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Haiti: "We are not out of the emergency phase yet"
February 12, 2010
Dr. Marie-Pierre Allié, president of Médecins Sans Frontières-France, who recently returned from a field visit to Haiti, analyses the situation there one month after the disaster. At present, areas of concern include the vacuum caused by the withdrawal of some of the international medical teams who rushed to scene after the earthquake, the ongoing lack of shelter, and the slow pace of aid distribution.
The extent of the destruction that I observed in the field is very unusual. This disaster leaves a profound impression even on those with prior experience in natural disasters, even after seeing the images over and over. In some places, families are living in the rubble of neighborhoods that have been completely destroyed. In other areas, the buildings still standing seem to be very unstable and dangerous. According to the United Nations, approximately 500,000 displaced persons have moved to more than 300 resettlement sites in the capital, but this is just part of the problem. We are talking about a capital city of 2.5 million people where almost no one is sleeping under a roof at this point.
We are not out of the emergency phase yet. At this point, there are two particularly important issues. Overall, it is essential to provide shelter faster. When hundreds of thousands of families are living unprotected from the weather, in crowded sites with few latrines, you've got a major health risk. No epidemics have been noted to date, but living conditions could promote the spread of a host of illnesses, specifically diarrhea and skin infections. The rainy season begins in a few weeks and we could see increased respiratory infections. We are already observing a spread of these illnesses among our patients.
Some of the emergency medical teams sent by other countries are leaving, although their patients still require treatment. Many of the wounded who were operated on need revision surgery and full post-operative care, which require weeks of hospitalization. Our teams have sharply expanded their post-operative capacity and continue to work on that issue. We are organizing comprehensive services, including medical and nursing care, physical therapy and psychological support. The needs in this area are now considerable, but the resources are now being cut back. The public hospitals need to free up beds so that they can resume their normal activities. It's premature for the other international medical teams to be leaving. It is too early for a return to normal. The rapid withdrawal of international teams after just a few weeks is not appropriate in a context like this one, where many wounded people require care for some period of time. This is a recurring issue in this kind of crisis. We saw it in Pakistan, after the 2005 earthquake, and after the tsunami.
The massive mobilization by certain countries to help the Haitians definitely had positive impacts. Significant resources were deployed, for example, to bring key infrastructure like the airport and port back into operation. The next question is, again, one of priorities. Should the assisting country first set up its headquarters and ensure the comfort of its troops–or would it be a better idea to give the country's authorities the resources they need to carry out their role? During a meeting with the Minister of Health in Port-au-Prince, I was struck by the very limited resources available to the Ministry's staff. The lack of coordination in the medical area posed a problem during the first two weeks. It occurred that our teams were assessing needs in a specific area and starting to work, while other teams wanted to launch their activities in the same place.
It's normal to see a delay of a few days before aid arrives in the field and a few weeks before resources are deployed to cover all needs. In Haiti's case, the needs are unusually extensive and the arrival and deployment of aid was necessarily slow and perceived as inadequate. This is a new kind of situation that involves massive destruction in a capital city. The Haitian government and the U.N. staff on site were harmed directly and physically, and took additional time to be able to organize an effective response.