INFORMATION KIT

Press contact: Sophie Mazoyer – +33 (0)4 26 68 76 47 – +33 (0)6 60 97 09 38 – smazoyer@handicap-international.fr

A YEAR OF ACTION IN HAITI

Updated: 22 December 2010

ACKNOWLEDGEMENTS 2 INTRODUCTION 3

LOCATION OF PROJECTS 6 SUMMARY OF ACTIONS 7

KEY FIGURES 8

HEALTH AND PROTECTION 9

HUMANITARIAN LOGISTICS AND MEETING BASIC NEEDS 15

For more information: www.handicap-international.fr

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ACKNOWLEDGEMENTS

Handicap International would like to thank the tens of thousands of individual donors who have responded to its emergency fundraising appeals for Haiti and who continue to support its actions in aid of people affected by the earthquake of 12 January 2010 in Haiti. On 3 February 2010, the French ambassador to Haiti, Mr. Didier Le Bret, was awarded the Claude Erignac prize for his efficient and courageous handling of the crisis. He decided to give half of the prize money to Handicap International to support the association’s actions in aid of the people of Haiti, with the other half going to set up a fund for the embassy’s Haitian staff. Since the launch of Handicap International’s response to the earthquake, the association’s actions have been supported by: - public bodies: Canadian International Development Agency (CIDA), European Commission

(Humanitarian Office - ECHO), UK Department for International Development, Flemish Government, Grand Lyon, French Ministry of Foreign Affairs, Luxembourg Ministry of Foreign Affairs, World Health Organisation, World Food Programme, Région Île-de-France, Région Rhône-Alpes, Swedish International Development Cooperation Agency (Sida), USAID/OFDA, USAID/Leahy War Victims Fund, Ville d’Annecy, Ville de Lyon, City of Munich;

- private institutions and companies: Aktion Deutschland Hilft, American Academy of Orthopaedic

Surgeons, American Friends Service Committee, American Red Cross, Bette Middler Family Foundation, Fondation Abbé Pierre, Fondation EDF, Fondation de France, Fondation Eden, Fondation Groupe SEB, Fondation Soros, Freedom of Mobility Foundation / MV Transportation, Inc., Fundación León Jimenes, Grande Mosquée de Lyon, Hôpital Assistance Belgique, Lycée français de New York, Mutualité française, NPD Group, Inc. Emergency Fund, Rheingold Family Foundation, sanofi-aventis, ShelterBox, T. Rowe Price Foundation.

Photo credits: Page 1: © Department for International Development - Russell Watkins - Pages 2, 4, 5, 6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18: © William Daniels / Handicap International - Pages 8, 11: © Federico Saracini / Handicap International - Pages 11, 14, 17, 19: © S. Sommella / Handicap International - Page 12: © S. Lubrano / Handicap International - Page 14: © T. Calvot / Handicap International - Page 16: © Handicap International - Page 17: © O. Dorighel / Handicap International - Page 18: © L. Radick / Handicap International - Page 18: © F. Berthaut / Handicap International - Page 19: © D. Sacca / Handicap International

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INTRODUCTION

An earthquake measuring 7 on the Richter scale hit Haiti, one of the poorest countries in the world, a t 4.53 pm (local time) on 12 January 2010. Handicap I nternational’s 100-strong team, present in the fiel d when the earthquake struck, escaped unharmed and la unched an immediate response to the emergency. Over the following weeks, Handicap Inter national rolled out a multi-disciplinary programme in response to the disaster. Handicap International is set to continue helping the Haitian people over the next three to five years. The largest programme in Handicap International’s h istory The number of people on Handicap International’s teams during 2010 exceeded 600, including some 80 expatriate staff. Handicap International now has a total team of 540 people in Haiti, including 60 expatriate staff. Almost all the intervention areas in which the association has developed an expertise have been represented during this mission. Handicap International’s actions in Haiti centre on three key activity sections: - the long-term case-management and assistance of the injured, amputees and paralysed persons in the

fields of functional rehabilitation (fitting and rehabilitation) and psychosocial support; - meeting the specific needs of the most vulnerable people, including targeted distributions and the supply of

transitional shelters; - the management of a humanitarian aid transport logistics platform in support of the aid community. Since October, Handicap International has also supported the work of international solidarity organisations in response to the cholera epidemic. Advocacy to meet the needs of the most vulnerable During humanitarian emergencies, Handicap International’s first responsibility is to aid the most vulnerable and excluded sections of society, and particularly people with disabilities. Given their extensive needs, this section of the population is easily forgotten and left behind during aid operations. By helping to organise the relief effort and performing continuous advocacy work targeted at other members of the aid community, Handicap International is able to more effectively fulfil its mandate.

