January 18, 2010

© Joshua Lutz/Redux

Benoit Leduc, MSF operations manager for Haiti

Benoit Leduc, Doctors Without Borders/Médecins Sans Frontières (MSF) operations manager for Haiti, and Loris de Filippi, MSF operational coordinator in Port-au-Prince, participated in a teleconference with press regarding MSF's response to the January 12, 2010, earthquake.

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Avril Benoit: Welcome to the Doctors Without Borders/Médecins Sans Frontières (MSF) media briefing. I’m Avril, director of communications based in Toronto. My name is A-V-R-I-L. Last name is B-E-N-O-I-T.

The purpose of the briefing is to give you the latest update from two of our most senior operations people in Port-Au-Prince. Benoit Leduc is emergency coordinator. His first name Benoit is spelled B-E-N-O-I-T and his family name, Leduc, is L-E-D-U-C. He can answer questions on our humanitarian response, security, issues around the cargo planes, and all the incendiary issues that are making our work very difficult…quite a challenge. Also with us to provide an additional medical overview is Loris De Filippi. Loris is spelled L-O-R-I-S, and De Filippi is D-E F-I-L-I-P-P-I. Loris has a medical background and is in Haiti as a coordinator for MSF, in Choscal in City Soleil, amongst other duties.
So, for the first 30 minutes of this briefing we will talk in English, and then we will switch to French

(2:01)
Benoit Leduc: Hello everybody, so just to describe what we’re seeing today.
Basically we’re seeing the patients that arrived to our structures, the existing structures in Port-au-Prince, and some of these structures have been damaged. So, patients were inside and people continue who, I mean, are wounded, trauma fractures, people coming to our structures. So we have been forced to reorganize, either move the structure when the (earthquake) hit, or make makeshift hospital and surgical capacity, and we operate also in places that we’ve invested with our teams and our materials.
So now we have all these patients, a lot of amputations, a lot of trauma, head injuries, and these people are waiting for operations. Pretty quickly…Now it’s day 6 so we are just trying to build up our surgical capacity and treat all those people who need treatment pretty soon.
(3:00)
And of course we are behind pace, it’s really a risk.
So that’s the first thing, the structures. Now, we have five structures in which three of them it’s possible to do surgery. We are clearly seeing altogether over a thousand patients. Registration was a bit chaotic but we’re pretty sure that this amount were able to reach us. And perform 300 surgical operations
At the same time we’re trying to see what’s happening in the western areas like Jacmel, Saint Marc, Petit Goave, Léogâne—places which have been very badly hit. The epicenter was on that side, in the southwest part of Haiti. So we have teams doing exploratory missions.

Access is pretty difficult; they had to hire a helicopter to go there. Basically, a lot of destruction in the town and no health capacity, no treatment operational, and it’s again the same—they need surgery and the trauma, it is a very urgent thing. Then of course in town, a lot of internally displaced persons (IDP) camps, difficult to count, difficult to get accurate figures. Most probably, when we talk of over 200,000 people sleeping in the streets, in any open space, any empty space they can find. You have groups of like several hundred families, thousands of people, sleeping there on the plastic sheeting.
What else do we see? There’s little operations going on. I know there are a lot of plans, a lot of teams on their way, but concretely there’s been only ad hoc food distribution, water distribution, or any action in assistance to the displaced people in town. Things are building up.
(5:00)
It’s difficult operations; we are facing logistic constraints. We had five of our planes: three cargo planes and two for expatriate staff. I’m talking of surgical teams that we tried to send in pretty quickly. Five of these planes were refused to land, had to go to Santo Domingo across the border. So these are additional delays. We clearly have like 48 hours additional delays because of these access problems to the site.

For our cargo, we’re bringing inflatable hospitals, with a 100-bed capacity, with 2 operating theaters, we have all the teams coming, and the drugs. Right now some of our structures are out of supplies. We have the team, we have the operational theaters functional, ready for staff, but we’re lacking some essential drugs. So this is something we’re trying to work on. We’re doing this stuff as fast as possible. Because basically they will go directly to the operating theater, these drugs to treat the people. So this is a bit of an overview….

