PORT-AU-PRINCE Clutching automatic assault rifles, truckloads of U.N. troops patrolled the streets of Haiti's shattered capital on the day after the earthquake hit last month, seemingly oblivious to the misery around them.
Cries for help from people digging for survivors in collapsed buildings were drowned out by the roar of heavy-duty engines as the troops plowed through Port-au-Prince without stopping to join rescue efforts, much less lead them.
A common sight since they were deployed in 2004, the U.N. troops huddled in the shade of their canopied vehicles.
There were about 9,000 uniformed U.N. peacekeepers stationed in Haiti when the quake struck on January 12 and they were the logical "first responders" to the disaster in the impoverished Caribbean country, whose notoriously weak central government was overwhelmed by the scale of the tragedy.
Initially, however, none of the peacekeepers appeared to be involved in hands-on humanitarian relief in what emergency medical experts describe as the critical first 72 hours after a devastating earthquake strikes.
Their response to the appalling suffering was limited to handling security and looking for looters after the magnitude 7.0 quake leveled much of the capital and took what Haitian President Rene Preval says could be as many as 300,000 lives.
There was looting in the capital, but it paled in comparison with the severity of the humanitarian crisis.
Horribly-injured patients flooded overstretched hospitals, forcing medical staff to decide which patients to treat and which were already too far gone to try saving.
"Doctors played God," said Tyler Marshall, a veteran former Los Angeles Times correspondent working with an international aid group that helped out in a tent city erected at the height of the carnage on the grounds of Port-au-Prince's University Hospital, the country's largest.
Scores of U.N. personnel died in the quake, including Hedi Annabi, head of the U.N. mission that was set up in 2004. That helps explain what many have criticized as a glacially slow kickoff of relief operations after one of history's worst natural disasters.
But in the days and weeks that followed it often seemed that lessons from other disasters were ignored in Haiti as fears of rioting or lawlessness overshadowed concerns about getting aid out quickly.
The U.N.'s top humanitarian aid official, John Holmes, is among those who have chided relief agencies, including the United Nations itself, for doing too little to help Haiti.
"We cannot ... wait for the next emergency for these lessons to be learned," Holmes wrote in a confidential email first published on the website of the journal Foreign Policy.
"There is an urgent need to boost significantly capacity on the ground, to improve coordination, strategic planning and provision of aid," said Holmes.
Edmond Mulet, acting head of the U.N. mission, acknowledged in an interview that it played a limited humanitarian role in the first few days after the earthquake since its operations were effectively decapitated.
"At the very beginning it was very difficult because all the headquarters was completely destroyed and all the leadership of the mission was killed," Mulet told Reuters.
'CRIMINALS AND BANDITS'
Mulet gained notoriety for wielding an iron fist during a previous stint as head of the U.N. mission when he led mostly Brazilian "blue helmet" troops in a successful crackdown on Haiti's heavily armed gangs.
And he has made no secret about juggling the competing needs of relief operations with law enforcement, in his bid to track down the more than 3,000 inmates who took advantage of the earthquake to escape from its main prison.
"We are here also to provide security," he said when asked about the failure of convoys of rifle-wielding U.N. troops to search for people trapped in the rubble of the ruined capital.
"I still have to patrol, I still have to go after all these criminals and bandits that escaped from the national penitentiary, the gang leaders, the criminals, the killers, the kidnappers. I cannot really distract myself from doing that."
The relief mission shifted into higher gear after U.S. troops deployed in large numbers and set up a supply chain to get food and medicine into areas crying out for aid.
But there were still many bottlenecks and setbacks, often involving U.N.-linked food distributions hobbled by inadequate organization, supplies and crowd control.
Unfortunately, U.N. troops in Haiti have over the years gained a reputation for toughness and abuse more than for easing suffering in the poorest country in the Americas.
"The only time I've seen one of these U.N. troops jump out of the back of a truck was to beat up on somebody or take a shot at them," said a member of the U.S. Army's 82nd Airborne Division, as he worked security during a recent aid handout.
"These guys have given all of us in uniform a bad reputation here," he said, asking not to be identified.
Haiti's wrecked infrastructure and poor transport links made it difficult to get aid out and keep it flowing, but that hardly made the situation different from that in other recent disasters around the globe.
'POOREST AND MOST VULNERABLE'
"The poorest and the most vulnerable people tend to live in the regions that are hit the most by natural disasters," said Solomon Kuah, an emergency medical physician based in New York who spent four weeks in Port-au-Prince after the quake.
There are no reliable estimates for the number of survivors who died from injuries due to inadequate medical supplies.
But Henriette Chamouillet, the World Health Organization's representative in Haiti, said everything from staff shortages to bureaucracy and a lack of packing lists snarled the delivery of containers full of medicines from Port-au-Prince's airport to doctors on the ground.
Port-au-Prince sits just 700 miles off the coast of Miami, which is home to a large Haitian-American community, and it seemed absurd that so few of the U.S. troops rushed there spoke French or were accompanied by translators.
One gripping image of chaotic food distributions came when U.S. helicopters offloaded boxes of MREs (Meals Ready to Eat) at a site in the capital. Many Haitians opened them up only to toss them away in disgust because no French or Creole-language instructions were included with the apparently useless packets of dust, explaining that they needed to be mixed with water as part of their preparation.
Rajiv Shah, head of the U.S. Agency for International Development, has touted the Haiti relief mission as "the largest and most successful international search and rescue effort ever assembled in history."
But more than six weeks after the quake hit, the mission is still largely in an emergency response mode. The U.N.'s World Food Program is limiting its food rations to 55-pound (25 kg) bags of rice and the Haitian government estimates that a million quake survivors are still living in the streets in makeshift encampments with no running water or toilets.
Doctors are almost done dealing with traumatic injuries but rehabilitation for some 40,000 amputees and rebuilding Haiti's health infrastructure are among long-term challenges.
"This is really a disaster of Biblical proportions," said Lewis Lucke, who was the USAID director in Iraq before coming to Haiti as U.S. ambassador.
U.N. and other officials have said the global response to Haiti's quake was quicker and more effective than in other recent disasters, including the Asian tsunami that killed 226,000 people in 13 countries in December 2004.
But experts say the United Nations has a lot to learn from smaller, more nimble medical groups like International Medical Corps, or IMC, and Paris-based Medicins Sans Frontieres, along with charities more experienced in distributing aid, such as CARE and Catholic Relief Services.
Kuah, who coordinated relief efforts for IMC, a California-based group that had highly skilled doctors treating patients in Haiti 23 hours after the earthquake struck, stressed the "need for speed" when it comes to saving lives.
"When you ask yourself if there were ways you could have prevented more mortalities or diminished excess mortality, with earthquakes, in particular, it's more timing than anything else," said Kuah.
(Additional reporting by Catherine Bremer, Jackie Frank, Patricia Zengerle, Mica Rosenberg and Andrew Cawthorne; Editing by Kieran Murray)