A city where the living sleep among the dead.

There is a body lying outside L’Hôpital de la Paix in Port-au-Prince – but it is the sight that awaits you inside its grounds that is most alarming.It is as if a massacre has been ­perpetrated here. Dirty white sheets cover some of the dead, others lie out in the open, some, their limbs entwined with another’s.

Many are the bodies of adults, but here to the right is a baby on her back, her belly bloated and pronounced.She is wearing a silvery blue top, just lying by the kerb, abandoned.A man stirs to the left. He unfurls a blanket that covers the ground and lies back down. The living are sleeping among the dead.

Nearby, still outside, a woman lies on a hospital bed. Like many she is too scared of aftershocks to stay inside.That is why they are here, out under the dark, star-filled sky.A man with wide eyes stares at a ­passing stranger. The site of the MSF aid agency has become a makeshift hospital. A relative moves to lift the sheet covering his two broken legs, as if there was any need to emphasise the suffering here.

A woman lies on an unfolded ­cardboard box. There is a pool of her blood slowly collecting below her waist. She needs help – so does everyone.The screams and whimpers of those in pain echo down the corridors. There are few doctors, little medicine.

One woman, a German it seems, says she has just stopped by to help. Her house, she says, was also damaged. A doctor gives her a small vial and she works her way gingerly over the other injured people to a man she has been trying to help.

It is clear many brought to the ­hospital with injuries have since died here. One man with tears in his eyes pointed to his young daughter lying on the dirty tiled floor. She has two broken legs and a large gash in her head. Her ­sister is already dead. “ça va?” her father asks. “Oui,” she replies softly – but she is not OK.

In pockets there is barely anything left of this city, and so far the people are largely having to cope on their own. Hundreds of corpses are lying in the streets of Port-au-Prince. Overnight a rumour went round of an approaching tsunami. Hundreds, it seemed, rushed from the coast and they came along dark, unlit streets carrying a few possessions.

There was no tsunami of course, but it showed how scared and alone the people feel. Many are thought to remain trapped underneath the larger buildings that collapsed and Haiti has little in the way of heavy lifting equipment to reach them.

The leadership here says tens of thousands of people have been killed. Some of the UN peacekeepers stationed here are among the dead. This country, so often in the past ­forgotten by the world, now needs its help more than ever. So, too, does another little girl lying on a table at the hospital. She stirs a little, almost looks asleep. It is not, though, a peaceful sleep – and by dawn she could well be dead.

A massive international air and sea lift of aid to earthquake-devastated Haiti was struggling last night to overcome ­obstacles in delivering rescue teams and emergency help to the more than 2 million people in need of immediate assistance.

Confronted by bottlenecks caused by wrecked runways, port ­facilities and roads, aid experts were warning it could be days before the relief effort gets fully under way, even as thousands of people remained unaccounted for beneath the rubble of Tuesday’s quake and bodies were piled in the ruined streets.

The Red Cross estimated 45,000-50,000 people were been killed in the magnitude 7.0 earthquake. Last night Haiti’s president, René Préval, said: “We have already buried 7,000 people in a mass grave.”

Aid agencies fear the crucial 72-hour window to find survivors would be missed if the help did not start getting through. Compounding the ­desperate problems, America’s civil aviation authority was forced to halt planes leaving the US for Haiti at the request of the Haitian ­government because there was no more room for them to land and no fuel for the planes to return.

US officials said Port-au-Prince’s ­airport was saturated and ground staff could not unload and move supplies into ­surrounding areas quickly enough to open up more space at the airport.

Among those unable to land yesterday was a team of 35 British rescue workers, including firefighters and doctors from Manchester and Lincolnshire, who spent 30 minutes circling above Port-au-Prince airport and were forced to turn back after they were running out of fuel.

Eyewitness accounts from Haiti described bodies decomposing in the streets, while the few hospitals not destroyed were overwhelmed with casualties. Others described whole neighbourhoods destroyed. “Many roads are blocked by fallen buildings. Many people walking around with open and serious wounds,” said Port-au-Prince resident Tara Livesay on her blog.

“The deceased are being dragged to the side of roads, covered in sheets and left. We don’t live in the hardest hit areas but even so there are many bodies.”

