Can Microlending Save Haiti?

A Fonkoze client’s business.

Linda Boucard of Fonkoze met with clients.

More than a million Haitians live in tent cities, like Léogâne’s, shown in June

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Can Microlending Save Haiti?

Since the earthquake, microbanks have been working to keep credit flowing to businesses like this fabric store.

Muhammad Yunus was microcredit’s pioneer.

VENANTE LINO, a small-business owner who lost nearly everything in the devastating earthquake in January, stood in line here along with dozens of other impeccably dressed women, all waiting to pay the latest monthly installment on the emergency loans they received to rebuild their businesses.

Mrs. Lino approached a folding table in the courtyard of one of the few remaining buildings in this town, located near the quake’s epicenter. She emptied her pockets of cash and gave all $40 to the loan officer.

“Every day, I wake up and ask God to make this better. Many days, I don’t think he’s listening,” says Mrs. Lino, a 63-year-old grandmother who lives under a tarp in her backyard with three grown children and four grandchildren, surviving on the meager income from a small food and cooking-oil business she reopened this summer with loan money. “Without this help, I don’t know where my family would be.”

Here in this once-bustling coastal town about 20 miles west of Port-au-Prince, more than 30,000 people — a third of the population — died as a result of the quake. Throughout Haiti, the toll may be as high as 250,000, and the economic effects have been staggering. The country’s economy is expected to contract by as much as 9 percent this year, and more than a million residents live in tent cities. And an outbreak of cholera, as well as a hurricane early this month, have left the nation even more vulnerable.

Especially hard hit are the tens of thousands of small-business owners, known as ti machann, who sell everything from heating oil to school uniforms from their homes and are often the sole breadwinners for their families. Because Haiti’s credit markets remain frozen, people like Mrs. Lino would have had almost no chance to rebuild if it weren’t for microbanks like Fonkoze, Haiti’s largest, which gave loans to the women in Léogâne.

In the best circumstances, sustaining a “bank to the poor” is no easy feat, but in Haiti after the earthquake, the challenge has been extraordinary. Even before the quake, 80 percent of the population lived on less than $2 a day. Today, while some 50 nations and organizations have pledged a total of $8.75 billion for reconstruction, less than 15 percent of the total promised for 2010-11 has arrived. (The United States has not yet paid all the $1.2 billion in reconstruction funds it pledged.)

Haitian microbanks provide a crucial lifeline to the poor, but their financial situations are sometimes nearly as precarious as those of their clients. Moreover, the banks are operating in a country that lacks many of the basic building blocks for businesses — reliable transportation, communication and supply networks — thus making the challenges all the more complex.

Their importance to hundreds of thousands of Haitian borrowers and savers gives these little institutions an outsize importance, making them “simply too big to fail,” said Greta Greathouse, a consultant with the United States Agency for International Development’s microsavings and lending program in Haiti.

“You are dealing with a very vulnerable and fragile population,” she said. The banks “need to get stronger on a permanent basis so they can offset the operational risks that come with Haiti because of the earthquake and the inherent risks that are unfortunately a way of life for the country and its people.”

MICROCREDIT banks, or microbanks, were pioneered by Muhammad Yunus, the founder of the Grameen Bank, which started 40 years ago by giving loans of a few dollars each to poor entrepreneurs in Bangladesh. In 2006, Mr. Yunus received the Nobel Peace Prize for this work.

In most cases today, microcredit clients start off with loans of as little as $25 to start a small business. The loans are often given to women who tend to spend their earnings directly on their families and communities. Many borrow in groups of five or more, and all members of the group work together and are responsible for repayment.

Some microlenders provide only loans, while others also offer education and health services. Partly because costs are so high, effective interest rates are often significantly steeper than those at traditional banks. In Haiti, rates range from 30 percent to 55 percent a year.

“Haiti is one of the most complicated environments for anyone to do business, let alone a small lender with an extremely poor clientele,” said Alex Counts, president of the Grameen Foundation, a nonprofit in Washington that fosters microlending. “Appropriate levels of interest are important, but it’s also essential these organizations continue to do the important work they do.”

