The dying give up hope as medicines fail to arrive

Jean St Louis also spent the night on the street and his task was even grimmer. He had been on a bus returning from work when the earthquake struck. By the time he reached home he was frantic with worry for his wife Melissa, 27, who worked at a government ministry, now badly damaged.

After three days of waiting in vain for her to appear, he began searching for her body. I found him early yesterday, squatting against a tree near the city's central morgue, staring across the road at a horrifying pile of a dozen or so bodies casually dumped on the pavement.

Passers-by shuffled past behind us, cloths pressed to their mouths to ward off the sickening stench. St Louis could see that several women were among the corpses. A dog sniffed at another heap of bodies further down the street. St Louis could not bring himself to go any closer.

Tens of thousands of Haitians may never learn the fate of their loved ones. Forced by the heat and the threat of disease to dispose of corpses as fast as possible, municipal authorities have been dumping them by the truckload in mass graves on the edge of the city.

One official calculated that 40,000 bodies have already been buried. Estimates of the final death toll have soared to 200,000 or more.

In some parts of the city roads are blocked by heaps of corpses awaiting collection. Angry residents have built funeral pyres of tyres and thrown bodies into the flames. Near the main cemetery one group of workers were pelted with stones when they attempted to dump another truckload of bodies. Countless others remained unburied.

For the living there have been glimpses of hope, but also a shattering realisation that help is arriving so slowly and ineffectually that it may be days, if not months, before they can look forward to permanent shelter and reliable supplies of food, water and medicine.

As the shock of the disaster gives way to anger, aid workers are worrying about security. Looting has become widespread, armed gangs have resumed the rivalries that plagued Port-au-Prince before the earthquake and even the United Nations suffered a break-in at one of its heavily guarded warehouses.

At a sprawling shanty town that has formed in the central square, the lucky ones shelter under plastic sheets but thousands are sleeping rough on the ground. Some wear masks to reduce the stench of rotting flesh; others have smeared white moustaches of scented disinfectant below their noses. Yesterday one group had camped within a few paces of a partially covered corpse in the gutter.

Many families had salvaged cooking implements from their ruined homes, but had nothing to cook. The World Food Programme acknowledged that distribution was going "very badly". Yet there were signs of inspiring resilience as Haitians adapted to conditions of unthinkable misery.

One mother poured some of her precious water so that her two young daughters could clean their teeth. "You have to try to be normal," she said simply. Yet the slow pace of the relief operation was causing immeasurable grief.

AT a small clinic close to the city centre, screams rang out as Dr Jerry Bitar pulled on his rubber gloves. A young woman before him, writhing in agony in the open air, had suffered stoically for the promised help that was nowhere in sight. Now all she could do was scream.

The woman had been struck by a falling house. A piece of rubble had sliced through her forearm from wrist to elbow.

Bitar had cleaned and dressed the gaping wound, but told the woman that he had run out of painkillers. While he had hoped that some would arrive at the Bernard Mevs clinic soon, none had appeared and now a potentially deadly infection was setting in.

"It's not just painkillers we're missing," Bitar said. "We have no anaesthetic to operate and we're desperate for an orthopaedic surgeon."

Bitar has so many injured patients that he has had to leave a dozen unattended on trolleys in the courtyard. "Most of the people you see here could be treated and recovering in hours, if only someone could help us," he added.

With giant bottlenecks in the supply of aid by air, land and sea, Bitar's clinic offered a frightening glimpse of a fate that may be shared by thousands more earthquake victims scattered across the broken city.

Many of those sleeping on ground next to hospitals and aid agencies are receiving rudimentary care, but doctors are already seeing gangrene among patients with open wounds or crushed limbs.

"They told us that foreign doctors were coming," said Claud Edouard Contave, whose eight-year-old sister has a broken thigh and a fractured jaw. "Where are these doctors?"

