The tent camps of Port-au-Prince have all the makings of disease breeding grounds; thousands of people living in temporary shelters, in very close contact, completely reliant on aid for clean water and sanitation services.

But as the disaster response from the Jan. 12 earthquake nears the seven month mark, not a single large outbreak has occurred. It's a victory that that's been heralded by Haiti's president, prime minister and the many NGO actors in the country alike.

"It is truly one of the great successes of this response," said Julie Sell, spokesperson for the American Red Cross in Haiti. "It is really quite remarkable that something hasn't happened on a large scale."

That's not to say that the camps have been disease free. There are cases of malaria, dengue fever, and other illnesses endemic to the region, and an outcrop of typhoid cases required an intervention in one of the camps, said the World Health Organization Haiti office.

"We also see a lot of urinary tract infections and skin diseases because of the unsanitary conditions," said Charles Lor, an epidemiologist with the International Medical Corps in Haiti.

What hasn't happened is a widespread outbreak of any of the highly contagious illnesses like measles, diphtheria and water-borne conditions like diarrheal disease, which can be especially deadly to children.

Those results can be attributed to a massive effort to truck and pipe potable water to camps and provide latrines and sanitation services, a large vaccination campaign, and an early warning surveillance system for pockets of disease.

"It takes an incredible effort to prevent the disease outbreaks from happening in these kinds of conditions," said Judith Timyan, USAID's Haiti health program coordinator. "The situation was so bad even before the earthquake ... so we were dealing with a disaster on top of a very chronic problem with sanitation."

All of that effort has come with an equally strenuous price tag. USAID estimates it will cost a total of about $1.2 billion this year to provide necessary services to the camps.

And keeping the pontoon-sized, rubber water bladders in the tent camps filled is costing Oxfam, one of the largest providers of water and sanitation services, $160,000 dollars a month for 47 camps, and $42,000 a month just to empty latrines.

"That is a lot, it's expensive, it's unsustainable," said Raphael Mutiku, Oxfam's water and sanitation coordinator in Haiti.

The water cluster is working to connect more camps with Port-au-Prince's existing water system and make repairs to that system, in order to continue providing clean water and prevent the spread of disease.

A prime example of the other side of Haiti's disease control efforts can be seen at the Petionville Club tent camp, sprawling over a former golf course and tennis club.

It's the site of one of International Medical Corps' 13 clinics in the area, which have provided more than 118,000 patient consultations since the quake and offer free vaccination services each week.

Early on a Monday morning, there are always mothers lined up to have their children vaccinated and UNICEF estimates about 275,000 children have been immunized since the quake by all the partners working in Haiti.

"There have been campaigns to inform people of the importance. Radio, television, agents going around with loud speakers," said Linda Rimpel, the primary health care coordinator for IMC.

The clinic also monitors cases of disease it sees, and teaches camp residents about early symptoms to watch for. Each week the clinic, and all the other health providers in Port-au-Prince, sends a disease report to the Ministry of Health, which compiles the data to determine if there is an increase in any disease that would warrant further investigation.

"It's a joint effort with all the NGOs and probably one of the only things that is coordinated, it works really well," said Lor.

Investigation has occurred several times, but the upticks in disease were either found to be isolated, or in the case of the typhoid increase, measures were taken to stop the disease from spreading.

Despite the successes that have been seen, USAID's Timyan warns it is vital to start finding ways for people to return to their communities or move to new communities formed outside of Port-au-Prince.

"That initial high level of energy, adrenaline, high level of humanitarian outpouring to respond to an emergency is waning," she said. "It's very expensive to keep services up in these temporary camps."

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AIDS Conference in Vienna; Photo by Steve Forrest/International AIDS Society

VIENNA, Austria | This year's International AIDS Conference, drawing to a close Friday, produced among other things a high-profile scientific breakthrough, endless policy discussions and plenty of new research to digest.

Jon Cohen, a correspondent for the journal Science, has been attending the International AIDS Society conferences since 1990. He talked to the NewsHour about the areas of research that excite him most coming out of Vienna:

The CAPRISA Microbicide Trial

In the biggest news of the conference, a team of researchers from South Africa presented the first solid evidence that a microbicide gel could provide a significant level of HIV protection for women. Using 1 percent tenofovir, an antiretroviral, the gel reduced HIV infection by 39 percent among all the women in the trial, and 54 percent among women who used the gel in at least 80 percent of sexual encounters.

"In the past dozen years there have been so many failures of not just microbicides but every single biomedical intervention," said Cohen. "The few things that have been successful either required surgery, in the case of circumcision, or the effect was so marginal that people have been arguing about the results every since."

The protection the microbicide gel provided should be improved and it likely won't be rolled out soon, said Cohen, but it's a solid foundation on which to build.

"No one is arguing about whether the effect is real because every way you look at the data, it still holds up."

Cure Research

"Cure" has been treated like a four-letter word by the HIV/AIDS research community for years now, said Cohen, because of past disappointments and the sense that it was sapping time and money away from research for prevention and treatment. But dozens of presentations at the 2010 conference talked with new hope about defeating HIV.

Two of the main approaches being discussed are suppressing the virus to an extremely low level permanently so that medication would no longer be needed, and eliminating HIV from the body entirely.

Even HIV positive patients who have controlled the disease well with antriretroviral drugs still have virus in their bodies that necessitates staying on those drugs, a costly, life-long proposition.

Research is showing that in these patients, a reservoir of HIV can collect in cells that remain dormant and sleeping for years, said Cohen, then suddenly release more virus, especially if treatment is stopped.

"They are coming up with strategies to tickle those cells to spit out the virus so they can mop it up" with medication, he said.

New Concepts in HIV Transmission

Despite the number of HIV positive people around the world, "sexual transmission of HIV is extremely inefficient," Director of the National Institute of Allergy and Infectious Diseases Anthony Fauci said during his plenary presentation at the conference.

Understanding just what the virus has to do to successfully infect a person is growing, and that information is critical to building effective early interventions, he said.

"People have been studying transmission since they discovered HIV causes AIDS but they are starting to get really detailed descriptions of what type of cell the virus prefers," said Cohen.

HIV has to find an activated CD4 cell in order to infect and begin replicating, and Fauci and his team found that cells with a specific kind of receptor, called an alpha 4 beta 7, are particularly vulnerable.

"Obviously that speaks to a vaccine or a microbicide because if you know how it happens you can come up with ways to stop it," Cohen said. "It's pretty remarkable the level of detail coming out."

VIENNA, Austria | Global AIDS leaders continue to call for sustaining and increasing HIV/AIDS funding in the face of the global economic crisis at the International AIDS Conference this week.

"For the first time we are seeing funding going down," said Michel Sidibe, executive director for UNAIDS. "Through solidarity we have put 5 million people on treatment, it's not the time to flat-line or scale down, it's time to scale up."

While the gains of the last decade have been immense by all accounts, the global goal of having universal access to HIV medications by 2010 was solidly missed. More than 10 million people still need drugs, just as commitment to the universal access target appears to be wavering.

