A family rushes and injured girl to a hospital on Wednesday in Port-au-Prince, Haiti. (Patrick Farrell/AP, The Miami Herald)When a powerful earthquake struck Haiti on Tuesday, many of those injured by collapsed buildings lay in the streets pleading for help. Even for those with open fractures and head injuries, there was little else they could do.

Haiti is not prepared to handle disaster.

By every measure, it's the poorest country in the Western hemisphere and it has a health care system to match.

There have been improvements in overall life expectancy and infant mortality, and vaccination programs have helped largely eradicate some diseases like polio, but the country remains desperate for affordable health services. What few services existed declined in the last two decades because of political instability.

The country spends less than $85 per person on health care every year, and much of what is actually delivered is done by a patchwork of agencies from around the world.

Haiti has a public health crisis, according to Médecins Sans Frontières (MSF)/Doctors Without Borders, one of several foreign medical aid groups that operate free emergency health services in the country. MSF's own clinics are often overwhelmed by people who can't afford to pay for private care. Public hospitals and clinics are plagued by management problems and shortages of medications, says the organization.

Little infrastructure, supplies, staff

Another crippling problem is that there aren't enough trained medical staff. Many doctors have left the country to escape violence or just to get paid. Cuba is filling some of that gap, training Haitians to be doctors and sending its own medical help during crises.

In the recent quake, MSF struggled to set up tent hospitals in Port-au-Prince because its three facilities were unusable.

The epicentre of the Jan. 12 earthquake. (CBC) "The reality of what we are seeing is severe traumas, head wounds, crushed limbs, severe problems that cannot be dealt with with the level of medical care we currently have available with no infrastructure really to support it," said Paul McPhun, operations manager for the group's Canadian section. The country's health indicators are grim. The average life expectancy is about 52, and Haiti has the highest infant and maternal mortality rates in the region.

More than 138,000 children under five die of preventable diseases every year, and women routinely die terrible deaths in childbirth because they live too far away from medical help, in rural areas without services or simply can't afford to pay for services.

UNICEF says that out of every 100,000 live births, 670 women died of pregnancy-related causes in 2006. That's five times the Latin American average.

Diarrhea, respiratory infections, malaria, tuberculosis and HIV/AIDS are leading causes of death. There is poor sanitation and increasing malnutrition, brought on by growing poverty.

In rural areas, only 14 per cent of residents have adequate sanitation, and most rural Haitians lack even basic health care services.

Years of political unrest ravaged health system

Another problem that's shut down hospitals is violence. Health care providers were so afraid of it at times that they wouldn't leave their houses to go to work.

Many Haitians use traditional healing as it's more readily available and it's believed that local healers can deal better with what are considered "native" problems. One study says about a quarter of all Haitian women seek out traditional healing when their child is sick, and the mothers who most often go that route are unlikely to vaccinate their offspring, one of the keys to avoiding deadly diseases.

Haiti's minister of population and health, Robert Auguste, says the country is rebuilding its rudimentary health care system, which has been ravaged by years of political unrest.

In 2008, he told the British medical journal the Lancet: "You cannot repair 20 years of disorder overnight."

But what you can do overnight is wreck some of the few institutions that work: two hospitals in the capital are reported to have collapsed in this week's earthquake.

Canada is one of Haiti's largest donors. It's committed $555 million over five years (2006-11) for reconstruction and development, and part of that money is going into basic health care services.

Whatever Canada has to offer, it can't arrive soon enough.