"Everyone copied on this note has already heard, most probably directly from PIH, about these storms and their impact on Haiti. I apologize for writing again and for asking my own colleagues and friends to consider sending more resources—we need food, water, clothes, and, especially, cash (which can be converted into all of the above)—so that Zanmi Lasante, and thus all of us, can do our part to save lives and preserve human dignity.

"The need is of course enormous. After 25 years spent working in Haiti and having grown up in Florida, I can honestly say that I have never seen anything as painful as what I just witnessed in Gonaïves—except in that very same city, four years ago. Again, you know that 2004 was an especially brutal year, and those who work with PIH know why: the coup in Haiti and what would become Hurricane Jeanne. Everyone knows that Katrina killed 1500 in New Orleans and on the Gulf Coast, but very few outside of our circles know that what was then Tropical Storm Jeanne, which did not even make landfall in Haiti, killed an estimated 2000 in Gonaïves alone. Logging on this morning from Mirebalais, I see that Ophelia has circulated the essay I wrote about what are, essentially, unnatural disasters.

"We’re faced with another round of death and obliteration. Haiti’s naked mountains promise many more unnatural disasters. We know that a massive reforestation program and public works to keep cities safer are what’s needed in the medium and long term. But there’s a lot we can do in the short term to help out with disaster relief.

"None of us regard PIH as a disaster-relief organization. Together, we’ve built PIH—meaning the network of locally directed organizations working in 10 countries—to serve a different cause. We wanted to attack poverty and inequality and bring the fruits of modernity—health care, education, et cetera—to people marginalized by adverse social forces. It seemed likely, as reports came in this week, that many other institutions and organizations would be far better able to respond to the after-effects of storms and floods. I’d been told, as the American Airlines flight passed over flooded Gonaïves, that the city was cut off from outside help, but even as I heard this, I knew that our own colleagues were there, volunteering what meager resources we had on hand, and a few hours later I was there too. I was hoping that we’d find that the city was receiving the expert attention of organizations trained to do disaster relief. So imagine my surprise, yesterday, when I discovered that very little in the way of help had reached Gonaïves or the other flooded towns along the coast.

"Although it’s not true that Gonaïves cannot be reached by vehicle, it is true that the city center is still under water, and that the road into the city is well and truly flooded. Between Pont Sonde—the only way to the coast, since the major bridge between Port-au-Prince and Gonaïves is out, as is that to the north—and the flooded city, we saw not a single first-aid station or proper temporary shelter. We saw, rather, people stranded on the tops of their houses or wading through waist-deep water; we saw thousands in an on-foot exodus south towards Saint-Marc.

"We saw a couple of U.N. tanks rolling through the muddy water over these streets, some Cuban doctors, and two Red Cross vehicles (one of them stuck in mud at least 10 miles from the city), and heard and saw helicopters overhead. But for the most part the streets were full of debris, upside-down vehicles, and dazed residents looking to get out before the next rains. Our friend Deo from Burundi was there and said it reminded him of nothing so much as what he’d seen there, and in Rwanda, at the time of the genocide in 1994—long lines of people carrying little more than their children, goats, and balancing sodden bags and suitcases on their heads.

"A speedy, determined relief effort could save the lives of t