Last year Haiti was hit by earthquake, hurricane and disease, but as Sarah Freeman reports, despite it all hope still survives.
Ezana Tales remember the exact minute her old life stopped and her new one began.
It was 4.52pm on January 12, 2010. Her three children had just returned from school. The two eldest, 11-year-old Jefflove and her nine-year-old brother Vekerson were just starting their homework, while her youngest son Manoupnepha was in the next room watching a cartoon.
In the midst of preparing food, Ezana was about to help her middle child with a particularly difficult question when the house began to sway. In the "tremblement" as many of the Haitians now refer to the devastating earthquake, shelves began to collapse, walls crumbled and Ezana gathered the children in her arms, running outside to a neighbouring field without time even to collect their shoes.
"I knew immediately there had been a lot of deaths," she says. "Near to our house a school had totally collapsed. I knew there were children in there."
The worst earthquake to hit the precarious small Caribbean island in 200 years left 230,000 dead, 300,000 injured and those that survived had little time to count their blessings. By the end of last year, Hurricane Tomas had battered the already poverty stricken country and as second relief operation got under way, a cholera epidemic took hold.
Since the triple tragedy, life has moved slowly in Haiti. The main roads may have been cleared of debris, the many bodies removed, but one million people – 380,000 of them children – still live in makeshift camps, hunkering down under tarpaulins out of the glare of the searing midday sun.
The traffic through the devastated capital Port-au-Prince remains grindingly slow, moving at the same pace as the women who meander past street vendors balancing water or baskets or vegetables on their heads.
As she looks back now, Ezana knows she was one of the lucky ones.
All of her children escaped without serious injury and after two nights sleeping outside she and her family moved to temporary shelter in the countryside. Yet each day when she looks at her daughter and her two young sons she sees the effect of the last 12 months clearly etched on their face and having recently separated from her husband feels a weight of responsibility.
"They don't want to eat, and they worry a lot," she says. "Jefflove thinks a lot and asked me the other day, 'Do you think I will finish my studies?' I encourage her as much as I can. She is an intelligent girl and very religious. My son Vekerson doesn't like to be too far from me. All of them wonder what is going on, first the earthquake, then the hurricane and now cholera. As a mother, I have suffered.
I have high blood pressure and I am nervous. Before the earthquake I was happy to be a stay-at-home mother, but now I don't like to be there on my own. I love my children and am worried about their future. I have cried a lot of tears for them and my country."
The disasters sparked a huge international aid effort. In a bid to minimise the spread of disease, UNICEF, alongside various charity partners, began emergency vaccinations, immunising two million children against polio, diptheria and measles; mosquito nets were distributed to 163,000 homes and gaping holes in the country's water, sanitation and healthcare system were quickly identified.
As footage of the devastation reached this country, millions of pounds of donations from ordinary members of the public in the UK flooded in, but as the days turned into weeks and months the ongoing problems in Haiti, a region for decades strangled by violent dictatorship, inevitably slipped off the agenda.
Peter Skelton, a physiotherapist, originally from Scarborough, spent a month working in Port-au-Prince following the earthquake. Like many he was struck by the profound dignity of people who had found themselves in extraordinary circumstances, but he knows that far bigger challenges now lie ahead.
"Haiti was a troubled country even before the earthquake, but the local expatriates talked of how the city somehow felt calmer and safer before the horrors of January 12," says Peter, who was out in Haiti with CBM, an organisation set up to support people with disabilities.
"Forward to today, when the news teams, disaster tourists and celebrities have largely left the country behind and you find a country blighted by a cholera epidemic, where 1.3 million people live in temporary camps, where security continues to worsen, where many people cannot access the health care they need and where donor pledges have yet to materialise.
"However, optimism must remain in a country where not one person has been unaffected by this tragedy. There must be hope that as the construction efforts pick up pace, issues of access, employment and education for those with disabilities will be prioritised and that discriminations can be fought by Haitians at every step."
Cholera remains Haiti's biggest threat. The bacteria has so far affected more than 112,000 people and while it is simple to treat, it's also easy to contract. UNICEF is now focusing its efforts on prevention rather than cure, working to ensure clean water supplies and launching a hygiene education programme.
So far the charity has distributed more than 13 million water purification tablets, seven tonnes of chlorine to disinfect the public supply and teams of specially trained educators have taken to the streets and marketplaces using megaphones and posters to spread the message.
Talks have also been given in churches, on the radio and via text messages and in schools students are being taught to take the word back to their families. Much of the work is about dispelling myths, like the one which saw new mothers stricken with cholera refusing to breastfeed their babies for fear of infecting them with the disease.
In the new clinics funded by donations to UNICEF, long queues still form with some having walked for hours through the night to see a doctor. It's still an improvement on what went before. Most conditions can now be treated at the first visit and only the most serious cases have to be transferred to the capital's main hospital.
However, those on the frontline face an uphill struggle. The majority of the country's 22,000 schools still lack safe drinking water, health specialists predict the cholera will remain endemic in the country for many years and aside from the many practical hurdles that must be jumped through to rebuild Haiti's infrastructure, the last 12 months has also wreaked emotional devastation among those who saw their lives destroyed in a few brief seconds.
Tears still well in the eyes of Jean Andre Durvier when he remembers the moments after the quake. Already a widower, he watched his house in the Port-au-Prince suburbs of Dalmas collapse and life has been a struggle ever since. However, there is a glimmer of hope.
