The United Nations is calling the earthquake in Haiti the most challenging humanitarian disaster ever in terms of relief work, and estimates say over 100,000 people may have been killed. Some reports now indicate the death toll could be around 200,000.

Hygiene and health are out of reach for the poor in Haiti even under normal circumstances. After the earthquake those left alive are locked in a bitter fight for survival.

UN spokeswoman Elisabeth Byrs says the Haitian earthquake is the worst disaster for the UN in terms of the resources available for its relief work. She says there is little or no government infrastructure and that many civil servants have been killed. Byrs says it is even more difficult than the aftermath of the Asian tsuanami of 2004 for relief agencies.

There are widespread reports of clashes over the meagre supplies which are available, and fears are rising that the country could slip into total chaos. The basic systems were already inadequate before the disaster.

Wealth in Haiti is measured in metres: the higher you live above sea level, the richer you are. At sea level, in the capital Port-au-Prince with its extensive shantytowns such as Cité Soleil and Carrefour Feuilles, most residents are denied even the most basic health facilities. The alleys in Carrefour Feuilles are so narrow that people can only walk through them in single file. Clearly, getting an ambulance through them would be impossible even in normal cicrumstances.

Depressing picture
Els Hortensius from the Dutch Interchurch Organisation for Development Cooperation, ICCO, paints a depressing picture of daily life for the hundreds of thousands of residents in the capital. “The houses made of planks of wood and corrugated iron have no running water and hardly any sanitation. Clean water is delivered every day in large tankers on the edge of the neighbourhood. Residents fetch water in buckets and jerry cans. The toilet is no more than a hole in the ground in the back garden. The contents run via open sewers straight into the ocean.”

Mass grave
Now there is little left of this primitive infrastructure. The first priority is to treat the sick and injured, and to prevent the spread of disease, says Dick Loendersloot, coordinator of the joint ICCO and Church in Action Haiti Emergency Aid Operation. Bandages, water purification tablets and medicine for diahorrea are needed first.

The bodies of the dead also have to be recovered as quickly as possible, says Mr Loendersloot. In a densely populated city, with temperatures around 30 degrees, corpses are a source of disease. “In the countryside it is easy to bury the dead, but in the city it is a major operation.” Haitian President René Préval has said that at least 7,000 bodies will be buried in a mass grave.

Foreign aid
But how do you get the aid to the people? The airport in Port-au-Prince is open, but then the lorries carrying aid get stuck on the damaged and blocked roads. The first reports are already coming in of looting at UN food depots.

It is not just the infrastructure that has been hit hard, so has the civil structure. Government buildings have been reduced to piles of rubble, ministers are missing and the UN peacekeeping troops are just as devastated as the local people.

Someone has to take the initiative, says Mr Loendersloot, who takes a rather sober look at the possibilities. A lot depends on the local people and aid from abroad. “And what you don’t have you can’t distribute. That is why water is primarily meant for drinking. Cooking and cleaning will have to be done with contaminated water.” For a while people will have to survive as much as possible on ready-made meals, which do not need cooking.

Wealthy people in the hills are not much better off. Those who can afford it, have an underground water tank. But they have been buried under rubble since the earthquake. Others buy bottled water, but you can't get hold of that anywhere now.

Violence
For the time being, a lot will depend on the degree of stability in the country. If the UN troops are able to keep the peace in Haiti, the first reconstruction work can begin in a month’s time, expects Mr Loendersloot. “But Haiti is the worst place in the world for an earthquake to happen. The shantytowns are a time bomb, because the people live in poor conditions at close proximity to one another. In addition, everyone has a weapon. All the ingredients for even more chaos.”