The Interim Haiti Recovery Commission, led by current Haiti Prime Minister Jean-Max Bellerive and President Bill Clinton, has promised to help coordinate incoming aid and in-country reconstruction efforts. But many observers point out that the commissioners have met infrequently, been slow to hand out aid money, and produced few tangible results. Stefano Zannini, MSF's head of mission in Haiti, noted in the Monday briefing that although coordination of so many agencies is a massive task, "you have a lot of people sitting around the table talking about what they would like to do, what they could do." But to get the country and its people back in the pink, he said, "there has to be coordination of action, rather than coordination of intention."
Despite all of the assistance health workers have brought to Haitians in need, visiting physicians are not engineers. "The cholera epidemic shows us a whole other aspect of health," Garfield says. "No matter how many nurses and doctors are there as volunteers, it is not going to affect sanitation." And these basics, such as clean water and sanitation, Moffett says, are what it's going to take to give public health necessary footing in Haiti.
MSF, for example, has depended on other agencies and the government to clear waste and provide water in order to be able to proceed with care for locals. With political unrest that occurred after preliminary election results were announced in December, "there were disturbances that meant, for example, that water trucks could not get through," Zannini said. Echoing Zannini's sentiments, Karunakara said, "I would like the national authorities to assume more of their responsibilities."
One of the ways the reconstruction commission or government could be doing more, Zannini said, was to hasten reconstruction of residential areas so that displaced people could move out of the temporary encampments in which they have been living.
Soon after the earthquake many public health experts worried that close quarters in the displaced-persons camps would lead to outbreaks of infectious diseases. Some are pointing to this fall's cholera outbreak as evidence of this inevitability. But as Garfield points out, "the epidemic got going in the Artibonite Valley, where there are hardly any displaced people."
The camps, in many instances, are offering people better access to clean water, sanitation and health services than they had before the earthquake. "One reason you can't get people out of the camps: because things are better there than they were" before the quake, Garfield notes.
After having lived in the camps for close to a year, many people have adopted them as their new homes and neighborhoods. "They've become sort of settled into these camps—they have neighbors and clinics and know where to go for help," Moffett says of the displaced Haitians.
A lack of jobs has also deterred many from being able to move back out into the broader community. Moffett contends that compared with when she first landed on the ground in Haiti a week after the earthquake, "the economy, since January, has come back online."
But without access to independence—financial and otherwise—many people continue to feel the mental strain of the disaster. Galea and his team have been tracking mental health issues following the temblor. Their data are currently under review for publication, but, he says, "we have evidence for pretty substantial mental illness as a result of the earthquake."
Most mental health issues usually appear soon after a major event and are likely to resolve themselves within six months or so, Galea says. But with so many people still lacking jobs and resources to get on with their daily lives, any additional hardships can lead to increased psychological stress.