The Underlying Tragedy

On Oct. 17, 1989, a major earthquake with a magnitude of 7.0 struck the Bay Area in Northern California. Sixty-three people were killed. This week, a major earthquake, also measuring a magnitude of 7.0, struck near Port-au-Prince, Haiti. The Red Cross estimates that between 45,000 and 50,000 people have died.

This is not a natural disaster story. This is a poverty story. It’s a story about poorly constructed buildings, bad infrastructure and terrible public services. On Thursday, President Obama told the people of Haiti: “You will not be forsaken; you will not be forgotten.” If he is going to remain faithful to that vow then he is going to have to use this tragedy as an occasion to rethink our approach to global poverty. He’s going to have to acknowledge a few difficult truths.

The first of those truths is that we don’t know how to use aid to reduce poverty. Over the past few decades, the world has spent trillions of dollars to generate growth in the developing world. The countries that have not received much aid, like China, have seen tremendous growth and tremendous poverty reductions. The countries that have received aid, like Haiti, have not.

In the recent anthology “What Works in Development?,” a group of economists try to sort out what we’ve learned. The picture is grim. There are no policy levers that consistently correlate to increased growth. There is nearly zero correlation between how a developing economy does one decade and how it does the next. There is no consistently proven way to reduce corruption. Even improving governing institutions doesn’t seem to produce the expected results.

The chastened tone of these essays is captured by the economist Abhijit Banerjee: “It is not clear to us that the best way to get growth is to do growth policy of any form. Perhaps making growth happen is ultimately beyond our control.”

The second hard truth is that micro-aid is vital but insufficient. Given the failures of macrodevelopment, aid organizations often focus on microprojects. More than 10,000 organizations perform missions of this sort in Haiti. By some estimates, Haiti has more nongovernmental organizations per capita than any other place on earth. They are doing the Lord’s work, especially these days, but even a blizzard of these efforts does not seem to add up to comprehensive change.

Third, it is time to put the thorny issue of culture at the center of efforts to tackle global poverty. Why is Haiti so poor? Well, it has a history of oppression, slavery and colonialism. But so does Barbados, and Barbados is doing pretty well. Haiti has endured ruthless dictators, corruption and foreign invasions. But so has the Dominican Republic, and the D.R. is in much better shape. Haiti and the Dominican Republic share the same island and the same basic environment, yet the border between the two societies offers one of the starkest contrasts on earth — with trees and progress on one side, and deforestation and poverty and early death on the other.

As Lawrence E. Harrison explained in his book “The Central Liberal Truth,” Haiti, like most of the world’s poorest nations, suffers from a complex web of progress-resistant cultural influences. There is the influence of the voodoo religion, which spreads the message that life is capricious and planning futile. There are high levels of social mistrust. Responsibility is often not internalized. Child-rearing practices often involve neglect in the early years and harsh retribution when kids hit 9 or 10.

We’re all supposed to politely respect each other’s cultures. But some cultures are more progress-resistant than others, and a horrible tragedy was just exacerbated by one of them.

Fourth, it’s time to promote locally led paternalism. In this country, we first tried to tackle poverty by throwing money at it, just as we did abroad. Then we tried microcommunity efforts, just as we did abroad. But the programs that really work involve intrusive paternalism.

These programs, like the Harlem Children’s Zone and the No Excuses schools, are led by people who figure they don’t understand all the factors that have contributed to poverty, but they don’t care. They are going to replace parts of the local culture with a highly demanding, highly intensive culture of achievement — involving everything from new child-rearing practices to stricter schools to better job performance.

It’s time to take that approach abroad, too. It’s time to find self-confident local leaders who will create No Excuses countercultures in places like Haiti, surrounding people — maybe just in a neighborhood or a school — with middle-class assumptions, an achievement ethos and tough, measurable demands.

The late political scientist Samuel P. Huntington used to acknowledge that cultural change is hard, but cultures do change after major traumas. This earthquake is certainly a trauma. The only question is whether the outside world continues with the same old, same old.

