If, as widely expected, the eventual death toll in the Haiti earthquake exceeds 250,000, it will have been almost the world’s biggest – second only to the Shaanxi earthquake in China in 1556 when over 800,000 are estimated to have perished.

The response across the world to Haiti’s latest disaster has been remarkable, mirroring the response to the 2005 Asian Tsunami. By January 27, the UN reported that donations had topped the $1 billion mark, while in the UK, the Disasters Emergency Appeal had reached the £50 million mark. Nations, rich and poor, and individuals, young and old have been contributing in the hope that this aid will help - by saving lives, supplying food and water, relieving pain and suffering, preventing disease, rebuilding lives and restoring livelihoods.

The earthquake dominated our television screens and media outlets in the first days after the earthquake struck. Early sombre coverage of the physical, apocalyptic devastation and of bodies in the streets was soon replaced by uplifting pictures of people being pulled out alive from wrecked buildings. These have increasingly given way to reports of those urgently needing aid not receiving it and a growing sense that the aid effort was disorganised, uncoordinated and lacked effective leadership, resulting in many lives being unnecessarily lost and substantial amounts of aid being wasted.

Hungry and thirsty Haitians were clearly angry. So, too, were a growing number of onlookers, including people who had contributed to the Haitian appeals - increasingly coming to the view that the aid effort and those providing the aid was failing largely because of human error and incompetence. Is the aid effort in Haiti ineffective and wasteful? If so, is this typical of the way the world responds to disasters?

While it is still much too early to judge the overall impact of the Haitian emergency response, a number of things are already becoming clear. The first is that the success of the aid effort was hampered almost immediately by major structural and systemic problems.

As Dan Smith rightly points out, it is a lack of preparedness which can turn a natural event into a disaster, with poor countries like Haiti lacking many of the resources necessary to prevent a disaster occurring. When a disaster does occur, a successful response is dependent upon a range of factors – strong government leadership, an effective disaster recovery plan, the capacity and toughness necessary to coordinate, manage and implement a massive and complex aid effort, with international support closely integrated with a network of effective local and grass-roots organisations. In Haiti most of these were either absent prior to the earthquake or destroyed by the earthquake. To make matters worse, the international back-up which would normally help to address key weaknesses at the national level – the United Nations – had to grapple with its own emergency; its offices destroyed, key staff killed or injured, and many more traumatised. Thus, early on, it was unable to effectively take on the leadership and coordinating roles it was mandated and expected to play.

Major earthquakes always create huge logistical problems. Thus, the early decision by the Obama Administration to send troops initially to take over the airport was a good one. However, this resulted in having three different authorities with overlapping mandates taking or assuming responsibility for the humanitarian response: the large US military force which began making decisions about distributing emergency supplies, the legitimate but largely dysfunctional Haitian Government and the initially weak UN.

UN-coordination to the rescue

In any large complex emergencies, it is challenging enough to try to coordinate the activities of the scores of different agencies working on the ground. But against the backdrop of this confusion of authorities and leadership, reports were suggesting that more and more agencies chose to begin to try to access and deliver aid on their own, a process which cumulatively only aggravates the logistical and planning problems and adds to the confusion that is common in the early stage of such emergencies. Notwithstanding these problems, however, and compared with other emergencies, in Haiti the UN-led coordination of aid at the sectoral level and especially the operation of “cluster systems”, with a lead agency managing the sharing of information to ensure the predictable delivery of services, has begun to function as well as, if not better than, had occurred in earlier large complex emergencies.

The cumulative evidence from other emergencies suggests a number of major knock-on consequences of weak national coordination.

• The first is a higher risk of poor to inadequate overall needs assessments. This tends to result in the exclusion of some of those in need and a mis-match between the types of aid given and the aid needed, problems made worse by the (all too common) failure to listen to and respond to the articulated and different needs of different affected communities. Relatedly, there is a higher risk that the proportionately greater needs of less visible and more marginalised groups, such as the disabled, are not adequately met.

• Providing temporary shelter and distributing food, though usually necessary in the short-term, need to be accompanied and increasingly replaced by providing people with cash (and cash for work), by working to help people re-establish livelihoods and to restore the functioning of markets and by assisting people as quickly as possible to return to “normal life” Such approaches typically ensure more lasting outcomes. But the larger the number of small inexperienced international agencies working hard to “do good” the less likely it is that this will happen.

