PORT-AU-PRINCE -- At daybreak a trickle begins, and then a stream of people head down from the hills around Haiti's capital in search of clean water.

Gina Baptiste grabs her son Dano, two neighborhood kids and 10 empty one-gallon vegetable oil jugs. Together they walk for two hours to reach the neighborhood of Tete de L'Eau, or literally the fountainhead, to fill up at a government-run pump.

''There is a river near my house, but the water is salty,'' Baptiste said. ``It gave me stomach pains when I drank it, so I stopped. Some people still drink it.''

In Haiti, where just a fifth of the households have running water -- a small percentage even for developing countries -- getting clean water is a daily struggle. It's also increasingly costly. With Haiti's economy shrinking -- the national currency has plummeted and gas prices keep rising -- a human necessity is taking a bigger chunk out of families' small budgets (From Baghdad to Haiti, so goes the war against murderous tyrants)

The situation recently earned the country of eight million a dire distinction: in a newly released water-poverty index of 147 countries, Haiti ranked last. British researchers developed the study to examine water access and environmental and living conditions.

Even drought-stricken Ethiopia edged out the Caribbean nation, according to the findings of the Center for Ecology and Hydrology in Wallingford, England. The Dominican Republic, which shares the island of Hispaniola, ranked significantly higher at 64.

Meanwhile, millions in international loans that could bring water to thousands are stuck in the pipeline -- $54 million from the Inter-American Development Bank alone -- blocked since international leaders cut off aid to Haiti after the country's flawed 2000 legislative elections.

NO CLEAN CLOTHES

On a recent morning, Lolo Francoise woke up in her home, only steps from the bay of Port-au-Prince. Her hair was braided tightly, clipped with white barrettes, and she said she wanted to be in her first-grade classroom.

''I like to learn,'' she said shyly. But she stayed home.

''My uniform isn't washed yet. It's dirty,'' Lolo said. Her family can't afford two gourdes -- or five cents -- to buy a pail of water to wash it, the girl explained.

To Haiti's poor, the lack of clean water is not only an environmental problem, but one with grave human consequences. It can be a matter of life or death.

In the United States, diarrhea is an inconvenience. In Haiti, it's one of the three leading killers of toddlers and infants, the Pan-American Health Organization says.

Typhoid fever, spread through ingesting the fecal bacteria of an infected person, also ravages the nation, said Dr. Paul Farmer, a Harvard-trained physician who founded and runs a health clinic in Haiti's Central Plateau. Though typhoid can be spread through food, it is mostly a waterborne illness in Haiti, Farmer said.

Farmer recounted the story of young Isaac Alfred, who arrived at his clinic one Thursday in February. Isaac had a raging fever and swollen belly. He appeared to be 10 years old, but actually was 15. Doctors immediately started operating and found bacteria had eaten holes in his small intestine.

'The surgeon said, `Oh God, this looks really bad,' '' Farmer said.

Isaac was appreciative for the care, thanking doctors every time they visited him. But three days later, the clinic's staff had to build a coffin for him. Since the Sunday afternoon Isaac died, two others have succumbed to typhoid at that clinic.

In the countryside where Isaac lived, many Haitians get water by finding fresh springs. But the island nation's freshwater supply has been doomed by both deforestation and haphazard development, Haitian officials said. First French colonists looking for prime export wood, then peasant farmers trying to heat food and homes, plucked the Haitian hills of their trees, denuding the tropical isle so that less than 3 percent has green cover.

FEW RESERVOIRS

Now rainwater -- instead of getting trapped in a tree's roots and staying in the soil -- flushes into the ocean, leaving many lakes and rivers parched. Of 30 of Haiti's original natural reservoirs, only two remain, Haitian Environmental Minister Webster Pierre said. The remaining bodies of water are thick with silt and pollutants after rainstorms.

Though Pierre says he doesn't expect Haiti to run out of water -- the majority of the nation's supply flows over in rivers from the lush Dominican Republic -- people can't get fresh water from streams and springs as they used to.

In Port-au-Prince the situation is acute. Water managers have dug deep wells on the outskirts of the city, but pirate water sellers already have pumped out so much that salt water creeps into the supply. The city has one natural mountain source, but it's now buried beneath squatters' homes and mansions -- even though the area is supposed to be set aside as a natural preserve. Sewage has seeped in, too.

''When I was a kid we would have a picnic near the wells,'' Yves-Andre Wainright, a former environmental minister under President Rene Preval, recalled of his trips to the mountains. ``Most of the wells are so contaminated now, you can use it only for washing clothes.''

Lack of planning and bad governance is how he explained the reasons for the problems.

In Peace Village, a neighborhood on the Jeremie Wharf precariously tied together by nails and tin slats, the five cisterns recently were dry for a week. A pipe broke, the government explained. So the 35,000 residents have to buy water from a neighbor with a cistern -- at six times the government's price.

Marianne Jean-Baptiste, eight months' pregnant, had to cut back to three buckets a day from 10.

''It's enough -- if I don't wash,'' Jean-Baptiste said.

School kids, their tiny fingers wrapped around gallon jugs, wind up the highway to communal pumps, then home. Older teens grab five-gallon buckets that once held paint, cleaning agents, or ''Red Rooster detergent,'' as Jessica Germaine's pail says.

Jessica fills it and places the pail on her head. Then she starts the 20-minute journey home, with 40 pounds of water on her 16-year-old frame.

The water still won't be enough for her family. So she'll start back for another round, plastic sandals squishing in the mud-filled road.

Reprinted from The Miami Herald of May 8, 2003.