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Across all aid sectors, and particularly the cross-disciplinary fields of protection and camp management, Handicap International draws attention to the general need to protect and include vulnerable people and people with disabilities in the relief effort. It reminds the various operators - UN agencies, NGO members of coordination clusters, the Interim Haiti Recovery Commission, etc. - of their responsibilities towards these groups by providing awareness messages, recommendations, technical support and training sessions, and by distributing information and technical guides. Lastly, Haiti has a long history of excluding people with disabilities, commonly known as “kokobés” (“good for nothing’s”). It is essential to avoid people with disabilities caused by the earthquake, despite their large number and the exceptional circumstances, being severely marginalized. The work of Handicap International’s teams includes specific actions adapted to the widespread deprivation experienced in urban areas, such as the Protection section of its Health programme which aims to reduce the abuse and violence sometimes suffered by the most vulnerable members of Haitian society. Earthquakes, bad weather, cholera, violence... a ca talogue of disasters The earthquake of 12 January 2010 was the most violent to hit the region in 200 years. Its epicentre was located 9 miles from the capital, Port-au-Prince, and exacted a heavy toll on human lives: some 230,000 people are thought to have been killed (as many as during the tsunami on 26 December 2004) and more than 300,000 injured. A million and a half people lost their homes. International aid organisations immediately supplied them with makeshift shelters but due to the slow reconstruction process many are still living in temporary accommodation. According to the International Organisation for Migration (IOM)1, at the end of November around one million people were still living in 1,200 temporary encampments. More than 661,0002 others were displaced to the provinces, most often finding shelter with host families. The Spring rainy season revealed the precarious living conditions of the earthquake’s victims. At the end of the hurricane season, on 5 November, Hurricane Tomas, despite its relatively limited impact, caused widespread panic and highlighted the absence of structures capable of responding to a new natural disaster. At the same time, a cholera epidemic suddenly spread across Haiti, killing more than 2000 people, with 40,000 requiring hospital treatment, according to the government.3 The epidemic is set to spread further over the coming months.4 The World Health Organisation (WHO) announced on 26 November that the cholera epidemic could affect up to 400,000 people. As a result, almost a year after the earthquake, Haiti is once again in the grip of a major emergency. Since November, Handicap International has adapted its activities to achieve three goals: - ensuring the security and continuity of its operations performed since January in order not to doubly

penalise the most vulnerable people; - performing complementary prevention activities to ensure that people assisted by the association are not

marginalized in general prevention activities and benefit from essential information to avoid contamination; - making an effective contribution to combating the epidemic nationwide, by enhancing the logistics platform

it manages in partnership with the World Food Programme (WFP), in order to supply dedicated humanitarian equipment to organisations working to fight the disease.

1 International Organisation for Migration, Displacement Tracking Matrix of 9 December 2010. 2 Haitian government. 3 Health Group (Haitian Ministry for Public Health and Population and WHO), 8 December 2010. 4 Haitian Ministry for Public Health and Population, 3 December 2010.

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The outbreak of this cholera epidemic, added to a tense electoral situation, has given rise to outbreaks of violence. The first round of voting in the presidential and parliamentary elections on 28 November stirred tensions across the country. This insecurity represents an additional obstacle to implementing solidarity actions. Political conflict between the first and second rounds of voting, with the second round scheduled for 16 January 2011, could lead to prolonged bouts of violence. The importance of coordinating actions with other o perators Following the earthquake, the organisation of our aid effort in the field has been made more difficult by the destruction or disorganisation of decision-making centres and by the multiplicity of operators on the ground However, Handicap International has endeavoured to work closely with numerous organisations. These include direct partnerships5, as well as numerous international operators6 and Haitian organisations7. Handicap International is helping to optimise the coordination of the humanitarian aid effort by transporting aid for some one hundred organisations using its logistics platform of 70 lorries.