A UNAIDS and Kaiser Family Foundation report released during the conference shows support by developed nations to low-income countries for HIV/AIDS programs decreased slightly from $7.7 billion in 2008 to $7.6 billion in 2009.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, one of the major contributors to HIV programs around the world, is also heading into its next crucial three-year funding replenishment with uncertain prospects for high-income country pledges.

"We need a $17 billion, at least, replenishment to allow countries to continue to scale up their abilities," Global Fund Executive Director Michel Kazatchkine said. "I'm hearing from donors, 'You know we really are under severe budgetary constraints.'"

Kazatchkine said the budget allocations come down to a political decision and a question of political priority. It is still unknown what donors will be willing to bring to the table in the fall, he said, aside from a proposed $1 billion U.S contribution for 2011, which would be a cut from its $1.05 billion contribution in 2010.

President Obama has also drawn criticism from advocates here because he requested only a small increase in the PEPFAR budget for 2011.

Promoting partnerships

Along with the constant call for donor commitments in Vienna has come a new call for more shared responsibility by developing country governments, more innovation for financing and delivery of services, and new cost cutting mechanisms.

"We would like to see a change in the way PEPFAR and Global Fund programs are embraced and run by governments," Ambassador Eric Goosby, U.S. Global AIDS coordinator, told reporters. He said recipient governments should sustain or increase their own financial commitment to the cause over time and build ownership.

"We cannot make only one part of the world responsible," said Sidibe, citing some progress on budget increases for HIV/AIDS in Kenya and South Africa.

African governments pledged in 2001 to allocate 15 percent of their budgets to health, but the World Health Organization reports that only six countries have met this commitment.

"AIDS is a matter of life and death. We can't attack AIDS with only donor funds," said Botswana's former President H.E. Festus Mogae. "You can't say something is a priority for you then say you will only do it if some other kind person gives you funding."

Pushing efficiency and innovation

Doing more with the money that is available may be the biggest necessity of the future, said many of the experts at the conference, including Bill Gates, co-founder of the Bill and Melinda Gates Foundation, a major contributor of global health funds.

"Even if we advocate for more funding, we can do more to get the most benefit from each dollar," Gates said in a speech to the conference.

Finding new efficiencies for prevention and treatment, as well as finding simpler diagnostics could cut costs, said Stefano Bertozzi, director for HIV at the Bill and Melinda Gates Foundation.

"You can also innovate on how you deliver," he said. "How you supervise, who you train, who you can train at a lower level."

Some of the innovative financing possibilities discussed at the conference to raise more funds included a small "Robin Hood" tax on financial transactions, which has been gaining traction recently, and a new initiative to offer people the option to donate to the cause whenever they purchase airline tickets online.

UNITAID is also building a new initiative to create a patent pool for HIV/AIDS drugs that are not available in a generic form to developing countries. Generic competition has reduced the cost of many first-line HIV medications by 99 percent in the last 10 years, said Ellen 't Hoen, senior advisor on intellectual property for UNITAID. But more people will need access to more expensive second-line drugs in the future, she said.

"One of the biggest challenges of today is how are we going to bring the prices down of the new medicines," 't Hoen said. The pool, which is still being developed, would allow licensing of drugs to generic manufacturers, with royalties paid to the developing company.

The way forward

Sidibe attributes a lot of the new energy around alternative solutions and collaborations to the pressure and anxiety caused by the economic crisis, and a move from "a period of abundancy to forced austerity."

"Vienna is an end, and a beginning of a new area," Sidibe said. "The response now will need to be smarter, more strategic and more targeted."

But Kazatchkine warned that innovative financing and efficiencies will not cover the resource gap to keep people on ARVs now and expand treatment in coming years.

"We are facing still an emergency situation," he said. "[Money] in the short term is what will be necessary."

VIENNA, Austria | Europe now has the fastest growing HIV epidemic in the world, due in large part to intravenous drug use, the World Health Organization told the International AIDS Conference in Vienna Wednesday.

The epidemic is disproportionately affecting Eastern Europe, which accounts for about 80 percent of the more than 100,000 new HIV infections reported in Europe in 2008.

"The situation in Eastern Europe is very volatile," said Martin Donoghoe, program manager for WHO's Europe HIV/AIDS office. "The dominant HIV transmission route in the East is injection drug use."

In some countries in the region an estimated 50 percent of all HIV infected individuals are injecting drug users, or IDUs, a population that is particularly hard to reach and serve with prevention and treatment efforts. HIV treatment levels in Eastern Europe are also some of the lowest in the world, Donoghoe said, because drug users are "highly marginalized."

"We have to face up to the fact that the epidemic in Europe is concentrated in these groups that as a society we have a problem with -- drug users, sex workers," he said. "It's very hard to attract sympathy, and funding, when treating these groups."

The WHO is calling for more harm reduction measures in these countries to combat the rise, including opiate substitution like methadone and needle exchange programs.

In Ukraine, which has the highest HIV prevalence in all of Europe, the government has been trying to scale up free needle programs and is serving more than 5,000 drug users with opiate substitution, a small but significant portion of drug users in the country.

Natalia Nizova, director of the Ukrainian AIDS Center, said it is a challenge to attract IDUs to services.

"There is still some stigma with drug users," Nizova said. "We use new information practices, target teenagers and young people, recruit from AIDS clinics and do peer consultations."

An estimated 87 percent of IDUs in Ukraine have now utilized a free needle exchange program. But that number is calculated from known drug users so is likely inflated, and for HIV prevention purposes needle exchange has to be used regularly by the patients.

Ukraine's efforts are being held up as a model for the region even though they still have much progress to make. Other countries in Eastern Europe have actually seen a drop in HIV prevention services for IDUs in the past two years, reported UNAIDS.

"We need to make sure [IDUs] have a way to access services, to have access to evidence-based therapy" like needle exchange and heroine substitutes, said Michel Sidibe, executive director of UNAIDS.

A study presented at the conference Tuesday found this is a problem worldwide, and that only a small percentage of IDUs get help to prevent them from spreading HIV to others.

Five percent of IDUs have access to needle exchange programs, and 8 percent can access opiate substitutes, said the study out of the National Drug and Alcohol Research Center at the University of New South Wales, Australia.

A critical momentum has been building around the issue of drug users at the conference, led by the Vienna Declaration, issued at the end of June and published again yesterday in the Lancet Journal.

The declaration calls on governments to support opiate substitution therapy and needle and syringe programs that have been shown to reduce HIV rates and criticizes the criminalization of drug users.

"There is a huge discordance between scientific evidence and policy as it relates to drug addiction," said Evan Wood, founder of the International Centre for Science in Drug Policy and one of the authors.

"A key concern is that by making addiction a crime you drive people into hidden environments where it's difficult to offer them prevention, care and treatment."

The declaration was endorsed by more than 10,000 people, including Julio Montaner, chairman of the AIDS 2010 conference, several former presidents of Latin American countries, as well as the head of the Global Fund to Fight AIDS, Malaria and Tuberculosis.

