Venecia Louis nearly starved last year after four tropical storms pummeled Haiti. Now the 4-year-old's cheeks are pudgier, but her hair is thin and her stomach is swollen — both telltale signs of malnutrition.
Like Venecia, Haiti is barely hanging on as the season's first named storm of hurricane season heads its way. Ana, downgraded to a tropical depression, was moving across the neighboring Dominican Republic on Monday, dumping about four inches of rain.
Almost 2 million Haitians do not get enough to eat every day, according to the U.N. World Food Program — down from 3.3 million last year, which is still about a third of the population. Aid groups have increased emergency stockpiles, but the conditions that put much of Haiti at risk have not changed.
Haiti's most vulnerable live in remote villages like Venecia's home of Mabriyole, a collection of shacks in the Baie d'Orange region. Heavy rains race down deforested mountains destroying houses, roads and fields every year. Bad roads isolate the region just when it needs help the most.
"There are many places like Baie d'Orange, and they are all vulnerable," WFP country director Myrta Kaulard said.
It's hard to top the horror that emerged last year on this remote plateau dotted with plantain and pine trees, where the sound of an approaching SUV brings everyone out of their concrete shacks and thatch huts in the hopes that it's someone bringing food.
12 miles in six hours
The area is no more than 12 miles south of Port-au-Prince's suburbs. But because there is no direct road, reaching Venecia's home takes six hours over a mountain highway and then following rocky roads through riverbeds and up switchbacks.
The mountaintops reward visitors with stunning views, with peaks rising more than 6,500 feet and rolling orange soil that ends suddenly as cliffs drop straight to the shimmering turquoise Caribbean below.
It looks like an ancient sailor's vision of the edge of the world — and last year it might as well have been.
As four storms killed nearly 800 people and caused $1 billion worth of damage in Haiti, it took nearly two months for aid groups to learn that 26 children had starved to death or died of malnutrition here.
Venecia was reduced to skin and bones, her abdomen distended from malnutrition, when her mother, Rosemen Saint-Juste, carried her in her arms to a clinic in Baie d'Orange, a couple of hours away. She was rushed to a Doctors Without Borders clinic in Port-au-Prince, where she was nursed back to health.
There, she drew worldwide attention to the emergency after she was captured in a Nov. 19 photo by The Associated Press, her bony limbs dangling from a sling scale and sunken eyes peering out from under a bright yellow bow.
Aid groups rushed to get food into the area — using helicopters after a WFP driver died when his truck slid off a road.
Eight months later, Venecia's face is more expressive. But her frail arms, patchy hair and continuing bouts of diarrhea are all signs of malnutrition.
Her older sister, 7-year-old Minush, has a swollen stomach and thin limbs as well. Only the oldest, 10-year-old Silner, has consistently appeared in good health.
Saint-Juste and her children received food aid for a while after Venecia returned from Port-au-Prince.
A few months ago, her husband, who works in Port-au-Prince, gave them a 50-pound bag of ground corn, which she keeps hidden from neighbors to ensure it will go to her children.
2-year-old too weak to walk
"I give them whatever food I can find: beans, corn, rice. But sometimes they still lose a lot of weight," Saint-Juste said, cradling a pale and listless 2-year-old who is too weak to move on her own.
In advance of this year's storm season, aid groups have stockpiled enough food to feed up to 1 million people for a month and a half, WFP spokesman Jim Farrell said.
But aid workers say emergency measures can only do so much, and more systemic changes that would help Haiti sustain itself remain distant.
Years of cheaply imported food under U.S. trade deals undercut local farmers, and Haiti now grows only 40 percent of the food it needs, according to the U.N. Food and Agriculture Organization.
Even when aid reaches Baie d'Orange — about 212 metric tons were distributed in the months after the emergency — the people of Mabriyole complain they can't get to it, as young men from a neighboring village threaten to attack anyone who tries to claim their share.
Meanwhile, poor farmers fill every available space, using techniques that degrade the soil and cutting trees to make charcoal. Fertile land that could produce crops is underused in some parts of the country because of land ownership disputes.
In Mabriyole, the harvest of beans, corn and sweet potatoes is coming soon. WFP stopped distributing food here in June to avoid undercutting local farmers, though food-for-work programs and distributions at summer camps have continued elsewhere in the country.
Kaulard says the country needs networks of people who can monitor areas like Baie d'Orange and Mabriyole for signs of crisis to prevent deadly delays like last year's.
So far there is nothing like that in place.