Since 26 January 2010, the UN and the WHO have entrusted Handicap International and the German organisation Christoffel-Blindenmission (CBM) with jointly coordinating all rehabilitation actions for injured persons across Haiti, the fitting of orthopaedic devices and the provision of assistance to people with disabilities. Handicap International and CBM have been working with the Haitian Ministry for Public Health and Population (MSPP) and the Secretariat of State for the Inclusion of People with Disabilities (SEIPH) to coordinate international and national aid stakeholders operating in disability-related fields.

On 1 December, in order to hand back responsibility, and any associated prerogatives, for activities in this field to the Haitian authorities, Handicap International transferred this coordination role to the MSPP, while remaining an active member of the “Rehabilitation, inclusion and disability” working group. Three to five years of action ahead The association is planning to translate its actions into long-term projects to allow Haitian operators to build their capacities and eventually take over the management of the projects put in place. Handicap International’s actions form part of a three-to-five year emergency/rehabilitation/development continuum in Haiti, which is a classic model of international solidarity action. In addition to its response to the cholera epidemic, which should give rise to additional projects in early 2011, Handicap International is developing the post-emergency phase of its operations. After setting up a temporary emergency orthopaedic-fitting service at the end of February, the association now produces permanent prostheses in its fitting centre in Port-au-Prince. It has now begun specific construction activities to provide liveable, hurricane- and earthquake-resistant temporary accommodation accessible to isolated and vulnerable victims of the disaster.

5 Chistoffel Blindenmission (CBM), Healing Hands for Haiti, the Haitian Ministry of Public Health and Population, the Haitian Secretariat of State for the Inclusion of People with Disabilities (SEIPH) and World Food Programme (WFP). 6 ACTED, Action contre la Faim, Adventist Development and Relief Agency (ADRA), Arbeiter-Samariter-Bund Deutschland (ASB), Chaîne de l’espoir/Alima, Croix-Rouge, Douleurs sans Frontières, Médecins du Monde, Médecins sans Frontières, Merlin, International Organisation for Migration (IOM), Oxfam, Partners in Health, ShelterBox, Solidarités International, Terre des Hommes… 7 Civil Protection Communal Committee (CCPC) in Petit-Goâve and Grand-Goâve, health facilities and associations.

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The association has begun performing transitional development actions , which are set to continue until at least the end of 2012. A more community-based approach is being taken to rehabilitation activities, through the involvement of the friends and family of patients, and a greater emphasis is being placed on local health facilities. Initial intensive training in rehabilitation and orthopaedic-fitting activities for Haitian staff will be organised along with capacity-building for local partners. The support for and rehabilitation of the injured provided by Handicap International’s staff is expected to gradually focus on the most complex cases, particularly paralysed persons. The long-term development phase is set to begin in 2011. It should mainly focus on supporting Haitian operators, health facilities and association partners in providing assistance to people with disabilities. Within this framework, the association is implementing a skills-transfer programme, which includes the setting up of a diploma-based orthoprosthesist training course in the near future, in compliance with international standards. The main aim of this stage is to help create resources and overcome non-existent or inadequate capacities in Haiti to help the country recover from its ordeal and plan for its development.

LOCATION OF PROJECTS

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SUMMARY OF ACTIONS

Health and protection

- Helping hospitals case-manage the injured (until July 2010).

- Supplying orthopaedic devices, mobility aids and specific equipment.

- Fitting orthopaedic devices (prostheses and orthoses).

- Assisting vulnerable people, particularly people with disabilities, within communities; protection activities.

- Community psychosocial support. - Cholera prevention actions.

Meeting basic needs

- Distribution of tents, food and essential items to earthquake victims, particularly the most vulnerable (until August 2010, then during the violent storm of 24 September and hurricane Tomas).

- “Cash for work” activities (until August). - Setting up transitional hurricane- and earthquake-

resistant shelters accessible to people with reduced mobility.

Humanitarian logistics

- Transport of humanitarian aid and the management of an inter-agency logistics platform for the World Food Programme (WFP).

- Support for NGOs in the fight against cholera.

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KEY FIGURES

Human resources

- Some 540 people, including around 60 expatriate staff. - Since 14 January 2010, some 170 expatriate staff from more than 20 different

countries8 have been sent to Haiti by Handicap International. - Since January, more than 600 Haitian staff have been provided with training.

