Orderlies pushed Jertha Ylet’s bed from the center of the hospital ward to one side so Dr. Michelet Paurus could plug in his electric saw. She was silent as the doctor cut off her plaster cast in measured strokes. Today she would have to leave the hospital, the doctor said. Ylet had resisted until the cast came off. She’d been at Les Cayes’ General Hospital since being brought there Aug. 14, unconscious and with her leg crushed, after a 7.2-magnitude earthquake destroyed her house, killing her father and two other relatives and seriously injuring her brother. There is no home to return to. A surgeon inserted a metal rod in her lower left leg on Thursday. Ylet, 25, had not been out of bed, much less tried to walk, since she arrived. Her 5-year-old daughter, Younaika, who was not injured, shared her bed and spent her days playing with other children around the ward. Read:Haiti raises earthquake death toll, passes 2,200 More than a week after the earthquake on Haiti’s southwestern peninsula killed at least 2,207 people, injured 12,268 and destroyed nearly 53,000 houses, Ylet represents an emerging dilemma for the region’s limited health care services: how to turn over hospital beds when discharged patients have nowhere to go. “I said to the doctor, ‘I don’t have any place to go,’” Ylet said. “I told them everything. The doctor doesn’t understand.” In the first days after the quake, the hospital was overwhelmed with patients. The injured lay on patios and breezeways awaiting care. Now there are still people in those areas, but they are discharged patients or people who were never admitted at all, who have been drawn by the donations of food, water and clothing that arrive at the hospital daily. “We have a lot patients who have been discharged, but are still hanging out in the yard,” said hospital director Peterson Gede. “The fact they know they will receive food and water ... they don’t have any intention to leave.” On Monday, Gede issued an order for hospital staff to begin to “motivate” patients to leave, “to make them understand that we need beds for new patient admissions.” It proved easier said than done. Not having a home to return to was a significant obstacle for Ylet and many others. Ylet lost consciousness when a wall of her cinderblock house in Camp-Perrin fell on her as the quake struck. Her boyfriend, Junior Milord, had left 20 minutes earlier for work. He froze in the street until the shaking stopped, then ran back to Ylet’s house. He found her buried near the front of the building, which unlike the back, had not completely collapsed. “I thought she was dead when I first started removing the blocks,” Milord said. He pulled her out and flagged down a passing car, which took her to the hospital in Les Cayes. “When I woke up I was in the hospital,” she said. Milord then returned to help dig out the bodies of Ylet’s father, cousin and brother-in-law. Their bodies are still at a funeral home, because the family doesn’t have the money to bury them. Milord lost his own home, plus two uncles, an aunt and a brother in the quake. Read: In Haiti, close relation between the living and the dead Milord said some of Ylet’s surviving relatives are camping in her yard. If Ylet and her daughter have to leave, he said, they will end up there too. Across the ward, nurse Gabrielle Lagrenade understands that reality as well as anyone. Lagrenade and her 21-year-old daughter, Bethsabelle, have been sleeping outside since the quake hit. They struggle to sleep on the gravel roadside with their heads less than 6 feet from the highway. All night long mopeds, SUVs and tractor trailers rain dust and pebbles on them. It’s the only level ground around the two-story building where they’d rented an apartment above a small clothing store. The land drops precipitously from the road to a stream running behind the building, which was constructed on reinforced concrete columns above a drainage gully that feeds into the stream. Two columns now display gaping spaces between the bottom of the building and the top of the supports. The landlord has wisely decided to tear it down. Despite her own precarious situation, Lagrenade, 52, continues to arrive daily for her shift at the hospital, carefully folding and stowing her bedding, discreetly slipping behind the row of roadside buildings to bathe and re-emerging in her spotless white nurse’s smock to hail a motorcycle taxi for the ride to work. Ylet is on her ward. About 22 beds spread across the room. Nurses and doctors wear masks, but patients do not, despite virtually no one in Haiti having been vaccinated for COVID-19. Nurses huddle around a wooden table at one end. Medical waste is tossed into a cardboard box in a corner. Lagrenade is not unsympathetic to Ylet’s plight and that of other newly homeless patients, but she is pragmatic. The beds are needed, she said. “After someone gets well they have to go,” Lagrenade said. This is what Paurus was trying to explain to Ylet. An orthopedist who came from Port-au-Prince to operate on her leg had cleared her to leave, the doctor said. “If we decide to keep patients whose homes were destroyed there won’t be room for (new) patients,” he said. “We have a lot of patients and emergencies who need a bed.” Read: Oxygen plant among earthquake-damaged buildings in Haiti Then Paurus got his saw. After her cast was off, Ylet said she would give up her bed, but camp outside on the hospital grounds, because they told her to come back Thursday for a follow-up appointment. But then some volunteers brought hot lunches. By the end of the day, Ylet was still in her bed. Milord said no one had come back to tell her to leave so there she was. “The doctor needs to understand that I don’t have a place to go and I am not leaving,” Ylet said. “I will stay in the hospital’s yard and sleep there until I am able to figure it out.”