The earthquake has not only turned Port-au-Prince, the ramshackle Haitian capital, into a potential Caribbean Pompeii - doomed to be abandoned by its residents - but is also testing the effectiveness of global aid.

As volunteers from more than 30 countries descended on Haiti, they faced a jammed airport, a wrecked shipping port and roads that looked more like goat tracks than highways.

Thousands of tons of relief supplies were piling up. "The big issue is how you get it out to the people," said Tanya Weinberg of Save the Children. "There are planes sitting there that haven't been unloaded."

In some parts of Port-au-Prince, water trucks were dispensing supplies and fresh fruit and vegetables were reappearing on market stalls. Yet the city remained a mind-boggling mixture of apocalyptic ruin and a return to routine.

On one side of the road an expensive car lay crushed beneath the rubble of a fallen shop; directly opposite it was business as usual at Adelle's car wash. A few hundred yards from the collapsed cathedral, uncollected bodies lay gathering flies on the pavement; around the corner a vendor under a yellow umbrella sold popcorn and bottled water, some of which appeared to have been supplied by the relief agencies.

Many Haitians were facing painful choices. "Our house wasn't completely ruined," said Contave at the Mevs clinic. "But there are big cracks and a wall is leaning. We don't know how long it will stand like that or if someone will tell us to knock it down."

Decades of flawed construction materials and invisible inspection procedures made Port-au-Prince one of the world's shabbiest cities long before last week's tragedy. Now the country's rulers, advised by their powerful international donors, must decide how much of the city to raze and how much of it should be rebuilt on so deadly a geological fault.

A hint of future Pompeii-style abandonment could be found at the end of a cliffside alley that begins innocuously enough with a small red sign: "The Haiti Rotary Club meets here on Tuesdays at 7pm".

Not any more. The alley ends at the Montana hotel, previously a shiny marble haven of luxury that was Port-au-Prince's most exclusive hilltop retreat from the steamy gunplay of the gang-infested slums on the plains below.

It was at the Montana that several Haitian government ministers had their offices; where numerous international aid organisations met; and where the few dignitaries who bothered to visit Port-au-Prince were invariably entertained.

Surrounded by expensive villas in Pétionville, the Montana and every house on that alley had collapsed in ruins at the first big shudder.

It seemed entirely in keeping with the hotel's luxurious reputation that when a single survivor, a Haitian woman named Dolores, was dug out from the bar area after a 72-hour rescue effort on Friday, the first thing she asked for was a glass of red wine.

"We had to laugh," said Rebecca Gustafson, a US aid worker accompanying the US firemen from Fairfax County, Virginia, who had dug Dolores out. "We were ready with antibiotics and fluids for dehydration, but the one thing we definitely don't carry is wine."

The destruction of the Montana - where the death toll remains uncertain but may run into the dozens - makes it extremely unlikely that anyone would ever rebuild more than a tent on that blighted ridge. The same may be said for vast swathes of downtown Port-au-Prince, where simply removing the fallen rubble may take the rest of this decade.

At one of the Pétionville villas, I asked through a locked gate if the owners had any plans to rebuild. "The owners have left Haiti," a man behind the gate replied.

The international rush to be seen providing aid also offered a humbling reminder of the difficulties faced by Britain's emergency response units as they battle to deploy their well-honed skills at saving lives.

The Haiti mission by an 80-member UK search and rescue team had begun encouragingly with a rapid deployment from Gatwick by a chartered Boeing on Wednesday afternoon. But it hit frustrating snags as the British found themselves up against the same depressing bottlenecks facing the relief workers, journalists and anyone else trying to battle their way into the earthquake zone.

Mike Dewar's journey had begun in Manchester on Tuesday night, when the 41-year-old fireman had mobilised within hours of the earthquake's strike.

By 3am he was driving to Gatwick with Echo, his six-year-old golden labrador rescue dog; by 4am on Thursday he had flown with the team into Santo Domingo in the Dominican Republic, which shares the island of Hispaniola with Haiti.

