YARMOUTH — I recently returned from Port-au-Prince, Haiti. This was my third trip to Haiti since the January 2010 earthquake, which killed an estimated 200,000 Haitians and left tens of thousands of children orphaned. An estimated 2 million children were affected by the earthquake, many seriously injured or traumatized and at high risk for post-traumatic stress disorder.

A large number of children are among the estimated 10,000 Haitians who have died and over 800,000 who have become seriously ill from cholera since the earthquake. (The disease remains endemic, killing roughly three dozen people a month.) What’s more, an estimated 350,000 people still live in crude displacement camps.

I traveled to Haiti representing the Portland-based nonprofit International Childhood Enrichment Program, with the goal of helping to construct safe playgrounds and play areas for children who have been traumatized by the numerous disasters that have plagued the country.

One of the major impacts of disasters, both natural and human-made, is a disruption in a child’s ability to engage in childlike play – play that is creative, imaginative, engrossing, all-consuming and almost always active.

While many may view play as less life-sustaining than the primary needs of food, shelter and sanitation, researchers have found that the inability to engage in childlike play prevents the child’s brain from developing essential factors related to resiliency and trauma recovery.

This is a “Catch-22” phenomenon: The higher-ordered functioning that would allow children to overcome future traumatic events is underdeveloped because of the trauma they experienced in their early childhood. In other words, without spontaneous play, children are many times stuck in “fight or flight” response and at risk for becoming isolated and depressed.

Haiti, the poorest country in the Western Hemisphere, has faced ongoing disaster throughout its 240 years of existence. (For a detailed accounting of Haiti’s troubled history, read Laurent Dubois’ “Haiti: The Aftershocks of History.”)

As I walked through the streets of Port-au-Prince, especially the extremely impoverished, sprawling Carrefour District, I pondered, “How and when will the lives of these millions of people improve?” Six years after the earthquake, Haiti is still in rubble, with little or no services.

My senses were overwhelmed by the sight and smell of people still living in crude displacement camp conditions, with roads and buildings still in disrepair and the stench of sewage flowing through the streets. My next question, logically, was: “What happened to the estimated $13 billion in earthquake aid?”

Journalist Jonathan Katz provides an answer to that question in his 2013 book “The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster.” Ninety-three percent of that money either went to United Nations agencies or international organizations, or it never left the donor government, according to Katz. On top of that, billions of dollars of promised funds were never delivered.

Global development analysts see problems with this disaster-relief spending model, in which the vast majority of funds are funneled through foreign contractors instead of the Haitian government or local businesses. Katz further explained that the majority of the money allocated for Haitian aid went for short-term assistance, such as bandages, tarps and food. The people were left without anything durable or sustainable.

The International Childhood Enrichment Program, which has worked to provide safe opportunities for children to engage in childlike play since 2004, avoids this paternalistic model. Instead, the program seeks to empower local residents to take ownership of the play spaces.

Currently raising funds to build two playgrounds in Port-au-Prince, the ICEP buys playground equipment from Haitian companies and hires local laborers to coordinate, build and install playgrounds in secure, accessible places such as schools, health clinics, orphanages and community recreation centers.

In the immediate aftermath of disasters, aid agencies, whether foreign governments or nongovernmental organizations, must provide immediate relief. For long-term, sustainable improvements, aid providers need to empower local citizens to rebuild their communities. Without such local involvement, countries in need of assistance may never develop the means necessary for a sustainable future.