Health

- More than 10,000 beneficiaries of Handicap International’s health activities. - More than 82,000 basic care and physical rehabilitation sessions performed. - Some 5,600 technical aids (mobility aids, orthopaedic devices and specific

equipment) have been distributed. - Prostheses: 426 beneficiaries recorded (fitted or currently being fitted). - Orthoses: 465 recorded beneficiaries (idem).

Psychosocial assistance - Some 25,000 beneficiaries, including 500 provided with regular follow-up care.

Logistics/distributions/“cash for work”

- Some 20,000 tonnes of aid transported (food, basic emergency equipment, medical equipment and reconstruction equipment) since 14 January 2010 for around one hundred organisations.

- More than 5,000 tents distributed to more than 26,000 people. - More than 30,000 items of equipment distributed to over 43,000 people. - More than 36 tonnes of food supplied to more than 10,000 people. - More than 4,000 people have benefited from “cash for work” activities. - More than 80 transitional shelters have been supplied to 330 beneficiaries.

8 Including from Australia, Austria, Belgium, Canada, Colombia, El Salvador, France, Finland, Japan, Lebanon, Luxembourg, Nicaragua, Pakistan, the Philippines, Switzerland, Togo and the USA.

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HEALTH AND PROTECTION Handicap International’s health activities are perf ormed in coordination with the Haiti government and other key national and international operators in t he sector. The health team in the field currently consists of 149 people (including 22 expatriate sta ff) working in two fitting and rehabilitation centr es, six disability focal points 9 and nine mobile teams . The Haitian staff recruited are mainly rehabilitat ion professionals and community workers.

300,000 INJURED PEOPLE The Haitian government estimates the number of people injured in the earthquake at over 300,000. Humanitarian aid operators are therefore facing a challenge of historic proportions, given the lack of care capacity in Haiti following the disaster. A very high number of amputations During the weeks immediately following the earthquake only the most serious cases were admitted to hospitals. Some patients with closed fractures had to leave without treatment to allow the most urgent cases to be treated first. Many patients who had not received care the first time round arrived in hospitals at a later date with complications and serious infections. As a result, amputations represented an exceptionally large proportion of the surgical operations performed by practitioners. Some amputations performed under extremely difficult circumstances required corrective surgery. Handicap International’s health team in Haiti produced a report at the end of January on the situation facing people with injuries. The total number of amputations is estimated at between 2,000 and 4,000, with at least 1000 people requiring a lower limb prosthesis. This conservative estimate is based on direct visits to 17 hospitals and data gathered by telephone and email from most of the country’s other health facilities in which operations have been performed, and from the relevant authorities. This evaluation has not been challenged since and is supported by most operators in the field. It has not been possible to reassess these figures due to problems collecting data at a national level and variations in data collection criteria applied by individual organisations. Assistance to hospitals Since 17 January 2010 and until July, Handicap International has provided support in some twenty hospitals and medical facilities in Port-au-Prince and its suburbs. The aim of this assistance, particularly post-operative rehabilitation care, is to prevent injured and/or paralysed persons from developing permanent disabling after-effects. Within this framework, Handicap International’s members have performed 25,000 rehabilitation sessions for more than 1,800 patients and distributed more than 1,200 items of equipment (crutches, wheelchairs, walking frames, mattresses, etc). Handicap International’s activity in hospitals was scaled-down before coming to an end in July because far fewer patients injured in the earthquake, many of whom had returned to live with their families, were turning up for treatment. Handicap International was able to intensify its actions within communities as a result.

9 Disability Focal Points enable us to provide the most vulnerable populations and people with disabilities with a local reception point to identify their needs and supply them with responsive aid.