As if Haiti’s 7.2 magnitude earthquake, a tropical storm and the coronavirus pandemic weren’t enough, the temblor damaged the only medical oxygen plant in the southern part of the country. The building that housed the oxygen concentrator machines that the region depended on partially collapsed, and the machines were upended. The Etheuss company is run by the a family famous for their vetiver perfume oils plant in the city of Les Cayes, one of the areas hardest hit by Saturday’s earthquake. “We are trying to get the oxygen production started again. That is our responsibility, because many people depend on it,” said Kurtch Jeune, one of the brothers who run the plant, as he showed reporters through the damaged, rubble-strewn plants on Thursday. The quake left concrete pillars and roofs at the facility leaning, and cement block rubble battered the tanks, electrical system and the delicate web of copper tubing that fills vital oxygen plants. “The oxygen generators are upside down,” Jeune said. “We did get a promise of help from the public works department to get the rubble out with excavators.” Read: Tensions over aid grow in Haiti as quake’s deaths pass 2K Jeune said that, apart from two medical oxygen plants in the capital, Port-au-Prince, his factory was the only one serving local hospitals. As the COVID-19 pandemic grinds on, Jeune says demand for oxygen has gone up 200% in the last month. “We have the capacity to supply 40 oxygen cylinders per day,” Jeune said. “We supply several hospitals.” The powerful earthquake that struck Haiti’s southwestern peninsula killed at least 2,189 and injured 12,268 people, according to official figures. More than 300 people are estimated to still be missing, said Serge Chery, head of civil defense for the Southern Province, which includes the small port city of Les Cayes. More than 100,000 homes were damaged or destroyed, leaving about 30,000 families homeless, according to official estimates. Hospitals, schools, offices and churches also were demolished or badly damaged. The earthquake was trailed by a tropical storm that brought heavy rain and strong winds at the beginning of the week. Private relief supplies and shipments from the U.S. government and others began flowing more quickly into Haiti on Thursday, but the Caribbean nation’s entrenched poverty, insecurity and lack of basic infrastructure still presented huge challenges to getting food and urgent medical care to all those who need it. Read: What makes Haiti prone to devastating earthquakes Adding to the problems, a major hospital in the capital of Port-au-Prince, where many of the injured were being sent, closed for two days beginning Thursday to protest the kidnapping of two doctors, including one of the country’s few orthopedic surgeons. The abductions dealt a blow to attempts to control criminal violence that has threatened disaster response efforts in the capital. Further, a group of 18 Colombian volunteer search-and-rescue workers had to be escorted out of the quake-hit city of Jeremie under police protection after a false rumor circulated that they had been involved in the July 7 assassination of President Jovenel Moise. The workers took shelter Wednesday night at a civil defense office, and police escorted them to the airport on Thursday. Moise’s killing, still unsolved, is suspected of being carried out by a group of Colombian mercenaries. Despite what happened to the Colombian rescue workers, Haiti is welcoming “everyone who is coming to bring assistance,” said Jerry Chandler, the head of the national Civil Protection Agency. Health care facilities in the Western Hemisphere poorest nation were already at a critical point before the earthquake because of the pandemic. The country of 11 million people has reported 20,556 cases and 576 deaths of COVID-19, according to Johns Hopkins University. Haiti received its first batch of U.S.-donated coronavirus vaccines only last month via a United Nations program for low-income countries. The rest of Jeune’s factory, which produces an essential oil used in fine perfumes, was also badly damaged. Read: Rescuers racing in Haiti as storm threatens to follow quake The family’s business processes bales of beige, stringy roots culled from the vetiver plant to produce more than half the world’s vetiver oil. Vetiver oil is also used for cosmetics, soaps and aromatherapy. It generates an estimated $12 million in revenue a year and employs anywhere from 15,000 to 60,000 farmers. The damage to the factory threatens Haiti’s already perilous rural economy, plagued by drought, soil erosion and tropical storms. Haiti produces more than 70 tons of vetiver oil a year, surpassing Indonesia, China, India, Brazil and the neighboring Dominican Republic. It is one of the country’s top exports, with up to 10,000 hectares (24,700 acres) harvested annually. But more than 60% of the crop still comes from individual producers, many of whom are struggling financially, according to Gabriel Gelin, a spokesman for the United Nations Environment Program in Haiti.

