Corruption, theft and other crime and Haiti's sheer shortage of fundamentals - reliable roads, telephone and power lines and a sound financial system - add to the difficulty as foreign governments and charities try not only to help Haiti recover from the disaster but pull itself out of abject poverty.
It is one of the poorest places on Earth. Most basic public services are lacking, people typically live on less than $2 a day, nearly half the population is illiterate and the government has a history of instability. The public has little opportunity to be sure that aid to the government is used honestly and well. Nor is following the money easy for donors, including the United States, 700 miles away and one of the country's biggest helpers.
"It has been a challenge and I think it really is one of the things we have to look at when the country has had such long-standing problems that it seems as though we have made little dent there," said Rep. Russ Carnahan, Democratic chairman of the House of Representatives Foreign Affairs Committee's subcommittee on international organizations, human rights and oversight.
The immediate focus is search and rescue and addressing immediate public health needs. But after that, "I think there's going to be a number of questions that arise," Carnahan said.
Just last month, a private group, the Heritage Foundation for Haiti, urged Haiti's government to complete an audit of a $197 million emergency disaster program to respond to corruption allegations over how the money was handled. Haiti's senate cited the allegations when it removed Prime Minister Michele Pierre-Louis in November and replaced her with Jean-Max Bellerive.
President Barack Obama promised at least $100 million in earthquake aid. That comes on top of substantial spending by the United States in Haiti in recent years for economic development, such as the country's textile industry, humanitarian assistance, environmental programs, and law enforcement, including trying to stop the use of Haiti as a pass-through point for narcotics en route to the United States.
Apart from earthquake relief, senators working on the next annual foreign assistance budget have proposed at least $282 million for Haiti; the House proposal would provide at least $165 million.
Much of the U.S. government's aid to Haiti comes through the U.S. Agency for International Development, which has provided at least $800 million from budget years 2004 through 2008, agency figures show.
At least $700 million more was pledged for Haiti by governments, international givers and charities at an April 2009 donors conference. Former President Bill Clinton, a United Nations special envoy to the country, told the U.N. Security Council in September that he was "100 percent committed to delivering tangible results to the U.N. and most importantly the people of Haiti."
The Haitian government relies on foreign aid to keep itself and its economy operating.
In a December 2008 Gallup survey, 60 percent of Haitians interviewed said there had been times that year when they didn't have enough money to buy food, and 51 percent said there were times they couldn't afford shelter.
Statistics about Haiti, as gathered by the U.S. government, chronicle a grim standard of living. According to the CIA and State Department, 1 in 8 children in Haiti dies before age 5. The life expectancy is 59 to 62 years. Malaria, typhoid and dengue fevers and other life-threatening illnesses long ago wiped out in the industrialized world still plague Haiti.
For government and private relief organizations, simply communicating and moving money and supplies around in the country, including money, were difficult absent a natural disaster like this one.
As of 2008, Haiti had 108,000 main telephone lines in use, putting it 142nd among countries in land-line phone use, but ranked better on cellular access. There were 3.2 million cellular phones in use in 2008, making it 105th worldwide by that measure, the U.S. government said.
"Attention on Haiti is often focused in times of disaster but not necessarily in the long-term," said Rich Thorsten, director of international programs for Water.org, a charity working to provide safe drinking water and sewage treatment to Haitians. "Funding that has been available does not necessarily go toward basic infrastructure like water and sanitation."
The Haitian government doesn't use its own resources for sanitation, and instead depends on charities, Thorsten said. In addition, international groups often do not coordinate, and there are also problems with security, corruption and political stability, he said.
"It is very important to keep track of the spending, and so when we work with partner organizations we make sure they have detailed accounting systems," he said. Supplies must be guarded, he added.