PORT-AU-PRINCE, Haiti — In the night, the children wake up crying.
"They always ask for someone to be with them. They ask why it happened. They think God is mad at them," says Marie Louise Woel-Michel, a hospital volunteer in the shattered Carrefour neighborhood of the Haitian capital. "They don't play."
The lawn of Adventist Hospital has become a camp for patients and their families, many of whom are among the 2 million people displaced by the earthquake that destroyed this city. Last week, residents found a little boy, 4 years old at most, in the bushes. He was chilled, dehydrated and silent.
"Either the parents are dead or abandoned him. We don't know his name," says Woel-Michel, a school principal whose husband is an Adventist radiologist. "We talk and talk and talk, but he doesn't answer."
In the devastation left after the Haiti earthquake, the heaviest blow is falling on the weakest: children. Already poor, underfed and underschooled, tens of thousands of Haiti's children now face the cruelest catastrophe: They are alone. Their parents are dead or have disappeared in the chaos. They have lost their homes, their friends, their sense of security. They are hungry, bleeding and afraid — of the present and of the future.
Kathiana Joseph, 9, is having nightmares. Her family's house in Cité Soleil, Haiti's worst slum, fell into the water during the earthquake. The family, including a brother and a sister, are living in the street.
"I am afraid it will happen again," she says. "I had a puppet. It's missing." It was her only toy.
Even before the Jan. 12 earthquake, 380,000 Haitian children, out of 4.2 million in the whole country, lived in orphanages or group homes, according to UNICEF. Whatever the final death toll of the Haiti quake — 150,000 are confirmed dead so far, Haiti's government says — thousands more children will join them.
The destruction presents an enormous challenge for UNICEF and other relief groups that focus on children, as they confront both the immediate crisis and the question of who will care for the children in the future.
"I think we'll be facing one of the most horrific disasters for children in memory," says Irwin Redlener of Columbia University, whose Children's Health Fund responded to Hurricane Katrina. Few events could compare to the "extraordinary loss of life and the potential for such psychological harm to children."
Nearly two weeks after the earthquake, children continue to arrive at hospitals gravely injured, with serious infections and broken bones. Few have had medical care, and many are suffering without painkillers. Many children have been in pain for so long they have stopped crying.
Doctors at Adventist were forced to amputate the gangrenous hand of a 12-year-old girl without proper anesthetic because of a shortage of drugs, says Mike Howatt, a Canadian surgeon volunteering with Global Medic. Otherwise, he says, they feared the infection would spread and kill her.
During the excruciating surgery, the girl seemed to be singing. "It was only at the end that I realized she wasn't singing," Howatt says. "She was praying."
'I'm not living well'
The needs of Haiti's children were vast even before the quake took away what little they had. Nearly half of Haiti's nearly 10 million people are younger than 18. Only half of Haitian children ever attend school, and only 2% finish high school, UNICEF says. Haiti's infant mortality rate and the rate of death for children younger than 5 are the highest in the Western Hemisphere.
Now, "we're in that kind of search and rescue operation ... for these unaccompanied children," says Patrick McCormick, spokesman for UNICEF. "Feed them, give them water, take care of them, protect them, and then start the process of registration and tracing to see if they have any family members left."
Once relief workers have tended to children's physical needs, they will have to help Haitian children face the psychological scars and tremendous upheaval caused by the disaster.
Stability is so important for children, Redlener says, that studies of kids displaced by Katrina show that even five years later, they still struggle in school. Rebuilding efforts often focus too heavily on infrastructure instead of communities and schools, he says. "What really matters is rebuilding the lives and the stability of children. That's what I'm hoping will be the biggest lesson that we can learn from Katrina that we can apply to Haiti."
While Kevin Brito, a relief coordinator for Adventist Development and Relief Agency Spain, tried to distribute energy biscuits at a tent camp this week, three little boys, about 5 years old, tugged at his shirt.
"They were jumping and playful, and they wanted to help with the boxes. They asked, 'Are you my friend?' " says Brito, a psychologist from Madrid. "That touched me. But as I thought about it, I realized how needy they are for affection. They wanted to know someone was caring for them." So Brito gave them small tasks, hugged them and rubbed their heads as they vied for his attention.