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FITTING OF ORTHOPAEDIC DEVICES & FUNCTIONAL REHABILITATION Launch of fitting in March In partnership with the Healing Hands for Haiti association, Handicap International set up a fitting and functional rehabilitation centre in a former warehouse near the Champ-de-Mars. The centre’s team consists of 48 people, 14 of whom are expatriate staff, including a team from the University of Don Bosco in El Salvador. Six members of Healing Hands for Haiti have also joined the team. Ten Haitian fitting and rehabilitation staff are currently attending training courses at the centre. Since the centre opened in early March, 883 patients have been registered, 426 of whom have been fitted with a prosthesis and 465 with an orthosis10. Some 4,500 rehabilitation sessions have been performed. N.B.: some ten other organisations also perform fitting activities. Initially, emergency temporary prostheses were supplied to lower-limb amputees. An essential stage in the orthopaedic-fitting process, these temporary prostheses enable patients to stand up again rapidly, prepare them to be fitted with a permanent prosthesis and promote their swift reintegration into society. The production of permanent prostheses, which take longer to produce but which are more aesthetic and longer-lasting, began in April. They are designed to last between three and five years for an adult, but need to be changed every six months for a growing child. The production of temporary prostheses ended, for all intents and purposes, in September. In January 2011, the association plans to start the orthopaedic-fitting of upper-limb amputees.

10 An orthosis is a device that corrects a limb or spinal impairment, such as a splint, collar or corset. Unlike an orthosis, a prosthesis replaces an absent limb or organ.

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“There are some magical moments at the fitting cent re”

Pascal Kodjo Agbegnedo is an orthoprosthesist train er from Togo. I work in a fitting workshop in Port-au-Prince for amputees. I produce prostheses and orthoses adapted to each person’s morphology. I fit them and adapt them, and my physiotherapy and occupational therapy colleagues perform physical rehabilitation activities appropriate to the patient’s lifestyle. Some days are magical, like when we fitted a 17-month old baby with a prosthesis. He walks better than anyone else now! We train Haitian staff on-site. It’s an essential part of ensuring the long-term future of our actions, particularly the follow-up of people fitted with devices. The prosthesis needs to be changed, repaired or adapted throughout the patient’s lifetime.

Two mobile fitting teams The fitting centre has two mobile teams who visit communities and focal points. After delivering the prostheses and orthoses, they perform the technical follow-up of people fitted with devices, perform adjustments and make minor repairs. Home visits allow teams to study the beneficiary’s environment, assess their needs, distribute technical aids and basic equipment, and refer patients to the psychosocial team. The role of the mobile team assigned to Petit-Goâve, an area located far from Port-au-Prince, consists in taking measurements and casts of the stumps of the amputees followed-up at local disability focal points. Equipped with the prostheses made at the orthopaedic-fitting centre, the team returns to the field to try the devices on patients. Following this process, the therapists at the focal point provide patients with long-term rehabilitation care. A second rehabilitation and fitting centre

Handicap International Belgium began work in Haiti on 18 January to provide physiotherapy care in three hospitals run by Médecins sans Frontières Belgique. From March, the team concentrated its efforts on Sarthe hospital. Since then, the association has been active in this hospital, where it manages a rehabilitation and fitting centre. By mid-September, 3,489 patients had been case-managed at the centre. The on-site team consists of a permanent staff of some thirty people, including 8 expatriate staff.

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Training of Haitian staff The association’s goal is to create and coordinate the country’s long-term capacity to provide rehabilitation and fitting services by training Haitian staff to ensure its future success. Expatriate technicians are working in collaboration with Haitian and expatriate staff from the Healing Hands for Haiti association for the time being, before other Haitian staff are provided with training. Six people are already taking on-going training to become orthopaedic-fitting technicians. Four Haitian rehabilitation assistants have also been provided with training since October. In partnership with Healing Hands for Haiti, the association is also set to provide Level Two training for orthoprosthesist technicians in 2011, over a period of two and a half years, in compliance with recognised international standards. The theoretical training modules followed more than twenty Haitians will be taught by teachers from the University of Don Bosco (El Salvador). These newly-trained orthoprosthesist technicians are expected to be able to take over from the expatriate teams sent to Haiti following the earthquake and provide long-term follow-up care to patients fitted with orthopaedic devices.

FOLLOW-UP AND MEDICAL CARE IN COMMUNITIES The six Disability and Vulnerability Focal Points (four in Port-au-Prince, one in Petit-Goâve and one in Gonaïves) were set up in partnership with the German organisation CBM and the Secretariat of State for the Inclusion of People with Disabilities, and with the support of Haitian disabled people’s organisations. The Focal Point teams now have a staff of 101, including 8 expatriate staff. The aim of these focal points is to improve the protection and service access conditions of people with disabilities and other vulnerable people, including the elderly, sick and isolated. Six mobile care teams use the focal points as a base for their visits to the capital’s districts and suburbs, including Carrefour, Delmas and the Champ de Mars, and work in a camp housing more than 40,000 people in Pétion-Ville.

