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PORT-A-PIMENT, Haiti (Reuters) - Foreign medics with orange stretchers and gallons of chlorine are stemming a cholera outbreak on Haiti's hurricane-struck coast but the focus on a disease U.N. peacekeepers brought here six years ago is slowing the delivery of food and shelter for storm victims.
Hurricane Matthew ripped through this southwestern region of Haiti last week, killing at least 1,000 people and leaving 1.4 million in need of aid, including hundreds of thousands made homeless. It also trashed crops and unleashed a new cholera surge.
Along the shattered coastal landscape of virtually flattened villages, angry residents have set up blockades of broken trees and branches to try to stop the trucks of food and other aid they have seen speed past them.
The roadblocks reflect an anger that could quickly escalate if aid agencies and the government do not speed up relief efforts in the poorest country in the Americas.
"The donations keep passing and they don't stop. We need food and shelter," said Jean Jacques, 30, a fisherman and subsistence farmer. Around him, around 50 local residents complained nobody had helped them.
The United Nations and aid organizations are now rushing out across areas hit hardest by the hurricane, the biggest relief operation in Haiti since a devastating 2010 earthquake.
But the massive effort needed to control a new spike in cholera since the hurricane and the tensions over food deliveries are a reminder of the history of foreign help to Haiti that has at times done as much harm as good.
In October 2010, Nepali peacekeepers accidentally introduced cholera into Haiti when their camp emptied infected sewage into a river. The disease has since killed more than 9,000 people.
"They recognise they are guilty and for that reason they try to help," said Haitian doctor Marie Sophia Sanon, who heads the cholera unit in Jeremie, the largest town near the hurricane's path and now largely reduced to rubble. Since last week, she has saved 72 people suffering the disease that kills with diarrhoea.
At least $9.5 billion of aid sloshed into Haiti in two years after the 2010 earthquake, which the government says killed more than 300,000 people. But many aid groups had priorities that often did not chime with the country’s needs.
Too much food aid undercut prices for farmers' own produce and hit sales at stores, damaging the economy and making it harder for Haiti to get back on its feet.
Too many tents and not enough building materials trapped people in shanty and tent cities for years.
The American Red Cross, which raised some $500 million for earthquake relief, was scorned for building just six houses, although it says it helped tens of thousands of Haitians with home repairs.
This time, Haiti and its partners are determined to avoid those mistakes, even as the early days of the relief effort appear chaotic.
"If they are not coordinated, we will have exactly the situation that we had after the earthquake, where everybody went in one place, where everybody brought the same sort of support," U.N. Humanitarian Coordinator Mourad Wahba told Reuters.
The Haitian Red Cross, which in 2010 focused on community first aid, food distribution and shelter, said on Tuesday its main concern now is cholera. Pouring resources into tackling the outbreak, however, means less is available to address other urgent needs.
The United Nations, which has released $5 million from an emergency fund and launched a $120 million appeal for Haiti, has also made tackling cholera a priority of relief efforts.
One of the most significant criticisms of reconstruction efforts after the earthquake was how little was done on disaster preparedness, while other densely populated, poor countries such as India and Bangladesh have made great strides.
This year, the World Bank-managed Haiti Reconstruction Fund redirected $14 million earmarked for natural disaster mitigation in southern Haiti to energy projects, a June financial report showed.
The U.N. Office for Disaster Risk Reduction on Tuesday said Haiti is "the world's most dangerous country" when natural disasters strike.
"The question now has to be asked why six years after the Haitian earthquake, adequate multiple hazard warning systems are not in place to ensure minimal loss of life in events such as this," spokesman Denis McLean said.
Cholera has killed up to 173 people since Hurricane Matthew ripped through the southern peninsula, churning human waste with river and well water and destroying homes, crops and livestock.
Tens of thousands of people are at risk and without adequate shelter weeks before Haiti's rainy season begins.
The head of the Organization of American States, Luis Almagro, said on Wednesday the latest cholera outbreak was "a harsh reminder of the responsibility of the international community for the misfortunes affecting" Haiti.
While people now know what cholera is, conditions in some areas mean they have no choice but to drink contaminated water.
"Everyone here is terrified about cholera," said Adrienne Stork, who works for the United Nations Environmental Program near Port-a-Piment, where the water-borne sickness was spreading this week.
The mayor of Chardonnieres, a small town near Port-a-Piment, told Reuters 125 people died there as a direct result of Matthew and another 160 in the cholera epidemic in his district, mostly in a village accessible only by foot or by helicopter.
Jake Johnston, a researcher on Haiti's earthquake reconstruction at the Centre for Economic and Policy Research in Washington said the U.N. should have done much more to rid Haiti of cholera long before the hurricane.
"Many lives would have been saved and the human toll from the hurricane would be reduced," he said.
Acutely aware of past mistakes, foreign governments and aid groups are this time letting Haiti's government coordinate relief efforts. It leads key meetings held in French and Creole, a contrast to U.N.-led meetings after the earthquake which were often in English, making it harder for Haitians to participate.
The storm did not batter Port-au-Prince, so the government is able to respond in a way that it wasn't able to after the earthquake. Donations are taken to a government warehouse in Port-au-Prince before being dispatched, Interior Minister Francois Anick Joseph said.
The new approach is not without pitfalls. Governments are bureaucratic and Haiti's is also small with limited reach in the provinces. Corruption is also a concern.
"Any government would struggle with coordination for a hurricane of this magnitude," said Mike Weickert, the response manager of World Vision, a Christian charity.
Some U.N. and charity officials say in private they are concerned slow decision making is holding up relief to remote villages and towns.
One aid worker said trucks were turned back near Port-a-Piment for not going through government channels.
Marie Claudette Regis, deputy mayor in port town Les Cayes, said the government had not responded to needs the municipality had communicated. "We have received nothing," she said.
Instead, the municipality used its own funds to buy foodstuffs and building materials for people.
One foreign aid worker attending a government coordination meeting in Les Cayes said Haiti had learned from the "free-for-all" of aid groups in 2010, but that the new approach was also dangerous.
"In the long-term, it's probably the right thing," the worker said, asking not to be named to avoid souring her relationship with the government. "In the short term, people are hungry and thirsty and they are going to die."
Additional reporting by Stephanie Ulmer-Nebehay in Geneva, Michelle Nichols in New York, Joseph Guyler Delva in Port-au-Prince, Christine Murray and Frank Jack Daniel in Mexico City; Writing by Frank Jack Daniel; Editing by Kieran Murray