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A two-year study unveiled in Vienna found that HIV infections in females were cut by 39 percent by using a new vaginal gel. Margaret Warner speaks with Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases for more.

JEFFREY BROWN: And finally tonight: What's behind the excitement surrounding a potential new way of preventing AIDS?

Margaret Warner has that story.

MARGARET WARNER:In the world of science and medicine, it's not often that researchers' findings win a standing ovation, but that's what happened today at the International AIDS Conference in Vienna over news of a potential breakthrough in preventing HIV among women and girls.

A two-year study of nearly 900 women in South Africa found a new vaginal gel containing the antiretroviral drug tenofovir significantly reduced the rate of new HIV infection. Among women who used the gel before and after sex three-quarters of the time, infection was cut 39 percent.

Among those who used it even more frequently, infection dropped 54 percent. This is the first time a vaginal product or microbicide has shown real promise for preventing AIDS. That's important for women, especially in Africa, where they account for 60 point of HIV infections.

For more about the study and its significance, we're joined from Vienna by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

And, Dr. Fauci, welcome.

How big is a development is this?

DR. ANTHONY FAUCI, director, National Institute of Allergy and Infectious Diseases: Well, it really is quite significant, in that it's a very important proof of concept of something that we have really failed at over the last several years. And that is to develop what we call a topical microbicide, which is a substance that a woman can by herself insert into her vagina that contains an antiretroviral drug or an anti-HIV drug that would block infection.

And it's very important, because it's been shown for the first time in several years of research on microbicides that it does in fact protect a significant proportion of the women who use it. It was a -- what we call a placebo control trial, where half the women got a gel with no medication in it, and the other half got the gel with this anti-HIV medication in it.

So, the answer to your question is, really, it is a significant advance towards getting a very important type of protection that women can use themselves, without their male partner knowing about it. So, in essence, it empowers women, which is very important, particularly in the developing world.

MARGARET WARNER:And it's relatively cheap, isn't it?

DR. ANTHONY FAUCI: Yes, it is. I mean, I can't give you a price on it, but a gel, the gel itself is a very common formulation.

And they're using 1 percent of solution of a drug in there. So, I can't imagine that this is going to be an expensive proposition at all.

MARGARET WARNER:Well, as you said, a half-dozen microbicides have been tested over the last 15 years, but with no success. Why do you think this one works?

DR. ANTHONY FAUCI: Well, the others were -- were not utilizing the principle of actually putting a specific anti-HIV drug in the gel.

The gels that were used were, for example, a typical spermaticide that is used for birth control to try and disrupt the virus, which really wasn't a very good strategy, because not only did it not work. In some of the trials, because it irritated the vaginal mucosa, it actually made women more susceptible to getting infected upon exposure.

So, it's been a series of either no good results or results that were actually unfavorable. This is the first trial, because it used a drug that, in its oral form, is regularly used as part of treatment for HIV people who are infected. A 1 percent solution of that drug was put in the gel. And that seemed to do the trick. And that made the results really quite significant.

MARGARET WARNER:Yet, even the better result only cut the infection rate in half. Why is that?

DR. ANTHONY FAUCI: That's the reason why I said it's a conceptual advance, and not a ready-for-prime-time product, because there was an interesting correlation in the study.

In order for a drug or a microbicide like this to work, women have to use it religiously when they have sexual intercourse. And there was a good correlation between the women who actually adhered to the protocol and used it every time they had a sexual encounter. They had a much higher rate of efficacy.

People who used it moderately had a lower, and people who didn't use it well at all had a much lower. So, the results that you're talking about is the accumulation of people who used it religiously and people who didn't do very much. So, adherence is going to have a major role.

There's a lot of things that we need to work on. One is, first of all, confirming the trial to make sure it does work. I believe it does. I saw the data. The data looked strong.

But the other thing is, is there a better way to improve upon it? For example, there's an ongoing trial now that uses the same product, but women use it every day, as opposed to just when they're anticipating a sexual encounter. There are a number of other processes that are in the pipeline now, for example, a long-acting one, where you don't have to put it in with every encounter. You may be able to maybe just put it in once, and it will be good for weeks or even longer.

I think, when we get to that point, you're going to see better results than just the 50 percent, which, in and of itself, is better than anything we have ever seen, but the goal, the endgame, is to do better than that 50 percent.

MARGARET WARNER:If the drug were not any better than 50 percent effective, would there be a danger of lulling women into a false sense of security?

DR. ANTHONY FAUCI: First of all, Margaret, no intervention works 100 percent. But whenever you have one that works partially, you always have got to be careful that there will be a disinhibition, as we call it, namely people taking more risks because they think they're protected.

The philosophy and the strategy of prevention is that we have to have combined prevention. Microbicides, even if it's, in this case, 50 percent -- we hope to get it up to 80 percent or more -- but even if it's partially protective, if it's used together with other types of preventive measures, such as the use of condoms and circumcision in a male, you put them all together, it's a package, what we call combination prevention.

MARGARET WARNER:How long will all this additional testing and the approval process take, if we're talking about making it available in the U.S.?

DR. ANTHONY FAUCI: Well, first of all, with our regulatory authorities and the way we look at things, that we want to make sure it's absolutely safe, because you don't want to have the paradoxical effect of doing more harm than good.

And when you have approval of something that will be on the shelf that doctors would prescribe, you're going to need a trial that's much larger, with much more data. And that's the reason why I keep getting back to saying that this is a very powerful proof of concept, but it isn't the definitive proof that would have the FDA approve it tomorrow. That's just not going to happen. We're going to need more data.

MARGARET WARNER:South Africa's health minister said today his country is considering rolling out the gel before it's officially licensed in the U.S. What do you think about that?

DR. ANTHONY FAUCI: I think that's -- that's something reasonable that should be respected. You know, here in this country, we have a prevalence of infection of less than 1 percent in the general population. In other populations within the United States, it's a little bit more. But, in general, it's very low.

If you look at southern Africa, particularly South Africa, they have close to five million cases of HIV, and they have a prevalence of around 10 percent, double digits. So, you can't judge in a one-size-fits-all. For some countries, even something with this degree of efficacy, a health minister, such as the health minister for South Africa, and the authorities in South Africa, may make a reasonable decision to roll it out. There's nothing wrong with that.

It has to be matched to what the situation is in the particular country involved.

MARGARET WARNER:Dr. Tony Fauci, thank you so much.

DR. ANTHONY FAUCI: Good to be here.

VIENNA, Austria | In a big step forward for the field of HIV prevention, a new study shows for the first time a microbicide gel provided significant protection for women from HIV infection.

Use of a vaginal gel containing the drug tenofovir before and after sex reduced acquisition of HIV by 39 percent among the women participating in the South-African-based study, and by 54 percent among those women who used the gel with high adherence.

The researchers also found the gel provided a 51 percent reduction in herpes infection.

The results of the study are in the journal Science this week and were presented Tuesday to a packed audience and a standing ovation at the 2010 International AIDS Conference in Vienna.

