Charities and aid groups in Haiti have been marked by scandals in the past decade.

Over the past decade the international community has sent more than $13 billion in aid to Haiti, but life for most in the country has only grown more perilous. Analysts say that support has propped up troubled institutions and prevented necessary reforms.

While religious groups and international aid organizations provide vital services for Haiti, the history of such groups in the country also includes cases of neglect and abuse, highlighting just how unregulated and unruly the international aid system can be.

In 2010, after an earthquake killed more than 200,000 in Haiti, the United States led a mass international adoption effort that saw many safeguards dropped to speed the evacuation of children. Some were sent to the United States without adequate paperwork or screening to make sure they weren’t improperly taken from relatives. An unknown number were left in the American foster care system because adoptive families had not been formally arranged or backed out.

The aid effort in response to the earthquake also brought other problems. A group of United Nations peacekeepers sent to Haiti in the aftermath brought cholera with them, and the outbreak that followed has killed as many as 10,000 people since then. The United Nations only acknowledged its role in the outbreak nearly six years later, and faced criticism for its unwillingness to hold itself accountable.

Oxfam, a British charity, fired at least four of its staff members over “sexual misconduct” in Haiti after a news report revealed that employees had hired prostitutes and organized orgies. Three others resigned, including the organization’s Haiti director.