Reporting from Port-Au-Prince, Haiti — When Guerrier Lejean feels nature's call, he creeps to the edge of his urban encampment and relieves himself in the bushes.
He has been doing so since the Jan. 12 earthquake left him homeless, and so have most of his approximately 2,500 neighbors who huddle in shelters made of sticks and bed sheets.
The crowded camp, wedged between an exhaust-choked boulevard and the Port-au-Prince airport, has no bathrooms. Many residents defecate into plastic shopping bags and hurl them into the fetid waters of a channel that runs along the edge of the camp.
"It's not good, but you have no choice," said Lejean, a 53-year-old auto-body repairman. "You can't just relieve yourself right where you live, in front of everyone."
A dire shortage of toilets in the more than 300 encampments that have sprouted willy-nilly across Port-au-Prince has added to the list of daily rigors faced by displaced residents. But it is more than a matter of inconvenience.
With rainy season expected to begin next month, sanitation and hygiene loom as urgent health concerns for about 1 million people living in fields and vacant lots in quake-struck areas in and around the capital.
Former President Clinton, the United Nations' special envoy to Haiti, called sanitation the most pressing need facing quake victims and warned of the dangers, "particularly for little kids."
"They have no place to go to the bathroom and, as a result . . . they may be contaminating every piece of standing water," Clinton said in an interview with Fox News' Major Garrett. And that, he said, could lead to diarrhea, dysentery, cholera and tetanus, "and we could have a huge second wave of casualties."
Aid workers say coming rains will increase the risk of disease outbreaks. Authorities are racing to get latrines built and portable toilets and hand-washing stations installed before heavy rains begin.
"Once the rain comes, the feces will flow everywhere," said Therese Dooley, senior advisor for sanitation and hygiene at UNICEF. "A gram of feces contains billions of bacteria and pathogens. What you have to worry about is them getting into the food chain and the mouth."
Haitian officials hope to have in place at least 18,000 latrines, one for about every 50 displaced people, within a few weeks. Authorities want to eventually cut that ratio to one latrine for every 20 people.
Aid groups are digging pits, installing portable toilets and erecting latrines with above-ground storage tanks. Camps are gradually being outfitted with hand-washing stations: 2-liter plastic sacks or 200-liter drums with nozzles and soap.
Relief officials point out that proper hygiene can be even better at preventing disease than latrines. UNICEF, has handed out hygiene kits with buckets, soap, toothbrushes and sanitary napkins to 86,000 families.
No outbreaks of disease have been reported, but the task has not been easy.
The crush of people in the impromptu urban settlements has left little room for latrines. Many people are bunked down on paved streets and parking lots, making it impossible to dig trenches to serve as makeshift outhouses, as has been done in some bigger camps. And in several places where such outhouses were constructed, early rains caused the walls of the pits to collapse.
Adding to the problems, not everyone knows how to use the facilities. A Haitian work crew building pit latrines on the grounds of a vast golf course-turned-camp was dismayed to find stall after stall soiled by people who did not lift the lids over the floor holes.
"Maybe there's a way to pass the word how to use the toilet," said crew member Samuel Jacques, who has been living in the camp since his house collapsed. He and fellow workers decided that someone should pass through the giant camp with a megaphone to instruct residents.
Aid workers say they are taking a flexible approach to sanitation, tailoring solutions for the conditions. Agencies have rented most of the available portable toilets in the country, about 500, and hope donated units from abroad will bring that number to nearly 6,000. Groups such as Oxfam are scrambling to get 30 more toilet-sanitation trucks shipped in from abroad.
Sanitation specialists are exploring more exotic methods, such as toilets that can separate liquid and solid refuse. In the short term, plastic bags may have to suffice in certain places -- but with a more reliable system for collection, said Nicholas Brooks, an Oxfam sanitation and hygiene specialist.
Longer-term answers will hinge on emerging plans for where to resettle people.
Experts point out that Haiti already was sorely in need of sanitation; fewer than a third of Port-au-Prince's residents had proper toilets before the earthquake. Many people relied on public bathrooms in their neighborhoods or relieved themselves in plastic bags and tossed them in a hole.
"You're already playing catch-up," said Dooley. "Even before the earthquake, there was a sanitation emergency."
For the displaced, the lack of toilets and sinks is another unhappy reminder of how little control they have over their lives, even as emergency supplies of food and water have grown more reliable.
In the encampment where Lejean was playing checkers with a friend, people filled buckets from a pair of giant plastic water tanks. Many residents now list a toilet -- any form of toilet -- as one of their two top needs, along with more permanent shelters.
"Circumstances caused us to live here," said Lejean's friend, 28-year-old Gaulthier Herbert. "Nobody wanted to live out here."