An effective microbicide has long been sought in the fight against HIV because it could be used discreetly by women, without the knowledge or consent of their partners, unlike condoms.

"It's the first time in the history of the disease that a study has been conducted that would give control [of HIV prevention] to young women," South Africa's Health Minister Aaron Motsoaledi said.

The study took place in KwaZulu-Natal, South Africa and included 889 women, half of whom were given a placebo gel.

While the tenofovir results do not provide complete protection, one of the study authors, Quarraisha Karim, said the efficacy level that was found is still a milestone in prevention.

"With microbicides, we have to look at the 39 percent in relation to what do we have to offer women who are at risk of getting infected," Karim said. "We are comparing 39 percent to nothing."

It's also the first time a microbicide has provided an "unequivocally significant" level of protection for women from HIV, said Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health.

He expressed confidence that the level of protection provided by the gel could be improved in future studies, either through changes in dosing, application or by combining it with other drugs.

"We should look at this as a celebration but also as a beginning ... of something we know we can do better on," Fauci said.

Prior to the tenofovir results, the field of HIV microbicides had seen trial after trial in the past 15 years end in frustration, including several previous candidates co-author Salim Karim (pictured here) investigated.

"I did several of the other studies so I've had to deal with the disappointment at every turn," Karim said. He attributes the new study's success to the fact that tenofovir does not work on the surface of the skin like past candidate microbicides.

"[Tenofovir] goes into cells, into the target cells where HIV will be targeting to enter and replicate so it acts at a different point in the pathogenesis process," Karim said.

It is also the first antiretroviral-based microbicide to go into trials, said Yasmin Halima, director of the Global Campaign for Microbicides.

"It's a really good result- it's the first result really," she said. "You have to -- as robust as the data is -- have another trial. We have to replicate and improve it; we need to see if we can up the 39 percent."

Karim agreed and said he still has questions about how exactly the drug is working in the body.

"I think the challenge for us lies in better understanding the biological basis of why some women became infected despite tenofovir," Karim said. "The second, and probably bigger challenge, is to try to improve the adherence."

The study cost $17.6 million -- $16.5 million of which came from USAID and the remaining funds from South Africa's Technology Innovation Agency.

The microbicide will not be available for use in the near future because it still needs to be licensed and approved by regulatory authorities. Karim said the World Health Organization and UNAIDS will be consulting with regulators in the coming weeks to find out what specific information still needs to be acquired for the product to progress.

Individual countries will decide on approval based on the strength of the study, the country's disease burden and other factors. Fauci called it "doubtful" that the U.S. FDA would approve the product at this point because of the size of the initial tenofovir study and the level of protection found, but said additional data from future studies could strengthen the evidence.

"That doesn't take away from the fact that this is unquestionably a conceptual major advance," he said.

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In the last of his week-long series of reports from Haiti, Ray Suarez examines the mental health problems survivors are having following January's devastating earthquake.

JIM LEHRER: Next tonight: the last of Ray Suarez's reports from Haiti, six months after the earthquake. It's a look at the nation's mental health.

RAY SUAREZ: In the desperate first days after the January quake, the first response went to those with bruised tissues and crushed limbs. Finding help was harder for those with bruised psyches or a crushed will to live.

MARIE DENIS ST. LOUIME, Doctors Without Borders (through translator): We are seeing more cases of people who have contemplated suicide now, because they have had the time to look back and really focus on what they have lost, whether it be a family member, or material things. They're looking back now. It's weighing on them.

RAY SUAREZ: Doctors Without Borders runs a vast field hospital in Port-au-Prince. There, psychologist Marie Denis St. Louime treats children at risk or already exhibiting mental health problems. They have survived loss of parents and siblings, homelessness, trauma, injury. And St. Louime is pushing back against their terrible sadness.

MARIE DENIS ST. LOUIME (through translator): We try to tell them that this has already happened, and they still have their life, so that's what they need to be grateful for. We try to encourage them to see that way. There is no way to go back. There is no way to change, so we do our best to give them strength.

RAY SUAREZ: The children are getting a variety of what's called psychosocial treatment. Sometimes, it's nothing more complicated than getting those who need the help away from the camps and clinics, as Mercy Corps did recently, to a soccer stadium, to be entertained by a popular disc jockey, to play the Haitian version of Simon Says, to run and dance, to just act like a kid.

ELYSE NOESILLE, Partners in Health, Haiti (through translator): Psychology is all about balance, and there is nothing balanced about living in a tent camp. Between the way they are living and not working, these are all things that compound mental health. So we're trying to address those needs and bring back order into their lives.

RAY SUAREZ: Elyse Noesille a psychologist working for Partners in Health. He says the children he sees have become more aggressive, have trouble sleeping, or overreact to noise. He works with the residents of a sprawling homeless camp, Centre Sportif Dadadou. A thousand families live here.

Noesille and his colleagues average about 800 consultations a month. He says, for his young patients, it's important to confront these issues now.

ELYSE NOESILLE (through translator): Are you having trouble focusing in class? Is there anything on your mind that takes you away from the focus of the class? Do you sleep well? Are you ever startled from sleep?

RAY SUAREZ: The Partners in Health mental health team estimates they see 100,000 mental health patients throughout the four camps they oversee. Psychologists like Noesille average 10 consultations per day. The heavy load can take an emotional toll for the healers as well.

ELYSE NOESILLE (through translator): Every time listening to patients tell their stories, I would relive the experience myself. So, as psychologists, we turn to each other for support.

RAY SUAREZ: Adults may be every bit as vulnerable as children, but a little better at hiding their suffering -- for a while.

WOMAN (through translator): I lost my mother and my son. Now I'm constantly having panic attacks, I keep reliving the moment of when my mom and my son perished.

WOMAN (through translator): I lost my family, my sister, my cousins. I feel like something is gripping me. I'm about to lose my head and I don't know what to do.

RAY SUAREZ: Michelline Richards struggles across a rutted field in a wheelchair, her infant son, Reginald (ph), born months before the quake in her lap. Richards was feeding Reginald when the quake began. As she ran from her house, part of the roof fell on the base of her spine. She's 19, paralyzed, and eight months pregnant.

Earlier this year, she was bounced from one medical facility to another, and wanted to die.

MICHELLINE RICHARDS, Haiti (through translator): I knew my baby was safe, but I kept asking why I didn't just die that day. My baby needs me, and my therapist has helped me understand that. I don't wish for death anymore. I'm better off and getting stronger.

RAY SUAREZ: Psychologist St. Louime says she expects plenty more patients to head to the clinic as Haiti's recovery continues.

MARIE DENIS ST. LOUIME (through translator): We find, six months later, the people who have repressed these feelings are now coming in to seek help. But, in their case, because they have repressed it, they have now done some damage to themselves and are starting to relive things with a lot more emotions, but don't know how to deal with it. These people, we try to focus on more, because they need much more work.

RAY SUAREZ: Mental health experts say some of the emotional burden has been eased by the fact that thousands of Haitians share similar painful stories and can grieve together. But, in a country where mental health services barely existed before the quake, the challenge remains huge.