Dewar, his dog and an advance party flew off to Port-au-Prince, then endured the acute disappointment of descending to 20ft above the runway before US military controllers ordered them to take off again because there was no space for them to unload. They were forced to fly back to Santo Domingo and try again.By the time the Brits went into action in Port-au-Prince on Friday, an American 80-man "heavy" team from Fairfax County had already been in Haiti for two days; it was joined on Thursday by a 42-member "medium" team and other units from Miami, South Florida and Los Angeles.

Other relief teams cooled their heels in Caribbean airports as they awaited US permission to land in Port-au-Prince. The inevitable grumblings at the way the US Federal Aviation Administration had seized control of Haitian airspace were heightened by the dangers that delay posed to those still trapped, especially children.

"Something like 40% to 50% of the population of Port-au-Prince is kids," said Dr Irwin Redlener of the Children's Health Fund. "Kids die much more rapidly of dehydration, of loss of blood, of shock. An infection will cause explosive diarrhoea, which can kill a trapped child."

Redlener noted reports that local workers had been trying to free a child with a shovel and were reduced to debating whether they would have to amputate its trapped leg themselves.

"Where are the search and rescue teams? Where are the medical teams?" one worker said.

Several Haitians also noted a curious imbalance in the attention paid to the Montana hotel collapse. At one point UN peacekeeping troops from Ecuador and the Philippines were guarding access to the site while rescuers from half a dozen countries took it in turns to patrol the wreckage.

"There's a lot of other places to look for missing people," said Jose Pierre, a Dominican-based Haitian who had made a six-hour drive across the border to check on his family. "But I guess they always like to rescue the tourists first."

It was back at the Mevs clinic that the danger of failing to deliver medical assistance fast enough was most painfully visible. Among the patients was Besa Pierre, a chubby four-year-old girl who had been playing at home when the twostorey house shuddered and a wall collapsed on her leg.

If she had had treatment from an orthopaedic surgeon, Besa would have soon been recovering. Instead she lay on her back on a trolley, her right foot strapped to a short wooden plank, which in turn was tied by string to an old plastic water bottle weighed down by pebbles and placed on the floor.

This makeshift contraption was intended to prevent her moving her leg. "She needs a simple repair that we can't do without anaesthetic or an orthopaedic specialist," said Bitar, a French-educated surgeon who attends the clinic with his twin brother, Marlon, also a surgeon.

They both know, though, that however much international aid they eventually receive, and however many bones they are able to repair, there are some wounds that they cannot hope to heal.

In the shade of a tall tree lay Sherline Crevarousse, a thin 15-year-old girl with a crude bloodstained bandage wrapped around her head. She also broke an arm and a leg when her family's house collapsed.

She was taken to the clinic, where neighbours had to tell her that her mother, sister and aunt were all dead. There has been no sign of her father.

"She was saved," said one of her neighbours. "But now she has no one left."

How to make a donation

British donors have already given more than £12m to help victims of the earthquake. The UK's Disasters Emergency Committee (DEC) described the response to its appeal as unprecedented, writes Sara Hashash.

The Queen, who has made a private donation, said she was "deeply saddened". Money has also poured in from celebrities. Gisele Bundchen, the supermodel, gave $1.5m (£922,000) to help with the relief effort. Brad Pitt and Angelina Jolie donated $1m.

A television appeal by George Clooney and other stars will be broadcast on all the main American networks on Friday.

How you can help:

To make a donation, visit dec.org.uk or call 0370 60 60 900, donate over the counter at any post office or bank, or send a cheque made payable to "DEC Haiti Earthquake Appeal" to PO Box 999, London, EC3A 3AA.

What your money will buy:

£25 will supply a kit of household essentials.

£50 buys a food pack to feed a family for a fortnight.

£100 provides temporary shelter for two families.

The funds raised by the DEC will support the efforts of its members, which include British Red Cross, Cafod, Christian Aid, Help the Aged, Oxfam and Save the Children.