Haiti Update #2: Beyond Search and Rescue
January 25, 2010
Extraordinary Disconnects Remain Between Scale of Disaster and Resources Available
Consequences of Profound, Pre-Existing Poverty on Impact of Earthquake Will Undermine Relief and Recovery Efforts
Thirteen days after the 7.0 quake that devastated Port-au-Prince and the surrounding region, the initial phase of “search and rescue” is clearly over. That is not to say that the occasional “miracle survivor” will not be pulled from the rubble, but those situations will be rare and random. Reports are that the medical situation for adults and children remains horrendous, in spite of large numbers of physicians now in country
Most striking – and insufficiently reported on – are the disconnects between the scale of the disaster and the combined resources that have been brought to bear from around the world.
Here are current principle concerns that must be addressed simultaneously:
Extraction of bodies and clearance of rubble need to proceed rapidly. “rescue” from the rubble is now over. Every effort to identify victims must be made and clearance of rubble will help open roadways and establish venues for survivors to get care and support. These venues may be in or near the Capital or even in neighboring Dominican Republic.
Establishment of safe, temporary locations for survivors who are now “internally displaced persons” within Haiti. These locations will need to focus on security, nutrition, safe water, sanitation, health care, day care, mental health support and resumption of education for children.
Supply and distribution logistics need to be better coordinated and managed. Materials headed to Haiti via ship, air transport and overland from the DR are now in abundance from a massive multi-national, international effort. Backlogs of needed supplies at the airport and other staging centers must be rapidly and effectively distributed to wherever needed.
Coordination of international relief efforts remains challenging at every level, though maximizing role of Haitian government is essential, even as it is still trying to regain its footing and control. Physical destruction of the Capital adds to a sense of social and political uncertainty which much be addressed rapidly, while understanding that getting vital supplies to survivors is of paramount importance.
Appropriate medical care will mean the difference between life and death for hundreds of thousands of Haitian survivors going forward. The immediate death toll from earthquake trauma is still unknown, though estimates range from 150,000 to 300,000 early fatalities. Almost all survivors will need medical attention, including care for on-going chronic conditions, emotional trauma, vaccinations and so forth. At the more serious end of the medical care spectrum will be care of non-fatal injuries sustained during the initial days of the disaster, including persistent wound infections, poorly managed or unmanaged orthopedic injuries or other surgical or advanced medical conditions.
Effective public health practices, already visible throughout the effective region include assurance of safe water, stabilizing food supplies, immunization programs and monitoring for water-born and other post-disaster related issues. Few of these programs are up to speed in relationship to the sheer scale of the challenges being faced at the moment, nor do they seem to be necessarily organized for the growing problems likely to be seen in the weeks and months to come.
Appropriate sheltering of survivors is one of the most daunting challenges to be faced in the coming weeks. Providing safe shelter for 1 million displaced individuals in a disaster devastated country that had already been among the poorest in the world is an overwhelming challenge. Temporary camps must be developed that are able to withstand persistent aftershocks, provide a sense of general stability, access to vital services, security, school and social service access and other basic staples. Significant rains are possible in Haiti from late April through July, ending coincident with the onset of “hurricane season”. Flooding, mudslides and substantial storms are therefore serious threats to earthquake survivors in the spring and summer. Rapid development of sufficient numbers of appropriate shelters or safe permanent housing is an extremely high priority for Haiti and the international relief community.
Given the enormous amount of work being done on all fronts, there are at least ten large – almost imponderable - issues that will continue to dominate strategies, short- and long-term as Haiti and the international community do whatever is needed to create a functional and resilient health care system.
Irwin Redlener, MD
President, Children’s health Fund
Twitter account: IrwinRedlenerMD