It's nearly dusk in Port-au-Prince on a recent sweltering summer evening, and four women at the Health Center of Croix des Bouquets are in the early stages of labor.

They are all expected to give birth by morning and will each be attended by the one nurse-midwife staffed for the night shift.

Already today, one of the public clinic's doctors had to keep a woman suffering from postpartum hemorrhage, or severe bleeding at birth, from dying. Another patient who is almost full term is losing the amniotic fluid that protects her fetus. If it continues, her unborn baby could die.

None of this is unusual for the clinic, which has been forced to take on a flood of new patients, like all the health facilities across Port-au-Prince that remained standing after the Jan. 12 earthquake. Health Center of Croix des Bouquets, which provides services for free to the public, saw between 60 and 70 births a month before the quake, but now attends to about 150 a month.

In Haiti, maternal mortality rates are especially high, and now doctors and nurses across the capital are also reporting a rise in new pregnancies since the earthquake, according to the World Health Organization's Haiti health cluster lead, Dana Van Alphen. The combination of fewer facilities and more mothers-to-be is stretching prenatal and birthing services to the limit.

"We've seen a great increase in the pregnancy rate since the earthquake, a lot of women come because of how promiscuous life has become since the earthquake," said Francenette Defonce, a nurse-midwife at Croix des Bouquets.

Dr. Laure Adrien, an obstetrician and gynecologist who oversees the public clinic and is executive director of the Haitian Society of Obstetrics and Gynecology agreed and said there are more difficult pregnancies as well.

"We have more complicated pregnancies; we have a higher percentage of hypertension, preeclampsia; we do have a lot of postpartum hemorrhage," he said.

The sanitation situation in the tent camps is also causing more postpartum infections. Many women from the settlements are coming to the clinic with unwanted pregnancies, sometimes with post-abortion complications, which Adrien said was not common before January.

"They will use [abortion] medicines, it's not complete and so then they come here seeking care for post abortion-infections," often bleeding heavily, he said.

Van Alphen of the WHO said 7,000 women affected by the earthquake are estimated to be giving birth each month in Haiti now, and 63,000 women affected by the quake are estimated to be pregnant. For clinics like Croix des Bouquets, close to large tent settlements, this means that every staff member is vital. Haiti has had a chronic shortage of both doctors and nurses for many years, but Adrien said the earthquake has brought another layer of competition for health workers, beyond the lure of moving abroad for better salaries.

"Our biggest problem here is to be able to retain our staff because a lot of the NGOs and organizations that came in this year have a big budget to pay staff, they are paying much more than we are capable of paying right now," he said.

"These employees are tempted to work for the NGOs and organizations where they could make much more money."

Nurse Defonce said she has not been tempted to leave her job here in Haiti, yet, because she loves the women she works with.

"It's beautiful when you help someone to give life," she said. "It's really rewarding, I love it."

For the women at the clinic, especially those about to give birth for the first time, the tie Defonce describes is clearly mutual.

Watch This Segment

Listen to the Audio

As part of his latest series of reports from Haiti, Ray Suarez details the road ahead for citizens who lost limbs after the country's devastating earthquake in January.

JIM LEHRER: Now: some of the casualties of the Haiti earthquake whose wounds never will go away.

Ray Suarez continues his reporting from the capital.

RAY SUAREZ: When Port-au-Prince began to fall on its three million people, thousands were crushed by collapsing ceilings and falling walls.

Thousands who didn't die must now learn to navigate a broken city missing a foot or a leg. These Haitians must make their living in a city that runs on manual labor with just one hand or arm. It is estimated up to 4,000 people underwent emergency amputations after the January earthquake.

And while six months have passed since then, the journey for many of the newly disabled is only just beginning. Adults are learning again how to do what they have known longer than anything else: to walk. And children, who need to keep replacing their prosthetics throughout their growing years, are getting back the futures almost stolen by falling cinder block.

MONICA PAUL, Haiti (through translator): I would like to go back to school, so I can finish education and become a nurse.

RAY SUAREZ: Thirteen-year-old Monica Paul is back for another fitting. She was trapped in the rubble of her home for a day. She had been washing dishes when the quake began, and part of her kitchen fell on her leg.

After an amputation, the remaining limb changes shape and size for months. Repeat visits, examinations, and fittings are necessary. Many amputees in Haiti are getting by with a temporary, until their final model is done.

Anna Avakian is in Haiti with the Hanger Ivan Sabel Foundation, an American charity that provides prosthetics to those who couldn't otherwise afford them. Navigating broken, rutted streets in a medically under-served city requires a tough replacement knee or ankle.

ANNA AVAKIAN, The Hanger Ivan R. Sabel Foundation: We're using prosthetic feet with less components, less little pieces to break, so they are -- it is a good long-term prosthetic foot for patients here. We're also making sure that we use a prosthetic foot that is the same color as feet here in Haiti. We're using African-American-colored feet. It's better for patient acceptance.

RAY SUAREZ: There is something a little disorienting about seeing piles of legs and feet, some assembled, some still being crafted, sticking up at crazy angles. Seen all together, they remind you of the living flesh they have been made to replace.

But that uncomfortable moment is banished by this: a boy, newly fitted, learning to walk with his new leg; and two young men, moments ago sitting on a bench with an empty sleeve of pants leg draped next to their healthy limb, now able to kick a ball back and forth for practice.

Thomas Calvot is with Handicap International, which runs this new prosthetic workshop, along with Healing Hands for Haiti. He says, as challenging as physical therapy is for patients here, the real challenge begins when they leave the clinic.

THOMAS CALVOT, Handicap International: This is kind of the double negative, in fact. They would be a amputee because their house fell on them. Of course they can receive a prosthesis, but when they get back, they get back to displaced-person camps, you know? Mostly, it's tents. It's a difficult condition. It's difficult ground. So, these people are facing huge challenge ahead.

RAY SUAREZ: And then there are extraordinary patients, like George Exantus. Exantus was a prize-winning competitive dancer before January 12, when he was pinned under rubble for two days. He lost his leg below the knee and suffered nerve damage in his hand.

ANNA AVAKIAN: We replaced the prosthetic foot so it was a little more flexible, and for him to be able to dance.

RAY SUAREZ: So, he still is?

ANNA AVAKIAN: Mm-hmm. Oh, yes, he dances wonderfully. You should put on some music and dance with him.

RAY SUAREZ: If you just happened on the dance studio where he used to teach and train, you can find him practicing again, but you would have to look twice to see his artificial leg.

GEORGE EXANTUS, Haiti (through translator): This is a temporary leg given to me so that I can practice and continue my therapy sessions at home. They have promised me a better leg, and I'm hoping at some point that will come true. But, to dance, you need an extremely expensive leg, but that's not available in Haiti. I will probably never get that.

RAY SUAREZ: For now, Exantus sees his visits to the dance studio as just as therapeutic as any doctor's office.

