January 20, 2010

By Dr. Rony Brauman, is the former President of MSF in France and is currently a Research Director at CRASH, MSF's center for reflection on humnaitarian action.

By Dr. Rony Brauman

The earthquake that devastated Port-au-Prince and neighboring areas has led to a worldwide surge of solidarity which we must fully appreciate because no country could face such a disaster on this scale alone. We do not yet have all the data or the time to fully assess the earthquake’s impact, but what we do know clearly sets this among the greatest catastrophes of the last hundred years.

The most immediate priorities are diverse, and the needs cannot be neatly compartmentalized because they are all interdependent.

For starters, there is help to the wounded, especially trauma requiring nursing and surgical interventions. These needs require medical units and surgical operating theaters outside of damaged existing structures that may collapse in the event of any aftershocks, which are a risk for several weeks after an initial earthquake. A number of medical-surgical teams, including ‘crush syndrome’ specialists, are already on the ground and have begun working rapidly (even if it is late from the point of view of the wounded in need of help.) This is a very important aspect of emergency relief, especially as the local hospitals are destroyed or badly damaged.

Yet medical care goes beyond the help to the wounded. Those evacuated from hospitals also need help, as do the homeless and refugees in camps where the lack of water and sanitation aggravate the already poor sanitary conditions that prevailed before the catastrophe. AIDS prevalence is high in Haiti and conditions are favorable to epidemic outbreaks. Here we are talking of the risk of pneumonia and digestive diseases, not the false risk of living among corpses. Corpses are not dangerous in spite of the widely held belief and in spite of what the media may say. One needs to reassure the local populace and their helpers about this in order to avoid possible panic that could result from the presence of so many dead bodies, which will need to be removed for social and psychological reasons but not because of a sanitary risk. Following the Tsunami in 2004, the insistence that corpses were a genuine danger by health officials led to just such a panic. Rescuing the living from the ruins is alas no longer realistic as their survival period is most likely to be over.

Beyond medical care, four other priorities need to be addressed simultaneously:

1. Reestablishing the communication system. Telephones are vital for the coordination of relief and for the diffusion of information for separated families.

2. Mobilizing machinery suitable for the rebuilding and clearing of roads and bridges, clearing and repairing public buildings, and clearing space for people who are now homeless.

3. Establishing storage facilities and networks of distribution for food and drinking water is essential. Many people have not had access to food for several days. Beyond these sufferings and the pain of privations, such measures also address the anger generated by despair and want.

4. Last but not least, the harbor needs to be repaired as it will enable cheaper, safer and larger supply routes than those provided by air.

Beyond these priorities, to understand the situation, we need to look at bigger issues. First, regarding the delay between the disaster and the arrival of international help, the media will focus on Haitians’ impatience at not receiving help, which is true but only in part. When faced with such a disaster, it always takes two to three days to respond with specialized units and several more days before they start to show their impact on a large number of victims. Even then, many will not get this international help, as it will unfold progressively. But we must remember that a good deal of assistance was locally provided in the first place. Most of those removed from the rubble were freed by their neighbors, while food supplies and help came from Haitians themselves. The media tend to focus too much on the arrival of international help, which is visible, while overlooking the fact that self help played and still plays an essential role. In the age of video, mobbing and looting are spectacular; daily solidarity is not.

When it comes to security and the role of the army, tensions and violence in a country as unequal as Haiti – only just recovering from a quasi civil war – will be everywhere. Since 2004, UN forces have mostly played a positive role in calming the violence and ensuring some respite in the country, but the real problems were not solved. Logistically, US forces or any army are extremely useful. They should secure the main relief hubs. But, one can doubt that the US army would be able to reestablish order in such a volatile environment, given their record. Furthermore one can be quite skeptical about the existing discourse according to which the Haitian government needs to be replaced by some kind of international trusteeship. Let the people of Haiti decide on their own government. History shows that this is not a country well-served by foreign interventions.

Major natural disasters are always a political stage, a place where political ambitions and rivalries play out. China today is asserting its role as a new world power by sending help, in much the same way as the US, Brazil or European countries. There is nothing outrageous in this. The disaster relief sent to Haiti reflects current international relations and it would be absurd to assess these interventions according to moral norms. In spite of the tensions arising from this situation, the international mobilization is taking place to benefit the victims, even if everyone does not yet have access to this help.

Finally, it is worth remembering that Port-au-Prince was already a damaged city before the earthquake. Hundreds of thousands of people lived in appalling conditions in shanty towns like Cité-Soleil or Martissant. This island has been exploited by the French since independence, and other Western powers have supported a succession of corrupt dictatorships, which only amplified the ravages of colonial depredation and helps explain in part the immense poverty of many people in Haiti today. One should hope that this major crisis may mark a new beginning. International aid for reconstruction, which is already a priority, could be a first step.

Dr. Rony Brauman, is the former President of MSF in France and is currently a Research Director at CRASH, MSF's center for reflection on humnaitarian action. This OpEd originally appeared in Le Monde on January 20, 2010. English translation from the French by the author.