(6:15)
Loris De Filippi: From a medical point of view, the situation is absolutely dramatic because we are running against time and already in our facility, for instance in Cite Soleil, we have something like 200 people that are waiting for an intervention, major or minor. The number of gangrene pathologies needs are increasing… (connection breaks up)

Just to give a surgical response as quick as we can: We are working, all our facilities in in an operation theater, we are trying to do as much as we can there. On the other end, other pathologies include pregnancies … so the big two maternities (facilities) in Port-au-Prince are closed so a lot of people are arriving in a very difficult state. Women, they have to deliver with … caesarean section.
(7:20)
Of course something that isn’t … (breaks up) … is the violence. Yesterday we received people with gunshot and other wounds. So apart from all the problems related to the earthquake there are other additional things that create a lot of problems. Pathologies that can be very important are tetanus. It is very important you know. There is a very, very low coverage—the lowest coverage in the Western Hemisphere—for Haiti. Like, six months ago there was a diptheria outbreak. So, it is very important to vaccinate as much as we can, at least people that are wounded in the hospitals. That’s why yesterday we tried, at least in our facilities, to vaccinate all the people... (8:28?)

Avril: Okay, thank you Loris De Filippi and Benoit Leduc. I received some statistics, some numbers just before the conference call began. And the latest overall figure is that, so far, MSF has treated well over 3,000 people. In terms of numbers of surgery already performed, we're close to 500, with the latest figures.

(Opens floor to questions)

9:25 AP: Hi, I was wondering why the distribution of aid has been so slow, and what needs to happen for this to speed up.

Benoit: I think we are facing logistic constraints; you know, lack of cars, some of the houses have been destroyed, the staff is traumatized. And I think there is this supply to bring the stuff to Port-au-Prince. Actually on the side, this is a clear constraint and delay. And then the general organization in this chaos, communications have been very bad. I don’t want to give the excuse to aid organizations, but it’s a difficult operation, we want to go as fast as possible. People are under the collapsed houses, it’s important for all the rescue teams to get in. People are sleeping in the streets. Everyone is trying to help and getting organized, and things are picking up, I would say.

10:30 The Times: This is obviously a huge operation. Do you have a sense that it is being well coordinated? Is it clear to you who is in charge at the top?

Benoit: Well yes, for sure it’s a difficult operation. Just for us, we have now 165 staff, like a dozen surgical teams, so we have to coordinate them. And we are working in our structures. I think your question is pertinent. This coordination issue so far is not existing, or not efficient at this stage. It’s an issue. I don’t really know who is in charge. We are doing our best to treat people who are just in front of our gates, and we are like “heads down” on the operating table so far. What’s happening with coordination, I don’t think we have a clear idea, because such a mechanism is not really in place right now.

Avril: Just to give you the precise figures as well, in terms of international staff inside Haiti right now, MSF has 165. As you may recall, we already had 30 working in the country from a whole contingent of 800 that were already present managing projects before, when the earthquake struck that is. In terms of international staff that are on their way to Haiti, at the moment there are 48 en route, and for Haitian staff, we have at the moment working 550.

12:15 WSJ: A question about the aid not getting in, the 5 planes that were diverted. How did the cluster system work in this case – did that work smoothly – that was put into place after the tsunami to get the aid on the planes, and the problem being at the airport that the United States military has put a priority in order over getting aid in? Is that the reason planes were diverted? And did the cluster system work well in this case?

Benoit: Well, obviously as the plane did not land and inside was some really vital equipment, like surgical equipment and a hospital, and also some surgical teams. The cluster system did not work with these planes, and we are 48 hours delayed in this operation. On our side we have been trying through all our contacts, which is at the UN, or people in the United States, or here in Haiti--everywhere--we have tried all the possible channels for these planes to land. We have been given assurances that they could land, and they ended up (circling) over Port-au-Prince, and eventually diverted to Santo Domingo.

WSJ: So was the blame the US military not giving you the clearance to land, they control the aiport, or was it the cluster system that the UN put in place?