One of the largest of Haiti’s microcredit groups, Finca Haiti, wrote off almost a third of its portfolio after many clients died in the earthquake or lost their homes and businesses. A staggering 53 percent of its borrowers were late on their payments. After losses of its own, ACME, another Haitian microbank, raised additional capital this summer.

Fonkoze, Creole for “shoulder to shoulder,” was started by the Rev. Joseph Philippe, a Haitian priest, in the mid-1990s. It has 45,000 clients and 43 branches across the country, but it lost $2 million in the three years before the earthquake. In 2008, after losses from a particularly bad hurricane season, the organization considered closing its for-profit bank and incorporating that division’s 24 branches.

Over all, the share of microcredit clients in Haiti who have defaulted or are at risk of doing so has risen to 18 percent, more than double the rate of a year ago. The international standard is 2 to 3 percent. Several of the Haitian microbanks, particularly some very small ones, could close or reduce their operations if their portfolios don’t improve, according to microbanking experts in Haiti and elsewhere. It’s likely that some will have to consolidate in order to survive.

Microbanks in other countries are increasingly aiming to become self-sustaining so they don’t need to continually raise funds to pay operational expenses. Some have transformed themselves from nonprofit into for-profit banks, raising questions of whether altruism and capitalism can co-exist. India’s largest microlender, SKS Microfinance, went public this summer, raising $358 million, and other banks may do the same.

While most microbanks in Haiti remain nonprofits, and have less financial transparency, Fonkoze started a for-profit bank (in addition to its nonprofit arm) in 2004 and reports both divisions’ earnings. It operated at a loss for three years but has stabilized after $15 million in donations this year.

Haiti has had natural disasters before, of course. But the earthquake’s impact on the nation’s banks was staggeringly high, in no small part because of the damage in Port-au-Prince, the capital, which accounts for 60 percent of the country’s gross domestic product. The banking sector, already fragile, was crippled. Out of 1,800 microbank employees in the affected region, 600 lost their homes. A quarter of the $38 million in outstanding microcredit loans in the region could end up defaulting, according to an analysis by Ms. Greathouse.

Despite the risks and financial costs, several Haitian microbanks are expanding, saying their loans are one of the only paths to self-sufficiency for the growing number of poor people in Port-au-Prince and the countryside.

For example, after losing a third of its 12,000 clients after the earthquake, Finca added back 1,000 clients this summer with the help of a grant from the Citibank Foundation. It’s a risky move: the percentage of Finca Haiti clients who are more than 30 days behind on their payments, a standard known as portfolio at risk, remains at 35 percent.

In July, after its director was ambushed in an attempted robbery, the bank moved its headquarters from the capital to a nearby coastal city, Saint-Marc, according to Rupert Scofield, the president of Finca, which is based in Washington and operates in 21 countries.

When it comes to doing business, “Haiti is probably the hardest place in the world right now outside maybe Afghanistan,” Mr. Scofield says. “It always seems just as things get stabilized, something else happens to pull the country back.”

Anne Hastings, Fonkoze’s co-chief executive, has become something of an international aid celebrity: she was a high-profile attendee of the Clinton Global Initiative conference this fall in New York. (The bank’s profile rose significantly in the days after the earthquake, when it was one of the only banks operating outside Port-au-Prince, and Ms. Hastings secured American military assistance to airlift $2 million in cash to desperate clients.)

Soon after the quake, Fonkoze wrote off 10,000 loans — almost a quarter of its total number — with funds from the Red Cross and others. The bank then gave each client a new loan and a one-time cash payment of $125, at a total cost of $8.5 million.

In recent months, the bank has broadened its health program and aggressively stepped up its operations, particularly in rural areas where poverty rates are highest and seem to be growing.

The bank has enlarged a loan program, called Ti Kredi, or Little Credit, to reach poor families that are not ready for larger loans. Ti Kredi offers loans of just $25, shorter repayment periods, additional support from loan officers, and literacy and health classes.