Because we are present in communities, we can provide basic care, perform physical rehabilitation activities for people with disabilities, offer psychosocial support and distribute mobility aids and equipment for day-to-day activities, such as mattresses and mosquito nets. People with specific needs are identified by the mobile teams and referred to appropriate facilities, such as organisations responsible for targeted food distributions to malnourished children or organisations providing individual psychological support.

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Home care team for paraplegics and quadriplegics Many Haitians live in conditions of extreme deprivation. Paraplegics and quadriplegics, who have specific and continuous case-management needs, are therefore particularly at risk. Set up in June 2010, a mobile team consisting of a physiotherapist, an occupational therapist and a community worker, operate in Port-au-Prince and the surrounding area and provide rehabilitation care, direct patients to medical facilities when necessary, assess their needs in terms of technical aids and basic equipment, and perform any corresponding distributions. The mobile team is also developing cholera awareness and prevention actions targeted at this category of patients, who are rarely included in mainstream prevention activities.

PSYCHOSOCIAL ASSISTANCE

The recreational events and discussion groups organised by the Disability Focal Points enable visitors to these centres to share their experiences with other victims and provide an initial response to the psychological suffering caused by the earthquake. Psychosocial workers from each focal point visit communities to perform follow-up work. They measure the family’s level of distress, identify possible family conflicts and refer people for individual psychological support if necessary. They also evaluate the level of inclusion of people with disabilities, where necessary, and raise the awareness of their family and friends. Amputees benefit from individual consultations with psychosocial workers in fitting centres to evaluate each patient’s psychological condition. They are provided with follow-up care throughout the fitting process and once they have returned to their communities. As part of a long-term strategy, Handicap International is a member of two working groups, “Mental health” and “Inclusion, rehabilitation and disability”, which bring together Haitian and international operators. In this way, the association is able to make a contribution to the national plan on mental health issues and the national plan on the inclusion of people with disabilities.

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PROTECTION

The protection of vulnerable people in crisis situations represents a major challenge during any emergency operation. In situations of extreme deprivation, heightened tension and social instability, vulnerable people, in particular people with disabilities, must be protected from the risk of violence, exploitation and abuse. Handicap International therefore monitors the implementation of specific protection measures as part of its actions and takes part in international coordination processes dedicated to these issues. The association performs protection activities which allow it to intervene in the most difficult cases identified in communities

(psychological, physical and sexual violence). Based on identification operations performed in communities and targeted at vulnerable individuals, these actions also aim to improve and develop referrals to other institutions involved in protection activities (in the field of gender-based violence, domestic violence, child protection, etc.) and to ensure that all available services (access to sanitary facilities, distributions of aid and food, etc.) are accessible to people with disabilities.

CHOLERA PREVENTION The activities of the association’s health teams have been seriously affected by the outbreak of a cholera epidemic, which was first identified on 19 October 2010. Their actions have also been revised to include awareness and prevention elements. Handicap International launched an awareness-raising campaign on 26 October targeted at the most vulnerable sections of the population. Each individual is provided with awareness information tailored to their personal situation in order overcome the difficulties they face in accessing mass awareness information. Their immediate entourage, family and neighbours are included in these activities. These awareness activities are performed by Disability Focal Point staff. A total of twenty teams across Haiti ensure that people understand the dangers of cholera and ways to prevent it Awareness activities are also performed to avoid stigmatising the sick and to encourage solidarity. Hygiene and cholera packs11 are also being distributed, initially to 400 families in Gonaïves. Lastly, the production workshop dedicated to the construction of transitional shelters in Petit-Goâve will also produce one hundred beds adapted to cholera treatment centres in Petit-Goâve, Grand-Goâve, Miragoâne and Les Cayes. Psychosocial activities have been temporarily suspended to raise the awareness of a maximum number of people. The awareness teams will nevertheless continue to identify those with specific support needs for referral to the psychosocial unit. Some Disability Focal Points are temporarily closed to the public but will provide a base for informing visitors on adaptation methods and raising awareness of prevention measures. The mobile rehabilitation teams and the team dedicated to helping people with spinal cord injuries (paraplegics and quadriplegics) are continuing with their activities, which include raising the awareness of patients and their families. Handicap International has also widely distributed recommendations for including people with disabilities in the management of the response to the cholera epidemic, particularly with regards to operators working in the fields of health, protection and camp management.