• Evaluations of recent earthquakes (such as the Bam earthquake in Iran in 2003) also suggest that agencies tend to under-estimate the severity and extent of psychological trauma, a problem exacerbated by the rush to bury the unidentified dead in mass graves. Even in the United States, only 10 percent of those affected by Hurricane Katrina reported receiving assistance locating loved ones in the first month after the hurricane.

As the emergency aid effort has begun to get underway in Haiti, unsurprisingly, all these problems are beginning to appear.

The public and media are often quick to judge the effectiveness of humanitarian agencies by the speed with which they spend the money raised – the failure to quickly spend aid funds can be an indicator of incompetence. However, a more widespread problem is the pressure to spend too much money too quickly on the search and rescue and relief phases of an emergency and not to plan for and set aside sufficient resources for the recovery phase. The evidence clearly shows that results in more lasting benefits. Sadly, Haiti is unlikely to be an exception to this rule.

Emergency response problems originate far beyond Haiti’s borders

The origin of many of these problems lies well beyond Haiti’s borders. They can be traced back to the overall structure and management of the global response to disasters and emergencies. For instance, the linked problems of weak disaster preparedness and inadequate local capacity to lead, coordinate and manage disaster relief remain commonplace across the world. They are caused in large part by donors and agencies giving insufficient priority to and allocating insufficient resources to building up local in-country capacities to prepare and plan for emergencies. This is not a problem unique to Haiti. As summarised in the evaluation of the Tsunami, “the quality and capacity of the international relief system is inadequate given the scale and frequency of modern emergencies”.

The core problem is that there is no effective overall international relief system within which the responses to successive emergencies are framed. The result is a very inefficient system characterised by a massive overall underfunding of emergencies and a huge mis-match between needs and the resources provided.

Media attention is dominated by the high profile emergencies like the Haiti earthquake and the 2005 Indian Ocean Tsunami, so the general public knows little about the global humanitarian funding crisis and the toll that funding shortfalls take on the lives of those who desperately need emergency aid. In contrast to the norm, and quite exceptionally, high-profile media emergencies tend to receive or even exceed the funds requested, in part because of the generosity of individuals: $13 billion was raised for the Tsunami; over half was provided by private and corporate donations. Almost all other appeals, and all those whose support is not linked to the short-term political interest of at least one major donor country, both large and small, remain underfunded.

Haiti’s recent history illustrates these funding shortfalls. Prior to this year’s earthquake, Haiti has been a major recipient of emergency aid for many years. Between 2006 and the end of last year, emergency aid to Haiti supplied food to almost two million people, basic medical care to over 600,000, and clean water to over 300,000 people. Before the earthquake Haiti was already dependent on emergency aid; today, that dependency is vastly greater.

Yet the emergency aid provided to Haiti in the years prior to the earthquake fell well short of what has been required. Thus, the last UN humanitarian aid appeal for Haiti, launched in September 2008, resulted in only 59 percent of the $121 million required being provided. Earlier, in 2003, only 38 percent of the $14 million required for life-saving needs was met. Hence, in part, the problems facing Haiti’s new emergency will be made more difficult to solve because of earlier failures to provide the country with the aid it desperately needed.

No quick fix

However successful the emergency support given to the Haiti earthquake is, it cannot “fix” Haiti. International experience suggests that at best it might place Haiti in a stronger position to embark on the longer path to development and sustained poverty reduction. Before the earthquake, Haiti was by far the poorest country in the Western Hemisphere, and has been getting progressively poorer: over 70 percent of Haitians live below the $2 a day) poverty line. Since 1975, a period far longer than the lifetime of the overwhelming majority of Haitians, the economy has recorded negative average annual GDP per capita of two percent. Most people are unable to find work and the majority of families depend for their survival on remittances sent by relatives working abroad. Before the earthquake, Haiti’s infant mortality rate was 84 per 1,000 compared with the regional average of 26. Only half the population were immunised against measles and had access to clean water and improved sanitation. What proportion of children goes to school? The data are so poor that the statistics on Haiti’s enrolment rates do not appear on the main international charts.

The international aid conference on Haiti to be held in March will discuss the reconstruction and development of the country. It provides the next building block for the high level of international support that will be needed not just for this year, but for many years, if not decades, to come – but provided in a way that is closely integrated into a development plan drawn up and implemented by Haitians.