In another program, clients are offered goats or chickens so they can sell milk or eggs, as well as a weekly stipend of $7 to help with expenses, and to ensure that they don’t need to kill the animals because they are hungry.

SINCE the summer, Fonkoze loan officers have canvassed the lush, mountainous region on motorcycles, in pickup trucks or on foot to sign up as many as 3,000 new clients and to meet with existing ones to monitor their progress and to collect loan payments.

One recent rainy day, Steve Werlin rode for more than an hour on the back of a pickup truck outside Mirebalais, a small, central plateau town two hours north of Port-au-Prince. Mr. Werlin, a regional Fonkoze director, was on his way to meet Marie Ange Joute, a 30-year-old mother of two. Ms. Joute joined Fonkoze in September and lives with her children, mother, sister and niece (who was sick with a severe eye infection) in a small mud house with a tin roof on a 20-by-20-foot parcel of land. The house, which Ms. Joute inherited from her father, is her only asset, and she said the family had sometimes gone without food and medical care over the last year.

She has no business background but recently received two chickens and a goat from the bank and started selling eggs and heating oil from her house. To save enough money to expand her inventory, she joined a savings club with 10 local Fonkoze clients. Each woman saves a third of her weekly stipend so that once every 10 weeks, they get a lump-sum payment of $20 for larger purchases.

Clients are required to do many things on their own, and face penalties if they cannot meet certain goals. On the day of the visit, Ms. Joute had yet to build a shed for her goat, which could become sick in the rain. So she was told she wouldn’t get her stipend the next week unless the shed was built. (Fonkoze gave her materials and training to build the shed, and she complied.)

“I want to make my own money and care for my family,” she said. “I want to provide for us if something goes bad. I know how to work.”

AFTER the upcoming presidential elections, Haiti’s government is expected to issue new banking regulations, including rules for microlenders. They aren’t regulated now, though they have appealed for years to the government for rules that could bring more certainty to the industry. If a microbank went out of business, for example, it is not clear what would happen to the many clients who deposit their savings in the bank.

Fonkoze has 200,000 savings accounts, totaling $14 million. Currently, it uses those funds to make new loans, and it says that all of its accounts are secure. Because it was able to write off risky loans early this year, according to James Kurz, a senior Fonkoze financial adviser, its portfolio at risk has fallen to 5 percent in recent months.

If Haiti’s economy doesn’t improve and the country cannot stem various other problems, even some people who have managed to eke out a living with the help of microcredit could face more difficulty.

Sainte Anne Louis sells sodas, canned goods, clothing and homemade peanut butter outside her home in Mirebalais, yards away from a construction site for a new rural teaching hospital. She says her sales have fallen by nearly half this year, in part because it has been hard to secure enough inventory.

Mrs. Louis, 54, supports her entire family, including her husband, two daughters and their families. She worries about what will happen if things don’t improve soon. “We are grateful for what we have today,” she says, “but we pray tomorrow will be better.”

Haiti cholera toll goes up to 724

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Haiti cholera toll goes up to 724

Death toll in the cholera epidemic in Haiti has risen to 724. The disease has infected a total of 11,125 people nationwide, according to the government figures.

PORT-AU-PRINCE: The toll in the cholera epidemic in Haiti has risen to 724, authorities said.

The disease has infected a total of 11,125 people nationwide, according to government figures released Thursday.

The maximum number of fatalities, 497, has been in the northern province of Artibonite, where the cholera outbreak began.

Nine deaths have been reported in Port-au-Prince, where thousands of people have been living in refugee camps since the Jan 12 earthquake that killed 300,000 people and left one million homeless.

According to tests performed by the Centre for Disease Control and Prevention, the disease has been caused by bacteria found in south Asia.

Cholera spreads to Haitian capital

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Cholera spreads to Haitian capital

Nearly half of Port-au-Prince's three million residents have been living in tents since the January 12 earthquake

More than 100 cases registered as thousands of people in Port-au-Prince's camps face growing risk of catching disease.