GEORGE EXANTUS (through translator): Since the quake, I haven't been able to teach here. I come here to clear my mind, enjoy the moment. I enjoy watching the students working on their dance, because what I used to do as a teacher and as a choreographer, I can't do anymore, and it will be a long time before I can get back to doing that. But here is a much better place to be than sitting at home.

RAY SUAREZ: Exantus plans to do quite the opposite of sitting at home by returning to the dance floor.

GEORGE EXANTUS (through translator): The main thing for me is the idea of competing again, make money, teach, and compete, and compete at a very high level.

RAY SUAREZ: We told him we would come see him next when he is able to compete again.

JIM LEHRER: Ray's next story is about mental health care for Haitians traumatized by the earthquake.

All week the NewsHour is reporting on the state of recovery in Haiti, six months after a powerful earthquake devastated the impoverished island nation.

As we've reported earlier, thousands of Haitians continue to live in tent camps after their homes were destroyed in the disaster. Now these camps have taken on a life of their own, with businesses and schools, among other things. Find more in this photo essay:

With 1.5 million Haitians still living in tent camps, international organizations and the government are struggling to find legally available land for new settlements and ways to decongest the existing camps. The government is now advising people who can return home safely to do so, as a preferred option.

Throughout Port-au-Prince, on side streets and behind security walls, many Haitians are doing just that, even if their houses are uninhabitable. Tiny private tent camps have sprouted up in yards and driveways as people try to start over on their old land.

Listen to the Audio

Ray Suarez talks with Haitian President Rene Preval about the recovery the country still faces, six months after a devastating earthquake.

JIM LEHRER: Finally tonight: the second of Ray Suarez's reports from Haiti six months after the earthquake.

He spoke with Haitian President Rene Preval yesterday.

RAY SUAREZ: Mr. President, welcome back to the "NewsHour."

RENE PREVAL, Haitian president: Thank you, sir.

RAY SUAREZ: This week, you declared the end of the emergency phase and the beginning of the reconstruction phase. What's the significance of that declaration? Why is it important to mark that time?

RENE PREVAL (through translator): I said we are moving from the emergency phase into the reconstruction phase, but we are maintaining the emergency phase.

For the past few weeks, we -- during the emergency phase, we provided the people with health care, water, and food, and the tents. And now we have met with them in their camp. We asked them about their needs. And we are working with those people in the camps who wish to return back to their initial neighborhoods.

RAY SUAREZ: So, what will the people of Port-au-Prince see as we move forward in the reconstruction phase? What will change?

RENE PREVAL (through translator): First, I must say that the means at the disposal of the state of Haiti are not enough to take charge of reconstruction. I want people who contributed to funds that were raising money to help the people of Haiti, I want them to know that those funds didn't come into the coffers of the state of Haiti, that we don't have those funds in our hands.

However, with our own means, we're going to do what's in our capability to launch the reconstruction phase. For example, we have received $35 million in donations. People who give 43 cents, or $1, $2, $10, $1,000, and contributors that give a million dollars, and in total $35 million, we have 20 million cubic meters of rubble in Port-au-Prince.

And removing them will cost $1.5 billion. In the first phase, we have -- we estimate to remove -- we will be removing two million cubic meters. And it will cost $120 million.

You can see that the $35 million that we have received cannot perform a job that will cost $120 million. And when the cleanup phase will be over, then we will have to start building -- rebuilding the roads. We will have some engineering work to do. And we will have to build shelters. And this is going to cost a lot of money. However, we did launch the operation. And we hope that the interim commission will take over as soon as possible.

RAY SUAREZ: Mr. President, you make the point that the government of Haiti didn't receive the money from individual donors around the world.

But that money did go to organizations that are interested in helping here. Will they be paying part of the costs of clearing your streets, of resettling people from the camps? Can you access that money for the purposes that you feel need to go ahead with the reconstruction?

RENE PREVAL (through translator): The government receives $35 million.

Now, the NGOs and the United Nations system received much more money than the government of Haiti. But I don't think how much they received. I'm asking them to give me their money. I'm asking them to work with us, because, right after the earthquake, there were hundreds of NGOs coming here and they started working. I understand that, because, at that time, the government was very weak, because all the ministries had been destroyed. The palace had been destroyed. Several employees, hundreds of them, had died.

So, I understood that the people set to work as soon as they arrived. But today I'm asking them to come and work with us. For example, the people from Fort National who were here at the ceremony today, they wish to go back to their neighborhood. But you must pay them also to clean up the rubble.

And I'm asking the NGOs to finance the cash flow and program for those people. After removing the rubble, you have to also transport them to the dumping site. You must pay for that. The problem is that each NGO had already engaged itself into some sort of activity. And now it's difficult for them to disengage and come and work together with us.

The biggest problem is coordination. And that is necessary. The means are there. The goodwill is there, but we need coordination. But it's difficult to tell an NGO to come and work with me, because they prefer also to work on their own.

RAY SUAREZ: As you look back over the last six months, are there things that you thought were going to be very difficult and very slow that have moved faster and better than you expected? And are there things that you thought would have been accomplished by today that are still waiting or moving much more slowly than you would have expected?

RENE PREVAL (through translator): When I speak with experts who are serious and honest, they tell me that this catastrophe is the greatest catastrophe humanity has known, and that the time that we have taken to achieve what we have achieved is the normal time in all such catastrophes.

In Indonesia, the government hasn't been affected. Here, the government has been affected. And, in Aceh, it took two years to remove the people from the tents. Tell me if I'm mistaken or not. Don't you have people in New Orleans who still have not gone back to their houses?

And we are talking of catastrophes that don't have the extent of damage that happened in Haiti. And we're talking of countries with much more means, with larger means than Haiti.

I think the international community is doing its best. I believe that the government is doing its best. We have problems. We have coordination problems. And we must make efforts to better coordinate. The interim commission must organize itself and set itself up, so that it can start receiving funds.

And the main thing is to start writing up concrete projects, so that, when the money will be there, the international community won't have to say, you are asking for the money, but you don't have any projects to spend that money on.

RAY SUAREZ: Mr. President, thanks for talking to us.

RENE PREVAL (through translator): I'm the one thanking you. And I'm taking this opportunity to thank you for making the cause of Haiti known throughout the world.

I also would like to say that the government is as worried as everyone else by the conditions of the people, and that the government is doing whatever it can to take them out of those conditions. But the thinking and the planning process takes time, and it's difficult.

RAY SUAREZ: Again, Mr. President, thanks a lot.

RENE PREVAL: Thank you, sir. Thank you.

GWEN IFILL: Ray reports next on the thousands of Haitian amputees struggling to adapt to new artificial limbs.

The temperature has been in the mid-90s, but the humidity makes it feel like it's over 100. The sun pounds the pavement, heat radiates from the cinder block walls that push pedestrians to a narrow strip of sidewalk in most of Port au Prince.