Tensions have been growing over the slow pace of aid reaching victims of a powerful weekend earthquake that killed more than 2,100 people in Haiti and was trailed by a drenching tropical depression. At the small airport in the southwestern community of Les Cayes, throngs of people gathered outside the fence on Wednesday when an aid flight arrived and crews began loading boxes into waiting trucks. One of a small squad of Haitian national police, outfitted in military-style uniforms and posted at the airport to guard the aid shipments, fired two warnings shots to disperse a group of young men. Angry crowds also massed at collapsed buildings in the city, demanding tarps to create temporary shelters after Tropical Storm Grace brought heavy rain at the beginning of the week. Read:Death toll from Haiti’s weekend earthquake rises to 1,941 Haiti’s Civil Protection Agency late Wednesday raised the number of deaths from the earthquake to 2,189 from an earlier count of 1,941 and said 12,268 people were injured. Dozens of people are still missing. The magnitude 7.2 earthquake destroyed more than 7,000 homes and damaged more than 12,000, leaving about 30,000 families homeless, according to official estimates. Schools, offices and churches also were demolished or badly damaged. The Caribbean nation’s southwest region was the hardest hit. One of the first food deliveries by local authorities — a couple dozen boxes of rice and pre-measured, bagged meal kits — reached a tent encampment set up in one of the poorest areas of Les Cayes, where most of the one-story, cinderblock, tin-roofed homes were damaged or destroyed by Saturday’s quake. But the shipment was clearly insufficient for the hundreds who have lived under tents and tarps for five days. “It’s not enough, but we’ll do everything we can to make sure everybody gets at least something,” said Vladimir Martino, a resident of the camp who took charge of the distribution. Gerda Francoise, 24, was one of dozens who lined up in the wilting heat in hopes of receiving food. “I don’t know what I’m going to get, but I need something to take back to my tent,” said Francoise. “I have a child.” International aid workers on the ground said hospitals in the worst-hit areas are mostly incapacitated and that there is a desperate need for medical equipment. But the government told at least one foreign organization that has been operating in the country for nearly three decades that it did not need assistance from hundreds of its medical volunteers. Prime Minister Ariel Henry said Wednesday that his administration twill work to not “repeat history on the mismanagement and coordination of aid,” a reference to the chaos that followed the country’s devastating 2010 earthquake, when the government was accused of not getting all of the money raised by donors to the people who needed it. Read: What makes Haiti prone to devastating earthquakes Meanwhile, the Core Group, a coalition of key international diplomats from the United States and other nations that monitors Haiti, said in a statement that its members are “resolutely committed to working alongside national and local authorities to ensure that impacted people and areas receive adequate assistance as soon as possible.” Aid has slowly trickled in to help the thousands who were left homeless. But distributing it under current conditions will be challenging. “We are planning a meeting to start clearing all of the sites that were destroyed, because that will give the owner of that site at least the chance to build something temporary, out of wood, to live on that site,” said Serge Chery, head of civil defense for the Southern Province, which covers Les Cayes. “It will be easier to distribute aid if people are living at their addresses, rather than in a tent.” Chery said that an estimated 300 people are still missing in the area. The U.S. Geological Survey said a preliminary analysis of satellite imagery after the earthquake revealed hundreds of