At least 115 cases of cholera , including the death of one person, have been registered in Haiti's capital, the most significant warning sign yet that the epidemic has spread from outlying areas to threaten hundreds of thousands of people in the city's camps.

Officials refer to a patient who has been hospitalised with confirmed and suspected cholera as a case.

Samples from patients in Port-au-Prince are being tested in a laboratory to confirm the presence of vibrio cholera bacteria, which has already killed at least 643 people in Haiti, said Gabriel Timothee, the health ministry's executive director.

If confirmed, the bacteria could imperil an estimated 2.5 to 3 million inhabitants.

He said many of the hospitalised patients are believed to have recently arrived from parts of Haiti such as the Artibonite Valley, where the epidemic was first registered and has done its most damage.

Al Jazeera's Sebastian Walker, reporting from Port-au-Prince, said that hospitals are "overwhelmed".

"Given the sheer number of cases that hospitals are receiving, it is simply not possible to conduct laboratory tests in order to give 100 per cent overall confirmation that this is cholera," he said.

Rapid spread

In little more than three weeks it is suspected of infecting tens of thousands of people, though only about a quarter of people infected normally develop symptoms of serious diarrhea, vomiting and fever.

More than 6,400 of the known 9,123 cases to date have been in the agricultural region, clustered around the Artibonite River.

Most of the people suspected of having the disease in the capital are in the Cite Soleil slum, the expansive oceanside shantytown at the capital's far northeastern edge and its closest point to the valley.

Since its discovery in late October, the disease has spread to half of Haiti's 10 administrative regions, or departments. More than 200 people have been hospitalised in the West department, where Port-au-Prince is located.

Nearly four per cent of the thousands hospitalised have died, most from extreme shock brought on by dehydration.

Investigation under way

Cholera had never been documented in Haiti before its sudden appearance last month. Officials are concerned that floods triggered by Hurricane Tomas on Friday and Saturday could exacerbate the spread of the disease, which is transmitted through the consumption of fecal matter contained in contaminated water or food.

Our correspondent said: "It is almost impossible to contain this disease in an environment like this. Port-au-Prince is a very overcrowded city with appalling sanitation infrastructure."

The release of a dam on the Artibonite River caused the infected waterway to swell Monday, but there were no reports of major flooding.

An analysis by the CDC has found that the cholera outbreak in Haiti most closely matches a strain of the disease found in South Asia.

Public health experts including Paul Farmer, the UN's deputy special envoy to Haiti, have called for an investigation into the origin of the outbreak.

An unconfirmed theory is that the disease was introduced to Haiti by UN peacekeepers from Nepal who are based on a tributary to the Artibonite River.

135 dead, 1,500 sick from cholera in Haiti: Official

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135 dead, 1,500 sick from cholera in Haiti: Official

A cholera epidemic in Haiti has claimed 135 lives and infected 1,500 people over the last few days.

ST. MARC: At least 135 people have died in a suspected cholera outbreak, and aid groups are rushing in medicine and other supplies Friday to combat Haiti's deadliest health problem since its devastating earthquake.

The outbreak in the rural Artibonite region, which hosts thousands of quake refugees, appeared to confirm relief groups' fears about sanitation for homeless survivors living in tarp cities and other squalid settlements.

``We have been afraid of this since the earthquake,'' said Robin Mahfood, president of Food for the Poor, which was preparing to fly in donations of antibiotics, dehydration salts and other supplies.

Many of the sick have converged on St. Nicholas hospital in the seaside city of St. Marc, where hundreds of dehydrated patients lay on blankets in a parking lot with IVs in their arms as they waited for treatment.

Catherine Huck, deputy country director for the U.N. Office for the Coordination of Humanitarian Affairs, said the Caribbean nation's health ministry had recorded 135 deaths and more than 1,000 infected people.

``What we know is that people have diarrhea, and they are vomiting, and (they) can go quickly if they are not seen in time,'' Huck said. She said doctors were still awaiting lab results to pinpoint the disease.

The president of the Haitian Medical Association, Claude Surena, said the cause appeared to be cholera, but added that had not been confirmed by the government.