Relief Groups Seek Alternative Routes to Get Aid Moving

As a limited number of relief flights landed at Port-au-Prince airport on Friday, international assistance agencies struggled to find alternative routes for aid in the face of survivors’ angry criticism that no help was getting through.

Officials at international aid organizations in Geneva and Rome said in telephone interviews that supplies had begun to arrive via Santo Domingo in the neighboring Dominican Republic, and that vessels with built-in ramps capable of delivering supplies to the badly damaged port in the Haitian capital were being organized.

The logistical challenges in and around the capital — damaged roads, little fuel — were daunting, but there were small signs of progress, the organizations said.

Organizations distributed tarps and other materials to 4,000 people without shelter on Thursday, and 8,000 more people were expected to receive similar assistance Friday. Ban Ki-moon, the United Nations secretary-general, said the World Food Program was feeding about 8,000 people several times a day, with high-energy biscuits and ready-to-eat meals. The mass devastation, however, dwarfed the effort.

“It is still a drop in the bucket,” said Elisabeth Byrs, a spokeswoman for the United Nations Office for the Coordination of Humanitarian Affairs in Geneva. “But step by step, it will increase.”

Confusion and chaos on the ground was mirrored in the air, with private aircraft clogging the airspace above Port-au-Prince’s airport, blocking some humanitarian fights from landing. By Friday afternoon, the Federal Aviation Administration, which has been coordinating air traffic control at the Port-au-Prince airport, issued a stern warning: no planes bound from the United States, military or civilian, would be allowed to land without express permission from the agency.

Exceptions would be granted only to humanitarian planes, based on arrival times and on the availability of space at the airport, a notice from the agency said. The F.A.A. warned pilots that fuel still was not available at the airport, and any aircraft bound there would need to have enough fuel to circle the airport for at least an hour.

The move may ease some of the deadlock that has been preventing relief from getting through. The World Food Program, for example, had been attempting to land a plane filled with food supplies to shore up existing stocks in the city, but as of Friday afternoon, it had not succeeded. The agency estimates that 2 million people are in need, said Greg Barrow, a spokesman.

On the ground, the deteriorating conditions were underlined by reports of looting, including at warehouses stocked with the remaining 6,000 tons of the World Food Program’s provisions in Port-au-Prince, Mr. Barrow said. The food relief agency, which says looting is not unusual in such crises, reported that it had recovered most of the food.

Emilia Casella, a spokeswoman with the agency, which is based in Rome, noted that regular food stores in the capital “have been cleaned out” by desperate Haitians, a report by The Associated Press said.

Ms. Byrs of the United Nations said relief agencies had started to shuttle staff and supplies by road, small plane and helicopter to bring in personnel from Santo Domingo, but that the arrangements remained irregular. She said that she believed survivors could still be found.

“There’s still hope; that’s the important thing,” she said.

Mobile operating theaters and more surgical specialists were en route, but were delayed in the air and on the roads from the Dominican Republic.

Doctors Without Borders said it had landed two cargo planes directly into Toussaint Louverture International Airport in Port-au-Prince, but others have had to go through Santo Domingo.

To the extent that Toussaint Louverture airport was able to function, it was thanks largely to the two air traffic controllers from the United States Air Force who had taken over the damaged tower and the United States Army soldiers who were directing ground operations.

Just about every route for relief supplies seemed to have problems. Mr. Barrow, the spokesman for the World Food Program, which is heading up logistical operations, said that on the narrow road from Santo Domingo, vehicles took 12 to 18 hours to reach Port-au-Prince. With unloading equipment damaged at the capital’s port, he said, the World Food Program was planning to charter vessels with ramps — which can unload without cranes — to bring in food. But sailing time for such vessels from the nearest point in the United States was three days.

“Realistically, for us to bring in food, the priority is by sea,” he said.

Once aid arrives at the airport, it will face additional logistical challenges. There was only one warehouse to hold the expected influx of materials and no clear plan of how to distribute supplies from the airport to the city.

DHL, the international shipping company, said 14 of its employees were on the ground to help manage arriving air freight in order to prevent bottlenecks at the airport. The team will assist in the distribution of these goods once roads are stable, working with the Red Cross, UNICEF and World Food Program, it said.

