It’s been four years since Port-au-Prince collapsed, and Haiti’s women are still working through the damage—both physical and mental—left by the catastrophic 2010 earthquake and its aftermath. The cameras and reporters have gone, but the twinned scourges of violence and exploitation continue to haunt Haiti’s ruins.

In the days after the January 12 earthquake, as survivors flooded into cramped displaced people’s camps, sexual assault emerged as a second wave of trauma in the devastated capital city. Though violence against women had been prevalent long before the quake, the disaster left women deeply vulnerable, with little security in the shelters and already-anemic legal protections for victims obliterated. Four years on, despite initial media coverage of Haiti’s “rape epidemic” and overtures of legal reforms, the crumbled social infrastructure has left victims with little recourse and bleak futures. Aid money has washed in and out, but now the spasm of global compassion has ebbed into a stream of predatory “development” schemes. And still, the social fabric continues to corrode under the pressure of entrenched global inequalities, both within the country and across the wealth divide between Global North and South.

Ravaged Landscapes, Scarred Bodies

After the quake, the emergency camps immediately became sites of extreme brutality, as gaps in safety protections—simple things like proper lighting in the shelters, or having to venture out alone to find clean water—exposed women and girls to attack. Surveys of survivors in the camps revealed rates of sexual-violence victimization as high as 22 percent of displaced people—not counting all those who might have been too frightened to come forward. In the following months, with some 1.5 million left homeless and all residents left with virtually no infrastructure, activists noted an emerging trend of women turning to “survival sex,” or the exchange of “transactional” sex for economic resources due to a lack of other options.

In the following months, which saw temporary shelters evolve into long-term makeshift settlements, women and girls were beset with what rights advocates called “gender aftershocks”—a wrenching knot of social and economic traumas that deepened longstanding gender divides. According to a broad analysis of post-earthquake violence by the advocacy coalition PotoFanm+Fi published in late 2012, international humanitarian authorities documented a sharp increase in post-quake pregnancy rates, linked in part to “sexual assault as well as transactional sex,” and warned of “consequences for young girls whose developing bodies are at higher risk for complications of pregnancy.” After the massive uprooting of so many families left women no means of supporting themselves, younger women in particular suffered “increased vulnerability to sexual assault and abuses,” especially in the chaotic camps. Yet outside the tent cities lay even more uncertainty.

The government has for months been sweeping away the last of these encampments (an aggressive eviction campaign drove the official displaced population count from roughly 280,000 to 172,000 between last June and October—though where they have been resettled, and their access to permanent housing, remains unclear).

But activists warn that the government’s primary vehicle for forced “transition” of the displaced is essentially shoving people toward more precarious circumstances. Even now, many poor women are struggling just to start rebuilding their lives, while inequities they faced prior to the quake have returned with a vengeance—from sexual violence to wrenching poverty and a tattered healthcare system.

These days, survivors encounter more ingrained security threats—like the paucity of decent housing and a massive health crisis wrought by the catastrophic cholera epidemic that erupted in 2010—which render women intrinsically more vulnerable to violence and exploitation in their households and workplaces.

Advocates stress that victims’ interior scars last long after the attack. According to PotoFanm+Fi’s data on more than 1,000 adolescent girls, gathered in a survey focused on teen pregnancy, many had sought counseling after rape due to issues like “shock, anger, depression and post-trauma,” and a “significant minority noted that they had a desire to die, while a small number had attempted suicide.” Yet of those who responded to a question on post-rape therapy, 40 percent of the girls said they had not received counseling after rape. The surveys’ results showed that young adolescents in particular suffered from inadequate sexual health and reproductive health services. The social stigma experienced by girls who were raped or who have traded sex further constrains their future social and economic opportunities.

The assault survivors who have sought justice have confronted a legal system that tends to further degrade women by, for example, requiring medical certificate as proof within seventy-two hours. According to a 2012 report by New York University’s Center for Human Rights and Global Justice and other advocacy groups, “representatives of government agencies responsible for addressing sexual exploitation hold stereotypes related to gender and poverty that present an obstacle to implementing practical solutions.” Impoverished women must weigh the risk of taking their case to a biased justice system against the prospect of more victim shaming.

While highlighting perennial deficits in social services, PotoFanm+Fi’s long-term analysis has challenged conventional assumptions about post-quake violence against women: Though early media reports focused on “stranger rape” in the camps, longer-term surveys suggest rape remains primarily a “familial crime,” perpetrated by people familiar to the victim. Domestic violence remains an overlooked form of gender-based violence, as it was before the disaster, and continues to be far more prevalent than cases involving only sexual assault. Moreover, sexual victimization of men, while relatively rare, might be significantly underreported, because of stigma surrounding homosexuality and HIV/AIDS infection. Other activists have reported a recent upsurge in attacks on LGBT people.

One bright spot is that grassroots efforts to tackle gender inequality and gender-based violence have crystallized amid the swirl of international aid and global media attention. And in the field, the latest reported data on sexual violence suggests growing awareness and willingness of victims to come forward.