When I was here in the days after the January earthquake, people in the relief and emergency aid business looked with worry at the tent neighborhoods sprouting from every empty space across the city: If people stayed in these makeshift shelters too long, it was said, eventually they wouldn't be so flimsy. Families that assumed they were going to live in the camps for the long haul would harden their shelters, and the camps would gradually morph into shantytowns.

Today in the Haitian capital, that process is well under way. Plywood, corrugated tin, beams, pieces of old iron gates ... they've been incorporated into the structures along with sheeting and tarps from international charities to make homes with a better chance of making it through the tropical storm season.

So what now?

I had a chance to conduct a one-on-one interview with Haiti's President Rene Preval that will be shown on the Newshour broadcast Tuesday night, and available online thereafter.

When the final preparations are being made for recording a conversation with a government leader, there's often an awkward interval filled with small talk and chit-chat, a nervous leader killing time, and a reporter trying not to talk about subjects he or she wants to cover in the interview before the cameras are rolling.

Language added another variable into the mix ... the president understands English pretty well, and speaks it less so. I understand French pretty well, but speak it less so... and you get the idea.

A prickly president had apparently been getting plenty of questions from the international press about where all the money given in the international outpouring of good will after the earthquake had gone. As we waited for the last technical adjustments to be made, the president looked at me and said, "Mr. President, can I ask you a question?" He paused, eyebrows raised, the beginning of a smile at the corners of his mouth. I took my cue. "Oh sure ... please."

The President of the Republic of Haiti continued. "Mr. President, can you tell me where all the money is that you received after the earthquake? Where is the money?" I played along.

"I'm still counting it," I said. "There's so much."

He got a kick out of that answer. But once we started the interview it became clear how much the questions about misappropriation, and about the lack of progress, had gotten under his skin. No matter what I asked President Preval, he returned to a few central themes:

a) The Haitian government itself got little of the money given to help the people of his country.

b) He wanted to thank the world, and at the same time remind donors that almost all of the promised and donated money was in the hands of NGOs and governments.

c) The criticism of his government's response to the crisis was not fair.

What is success?

One of the most depressing things I saw in Port-au-Prince back in January was a South American Red Cross outfit trying to give out family food boxes from the back of a shipping container. The camp had about 4,000 residents, and had only gotten sporadic food shipments in the weeks since the quake, and no water at all.

The need was great. The supply of boxes was insufficient. The Red Cross staff was too small and the security detail nearly nonexistent. Desperate people stood patiently in a line that stretched from the entrance to the public park turned tent city, way back into the shelters.

The situation could not be managed. The people were turned away and the doors to the shipping container were swung closed.

That incident would not be repeated today. The systems in place for getting food, water, and medical care to the camps are so well-established that thousands have left their homes in Port-au-Prince to live in the tent cities.

Structural engineers have assessed the integrity and reparability of 170,000 houses, marking them with a red, yellow, or green sign to indicate whether they need to be torn down, need some repair work, or can be lived in today. The armies of the unemployed can be seen in hardhats and matching t-shirts, taking down code red buildings in every part of the city.

Schools were destroyed along with everything else back on Jan. 12. Kids were frequently hurt playing in the rubble, burned in open fires, or scalded by boiling water. Now 80 percent are back in temporary schools, some as rudimentary as a series of tarps in the courtyard of their old school buildings ... but they're there, learning, and off the capital's rubble-strewn streets.

As you create a ledger for post-quake Haiti, some credit has to be given for the things that did not happen. A number equivalent to the population of a major American city had been chased into public parks, onto highway median strips, and into vacant lots. At the time there were dire but not exaggerated predictions of widespread disease, violent crime, and an eventual uprising in the packed alleyways of improvised homes banged together from plywood and tarps.

Instead the Haitian government, with the help of the United Nations, reorganized the police, still reeling from heavy losses in the quake. Medical NGOs and emergency relief organizations marched into the camps and set up clinics, hospitals, counseling services, and vaccination programs.

But hey, it's been six months

If you're sitting on your living room couch in Britain, Germany, or the United States, seeing pictures taken this week in Port-au-Prince, it doesn't look like anything has changed. Fewer than 20,000 families have been moved to transitional housing from the tents. Only now is the interim commission set up to deal with planning and reconstruction really able to approve plans, complete contracts, and really move ahead with the rebuilding of the city.

The residual mistrust of Haitian governmental bodies is hampering the allocation of resources. Realizing that rank and file citizens who texted in $10 or wrote a check would roll their eyes if the end recipient of the money was the Haitian government, governments have appropriated little of the money promised at international donor's conferences. Haiti's reputation for corruption, incompetence and cronyism, however richly deserved, is a severe handicap now that there's so much work to be done and so little money to do it. Having become an "NGO Republic" in the years before the quake, Haiti is little able to call upon its own organizational resources to get the reconstruction started.

Former President Bill Clinton, now co-chairman of the interim commission with Prime Minister Jean Max Bellerive, seemed well aware of this as he stepped to the microphone at a program marking six months since the quake, conducted in front of the ruins of the National Palace. He told his audience of Haitian leaders, the diplomatic corps, and the world's press that the Preval government had taken extraordinary steps toward transparency, accounting for every penny received and spent in ways few governments would. He admonished the world not to forget Haiti, and assured people everywhere that their generous gifts would be well used.

Clinton also noted that the city of Banda Aceh, swamped in the Indian Ocean tsunami and in a much richer country with an intact government, was behind where Port-au-Prince is today. In the same vein, President Preval asked me rhetorically whether the thousands who fled Hurricane Katrina had homes they could return to five years after the storm.

A country with few land surveys, and little in the way of clear title now has to figure out where people can be moved and where they can't without resorting to wholesale expropriation. New schools can't be built until its known where the new homes will be. The health system has to be rebuilt to allow emergency aid agencies and volunteers to pull out and leave the job to Haitians. The president and prime minister have spoken publicly of the transition from the emergency phase to the reconstruction phase. They quietly acknowledge how heavily their country's tomorrows are burdened by its pre-quake yesterdays.

I'll have more later in the week.

Listen to the Audio

Margaret Warner talks with Ray Suarez, who has returned to Haiti six months after a devastating earthquake.

JUDY WOODRUFF: Margaret Warner talked with Ray right after he sent that report.

MARGARET WARNER: Hey, Ray, it's good to see you. That was quite bleak picture you painted there. What's the major roadblock to get reconstruction going faster?

RAY SUAREZ: Well, first they had to have a plan. Then they had to have institutions that could handle a gush of billions of dollars that is pledged over two years.

There are hold-ups all along the chain from the national capitals that have pledged the money to the intermediaries like the world bank to the government here.

So right now it seems that money has been damning up behind some of these blocks but now that there is an institutional setting, a commission set up by Bill Clinton and the prime minister, Jean-Max Bellerive, and now there are actual plans and people ready to get to work, money will start to flow more easily, more readily, and people will really start to see the work on the ground moving ahead more quickly.

MARGARET WARNER: Now, you were there six months ago. Any bright spots you see when you compare the two pictures?

RAY SUAREZ: Absolutely. People who are in need of medical care are getting it much more reliably than they were before.

