MSF in Haiti

Last updated: August 2012

A Caribbean nation of roughly 10 million people, Haiti is the poorest country in the Western Hemisphere, according to the Human Development Index. The chronic political and economic instability has had a profound effect on access to healthcare. The country has a continual shortage of trained healthcare personnel and hospitals continually lack supplies.

Even before the devastating earthquake that struck Haiti in 2010, basic healthcare was out of reach for most Haitians. Fees charged by public and private health facilities made care unaffordable; patients could be turned away because the hospitals were full, or they would have to abandon treatment when they ran out of money. Medical facilities were frequently shut down by strikes.

Giving birth in Haiti was a risk; the country's maternal mortality rate was the highest in the hemisphere, and 50 times the rate in the United States next door.

When the earthquake struck on January 12, 2010, hundreds of thousands were killed or injured, and millions were suddenly homeless. There were huge medical and non-medical needs on top of the pre-existing ones—for surgery, post-operative care, shelter, and water and sanitation. This was compounded months later by a cholera epidemic that ultimately affected every part of the country. Between October 2010 and July 2011, cholera killed more than 5,000 Haitians; MSF treated more than 140,000 patients, or about 40 percent of the more than 330,000 reported cases.

MSF has worked in Haiti since 1991.

For all stories on MSF in Haiti, click here.

Current Activities

MSF is providing medical care for survivors of the 7.0-magnitude earthquake that struck Haiti on January 12, 2010. In Port-au-Prince and in Léogâne, west of the capital, MSF provides emergency, trauma, obstetric, pediatric, maternal, and orthopedic healthcare to a population still reeling from the disaster. Since the quake, MSF has opened five hospitals and supported two Ministry of Health hospitals. Surgery, physiotherapy, and emergency obstetric care are priorities; but MSF counselors also provide mental health care, as well as treatment and counseling for victims of sexual violence. 

Teams have continued to treat patients for cholera into Summer 2011, a continuation of the devastating epidemic that affected every part of the country in 2010. However, after a spike in cases during May and June, teams reported that numbers had begun to drop again as of June 19.  

In May, a year and a half after the earthquake, MSF began to reorganize its activities. MSF closed its tent trauma hospital situated on a school sports field and open a new facility close to the Cité Soleil and Martissant neighborhoods, where there is the most need. The tent hospital, which focused on orthopedic surgery, physiotherapy, and psychological support, had replaced a busy trauma hospital that was destroyed during the quake. 

MSF also plans to open a new, 114-bed hospital in the Tabarre neighborhood of Port-au-Prince at the end of the year; activities there will also focus on surgery and medical care.

The new MSF Obstetrical Center is replacing another MSF hospital destroyed in the earthquake. Following the quake, staff had supported a Ministry of Health maternity hospital for a year, responding to complicated births. In the new facility, MSF will continue providing emergency obstetric care, treating cases where the life of the mother or the baby is in danger, an urgent need considering Haiti has the highest rates of maternal mortality in the western hemisphere.

With the openings of new MSF facilities, MSF's Bicentenaire Hospital in the south of the city, is set to close at the end of the year. 

Also in May, cholera made a comeback and appeared to be on the rise again. MSF reopened emergency cholera treatment centers (CTCs) in Port-au-Prince and the surrounding area to prevent existing centers from being overwhelmed. 

For much of the early part of 2011, cholera continued to plague the country. As of January 3, MSF or MSF-supported structures had treated a total of 84,500 patients for the disease, a figure that represented 57 percent of all cases nationwide, according to figures from the Haitian Ministry of Health. Staff paid particular attention to cases of children afflicted with cholera, as pediatric cholera cases faced a host of specific challenges. 

MSF has been in Haiti since 1991.

History

The Early Days: Improving Community Health Units (CHUs)

The Haitian government began a nationwide decentralization of the healthcare system in 1996, introducing Community Health Units (CHUs) consisting of one hospital and 18 health centers per 200,000 people. MSF worked to launch the CHU covering the communities of Saint-Marc, Desdunes, and Grande Saline. At St. Nicolas Hospital in Saint-Marc, MSF trained medical staff in basic surgery and anesthesia techniques for high-risk births. MSF also supported the CHU in Verrettes, which covered the communities of Petite Rivière, Verettes, and de Chapelle, with particular attention paid to the health center and five dispensaries in Petite Rivière.

In response to Haiti’s high maternal mortality rate, teams in both MSF-supported CHUs put special emphasis on improving maternal care at all levels. Other key goals included improving management of the CHUs and ensuring emergency surgery.

2004-07: Assisting Victims of Violence and Flooding

Much of MSF’s work from 2004-07 focused on responding to emergency trauma needs in the capital, as political violence took its toll on the civilian population. Outside the capital, MSF continued to operate its maternal care and primary healthcare facilities in Petite Rivière.

Trauma Services in the Capital

When civil unrest broke out in Haiti in early 2004, MSF teams who were already working there began providing emergency medical care and expanding emergency trauma operations in the capital city of Port-au-Prince.