Benoit: Between the 2 systems I don’t think there is a smooth liaison in who decides what. It’s not clear to us, as I said before. Then yesterday we clearly had 2 planes diverted with cargo inside. People had been informed, I think the US were on the ground at the airport. The airspace, maybe I think it’s the Haitians but please confirm, because I think it’s changing all the time who is controlling. The planes didn’t land, and this was yesterday afternoon.

Avril: We have had 4 cargo flights that successfully have flown to Port-au-Prince, with a total tonnage of 135. We have 2 cargo flights that flew to Dominican Republic with their total tonnage being 65. At the moment we have 6 cargo flights planned for the rest of this week, with a total tonnage of 195.
14:50

15:21 TV NOVA: I would like to know more about the security issue and about the security situation on the ground. Could you describe it, is it dangerous, for example, more during night, what happened in this field please.

Benoit: I know there have been very localized incidents. People are very tense, and people are shocked. So it’s more reasons for them to get frustrated when they see that the aid and the food for example, or the care is not fully implemented, only at the very ad hoc and very [indecipherable] distribution stage. So there have been several problems, people running, and I think Loris can give the details of what happened maybe this morning at the airport. But we know that some of the distribution has ended up in, I don’t want to exaggerate my words, but maybe very small riots. People are shocked, people are tense, people are desperate, they’re in the street now for 6 days, so this adds to the tension. And there are sporadic reports of either shootouts or incidents, security incidents, more things happening throughout the town.

TV NOVA : Did I also hear well that you have also treated people with gunshots?
Benoit:This I would like Loris to confirm because he has been to this hospital……..

Loris: There is an increasing of wounds in the hospital, two facilities in the...:: breaks up from 17:10-17:19:: Yesterday, we took care of about 6 people in the Choscal Hospital and some of them in the Martissant Facilitiy. Today we were witness of a very difficult situation at the airport. Probably there were distribution of fuel, and this time a lot of people are really struggling to get a little bit of fuel to move, and of course, this can really increase the tension. Some people shot in the air, at the airport, and brought this sort of incredible movement of people that was carrying even our staff…that was (18:07?)…to the airport.

18:25 ALERTNET: A question about the fuel that you were saying, does MSF take in all its own fuel, and what is the fuel situation, because I’m hearing that’s one of the problems with getting the aid out from the airport to the people. And can I also ask about the situation of mass graves? What are you seeing on ground, are there lots of people being buried in mass graves, and is that a sensible thing to do at this stage?

19:00
Benoit: The fuel, it’s a real issue, our hospitals are running on generators day and night, so we need quite a lot of fuel. So far, we still have stock because we were present in Haiti before the quake. At the petrol stations there is a big lineup, and tensions in town. All, they are closed, so it’s going to be an issue if the supply doesn’t come in the coming days.

Loris: No... Apart of the fact from the fact that we are witnessing the situation, we have nothing to add on the situation. We know that it is a very big problem… but we have nothing to comment on.
On the grave, what we can say is that when we arrived at the hospitals where we work, the number of death was pretty big. We tried to investigate and to give a name to all the bodies. More or less, we had 90 percent of the names, and we bring these people to a company that normally is (20:27)..in Cite Soleil…But we are not aware about mass graves so far.

Avril: I would also encourage journalists to consult a fact sheet from the International Committee of the Red Cross called “Why dead bodies do not cause epidemics.” We’ve been receiving a lot of questions about this, and our sense is that this fact sheet is actually very accurate and very much reflects what MSF has seen over the years with respect to this question of whether these dead bodies actually pose some risk of spreading disease.

21:12 GERMAN PRESS AGENCY: The American military has apparently taken over the airport and all of this. Is the aid operation becoming too militarized in your opinion? Secondly, what are sort of your longer term security concerns in Haiti?

Benoit: First, we just want the aid operation to be efficient. So far I think we can gain in efficiency; it's needed. Then, it’s a more general question about the militarization of humanitarian (aid). You know, the military distributing food, and at the same time having a gun, it’s extremely confusing. It’s a constraint for us in places like Afghanistan, in Iraq, in all the areas where military staff are doing humanitarian action or at least perform such actions under that name. So this is something that we are concerned with in MSF in general. To come back to your question, for Haiti, I think for whoever controls the airport to facilitate planes that have the emergency and needed equipment - this is the first problem right now.