Water is being delivered to all the camps almost all of the time. So people have a steadier and more reliable supply of water than they did before the earthquake.

And now Haitian school kids are heading back to temporary schools all around the city. They were out of school for months and that was one of the major complaints of the people who were homeless. Not get me out of this tent, but help me get a job and help me get my kids back to school.

MARGARET WARNER: And very briefly, you're going to be there all week. What are we going to hear from you the rest of the week?

RAY SUAREZ: Well tomorrow night we'll have an interview with the Haitian president, Preval. Later on in the week we'll have reports on the efforts by the international community to get prosthesis for the thousands of amputees here in Port-au-Prince. And then another report on mental health services, which were already severely lacking before the earthquake but now with all the trauma and the stress and the dislocation, very much needed here in this capital.

MARGARET WARNER: Well, we'll look forward to it, Ray. Thanks, take care.

RAY SUAREZ: Good to talk to you, Margaret.

Listen to the Audio

Ray Suarez reports on the still-recovering Haitian capital of Port-au-Prince, where some one million people still remain homeless.

JUDY WOODRUFF: Next, Haiti tries to rebuild. Ray Suarez has returned to the heavily damaged capital Port-au-Prince. Here is the first of his week-long series of reports on the situation in Haiti, six months after the quake.

RAY SUAREZ: In Port-au-Prince, deconstruction comes before reconstruction. Hundreds of thousands of cubic yards of rubble have been cleared from building lots and streets, yet shattered buildings still stand in every direction.

When the tremors stopped, this metropolitan area had been shaken to pieces. An estimated 300,000 lives ended, tens of thousands of buildings destroyed, untold numbers injured, 600,000 people fled to the rest of the country.

More than a million people are homeless in the Haitian capital. More than a million. Imagine putting the entire population of Dallas out on the streets. It's the most visible sign of the work that remains to be done.

NIGEL FISHER, United Nations: There are clear plans, clear targets now. We need the resources.

RAY SUAREZ: Nigel Fisher is a United Nations deputy special representative in Haiti.

NIGEL FISHER: When you think about a million-and-a-half people in camps, 1,300 sites from a few tents to huge camps, while there has been violence and there is unacceptable violence against women in quite a few counts, overall there's a level of calm of people who have been incredibly hit, have lost so much, which I find amazing.

RAY SUAREZ: Whether or not you see Port-au-Prince six months after the quake as on the right track depends on how you define success. All around the sprawling city, privately and publicly hired crews are breaking up rubble and bringing down houses inspected and judged to be beyond repair. Still, fewer than 20,000 new houses have been built to move Haitians from the camps.

DR. GEORGE MICHEL: They are living in very dire conditions. They are in tents that are crumbling. They are living in cabins. And they should have expected better from their government.

RAY SUAREZ: Dr. George Michele is a well known medical doctor, journalist and historian in Port-au-Prince.

DR. GEORGE MICHEL: I think one of the priorities of this government would be to quickly build modern housing to give every single one who has lost their house a shelter because they have reconstruction money in hands. You have to address the housing problem and unfortunately, I've seen very little done so far in this direction.

RAY SUAREZ: There's been widespread criticism that the dispersement of a promised $5.5 billion in international aid has been slow, but Prime Minister Jean-Max Bellerive says a comprehensive urban plan needs to be finished before any big spending can take place. He said the international community and his people need more patience.

JEAN-MAX BELLERIVE, prime minister, Haiti: People have their own frustration, but they see and they understand that every day their life is getting more and more normal.

But if you are somebody sick under a tent, it's raining, your children are going to school, you have lost your business, and you put a microphone in front of that person, how do you feel your government is doing for you. I can understand and I can relate. I can measure the height of the frustration.

RAY SUAREZ: Bellerive says now that planning stages are near complete, the people of Port-au-Prince will see more evidence of the rebuilding.

But it's going to take years, longer than these workers can wait. They're shoring up the steep hillside that became their home when the earthquake destroyed their neighborhood just across the valley. They're digging drainage, filling sandbags, mixing cement to keep their shelters from sliding into the ravine when the heavier rains come.

Julie Sell is with the American Red Cross.

JULIE SELL, American Red Cross: The goal of the Red Cross is to get people into transitional shelters, something that will be more stable than this. Because of the land issues, which are incredibly complicated, and the millions of cubic meters of rubble that are covering Port-au-Prince, there have been delays in trying to build those transitional shelters.

So until we can get people into something that is more sturdy, we're trying to give them the tools and the knowledge to protect themselves as well as possible on these temporary settlements.

RAY SUAREZ: They would like to move to safer land but they can't. Proof of ownership of land is rare in Haiti and the quake has launched thousands of disputes. Many of the government's records were destroyed in the quake and it's been cautious about seizing property, even when people need to be moved from dangerous conditions.

RENALD DERAZIN: When it rains it's like a big river because everybody is in the water.

RAY SUAREZ: 29-year-old Renald Derazin lives with his wife and daughters in Port-au-Prince. He and his neighbors in this make-shift tent village have had to move their tents further and further from rising waters brought on by recent rains.

RENALD DERAZIN: Because you can see that the tents are too close one to the other because we don't have enough place. And we have, as you can see, about four and five tents in the water.

RAY SUAREZ: This water is dangerous to your family.

RENALD DERAZIN: Oh, yes. We tried to prevent them to not work in the water because there are many kinds of insects and mosquitoes and many kinds of things. I mean that's why we had a lot of malaria cases and also typhoid, we have two cases of typhoid.

RAY SUAREZ: The International Organization for Migration, a U.N. agency, is hoping to move Renald and his neighbors soon.

A visit to Haiti's general hospital reflects the tone of Haiti six months after the quake. Heavily damaged with many staff among the dead and injured, it swarmed with volunteers, emergency cases, the broken, the dead and the dying in the frantic days after January 12. It's now a much calmer place. Still, pediatric patients today are being treated in tents outside in the tremendous heat, and much of the medical staff that stayed on the job for months will only next month get their retroactive checks for the last eight months.

When the wiring is finished, the children's ward will move to these temporary buildings, but the director, Dr. Alex Lassegue wants a new hospital.

DR. RONALD LASSEGUE, Central Hospital: We work now to assemble sufficient funding to have another hospital, a new hospital, a new building and new way to deliver the care to the Haitian people.

RAY SUAREZ: After their many years of setbacks, people here continue to work very hard, endure all with a sturdy stoicism and a ready smile. But to get people out of camps that provide more security, water and food than their pre-earthquake homes, you have to give them a reason to leave.

NIGEL FISHER: If you remember that six out of seven people living in Port-au-Prince before lived in the slums, they didn't have access to water and sanitation, the things they're getting now in camp. So unless we can start to look at making sure that those services are available and affordable back in their communities, then they won't go back.

RAY SUAREZ: Now more than ever, Port-au-Prince is a city that moves to the rising and setting of the sun, bustling, teeming and occasionally still the capital of the poorest country in the Americas ends the first six months of recovery moving ahead and still way behind.