As a sense of crisis grew over the slow speed of the emergency response, Elisabeth Byrs of the UN’s office for the ­coordination of humanitarian affairs, said: “The priority is to find survivors. We are working against the clock.”

The problems confronting the ­emergency efforts were disclosed even as Barack Obama appealed to his ­immediate predecessors, George Bush and Bill ­Clinton, to help co-ordinate the US efforts to help Haiti, in what Obama described as “one of the largest relief efforts in our recent history”.

His comments came as he ordered the deployment of thousands of troops and civilian aid workers and promised $100m in relief funds. “To the people of Haiti, we say clearly and with conviction, you will not be forsaken, you will not be ­forgotten,” he said.

The US army and marines are sending some 5,500 troops while more than six US military ships are being sent, including the aircraft carrier USS Carl Vinson. Britain, which has also promised £6m in immediate aid, was among a host of ­countries pledging to send assistance, including China, France, Mexico and Australia.

One of the most pressing problems the effort will have to overcome is the damage to the docks.

“The derricks at the port, which would be our preferred route to deliver food, are too badly damaged to be operable,” said Gregory Barrow of the World Food ­Programme, which is appealing to donors for 14m ­ration packs that can be eaten without cooking – enough to feed 2 million people for a month. “Many of the people we need to feed have no cooking utensils or kitchens which is why the rations are urgently required.”

At the airport, the main concourse was hit by the earthquake with the number of working runways reduced from three to one. In addition there has been a shortage of heavy lifting equipment suitable to unload most non-military kinds of ­aircraft quickly, while damage to the control tower has also limited the types of aircraft that could land.

“The airport is only really open to ­aircraft that have their own heavy lift,” said Ian Bray of Oxfam, whose offices in Port-au-Prince were destroyed with the loss of one of their staff. “There is a bottleneck. We have staff in Miami and Dominican Republic we are still trying to deploy into the country. Another of the problems we are facing is the lack of effective communications with Haiti which affects how quickly we can make decisions about what we should be sending and to where.”

A further problem reported by aid agencies was that many of their staff were looking for their own families. “Many of our own staff are still looking for their own families,” said Harjeet Singh, head of emergencies for Americas for ActionAid. “It is completely normal and very human. But it does mean that any work, even an initial assessment of what needs to be done, is going to be difficult.”

The road route from the Dominican Republic was also proving problematic, with a key bridge damaged preventing large convoys from crossing.

Alejandro Lopez-Chicheri of the WFP, who arrived in Port-au-Prince yesterday, as the organisation began distributing food at hospitals, gave a devastating depiction of the aftermath. “It is very difficult,” he told the Guardian yesterday. “Many people are sleeping outside. Many people are sleeping at the stadium and in the parks. They are afraid of secondary shocks.

“We are setting up in several parts of Port-au-Prince. There are aircraft coming in. I have seen some. But for now we are focusing on the hospitals – feeding the sick and the most badly injured who need it most.

“In the city I’ve seen neighbourhoods that are totally destroyed. There is a problem with water. I’m hearing reports of scores of thousands dead.”

Jimitre Coquillon, a doctor’s ­assistant working at a triage centre set up in a hotel parking lot told the Associated Press: “This is much worse than a ­hurricane. There’s no water. There’s nothing. Thirsty people are going to die.”

Some were left beside the rubble, others were shrouded under sheets and lined up in rows, others were packed and stacked in pick-up trucks: there was no escaping the dead of Port-au-Prince today.

The general hospital, its services all but collapsed, became host to a growing army of corpses. Carried, dragged and wheeled there, their ranks swelled by the hour, from dozens to hundreds, to more than a thousand. “I can’t say how many more bodies will be brought here,” the hospital director, Guy LaRoche, told Reuters.

It was day three in Haiti‘s capital, and if anything the horror worsened. At the Ecole Normale Delmas, ­teams extracted the bodies of teenage schoolgirls in orange uniforms; their faces were smashed.

Laura Bickle, an orphanage worker, said: “They are pulling people out of the rubble, literally, blood running in the gutter like water.”

The city’s parks were filled with people with no homes or shelter to which they could go. Many of them erected shades from sheets and wood to protect themselves from the sun.