22:49 MEDSCAPE: We have readers who are physicians and nurses, who want to volunteer. what is best way they can help you?

Avril: If you don't mind I'll just jump in with an answer to this, since we're trying to focus this briefing very much on the latest field information. For any experienced medical or non-medical staff, say the non-medical with logistical background in this kind of work, they would be encouraged to contact the human resources of their national MSF/Doctors Without Borders section. So, for example if you go to msf.org, which is our international website, you can connect to the section that takes in applicants for aid work with us.

23:46 NYT: I have a couple of questions on the airport and on security. I ran your complaints by [indecipherable], who’s the head of logistics for peacekeeping. She said it’s just too small of an airport to handle the number of flights that come flooding in from all over the world, and they had to come up with a list of priorities, so they said water, food, and then medical equipment. While she conceded that your hospital is important, she said 24 hours to get to Santo Domingo, given the size of the airport, is not a terrible delay. I would wonder how you would react to that. Second, I heard they are beefing up police force, they have more police this morning, because they want these humanitarian deliveries to be guarded. Are you seeing problems? Do you think that’s a good idea, that they bring in extra 3,500 troops mostly to guard humanitarian convoys?

Benoit: I will repeat, we have 48 hour’s delay, so we are frustrated, we have doctors who have patients in some of the structures without the proper drugs or the equipment to perform the operations they need, it’s a fact. We are 2 days behind on the operations because of this access. Of course, it’s a small airport, of course there are a lot of planes, but then it’s clearly a matter of defining priorities. We have the staff on the ground, we have the structures missing some staff. It’s frustrating. Then, I’m not the best person to answer about the deployment. Of course, we just want the operations to go on. So, for the moment we don’t see a lot of either police, either UN in the streets, only in certain strategic places or roundabouts, but the streets are pretty empty of police, this is what I can say.

26:00
Loris: Just to add something on that--it is quite amazing and frustrating the fact that 24 hours later we were operating with surgical teams, and now we are almost…I won’t say stopping the operation, but really going slow because we don’t have basic things to do operations and to assure the minimal of quality. This is absolutely difficult, and we hope we will find a solution very quickly. I hope to even be organization that we collaborate with directly just to assure that one or the other gets enough materials to assure this quality intervention.

27:19 DAILY TELEGRAPH: You say that vital medical operations are being delayed because these flights aren't able to be getting in. Could you give a figure on the number of avoidable deaths you think there may have been as a result of these delays?

Benoit: We are now in 3 places where we perform surgery, day and night, in 2 different operating theaters. So, all these places run at full speed, and you make the calculation if they can perform per OT 10 vital surgeries per day. Already we can say that hundreds of people might go away, we might lose them, either they will be amputated with the risk of septicemia after 6 days of infected wounds. So this is basic – and it’s hundreds. These are vital operations. When we talk about septicemia, it means we are going to lose some of those people in the coming days, after 10 days--2 weeks. We are afraid. And I come back to the previous question from one of your colleagues, that our halls in the hospitals might be full.

29:23 ORT IRISH NATIONAL RADIO In relation to the exploratory mission to the southwest, have you received any information back in relation to what it’s like there at the moment?

Benoit: Our team was able to go by helicopter to Jacmel, they’ve been to Saint Marc, Petit Goave, Grand Goave, in these places, and Léogâne also. They talk about very heavy destruction, a percentage like 80% of the town which is down. These areas are quite populated, I don’t have the exact figures in mind, but of course health structures have been affected, and they say there that the assistance for sure is not in place. Several other groups are trying to put hospitals, starting to intervene. But so far, clearly, big needs, no surgical capacity, no health access in general, and little in place in terms of assistance.

ORT IRISH NATIONAL RADIO HOW LONG WILL IT TAKE YOU TO ACCESS THESE AREAS?

Benoit: Well, our teams are there. We’ve got the staff, we’ve got some of the equipment, so now they’re just working on getting trucks and getting the stuff and people on the ground and getting staff. So these days, we’ll start the operations, we're just running against time. By the end of this week, clearly we want to increase the functional capacity.