Some activists have established local “safe houses” to provide community-based counseling and legal services. KOFAVIV (Komisyon Fanm Viktim pou Viktim, the Commission of Women Victims for Victims) runs rehabilitation programs to help women and girls stabilize, get job training and access medical and mental healthcare. The Port-au-Prince-based group, founded by rape survivors in 2004, has collaborated with technology groups and other survivor networks to develop a digital tracking system for incidents of sexual violence. And in the fraught politics of Haiti’s reconstruction, the group has advocated for the rights of women and for their inclusion in the recovery as workers and caregivers.

Yet often, it’s only the women who listen. “Listening to a person’s rape story is not an easy task. Every time it’s like if you were in the shoes of the woman who’s talking to you,” said Manou, who works at KOFAVIV’s crisis call center. Testifying for the Survivors for Survivors documentary project, the 31-year-old remarked, “The poorest women are always the most abused. Society doesn’t stop to think about their suffering. Only a few grassroots organizations take on the challenge of helping women who suffer all kinds of violence.”

But it remains unclear whether these initiatives can grow to meet their communities’ overwhelming needs. The global outpour of aid dollars is drying up far faster than Haiti’s ruins are healing. According to PotoFanm+Fi, “less than 1 percent of international bank funding has been dedicated to fighting sexual violence.” And while there were budding efforts in the government to prioritize gender issues, international aid “largely flowed to non-government agencies, leaving Haiti’s women’s ministry with too little funding and political muscle to oversee a national effort by many small and larger actors.” Overall, the vast majority of USAID money has been allocated through non-local organizations.

Nonetheless, there have been some inroads: KOFAVIV has brought about 200 rape cases through the court system since the quake, a sharp increase from previous years. Last spring, officials announced proposed reforms, based on a draft law initiated by the Ministry of Women’s Affairs, to strengthen protections against sexual violence crimes. According to KOFAVIV’s US-based partner MADRE, the legislation has been stalled since the president has not sent it on to the Parliament, but they are working with sympathetic officials to keep pushing the reforms.

As donor aid dwindles, “all the Haitian organizations are taking a hit,” says Lisa Davis, MADRE’s director of Human Rights Advocacy. “Part of the problem with emergency money is that so little of it actually goes into systemic repair, which is usually needed to stop emergencies from arising again—or at least being able to be addressed if they do.”

Building Back to What?

After the haphazard shower of aid, the international donor community’s credo of “building back better” has hardly broached the broader project on Haiti’s horizon: moving beyond the trickle of grants and toward a social seismic shift. Haitian women today need the security of a sustainable livelihood. Yet donor-led economic “development” has mostly bypassed Haiti’s poorest populations—especially the women disproportionately affected by poverty.

Haitian women face structural violence in the drudgery of factory jobs that cannot feed a family, in the poverty that forces parents to cut expenses by pulling girls out of school, and women to stay with abusive partners because they depend on them for housing.

Haiti’s new housing development plan, launched in 2012 in conjunction with the World Bank and international donors, largely overlooks the gendered dimensions of the housing crisis. An analysis of the aid efforts, published by US-based watchdog group Gender Action in October, found that the government’s proposed private housing solutions are prohibitively costly for many Haitians, and that the government’s housing scheme “marginalizes the poor, and women in particular, who are less likely than men to control household incomes and are predominantly responsible for unpaid, time-consuming housework.”

Gender Action’s analysis of the policy criticizes international financial institutions for largely failing to address women’s specific development needs and ignoring gender issues. Despite women’s vital role in the workforce, they were often not included in the recovery planning process. Although many of the recovery projects claimed to be focused on women’s equality, Gender Action noted that development projects were often designed with a gender-neutral approach—which led business development programs to ignore the historical underrepresentation of women in management positions, or fail to take into account gender barriers in access to credit. In the post-quake patchwork of grants scattered across fledgling NGOs, many initiatives touted humanitarian lingo about “enhancing labor market outcomes for women” and other marginalized populations, but rights advocates point out that projects have often simply failed to demonstrate measurable impacts on target communities.

So far, the large-scale economic recovery agenda mirrors the neoliberal policies that existed before the quake—a development framework tied to crushing international finance debt (canceled after the quake but now on the rise again), export-dependent manufacturing “free trade” zones and cyclical, political turmoil–punctuated US- and UN-led military interventions. The redevelopment plans bolster this status quo by driving investments into the garment sector, to supply major North American brands like Walmart and Gap. According to the labor advocacy group Better Work, this mostly female labor force earns some of the lowest wages in the hemisphere, starting from a legal minimum of about US$5 per day. To approach a survivable income level, workers typically rely on extra earnings eked out under an exploitative piecework scheme.

The group’s investigation of twenty-four factories revealed that all facilities had violated minimum-wage standards. Last November, some manufacturers, including Fruit of the Loom, announced plans to comply fully with Haiti’s newly increased standard wage for garment workers, about US$7, though pay scales still fall well below a living wage for locals. On top of basic workplace justice issues like non-payment of overtime and shoddy facilities, women workers reported instances of gender discrimination, and advocates noted many sexual harassment incidents may have gone underreported.

Port-au-Prince garment worker Osnaque summed up the plight of women like her in a recent study by the Workers Rights Consortium: “We never can accomplish anything in our lives, because with a salary like that, we can only eat and nothing else.”

These are the women who are rebuilding Haiti now. And while Osnaque and her fellow workers struggle without so much as a living wage, the foreign aid that once flooded her city’s shattered landscape steadily evaporates.