landslides. While some officials have suggested that the search phase has to end and heavy machinery should be called in to clear rubble, Henry appeared unwilling to move to that stage. “Some of our citizens are still under the debris. We have teams of foreigners and Haitians working on it,” he said. He also appealed for unity: “We have to put our heads together to rebuild Haiti.” “The country is physically and mentally destroyed,” Henry said. Read: Rescuers racing in Haiti as storm threatens to follow quake Dr. Barth Green, president and co-founder of Project Medishare, an organization that has worked in Haiti since 1994 to improve health services, said he was hopeful the U.S. military would establish a field hospital in the affected area. “The hospitals are all broken and collapsed, the operating rooms aren’t functional, and then if you bring tents, it’s hurricane season, they can blow right away,” Green said. Green noted that his organization has “hundreds of medical volunteers, but the Haitian government tells us they don’t need them.” Nonetheless, the organization was deploying along with others.

Haitian officials raised the death toll from a deadly weekend earthquake by more than 500 on Tuesday after Tropical Storm Grace forced a temporary halt to search and rescue efforts, a delay that fed growing anger and frustration among thousands who were left homeless. Grace battered southwestern Haiti, which was hit hardest by Saturday’s quake, and officials warned some areas could get 15 inches (38 centimeters) of rain before the storm moved on. Intermittent rain fell in the earthquake-damaged city of Les Cayes and in the capital of Port-au-Prince. Late Tuesday afternoon, the Civil Protection Agency raised the death toll to 1,941 and the number of injured to 9,900, many of whom have had to wait for medical help lying outside in wilting heat. Read: Haiti quake death toll rises to 1,419, injured now at 6,000 The devastation is centered in the country’s southwestern area, where health care has reached capacity and people have lost homes and loved ones. Patience was running out in the Western Hemisphere’s poorest nation. Haitians already were struggling with the coronavirus, gang violence, worsening poverty and the July 7 assassination of President Jovenel Moïse when the quake hit. Bodies continued to be pulled from the rubble, and the smell of death hung heavily over a pancaked, three-story apartment building. A simple bed sheet covered the body of a 3-year-old girl that firefighters had found an hour earlier. Neighbor Joseph Boyer, 53, said he knew the girl’s family. “The mother and father are in the hospital, but all three kids died,” he said. The bodies of the other two siblings were found earlier. Illustrating the lack of government presence, volunteer firefighters from the nearby city of Cap-Haitien had left the body out in the rain because police have to be present before a body can be taken away. Another neighbor, James Luxama, 24, repeated a popular rumor at many disaster scenes, saying that someone was sending text messages for help from inside the rubble. But Luxama had not personally seen or received such a message. A throng of angry, shouting men gathered in front of the collapsed building, a sign that patience was running out for people who have waited days for help from the government. “The photographers come through, the press, but we have no tarps for our roofs,” said one man, who refused to give his name. The head of Haiti’s office of civil protection, Jerry Chandler, acknowledged the situation. Earthquake assessments had to be paused because of the heavy rain, “and people are getting aggressive,” Chandler said Tuesday. Some children were orphaned in the quake and some youngsters were starting to go hungry, said Carl-Henry Petit-Frère, a field manager for Save the Children, which said in a statement that it was distributing what it could to people living on the streets without protection from the wind and rain. “I see children crying on the street, people asking us for food, but we are low on food ourselves as well,” Petit-Frère said, adding that children were warned not to go into houses because they could collapse. “The organizations that are here are doing what they can, but we need more supplies. Food, clean water and shelter are needed most, and we need them fast.” About 20 soldiers finally showed up to help rescuers at the collapsed apartment building. Prior to that, the only help that arrived was from poorly equipped volunteers. “All