In February, MSF started running emergency rooms at the St. François de Sales Hospital and at St. Nicolas Hospital in Saint-Marc, providing free medical care to those wounded in the fighting or during demonstrations. In December, MSF began work at a trauma center in St. Joseph’s Hospital in the capital’s central Turgeau neighborhood.

Port-au-Prince continued to be plagued by violence into 2005. On July 5, the deteriorating security situation led MSF to call publicly on all armed groups to respect the safety of civilians and to allow the wounded to obtain emergency medical care. Ironically, the following day, the UN Stabilization Mission in Haiti launched a day-long military operation in the Cité Soleil slum, and the local trauma center received 27 gunshot victims—three-quarters of whom were women and children.

MSF re-opened Choscal Hospital and the Chapi Health Center in the heart of Cité Soleil in August 2005. Staff performed nearly 12,000 medical consultations and 800 emergency interventions in the first three months. MSF also opened a basic healthcare project in the Decayette region of the capital.

In 2006, amid a resurgence of violence in Cité Soleil, MSF temporarily closed its primary healthcare center in Chapi and focused its efforts at St. Joseph’s Hospital in Turgeau, St. Catherine’s/Choscal Hospital in Cite Soleil and the Jude Anne maternity hospital in Delmas. At the end of 2006, MSF relocated its program at St. Joseph’s to La Trinité Hospital.

MSF also opened a 48-bed rehabilitation center in the Pacot area, offering physical rehabilitation and psychological services. More than 256 patients were admitted for treatment in 2005 and an additional 613 people received outpatient physical therapy. Eighty-seven received psychological support.

In May 2007, MSF opened a new facility, also in Pacot, devoted exclusively to treating victims of sexual violence. The center offered treatment for STDs, preventive measures against HIV/AIDS transmission, and a safe and private rehabilitation center.

At the end of 2007, MSF handed over its operations in Cité Soleil to local Ministry of Health authorities and focused its efforts on conditions in the Martissant slum, where teams had worked since 2006. In Martissant, MSF ran a health center and began operating several mobile clinics amid increasing violence.

Providing Maternal Care

From the start of its work in Haiti, MSF had always focused on improving maternal and child health in a country where only 26 percent of births are attended by skilled health personnel, according to the WHO. The women of Haiti suffer from the highest maternal mortality rate in the Western Hemisphere, with 630 women dying for every 100,000 who give birth.

In March of 2006, MSF opened a free women’s health center at the Jude Anne Hospital in the Delmas slum of Port-au-Prince. Teams built and outfitted an operating theater and installed new water and sanitation systems. When the doors of the hospital opened on March 15, 40 pregnant women were already waiting for help.

Response to Flooding

Heavy rains in May 2004 resulted in severe flooding in villages located near the border between Haiti and the Dominican Republic. The water devastated an already poor region, destroying houses and crops and killing hundreds. The situation worsened in September, when tropical storm Jeanne hit northwestern Haiti, causing severe flooding in Gonaïves. With more than 2,000 people dead, 3,000 injured, and tens of thousands left homeless, MSF mobilized an emergency team and began offering care in a health center in Robateau, in the western part of the city.

MSF organized helicopter emergency evacuations from the region to Port-au-Prince, where victims received medical treatment in St. François de Sales Hospital. In the flooded region, MSF ran mobile clinics, donated basic emergency kits, conducted medical consultations, and provided psychological counseling for those affected by the disasters.

From mid-October 2004 until the end of the year, MSF worked in other areas affected by the storm, carrying out approximately 2,500 consultations in villages and towns in the northwest. MSF supported the public hospital in Port de Paix, reorganized the emergency room, reinforced the pediatric and maternity wards, and rehabilitated the hospital's pediatric ward, water system and waste management area. Toward the end of 2004, MSF started working in the K-Soleil health center in Gonaïves, providing emergency medical care and maternity care and treating children at the town's public hospital. This emergency intervention ended in February 2005.

2008-09: Violence Stabilizes, Tropical Storms Strike

As the security situation in the capital began to marginally improve, MSF maintained its projects at the Jude Anne emergency women’s hospital, the Pacot rehabilitation center, the Martissant primary healthcare center and the Trinité trauma center.

After emergencies such as the food riots in April and the collapse of a school in Petionville in December, most of the patients were brought to the Trinité emergency room. In 2008, more than 17,950 patients were treated and more than 6,100 underwent surgical interventions.

At the end of the year, teams also traveled to the Artibonite, Northwest, and Southeast Departments of Haiti and completed a nutritional survey assessing malnutrition in the regions. 

Maternal Health

Haiti’s maternal healthcare needs soon became too much for Jude Anne to handle. In one day in October 2008, hospital staff assisted a record high of 56 women giving birth and received 160 women waiting for hospitalization. The hospital became so overwhelmed by demand that mothers gave birth in the hospital’s waiting room, the staircases, and in the washrooms--essentially anywhere they could find space.

