Nearly 800 people died in the four storms that ravaged Haiti this year
More than six weeks after the fourth cyclone in three weeks hit Haiti the relief operation has almost ground to a halt according to a major aid organisation there.
Max Cosci, spokesperson for Medicins Sans Frontieres in Haiti, says that a mixture of red tape and a failure to properly coordinate the work of different aid agencies is to blame.
"There are a lot of organisations, especially NGOs and humanitarian organisations, international or national and there is not a clear coordination among them" he says.
Mr Cosci is particularly concerned about the lack of progress in helping the people of the badly hit town of Gonaives.
"The streets are full of mud, the houses are still destroyed. People are living on their roofs. If you went there you would say, oh my God, the cyclone was yesterday - not a month or five weeks ago."
At least 800 people are known to have been killed in the storms, the last of which hit Haiti in early September. Many people are still missing and hundreds of thousands are still homeless.
Many homeless people still sheltering in churches and schools have been pushed out onto the streets, as classes and congregations reclaim the buildings.
Aid has also been stolen and sold on the black market and malnourished children given the wrong type of food, delaying their recovery even further.
Haiti's Prime Minister, Michele Pierre-Louis, agrees that the relief operation is badly organised and that her government is finding it impossible to coordinate the work of many international aid agencies.
"It's true that there is a major coordination problem. You see, a lot of NGOs do as they wish and the government has not been able, so far, to coordinate their efforts," she says.
Ms Pierre-Louis says this is because western countries have long viewed Haitian governments as corrupt and inefficient.
As a result they channel their donations through international aid agencies, or NGOs, who then virtually run the show.
She insists that times have changed and foreign aid organisations should now allow her ministers to better co-ordinate their activities.
But Ms Pierre-Louis believes the world's financial crisis, which has resulted in much of the promised aid failing to arrive in Haiti, is an even bigger problem.
"Close to a month after [the last cyclone] we only got 10% of the amount solicited," she says.
The city of Gonaives was completely devastated by Tropical Storm Hanna
Haiti is a largely mountainous country and many remote villages were hard to reach even before roads and bridges were damaged or even washed away by the hurricanes.
As a result helicopters are vital to the relief operation. But these are in short supply and expensive to use.
MSF's Max Cosci says the consequence of this is a growing desperation in areas hard or virtually impossible to reach by road.
"People are beating each other to get some small things. When we go there by helicopter they are starting to fight because they think that we have food. It is the consequence of the hunger of the people and the lack of humanitarian aid in these regions," he says.
With rice crops in many areas of Haiti wiped out by the cyclones and much of the world still consumed by its own financial woes the people of Haiti face an increasingly worrying future.