we have are sledgehammers and hands. That’s the plan,” said Canadian volunteer Randy Lodder, director of the Adoration Christian School in Haiti. Sarah Charles, assistant administrator for the U.S. Agency for International Development’s Bureau for Humanitarian Assistance, said its disaster response teams were forced to suspend operations as the storm arrived Monday, but members were back Tuesday to assess its impact and continue helping. Read:What makes Haiti prone to devastating earthquakes “We do not anticipate that the death toll related to this earthquake will be anywhere near the 2010 earthquake, where more than 200,000 people were killed,” Charles told reporters. The scale of the damage also was not as severe as that earthquake, she said, adding: “That’s not what we’re seeing on the ground right now.” In a statement, the U.S. military’s Southern Command said it was moving eight helicopters from Honduras to Haiti and that seven U.S. Coast Guard cutters were en route to support the USAID team. Two cutters already are there along with two Coast Guard helicopters and U.S. Navy P-8 Poseidon aircraft that are taking aerial images of earthquake devastated areas, the statement said. The effort was being mounted “to provide the kind of emergency response that is necessary in a human tragedy and catastrophe like this,” U.S. national security adviser Jake Sullivan told reporters at the White House. John Morrison, public information officer for the Fairfax Co. (Virginia) Urban Search and Rescue, said its team was still trying to find survivors. Two U.S. Coast Guard helicopters had ferried searchers to six stricken communities on Monday. “The team reports that food, health care services, safe drinking water, hygiene and sanitation and shelter are all priority needs,” Morrison said. He added that rescuers had not seen any signs of people trapped alive in buildings. U.N. spokesman Stephane Dujarric told reporters Tuesday that the organization had disbursed $8 million to its agencies so that they could get supplies they need immediately. He said the U.N. is “playing a leading role” supporting Haiti, but added that “the government has the primary responsibilities.” “I think the lesson learned is always for better and improved coordination so as not to see the chaotic scenes that we had” in the aftermath of the country’s devastating 2010 earthquake, Dujarric said. “We sometimes see where countries are, with the best of intentions, sending aid that may not be needed. ... So, I think the lesson learned is always better and more improved coordination to avoid waste and to avoid redundancies.” Rain and wind raised the threat of mudslides and flash flooding as Grace slowly passed over southwestern Haiti’s Tiburon Peninsula before heading toward Jamaica and southeastern Cuba. Forecasters said it could become a hurricane before hitting Mexico’s Yucatan Peninsula. Officials said the magnitude 7.2 earthquake destroyed more than 7,000 homes and damaged nearly 5,000, leaving about 30,000 families homeless. Hospitals, schools, offices and churches also were demolished or badly damaged. In the village of Bonne Fin, a one-hour drive from from Les Cayes on dirt roads, the mountaintop Hospital Lumiere illustrated the anguish and complexity of Haiti’s medical crisis and dire need for outside help. No one died or was injured at the hospital when the quake hit, but the operating rooms partially collapsed. Through cracks in a wall, Dr. Frantz Codio could see three glistening anesthesia machines he needed to perform orthopedic operations on broken bones. But he could not get to them because the building’s cement roof was leaning at a crazy angle — in some places just 3 or 4 feet (0.9 meters to 1.2 meters) above the floor. Despite warnings not to go inside the structure, Codio did so on Sunday and pulled one of the machines out. “People said, ‘Don’t go in there, it’s too dangerous,’ but I had God with me,” Codio said. Read: Death toll of powerful earthquake in Haiti soars to 1,297 Etzer Emile, a Haitian economist and professor at Quisqueya University, a private institution in Port-au-Prince, said the earthquake will almost certainly result in more long-term poverty for Haiti’s struggling southwestern region. Political instability and gang criminality along the southern roads into the region have particularly hobbled economic activity in recent years. “The earthquake has just given a fatal blow to a regional economy already on its knees for about 2 1/2 years,” Emile said.