``The concern is that it could go from one place to another place, and it could affect more people or move from one region to another one,'' he said.

Cholera is a waterborne bacterial infection spread through contaminated water. It causes severe diarrhea and vomiting that can lead to dehydration and death within hours. Treatment involves administering a salt and sugar-based rehydration serum.

No cholera outbreaks had been reported in Haiti for decades before the earthquake, according to the U.S. Centers for Disease Control and Prevention. Haitian officials, including President Rene Preval, have been pointing to the lack of severe disease outbreaks as a hard-to-see success of the quake response.

With more than a million people left homeless by the disaster, however, experts have warned that disease could strike in the makeshift camps with nowhere to put human waste and limited access to clean water.

At the hospital, some patients including 70-year-old Belismene Jean Baptiste said they got sick after drinking water from a public canal.

``I ran to the bathroom four times last night vomiting,'' Jean Baptiste said.

The sick come from across the Artibonite Valley, a starkly desolate region of rice fields and deforested mountains. The area did not experience significant damage in the Jan. 12 quake but has absorbed thousands of refugees from the devastated capital 45 miles (70 kilometers) south of St. Marc.

Trucks loaded with medical supplies including rehydration salts were to be sent from Port-au-Prince to the hospital, said Jessica DuPlessis, an OCHA spokeswoman. Doctors at the hospital said they also needed more personnel to handle the flood of patients.

Elyneth Tranckil was among dozens of relatives standing outside the hospital gate as new patients arrived near death.

``Police have blocked the entry to the hospital, so I can't get in to see my wife,'' Tranckil said.

The U.S. Embassy in Port-au-Prince issued an advisory urging people to drink only bottled or boiled water and eat only food that has been thoroughly cooked.

Haitians Cry in Letters: ‘Please — Do Something!’ By DEBORAH SONTAG

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Haitians Cry in Letters: ‘Please — Do Something!’ By DEBORAH SONTAG

Ms. Felicien read one appeal for help as other camp residents listened. "It is like we are bobbing along on the waves of the ocean, waiting to be saved," she said.

Sandra Felicien dropping a letter seeking help into a collection box at the camp for displaced earthquake survivors where she lives.

CORAIL-CESSELESSE, Haiti — It was after midnight in a remote annex of this isolated tent camp on a windswept gravel plain. Marjorie Saint Hilaire’s three boys were fast asleep, but her mind was racing.

The camp leader had proposed writing letters to the nongovernment authorities, and she had so much to say. She lighted a candle and summoned a gracious sentiment with which to begin.

“To all the members of concerned organizations, I thank you first for feeling our pain,” she wrote slowly in pencil on what became an eraser-smudged page. “I note that you have taken on almost all our problems and some of our greatest needs.”

Ms. Saint Hilaire, 33, then succinctly explained that she had lost her husband and her livelihood to the Jan. 12 earthquake and now found herself hungry, stressed and stranded in a camp annex without a school, a health clinic, a marketplace or any activity at all.

“Please — do something!” she wrote from Tent J2, Block 7, Sector 3, her new address. “We don’t want to die of hunger and also we want to send our children to school. I give glory to God that I am still alive — but I would like to stay that way!”

In the last couple of weeks, thousands of displaced Haitians have similarly vented their concerns, depositing impassioned pleas for help in new suggestion boxes at a hundred camps throughout the disaster zone. Taken together, the letters form a collective cri de coeur from a population that has felt increasingly impotent and ignored.

With 1.3 million displaced people in 1,300 camps, homelessness is the new normal here. Two recent protest marches have sought to make the homeless a central issue in the coming presidential campaign. But the tent camp residents, miserable, weary and in many cases fighting eviction, do not seem to have the energy to become a vocal force.

When the International Organization for Migration added suggestion boxes to its information kiosks in scores of camps, it did not expect to tap directly into a well of pent-up emotions. “I anticipated maybe a few cranky letters,” said Leonard Doyle, who handles communications for the organization in Haiti. “But to my absolute, blow-me-down surprise, we got 700 letters in three days from our first boxes — real individualized expressions of suffering that give a human face to this ongoing tragedy.”