Commercial air service to Port au Prince is suspended until at least Sunday, the F.A.A. said.

For many organizations, the work in Haiti has been transformed into exploring every route to bring in relief supplies and to expect the unexpected when earlier plans fall part.

Catholic Relief Services, for example, plans to ship water and food rations for 500 families over the road from Santo Domingo on Saturday, but reports of looting near the Haitian border have made their drivers nervous. So now, they are trying to get a United States military escort for the convoy once it crosses into Haiti.

A boat with thousands of metric tons of vegetable oil and soy-fortified bulgur wheat that has been en route for weeks is also due to arrive Saturday at Port-au-Prince. After a day of negotiations, it now looks like the ship will be rerouted to a functioning port, Les Cayes, in the south.

Staff members, meanwhile, continue to arrive at the Port-au-Prince airport when they can manage it.

“It’s about work-arounds,” said Schuyler Thorup, the director of Latin American operations for the organization. “There are tremendous challenges.”

Alan Cowell reported from Paris, and Sharon Otterman from New York. Reporting was contributed by Damien Cave and Marc Lacey from Port-au-Prince, Haiti; Micheline Maynard from Detroit; and Liz Robbins and Maria Newman from New York.

For the Trapped, Rescue Is but the First Hurdle

PORT-AU-PRINCE, Haiti — Herby Amel’s father dug through the collapsed college building first, pulling out a body so he could reach his son, trapped 20 feet into the pile. But when a rescue team from Miami arrived early Friday morning, Herby’s left ankle remained pinned under a fallen beam.

He was trapped, alive and awake, in a crevice just wider than his shoulders. The American rescuers considered amputation, then chose instead to sedate Mr. Amel and carefully pull him back through the rubble.

It was 3:17 a.m., and the dark street was crammed with relatives and friends, their hands bright white with concrete dust from digging. Finally, “up” came the call. Mr. Amel, 21, emerged, a thin, young man with swollen legs. One rescuer wiped away tears.

It was, by most disaster measures, a successful rescue, though being pried from the rubble was only a beginning, by no means assuring survival. Mr. Amel’s fate reflects the complications and struggles of the current aid effort in Haiti. His drivers were not sure they would find a hospital with room for him. With or without the amputation that doctors thought he needed, his life was threatened from toxic shock and infection.

And the search-and-rescue experts from Miami who saved him had spent 10 frustrating hours on the ground before they could set out to dig for survivors.

The group of 80 had been ready to go on Wednesday, less than 24 hours after the catastrophic magnitude 7.0 earthquake hit. But just before their scheduled departure, they had to cancel. They were told the airport would not let them land.

They rescheduled for Thursday, and were fortunate enough to find themselves on the loud, crowded tarmac here at Toussaint Louverture International Airport by 10:30 a.m. after some circling in the air. Transportation to the United States Embassy appeared relatively quickly, too, within two hours.

But bad news followed. A cargo plane with their pneumatic hammers, lights, tents and other equipment had been delayed. Later, they found out that it had been rerouted to Santo Domingo, in the Dominican Republic.

The group chafed at the holdups. Rudolph Moise, a barrel-chested doctor and colonel in the Air Force Reserve, who grew up in Haiti, paced. By 2 p.m., little had changed. Leaders from the three task forces here at the time — Fairfax County, Va., Los Angeles County and Miami-Dade County — met in an embassy conference room to plan out strategy. Maps were blown up and hung on the walls.

Team leaders complained of equipment they did not have and of delays.

But at this point, Carlos Gimenez, a hard-charging firefighter from Miami with a chin as square as a cigarette box, just wanted to get out. With some pushing, he commandeered a handful of vans and S.U.V.’s and drove toward downtown at 3:35 p.m. Within minutes, he saw bodies alongside the road. Eight on a hilly street of the Nazon area. Two others a few hundred yards up, with legs protruding from gray rubble.

“Man, there are a lot of kids,” said Mr. Gimenez, looking at a small body under a sheet.

