In the aftermath of the earthquake near Port-au-Prince, Haiti, it is useful to review the four stages of post-disaster misery and to consider how our expensive Western institutions and society are designed to protect us. Each successive stage is easier and cheaper to prevent or mitigate than the stage before it. Unfortunately, in the case of Haiti we're likely to see all four stages play out to their fullest.

Stage 1: Immediate aftermath. People are killed or injured directly by the disaster itself. Stage 1 is often impossible to prevent and very expensive to mitigate.

Stage 2: Zero to three days. Within the first 72 hours people who were injured during the disaster will start to die from their injuries if they do not receive treatment. People who are trapped in rubble or otherwise isolated will also die. Stage 2 can be mitigated by extensive search and rescue capabilities that are on-site in the immediate aftermath of the disaster, and by a robust medical system that was not degraded itself by the disaster.

Stage 3: Four days to two weeks. Lack of water, sanitation, and electricity (depending on the climate) will begin to cause an explosion of communicable diseases within the first two weeks after a disaster. People who survive the disaster itself will fall sick with respiratory and digestive tract diseases, and minor injuries will become infected and cause further mortality. Caches of emergency water will be consumed, further weakening the survivors. Stage 3 can be prevented or mitigated by quick repairs to basic services and by the delivery of water and generators.

Stage 4: Two weeks to one month and beyond. Starvation will take hold in urban areas if basic infrastructure is not restored within one month. Urban population centers will begin to dissipate as survivors migrate into rural areas in search of food. Social unrest will quickly lead to the complete breakdown of pre-disaster political institutions, and survivors will form into ad hoc gangs or tribes. Violence will break out as these groups fight for control of resources. Stage 4 can be prevented by strong institutions that are powerful and organized enough to prevent food scarcity and provide basic physical security.

As we've seen in Haiti, most third-world urban centers are precariously balanced -- they wear a visage of civilization, but reality can come crashing down in an instant. The institutions required to mitigate suffering in the aftermath of a disaster are a form of insurance that must be built before a disaster strikes, but they're viewed as a luxury that poor countries are reluctant to invest in when money could instead be spent building an appearance of civilization. They choose to have a higher median quality of life with greater risk than a lower median quality of life with less risk.

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