By Peter Williams, The Guardian
July 12, 2010
Reconstruction efforts must prioritise infrastructure as well as shelter and medicines
Haiti, with its population of 9.5 million – the size of the UK’s five largest cities – has for much of the last century remained one of the poorest countries in the world. Prior to the 12 January earthquake, the average life expectancy was 43 years, in stark comparison with the UK’s 79 years. Major barriers to social development have been cross cutting – not least a legacy of bad governance and the unequal distribution of resources. The country simply lacked the necessary investment in infrastructure which so many of its neighbours (excluding Cuba) prioritised in the 1980s and 90s – chief among these were civil, health and ICT investments. Natural disasters have certainly compounded the challenge – in 2008, hurricanes left 1 million homeless and brought an increase of widespread infectious diseases. In the wake of the 12 January earthquake, all of these challenges and more came to a head.
The earthquake left 1.5 million homeless, almost 0.5 million injured and tens of thousands in need of psychosocial support. The large number of internally displaced people has dramatically increased the risk of communicable disease transmission. It therefore comes as little surprise that the country faces the two-fold challenge of improving both the health and housing of millions: challenges which are interdependent.
Let’s explore the facts. When a lack of access to suitable water, sanitation and housing is compounded by overcrowding, conditions are ripe for health risks such as diarrhoea and respiratory-related illnesses. A more latent danger (not because it’s any less of a threat, but because it is harder to detect) is the increased susceptibility to socio-medical challenges such as HIV/Aids – for which high-risk behaviours correlate to poor socio-economic status such as bad living conditions.
Let us not forget that at the time of the earthquake, there were approximately 120,000 people living with HIV in Haiti. For the latter, research shows sub-standard housing increases the risk of opportunistic illnesses among people living with HIV/Aids. Poor heating and ventilation causes mould, fungus and bacteria which compromise the respiratory system. Yet there is a solution: bring in improved ventilation and reduce indoor humidity and you significantly reduce the risk of the HIV-positive individual contracting tuberculosis (TB). These are simple solutions, but still one-third of people living with HIV/Aids are co-infected with TB. In fact, without proper treatment, 90% of people with HIV/Aids die within months of contracting TB.
Following the Asian tsunami, the publication Lessons Learned from Aceh(published by Arup/DEC) provides guidance for the future actions of the international community. One of the key lessons learned from the “build back better” model was that a multi-sector approach to reconstruction is not only necessary but central to delivering a lasting improvement to people’s lives. In Indonesia, this meant an improvement to livelihoods through training projects which were integrated with rebuilding.
In Haiti, I would advocate the same but expand this to include a shifting of the paradigm to look at civil infrastructure and health as two interconnected areas of development. Architecture for Health in Vulnerable Environments is committed to this approach, firmly believing in a new landscape where locals – civil society, public and private sectors – can champion the use and reuse of housing as a key strategy for improving health. This can be through the support of innovative ideas which prioritise the built environment in combating disease as well as investing in models of decentralised healthcare. A reprioritised model towards community home-based care systems fits well with the socio-cultural landscape of Haiti, where social and informal networks have a history of being alive and strong and where, sadly, hospitals and health clinics are now damaged or under resourced.
We’ve heard time and again that earthquakes don’t kill people – buildings do. But I would add that buildings can also dramatically improve people’s lives, reduce the risk of poor health and increase the chances of an already ailing individual leading a longer and healthier life. Yes, of course it is essential to bring emergency shelter and medications for those most urgently in need, but let us also seize the opportunity to start something new. As we rebuild in Haiti, let’s keep this vision at the forefront of the agenda: health and housing as co-dependent instruments of development.
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