Crowds of Haitians streamed by on foot, some with rags over their mouths to prevent breathing the stench of decay. Farther into Nazon, a sheared-off wall of a home revealed a living room with a painting still on a peach-colored wall.

Only 20 minutes out of the embassy’s gate, Mr. Gimenez had identified three areas that they might need to come back and search. The fourth, however, looked more urgent. A crowd of young men stood on what looked like a small mountain poured like sand from an hourglass: G.O.C. University.

The team was told of at least four people trapped below. Mr. Gimenez crawled down into a hole, where he could hear a young woman’s voice. Two men seemed to be hidden underneath an area across the roof.

The fourth person was being pulled up by Haitians. He emerged around sunset, unable to move or speak with anything louder than a whisper. “He’s calling for his mother,” said a young man standing beside him.

Mr. Gimenez grew more intense. “We need to go,” he said. The crowd, he feared, would soon become more demanding and more frustrated when they were unable to reach the people who were trapped.

Back at the embassy, he tried to find a way to return. Two hours later, at 7:30 p.m., he was still without his equipment, and swearing. “It’s frustrating,” he said. “Half our gear is in Santo Domingo.” After an hour that felt like an eternity, a partial solution emerged. The Miami team would borrow equipment from Fairfax County. First, though, they needed drivers, and the men who took them out in the afternoon refused. “No go, tonight,” one said. He offered no explanation.

Other drivers were found, and the group was back on the road at 8:50 p.m. They headed to pick up equipment at a search site, at the Hotel Montana, where Dr. Moise had stayed just a few months earlier. The half-dozen vans and S.U.V.’s spent nearly half an hour to climb the road, get what they needed and turn around.

They turned a sharp corner. They had reached the path up to the mound of G.O.C. University. A crowd of Haitians headed down, shouting, running with what looked like a body. It was the young woman Mr. Gimenez had heard speaking five hours earlier. Her leg, red and damp with blood at the knee, moved just a touch in the glare of headlights — she was alive.

The crowd asked the Americans for transportation. Mr. Gimenez told his group to stay in their vehicles. He called for Dr. Moise. They tried to calm the agitated crowd and explain that search-and-rescue teams were not equipped to be ambulances.

A local police truck that had driven by suddenly began to back up. The young woman was placed in the back, and more than 20 people elbowed and squeezed to get in the back with her.

It was time for the Americans to search for others. There were conflicting reports about two young men being pulled out by locals. Maybe they were saved, or maybe they died, but after sending three search dogs over the pile and using high-tech cameras and listening devices, the Americans found no signs of life. They could see at least four bodies in the pancaked floors below.

Gerald Jeanty Jr., 29, who stood halfway up the path, said he had been searching through the rubble for his cousin, a professor at the university who answered his phone Thursday morning. His wife had called, and he said he was trapped. She called over and over again, but there was never another answer.

“It’s all collapsed,” Mr. Jeanty said, noting that his cousin worked on the first floor of the seven-story building. “And he’s at the bottom.”

As they gathered again at their vehicles, the Americans seemed disappointed. The team from Fairfax had taken back their listening equipment just as they were trying to determine whether they heard a faint tap-tap-tap from deep within the tangle of rock and steel. The people they imagined saving were gone.

But when they arrived at the Collège du Canapé-Vert, they knew they could help. The candles Mr. Amel’s father had placed in the rubble, like medieval torches, guided them to Herby, who was studying to be a teacher.

They found a second person near the top of the rubble, crammed into a staircase where he apparently fled during the tremor. It would take much longer to get him out, but they were hopeful. In previous earthquakes, they had found survivors up to 14 days later. In this case, though, he died where he lay.

What they tried not to think about was what happened next for those they saved. The hospitals were full, and the United States Embassy, with its two Air Force doctors, told them not to bring back Haitian patients.

Mr. Amel and his mother, father and sister drove off into the dark. They were all quiet and calm, if only temporarily. The Americans had given him a fighting chance, but the ketamine used to sedate as they tugged him out would wear off in an hour. Pain, struggle and reality would soon be setting in.