While they appeared mostly calm, and efforts elsewhere concentrated on rescue, last night came the first reports that patience could be wearing thin. Angry protesters reportedly set up roadblocks using dead bodies to signal their anger at the lack of aid, Reuters reported.

Haiti’s Red Cross said the toll could be between 45,000 and 50,000, with 3 ­million or more hurt or homeless. Seemingly everywhere, limbs covered in dust poked from the rubble, some stiff and pointing to a tropical sky criss-crossed, on occasion, by helicopters and aeroplanes.

In places there were moans and muffled cries beneath the ruins, spurring frantic efforts to dig people out with bare hands and improvised tools. There were glimpses of joy: an Estonian UN worker freed from rubble clenched his fist in jubilation; there were celebrations as Gladys Louis Jeune was rescued smiling and alive after 43 hours in the rubble. But they did not change what became brutally clear: Port-au-Prince was a tomb.

“It’s the worst I’ve ever seen,” Bob Poff, the Salvation Army’s director of disaster services in Haiti, told CNN. “It’s so much devastation in a concentrated area.”

The network’s medical correspondent, Sanjay Gupta, gave the bleakest assessment. “What I have seen here, I’ve never seen before. While I hate to say this, it seems somewhat hopeless.”

Workers said finding ­survivors under the rubble was a race against time; the vast majority would die within three days – in which case that race will soon be lost. UN peacekeepers seemed overwhelmed by scenes of armageddon.

“We just don’t know what to do,” a Chilean told Reuters. “You can see how terrible the damage is. We’ve not been able to get into all areas.” A few police were seen loading bodies into a van but most officers were absent, presumably dead, injured or trying to taking care of their own families.

With communications mostly still down Twitter once again became a resource for those desperately seeking news of loved ones. From @LadyDior47: do you know what neighborhood rue l’enterrement is in? My aunt owns a store there. I cannot get in contact with her :(”

The clinics and hospitals still standing were crammed. Some survivors had feet or arms twisted at unnatural angles, others had bandages dripping blood.

In one hospital, which appeared to have just a handful of doctors, a man with his injured daughter told the BBC: “I need help … the kid is dying, and she’s frightened; she needs to go to the operating room, but there’s no help. The rest of my family … they buried them somewhere, I wonder what happened to them. Here is my last daughter, I’m trying to keep her alive, and I need help.”

The Red Cross said it was overwhelmed and out of medicine and body bags. The head of Médecins du Monde, Olivier Bernard, told AFP aid would need to arrive by last night to save lives.

Patients with traumas, head wounds or crushed limbs poured into Médecins Sans Frontières’s temporary structures but it could only offer basic care, Paul McPhun told reporters. “The smell’s nauseating. Bodies lie out on the lawn, among them lie the injured; inside, screams and whimpers of those in pain echo down corridors.”

Almost every turn presented a nightmare scene. A dead abandoned baby. A man with stumps for legs. A woman on an unfolded box, blood pooling beneath.

In the Hotel Villa Creole, guests with no medical training tended strangers. “These people have nowhere else to go,” Anne Wanlund, an office worker from Washington DC, told the Miami Herald as she picked pieces of concrete out of a woman’s head wound. In the lobby Judithe Jacques, who brought in her mother Marguerite with a broken knee, fought back tears. “Where are the doctors? We expected doctors.”

Infrastructure and any semblance of the state had collapsed, but the city, in normal times a byword for lawlessness, displayed solidarity and stoicism. However, there were warnings that isolated cases of shooting and looting could spread.

“The streets are now Haiti’s living room and bedroom, with everything closed,” said Richard Morse, manager of the Hotel Oloffson, made famous in Graham Greene’s The Comedians. “Money, food, drinks, supplies, rotting bodies, impatience, despair will all become a problem. ”

Planes laden with supplies were landing at the airport, but doctors worried dehydration and disease might outpace them. “Money’s worth nothing right now; water is the currency,” said a foreign aid worker. A power blackout, scant water and ­medicine, and decomposing corpses made a lethal cocktail, Peter Hotez, head of the department of microbiology at George Washington University, told CNN.

“What you have is the perfect storm of infection. It is already a fragile ­infrastructure with high rates of infectious tropical disease.

“Now there are potential breakdowns in sanitation, clean water, housing … it’s a terrible mix.”


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