Earthquakes have been wreaking havoc in Haiti since at least the 18th century when the city of Port-au-Prince was destroyed twice in 19 years. Saturday's powerful quake killed hundreds and injured thousands more. Eleven years earlier a temblor killed tens of thousands of people, if not hundreds of thousands. Haiti sits near the intersection of two tectonic plates that make up the Earth's crust. Earthquakes can occur when those plates move against each other and create friction. Haiti is also densely populated. Plus, many of its buildings are designed to withstand hurricanes – not earthquakes. Those buildings can survive strong winds but are vulnerable to collapse when the ground shakes. READ: Death toll of powerful earthquake in Haiti soars to 1,297 Why is Haiti prone to earthquakes? The Earth's crust is made up of tectonic plates that move. And Haiti sits near the intersection of two of them – the North American plate and the Caribbean plate. Multiple fault lines between those plates cut through or near the island of Hispaniola, which Haiti shares with the Dominican Republic. What is worse, not all of those fault lines behave the same way. "Hispaniola sits in a place where plates transition from smashing together to sliding past one another," said Rich Briggs, a research geologist at the US Geological Survey's Geologic Hazards Science Center. What caused the most recent quake? Saturday's magnitude 7.2 earthquake likely occurred along the Enriquillo-Plantain Garden fault zone, which cuts across Haiti's southwestern Tiburon Peninsula, according to the USGS. It is the same fault zone along which the devastating 2010 earthquake occurred. And it is likely the source of three other big earthquakes in Haiti between 1751 and 1860, two of which destroyed Port-au-Prince. Earthquakes are the result of the tectonic plates slowly moving against each other and creating friction over time, said Gavin Hayes, senior science adviser for earthquake and geologic hazards at USGS. "That friction builds up and builds up and eventually the strain that is stored there overcomes the friction," Hayes said. "And that is when the fault moves suddenly. That is what an earthquake is." Why can earthquakes in Haiti be so devastating? It is a combination of factors that include a seismically active area, a high population density of 11 million people and buildings that are often designed to withstand hurricanes – not earthquakes. Typical concrete and cinder block buildings can survive strong winds but are vulnerable to damage or collapse when the ground shakes. Poor building practices can also play a role. The 2010 quake hit closer to densely populated Port-au-Prince and caused widespread destruction. Haiti's government put the death toll at more than 300,000, while a report commissioned by the US government placed it between 46,000 and 85,000. "I think it is important to recognise that there is no such thing as a natural disaster," said Wendy Bohon, a geologist with Incorporated Research Institutions for Seismology. "What you have is a natural hazard that overlaps with a vulnerable system." What does the future hold? READ: At least 304 dead, 1,800 hurt as powerful quake slams Haiti Geologists say they cannot predict the next earthquake. "But we do know that earthquakes like this can cause similar-sized earthquakes on the next portion of the fault," said Hayes of USGS. "And it is quite a significant hazard in places that do not have the construction practices to withstand the shaking." Construction of more earthquake-resistant buildings remains a challenge in Haiti, which is the poorest nation in the Western Hemisphere. Before Saturday's quake, Haiti was still recovering from the 2010 earthquake as well as Hurricane Matthew in 2016. Its president was assassinated last month, sending the country into political chaos. And while there have been some success stories of Haitians building more earthquake-resistant structures, the country has lacked a centralised effort to do so, said Mark Schuller, a professor of anthropology and nonprofit and NGO studies at Northern Illinois University.

People in Oregon will be better prepared for earthquakes — particularly important in the Pacific Northwest because experts say “the big one" is coming — as an early warning system launched Thursday, the 10th anniversary of a devastating quake and tsunami in Japan.

Two strong earthquakes of magnitude 6.2 and 5.7 hit Colombia on Tuesday, said the Colombian Geological Service.