While the school his children attended has not yet been rebuilt, next door a tiny classroom has sprung up. Jean's eldest son Mackintosh is described as a model pupil and for both he and his younger brother Freddy the classroom is a welcome refuge from reality.
"They are with their friends who are terribly important and they can learn," says school principal Elizabeth Myrtha Hyppolite. "It is much better that they are at school than at home surrounded by the memories of January 12 or in the camps which is not an environment the children should be exposed to for a long time."
Building work in Haiti continues, but the emotional scars will take much longer to heal. "I think about this every day," says Jean Andre, hanging his head and nodding silently. "I live from day to day, relying on the generosity of friends and family and what little work I can get.
So many things have happened this year and my children feel confused. I am their father and I am the key figure in their life. I have to keep their morale up and keep them stable. I have to be their anchor."
ISLAND'S LEAGUE TABLE OF DEATHS
1935: Storm kills 2,000.
1946: A tsunami hits the island, leaving 1,790 dead.
1954: Hurricane Hazel results in a death toll running into hundreds.
1963: Hurricane Flora kills 6,000 in Haiti and Cuba.
1998: Hurricane George destroys 80 per cent of the island's crops.
2004: Following floods which kill 2,600, Tropical Storm Jeanne leaves 1,900 dead.
2007: Tropical Storm Noel triggers mudslides and floods.
2008: Three hurricanes and a tropical storm claim the lives of 800.
2010: An earthquake with its epicentre in capital Port-au-Prince kills 200,000, and a hurricane floods the temporary camps. So far the cholera epidemic has killed more than 2,500 people.
How aid is helping to slowly reunite families and givechildren hope for the future.
In the days after last year's earthquake shook Haiti to its foundations, Joseph Charles struggled to believe there could ever be a happy ending for his three young daughters.
Like most of his fellow countrymen, Joseph had earned a modest income. He worked hard as a rice farmer in the bustling seaside town of Leogane and with the money his wife made selling fruit and vegetables, they made just enough to get by. Together the couple, along with 12-year-old twins, Latima and Karline, and toddler Jocelyn, lived a quiet life, but the earthquake, which measured a massive 7.3 on the Richter scale, took away what little they had in an instant.
With no house and no income, the couple were forced into a corner and had no option but to put their three girls into a local residential centre. There, they told themselves, they would at least be fed and looked after. It's the kind of social net many poor Haitian families have been using for decades.
The country is poor beyond the comprehension of Western societies. Almost two-thirds of the population took home less than $2 a day before the earthquake. After the disaster many earned nothing at all. Yet, Joseph and Marie couldn't help feeling they could have done more for their children.
"I was embarrassed and ashamed," says the mother-of-three. "It was the most difficult thing I have ever had to face. We visited the children every second week, but it was heart-wrenching to leave them. We felt we had failed in our duty as parents."
In a country which was already the poorest nation in the Americas, the earthquake pulled the rug from under many struggling yet fiercely proud families.
"The economic situation of children and their families prior to the earthquake was precarious at best," says UNICEF Haiti chief of child protection Jean Lieby. "Forty per cent of all the children registered were actually separated from their parents prior to the earthquake. There are deep-rooted inequities in Haitian society and those have only been worsened by last year's disasters.
"Children in particular have suffered and the problems that exist require more than an emergency response to resolve. It needs organisations like UNICEF to prepare Haiti and its people for the future."
Today, Leogane is no longer the busy provincial hub it once was. Buildings remain flattened, rows of homes have been replaced by temporary encampments and the threat of cholera casts a dark shadow over the place. Yet from amid the rubble stories are emerging which stand as testament to the resilience of the human spirit.
UNICEF's partner, the international support agency Terre des Hommes has set up a project to help prevent even more families fragmenting.
Currently it operates on a small scale – Joseph and Maria are among just 24 families so far selected for the scheme – but its achievements have been priceless. With their help, Joseph has not only been able to return to his rice fields, but now employs staff which in turn allows them to provide for their own families.
After a couple of months at the residential centre, the Charles' girls came home, which was the ultimate success story for a project set up to show even the most devastated family units can be rebuilt. Yet those involved in the crisis know it is only just the start of a healing process which will take years and quite possibly decades.
"We have seen results in the past year," says UNICEF Haiti representative Francois Gruloos-Ackermans. "We have helped register and reunite many children who were separated from their families and together with other agencies have set up schools, procured tents and educational materials, which has allowed 720,000 children to resume lessons and in some cases start for the first time.
"But significant gaps remain and much more must be done, Chronic malnutrition affects one in three children under the age of five and more than half of Haiti's children still don't attend school.
"These children have the right to grow up with education, nutrition, clean water and safe sanitation; they have a right to be free from exploitation and disease and we believe that with support and commitment, the seeds of recovery and development can be planted and these goals can be achieved."
No one is pretending that all is well in Haiti. Much rubble still has to be cleared, issues of land tenure continue to be an obstacle for those trying to rebuild a battered infrastructure and corruption and child trafficking requires constant monitoring.
However, for all the problems in Haiti, many are starting to emerge from the darkness of the last 12 months and the excited look on the faces of the Charles children as they rush to greet their mother who is waiting at the doorstep of their small home says it all.
They are once again a family, and that is the one thing that matters most of all.