The risk of post-traumatic stress is high, specialists say, if children aren't helped. Children have to sort out what they've been through, says Carolyn Miles, chief operating officer of Save the Children. "There's the shock, then there's the 'I just want to hang on to something,' then there's the anger."
As powerful, often conflicting emotions emerge, children need solace and support, says Caryl Stern, head of the U.S. Committee for UNICEF.
"There are kids who are just wandering the streets right now. We need to find them. We need to hug them. We need to give them blankets. We need to tend to their health problems," Stern says. Even in Haiti, which has been racked by hurricanes, floods, riots and mudslides, "for many children, this will be their first major disaster. They don't know that tomorrow may be a better day. They need to be convinced of that."
Jenika Seveur, 10, was playing soccer when the quake struck. She fell down. "I feel bad. I'm not living well. I'm hungry," she says. "We have no place to live. We are living in tents. I don't like it."
If she could make one wish, it would be "for the Americans to help us."
'Angry and nervous'
At Adventist, Woel-Michel says children are clingy and fearful of straying far from family. An 11-year-old girl whose leg was amputated cries all the time.
"She thinks she will never be a mother," Woel-Michel says. "We keep telling her it won't keep her from doing what she wants. I just invent stories about people with similar injuries with happy endings to make them feel better."
Woel-Michel sees the effects of the disaster in her own son. "I wanted him to come here as a volunteer, but he couldn't," she says. "He cannot cope yet. He's angry and nervous."
Aid groups including UNICEF and Save the Children are setting up special tents for children in camps of displaced residents, to start what they call "psychological first aid." Mercy Corps is handing out "comfort kits," including a blanket and stuffed animal. The children's tent "gives kids a place to go. It starts some sort of normal routine," says Miles, of Save the Children.
The tents also will be places where relief workers can register children who are alone, in hopes of reuniting families. UNICEF is worried about unaccompanied children being abused and exploited.
Mercy Corpswill begin training teachers, church groups and community leaders in Haiti to recognize signs of post-traumatic stress in children: clinging, crying, and sleep and toilet-training problems. The group also is translating into Creole a workbook it gave children after 9/11 and Katrina. It asks children to draw pictures of what they lost, fear and hope for.
Lesly Luc, 11, already has recorded his experience. In two pages of neat script, he recounts running out of his house with his brother and wandering around the city. He wrote about his mother screaming when they couldn't find his father, and their joy when they saw him run toward them covered in dust. He wrote it to remember the day his town in Léogâne, about 20 miles west of Port-au-Prince, became the epicenter of the earthquake.
"If I have children, I have that to share with them," he says. "I'm hoping that never happens again. Too many people died."
Lesly's family now lives in a shack of corrugated tin in a tent city in a park. The shack has an adjoining area enclosed by blankets tied to wooden poles.
Sixteen people cram into the space. He sleeps on a mattress on the ground. When it gets too crowded or hot, they take turns sitting up so the others can lie more comfortably. He has no toys or television. He spends his days sleeping, drawing and writing with a pen on a notebook that his parents found in rubble. Always, he is looking for food: One day last week, his only meal was wheat mashed in water.
Since the quake, he says, he has been feeling weak. His head hurts, and his stomach is upset.
"Before, I had a house, I went to school," he says as his parents watch and nod. "Life was good before, but right now, it's not."
Seven-year-old Schneider Michele hasn't been able to walk since a block of concrete fell on his leg. His right shin is bandaged, and blood seeps through the cloth. His mother, Anny, carries him on her back.
They sleep in a yard without blankets or tents, just a pad to lie on. "After the earthquake, we went to another family to live with them, but their house fell, too," Schneider says. "I have no home to go to."
Rather than describe what he has seen, Schneider looks down, picking at lint on his mother's T-shirt. He cries all the time, Anny Michele says.
"Before, I always found a way to feed my son and send him to school," she says. "I don't see a future for him."
In the desperate international effort to help Haiti's children, relief workers hope to restore not only their physical and mental health but also their ability to endure — and even to dream.
Schneider wants to be an engineer. "If I made houses with metal roofs instead of using cement," he says, "maybe so many houses would not fall down, and people would not die."
Moore reported from New York