11 Packs contain a plastic bucket with a lid, a bag to keep belongings dry, a fleece blanket, a bath towel, a sponge, bars of soap, water purification tablets, and oral rehydration solution sachets.

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HUMANITARIAN LOGISTICS AND MEETING BASIC NEEDS

Faced with a population deprived of its very means of existence, Handicap International contributes to the logistical organisation and coordination of the rel ief effort and to meeting basic needs in order to f ulfil its mandate to help the most vulnerable sections of the population. The association manages a humanitarian aid transport platform for all solidarity operators present in Haiti. Since the end of October 2010, this logistics chain has formed part of the response to the cholera epidemic. Meeting the basic day-to-day needs of Haitian victims includes the distribution of aid, “cash for work” activities and the construc tion of transitional shelters for vulnerable and isolate d people.

MANAGEMENT OF THE INTER-AGENCY LOGISTICS PLATFORM After Haiti was hit by a series of hurricanes, Handicap International managed a logistics platform for the transport of humanitarian aid, in partnership with the World Food Programme (WFP), from 2008 onwards. Handicap International’s humanitarian logistics team in Haiti now numbers 160 people (including 5 expatriate staff) spread over four operational bases (Port-au-Prince, Cap-Haïtien, Gonaïves and Jacmel). It manages a fleet of 70 lorries, including some 50 six-wheel drive all-purpose vehicles each capable of transporting 3.5 tonnes of goods to areas that are difficult to access. The association also coordinates some 20 flatbed lorries made available by the Clinton Foundation capable of transporting 8 tonnes of freight, which are used mainly in urban areas. The association also managed two humanitarian aid storage warehouses with a capacity of 2,500 and 3,000 sq.m. respectively from February 2010. The first closed in June and the second in September. Since 14 January, Handicap International transported has almost 20,000 tonnes of aid, including 9,000 tonnes of food for some one hundred organisations12, including some fifteen Haitian organisations13. In response to the cholera epidemic, the platform transported 394 tonnes of aid between 22 October and 4 December 2010, for some fifteen organisations involved in preventing and treating the disease in Port-au-Prince, Cap-Haïtien, Gonaïves, Saint-Marc and Jacmel.

12 They include UN agencies, Action contre la Faim, Caritas, Croix-Rouge, Food for the Poor, Fraternité Notre Dame, Médecins du Monde, Mercy Corps, Oxfam, Pompiers sans Frontières, Plan, Première Urgence, Save The Children, Secours Islamique and World Vision. 13 Including Acrecom, Haitian Red Cross, Dinepa, Espoir de l’Horizon, Meyer, Ministry of Public Health and the Population, Santo 19 and Signeau.

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DISTRIBUTION OF EMERGENCY AID AND “CASH FOR WORK” The distribution activities performed by Handicap International take into account the specific needs of people with disabilities, the vulnerable and the elderly, particularly in terms of facilitating their access to aid and meeting their mobility needs. Petit-Goâve and Grand-Goâve

