With hundreds of millions in donations languishing, freelance humanitarians are filling the void.

By Kitt Doucette

Vince DeGennaro Jr. is not taking no for an answer. Sporting cheap flip-flops, cargo shorts, a University of Miami Hurricanes T-shirt, and black wraparound sunglasses to shield his bloodshot eyes, he’d look like a rangy beachcomber if he were ever to stand still. Right now, though, he’s storming past two machine gun–toting guards at the World Health Organization’s warehouse in Port-au-Prince in a last-ditch effort to find the immunoglobulin used to treat diphtheria.

It’s hardly standard operating procedure, but in a place as broken-down as Haiti, off-the-books measures are often the only hope to get things done. The rainy season has arrived, and with it the first confirmed diphtheria death. The medical community working here — DeGennaro, 30, is the chief medical officer of the University of Miami’s Project Medishare field hospital in the capital — is scrambling to avoid an outbreak, something everyone’s been dreading ever since the January 12 earthquake that left 230,000 dead and 1.5 million homeless. Most of the homeless are living in filthy, overcrowded tent camps — the perfect breeding ground for diphtheria, along with cholera, malaria, and dengue fever. DeGennaro is in Haiti for the third time since the earthquake. His paid vacation from Columbia University’s New York–Presbyterian Hospital in New York City, where he’s a second-year resident, is long used up, and DeGennaro is struggling to cope with the limitations of a place like this. “Medical solutions will always be a drop in the bucket,” he says, “as long as people are living in tents.”

DeGennaro, who is fluent in Creole, runs a hospital with around 120 full-time patients, 100 medical staff volunteering from the U.S. every week, and a local staff of 150 under his command.

As he swings open the door of the warehouse, he’s greeted by a flustered Frenchwoman. Terse words are exchanged, a phone call is made, and she leads him into a dimly lit industrial garage functioning as the WHO’s pharmaceutical stockpile. Five minutes later, DeGennaro emerges with a cooler full of antibodies and directs the driver of a beat-up SUV to take him to Port-au-Prince General Hospital, where he’ll drop off a few doses.

“No paperwork, no pointless meetings, no red tape, no bullshit — that’s the only way to really get things done here,” he says. Despite an enormous outpouring of support in which half of all American households donated money on the country’s behalf — adding $1.1 billion to the $9.9 billion pledged by the governments of more than 60 countries — progress in Haiti six months after the earthquake has been agonizingly slow by any measure. What’s left of the government here claims that only 2 percent of the promised aid has been dispersed; they also complain that foreign aid groups aren’t communicating with them. The aid organizations, meanwhile — along with other governments, including the U.S.’s — call out the Haitian government’s inability to make decisions, communicate effectively, or otherwise demonstrate its leadership.

Amid all the finger-pointing, one thing is abundantly clear: Neither the government nor the major NGOs — organizations such as Unicef, Oxfam, and the American Red Cross (ARC) — have been able to work here. In the middle of hurricane season, with homelessness and disease on the rise, a paltry 5,500 of the 127,000 scheduled “semipermanent” structures have been built, allowing for only 28,000 of the 2 million Haitians affected by the earthquake to be relocated from the tent cities.

To drive with DeGennaro through the streets of Port-au-Prince is to ride shotgun through a surreal tableau of human misery. Malnourished children bathe in fetid gutters filled with debris; dark faces with yellow eyes peer out from behind tattered plastic tarps. The UN estimates that more than 665,000 tarps and 97,000 tents have been handed out, but more than 40 percent of both have already been shredded by the intense sun, rain, and wind. Mothers carrying limp babies line up at one of the few functioning water stations, and large groups of young men and women sit in the shade giving hundred-yard stares.

In front of the gutted government palace, graffiti covers every wall — DEATH TO THE NGO THIEVES, reads one; OBAMA, WE NEED CHANGE, declares another — along with remarks about Haiti’s president, René Préval. (One such scrawl, translated, asks for Préval to pull his balls out of his ass, adding, with mock politesse, s’il vous plait.) DeGennaro rolls down the window as we approach the festering tent city on the palace grounds, and the stench of stale vomit and fresh diarrhea fills the air. The whole place is boiling with a growing sense of unrest fueled by desperation. Last week, two aid workers were kidnapped and murdered; many aid organizations now keep their volunteers under curfews and lockdowns inside walled, barbed wire–circled compounds. Local radio stations accuse the government of stealing all the donated money and urge listeners to target foreign aid workers, sexual assault and other violent crimes are commonplace, and gangs have emerged atop the power structures of the tent cities.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) in Haiti reports that of the 1,241 known refugee camps in the Port-au-Prince area, only 206 are officially recognized or sanctioned in any way. Wealthy landowners have begun hiring armed men to forcibly evict residents of unsanctioned camps out of fear that the “temporary” camps will become permanent. Homeless for the second time in six months, the newly evicted have begun camping on roadside medians and on top of trash dumps and mass graves and graveyards — where they continue to die.

DeGennaro looks down at the small cooler in his lap, then out the window with his own hundred-yard stare. “The Haitian people are used to being shit on,” he says. “But the situation right now is pathetic.”