Humanitarian relief for the Haiti earthquake: The challenge of coordination

We've all watched with disbelief the images emerging from Haiti. The estimated death toll is 45,000 to 50,000; damage to an already fragile social and economic infrastructure is harder to quantify. Based on past disasters and the current tragedy, the biggest challenges facing humanitarian responders are: Coordination, communication and distribution. Some of the more obvious points about response efforts include:

* The greatest need for recue-workers and emergency medical personnel is generally in the first 48-72 hours after a disaster. Unfortunately it usually takes much longer than that for foreign doctors and mobile hospital units to arrive.

* Food, sanitation, shelter and access to clean water are probably the most important immediate needs, to prevent disease outbreaks, and allow the injured to recover.

* The logistics of importing supplies, then distributing them are a huge early challenge, due to damage to airports, seaports, and roads. Efforts at assessing needs are also hampered by difficult travel, and damaged communication systems.

* Burial of bodies is not a major immediate health concern, though there are obvious social reasons to remove corpses as soon as possible.

Coordination, however, is the meta-problem. Nearly all humanitarian relief efforts have suffered from poor coordination. Someone needs to organize efforts, so that location A doesn't get tents but no food, leaving location B with exactly the opposite. Coordinators ensure that services match needs, and supplies are distributed equitably, rather than only among friends while being withheld from enemies. Poor coordination results in waste, and ineffective response (people not getting what they need, even though it's stacked in a warehouse nearby).

Post-disaster scenes are chaotic: Massive damaged, significant loss of life and property. People are shocked, possibly angry. There may be social unrest and looting, and soldiers tripping over nurses who are bumping into communication specialists elbowing sanitation engineers out of the way of bulldozers clearing rubble to let military helicopters land. Into this scene may also creep folks doing no good, and even some harm: Scientology trauma teams guiding victims to prayer rather than real treatment, yogis and chiropractors addressing conditions beyond their specialties' ability to cure.

While the UN often assumes the coordinating role, the Haitian response is hampered by the devastation of local UN mission. Into this vacuum has stepped the US military, creating another conundrum. Militaries are logistical experts, with access to helicopters, ships, tents, portable hospitals, and armies of able-bodies. But working with the military is tricky, since it undermines the widely held belief that humanitarian responders must remain unaligned and impartial.

Finally there is the idea that there are no "natural disasters," only natural phenomenon and man-made disasters. This means we fail to adequately develop societies' resilience to withstand natural events such as earthquakes and tsunamis.

This bears consideration as you reach for your check book to send in a charitable donation: Give in response to this tragic event, but continue giving after the event, to build social resiliency necessary to prevent the next disaster.