Located around ten kilometres from the epicentre of the earthquake, these two intervention areas were 60% destroyed, with some 50,000 people affected in these regions alone. Relief was harder to transport to these areas, which are surrounded by mountainous terrain. More than 1,000 ShelterBoxes, with a unit value of 750 euros, were given by the association of the same name (see www.shelterbox.org) to Handicap International, who distributed them in the most acutely affected rural areas. ShelterBoxes are plastic boxes containing a ten-person tent and equipment suitable for daily life in this type of shelter for several months, including a floor mat, blankets, a stove, cooking utensils, jerrycans, a water purification system, a saw, an axe, a shovel, rope, a mosquito net, and activity packs for children. The association has also distributed more than 4,500 tents to over 23,000 beneficiaries, as well as 36 tonnes of food to more than 2,000 households (equivalent to 10,000 people) and almost 30,000 items of equipment to over 8,000 households, reaching more than 42,000 beneficiaries. The non-food aid distributed mainly concerned items essential to every day life, such as plastic sheets, rope, jerrycans, cooking and hygiene packs, mattresses, blankets, mats and mosquito nets. In Haiti’s particularly inaccessible mountainous regions (the Mornes), Handicap International and its partners distributed aid most often by helicopter, or by lorry whenever possible. Port-au-Prince and the surrounding urban area In Port-au-Prince, where national and international aid is concentrated, the association has set up a database of particularly vulnerable persons, such as families with disabled members, for example. The data is supplied by the association’s health teams and its partners. The association aids this particularly fragile population through distributions and the provision of shelters. More than 660 tents have been distributed, providing shelter for 3,000 people. More than 1,300 items of equipment have also been distributed to more than 430 households, reaching over 2,100 beneficiaries. This includes the meeting of day-to-day needs. 45 shelters were built between May and August 2010. These temporary shelters have a wooden framework, plastic sheeting or plywood walls and a corrugated roof. Each of these shelters is made accessible to people with reduced mobility. The distribution of tents and the construction of shelters is sometimes accompanied by small-scale clearing or reorganisation projects, mostly performed as part of “cash for work” schemes.

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“Cash for work” “Cash for work” projects supply the population with a source of income through occasional work, generally as part of manual clear-up operations. The workers are paid the Haitian minimum wage - 200 gourdes (4 euros) a day. Between May and August 2010, Handicap International set up three “cash for work” programmes involving more than 600 people for a total of 4,000 direct beneficiaries: the renovation of the Route de Palmes, at the top of the Mornes mountain range in Petit-Goâve and Grand-Goâve, the demolition and clear-up of houses in Petit-Goâve, performed in conjunction with the Civil Protection service, and the setting up of a centre to produce temporary shelters in Port-au-Prince.

Impact of the hurricane season Following the storm that hit Haiti at the end of September 2010, Handicap International evaluated 500 beneficiaries, considered to be among the most vulnerable individuals, at Disability Focal Points. Each person was contacted to identify their needs in terms of tents and plastic sheeting. Distributions were performed to meet specific needs. The emergency shelters built in Port-au-Prince, which have a wooden framework, walls made from plastic sheeting, corrugated roofing and a cement base, stood up well to the storm. In preparation for the passage of hurricane Tomas on 5 November, the association performed identification and prevention activities aimed at the most vulnerable groups and ensured that the weakest among them were transported to secure shelters.

BUILDING TRANSITIONAL ACCOMMODATION

Handicap International has begun building more than 1,000 transitional, hurricane- and earthquake-resistant homes accessible to people with reduced mobility. These shelters are designed primarily for the most vulnerable sections of the population. Between now and September 2011, 5,000 people will have been provided with accommodation in Petit-Goâve, Grand-Goâve and the surrounding mountainous areas.

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These shelters are theoretically designed to last between three and five years. However, if properly maintained, they can last longer, since their structure is designed to resist bad weather. They have a wooden framework and walls of woven wooden slats, with a roof designed to stand up to strong gusts of wind. The floor is made from wooden planks or a raised concrete slab to protect occupants from humidity during the rainy season. If necessary, these transitional shelters are fitted with a ramp to ensure their accessibility. Offering a living area of 18 sq.m. and a 6 sq.m. covered terrace, each shelter is designed for a family of five. Modules of different sizes will also be made available to suit each size of family or construction area. These prefabricated shelters are prepared in packs which are then transported to the area in question before being assembled with families to foster full “ownership” and to ensure they are able to keep the shelter in a state of repair. By the end of October 2010, the first 80 transitional shelters had been delivered, providing accommodation for more than 330 people. Several others have been delivered to Grand-Goâve where Médecins du Monde will convert them into health centres, in conjunction with the Haitian Ministry for Public Health and Population.

Accessibility Handicap International benefits several other associations with its expertise in the field of accessibility. It is also part of several working groups formed by humanitarian operators present in Haiti. Its task is to promote the accessibility of existing buildings (medical facilities, latrines in temporary encampments for earthquake victims, etc.) and to ensure the requirements and principles of accessibility are taken into account in rebuilding projects. The association uses advocacy to raise the awareness of its partners, NGOs and medical facilities, etc. to the need to include people with disabilities at each stage of an emergency response and to help them access aid. All of Handicap International’s projects, particularly transitional shelters, take accessibility requirements into account.