In some cases, the letters contain a breathless litany of miseries, a chain of woes strung together by commas: “I feel discouraged, I don’t sleep comfortably, I gave birth six months ago, the baby died, I have six other children, they don’t have a father, I don’t have work, my tarp is torn, the rain panics me, my house was crushed, I don’t have money to feed my family, I would really love it if you would help me,” wrote Marie Jean Jean.

In others, despair is expressed formally, with remarkable restraint: “Living under a tent is not favorable neither to me nor to my children” or “We would appreciate your assistance in obtaining a future as one does not appear to be on our horizon.”

Several writers sent terse wish lists on self-designed forms: “Name: Paul Wilbert. Camp: Boulos. Need: House. Demand: $1,250. Project: Build house. Thank you.”

And some tweaked the truth. Ketteline Lebon, who lives in a camp in the slum area called Cité Soleil, cannot read or write. She dictated a letter to her cousin, who decided to alter Ms. Lebon’s story to say that her husband had died in the earthquake whereas he had really died in a car accident. “What does it matter?” Ms. Lebon said, shrugging. “I’m still a widow in a tent with four kids I cannot afford to send to school.”

At this camp’s annex, Corail 3, Sandra Felicien, a regal woman whose black-and-white sundress looks as crisp as if it hangs in a closet, has become the epistolary queen. An earthquake widow whose husband was crushed to death in the school where he taught adult education courses, Ms. Felicien said she wrote letters almost daily because doing so made her feel as if she were taking action. “We are so powerless,” she said. “It is like we are bobbing along on the waves of the ocean, waiting to be saved.”

Like the hundreds of families around her in Corail 3, Ms. Felicien and her small son lived first in Camp Fleuriot, a mosquito-infested, flood-prone marsh where many were feverish with malaria or racked by diarrhea. In July, they were bused here to the outskirts of this planned settlement, which is supposed to become a new town someday.

Transitional shelters are being built in this remote spot, and a hundred or so are completed and stand empty. For the moment, though, the one-room houses, like the tents beside them, exist in a sun-scorched vacuum beneath deforested hills. They are surrounded only by latrines, showers and the information kiosk, with its blackboard, bulletin board and suggestion box.

One afternoon last week, Ms. Felicien settled onto the tarp-covered rocks in front of her tent — “my porch” — and used a covered bucket for a writing desk. She was feeling robust, she said, because a neighbor had just treated her to what amounted to brunch — a pack of cookies that she had shared with her son.

She started to recopy the rough draft of a letter that she had written that morning. She was writing in Creole, although her French is impeccable, because “only a Haitian could really understand,” she said.

While she wrote, with a reporter by her side and a photographer taking her picture, a boisterous crowd from the camp gathered, concerned that she was getting special attention from foreigners. Their complaints grew so deafening that she rose to address them, explaining that, in fact, the particular letter she was writing was not personal but on behalf of all her neighbors.

Raising her voice to be heard, she read aloud the letter: “Sept. 14. Today we feel fed up with the bad treatment in Block 7. Have you forgotten about us out here in the desert?” The crowd quieted. She continued reading: “You don’t understand us. You don’t know that an empty bag can’t stand. A hungry dog can’t play.” Other tent camps have health clinics or schools or at least something to do, she read. “Why don’t we have such things? Aren’t we people, too?”

Heads nodded. The tension dissipated. The crowd dispersed. Ms. Felicien walked her letter to the kiosk to post it. “I don’t know why I keep writing,” she said. “To this point they have not responded. It’s like screaming into the wind.”

Mr. Doyle said that all the letters are read, some aloud on Radio Guinen, which broadcasts daily from tent camps as part of an International Organization for Migration communication program. But the $400,000 program was intended to give voice to the voiceless and not food to the hungry or money to the destitute. So unless the writers express a need for protection, as from rape or abuse by camp leaders, their individual requests are not likely to be answered.

Told this, Ms. Felicien said, “Ay yi yi” and shook her head. And then she posted her letter all the same.