In February 2009, MSF moved its maternal health operations from the overcrowded Jude Anne facility to a larger hospital in the Cité Solidarité region of the capital. To avoid any duplication of public health services, MSF focused on helping women who were experiencing complications, and transferred those with straightforward pregnancies to government-run centers in the city.

Emergency Response After Storms

After two tropical storms and two hurricanes hit Haiti at the end of August 2008, MSF launched an emergency intervention in the town of Gonaïves in the north of the Artibonites. MSF re-opened an 80-bed hospital in Gonaïves in cooperation with the Health and Population Ministry, the only structure in the region equipped to respond to emergencies and provide obstetric and pediatric services. During the last three weeks of 2008, 675 patients were admitted to the emergency room and more than 110 deliveries and 50 surgical interventions were performed.

MSF also distributed hygiene kits for 5,000 families, including plastic sheeting, soap, and jerry cans. MSF mobile medical teams traveled by car, on horseback, and on foot around Gonaïves and the surrounding isolated villages to provide assistance to the most vulnerable people staying in temporary shelters. In total, MSF teams performed more than 3,500 consultations via this service. In one case, MSF mobile teams discovered an entire village that had been stranded and submerged for four weeks.

For more on MSF’s response to the 2008 storms, click here

2010: Earthquake and Cholera Epidemic

Before January 12, 2010, many people who could not afford to pay for care became highly dependent on MSF's free emergency services. MSF was running three secondary level health care structures in Port-au-Prince: an emergency health center in the Martissant slum; an emergency hospital for trauma and orthopedic surgery which also had an intensive care unit for burns and a rehabilitation center, in the Pacot neighborhood; and an emergency obstetric care hospital with antenatal care clinics in the Delmas area. These facilities were designed to address the medical needs of populations living in very poor, violence-plagued urban communities.

When the devastating earthquake struck, killing an estimated 222,000 people and leaving 1.5 million homeless, MSF mobilized the largest emergency response in the organization’s 40-year history. Ten months later, MSF staff supported their Haitian colleagues in tackling a nationwide cholera outbreak that would infect more than 180,000 people in less than three months.

Healthcare had already been out of reach for most Haitians. Fees charged by public and private facilities made healthcare unaffordable. Public hospitals and clinics were plagued by management problems, strikes, and shortages of staff, drugs, and medical supplies. Patients could be turned away because the hospitals were full, or would have to abandon treatment when they ran out of money. Giving birth was a risk: Haiti’s reported maternal mortality rate was 630 deaths per 100,000 live births.

The earthquake threw the country into a period of turmoil. Thousands of Haitians, most of whom were directly affected by the disaster, mobilized, along with hundreds of international MSF staff. MSF’s regular deployment of 800 field staff in Port-au-Prince quickly expanded to 3,400 people working in 26 hospitals and four mobile clinics. From January 12 to October 31, 2010, medical teams treated more than 358,000 people and performed more than 16,500 surgeries.

Surgery in Tents: the Emergency Response

Twelve Haitian MSF staff members were killed in the earthquake. MSF’s obstetric and trauma hospitals were destroyed. The only remaining operational MSF facility, the emergency facility in Martissant, a slum in southern Port-au-Prince, was quickly overwhelmed. Within hours of the earthquake, more than 400 critically injured patients arrived at the Martissant health center.

MSF teams performed minor surgeries at what had been a post-operative rehabilitation center in the Pacot region of southern Port-au-Prince. In and around the collapsed La Trinité Hospital, surgery was carried out in tents and, after a few days, in a converted shipping container. Within approximately 48 hours, MSF identified available space at the Ministry of Health’s Choscal Hospital in the northern Cité Soleil region of the capital and managed to start surgical activities in two operating theaters there. By January 15, teams were also performing major surgery in tents around MSF’s field hospital in Carrefour, a region in western Port-au-Prince. MSF surgeons performed more than 5,700 major surgical procedures during the first three months, 150 of which involved amputations.

Emergency field hospitals were set up in all kinds of structures – a dental clinic at Bicentenaire, and a school in Carrefour, An inflatable tent hospital replaced the destroyed La Trinité Hospital and provided emergency medical care, as well as more specialized trauma and orthopedic surgical procedures. Semi-permanent structures were used in Léogâne, on the coast west of Port-au-Prince. In Léogâne, which was the epicenter of the quake and saw 80 percent of its buildings destroyed, the MSF facility remains the only hospital in the area.  

In Sarthe in northern Port-au-Prince, MSF opened a center for post-emergency surgery and post-operative care where more than 500 patients underwent specialized orthopedic or reconstructive surgery. Physiotherapists with Handicap International worked in collaboration with MSF to help patients recover and adapt to prosthetics. MSF also provided mental healthcare.

Jacmel, a town on the southern coast, was also badly hit by the earthquake. MSF teams started supporting the 80-bed Saint Michel Hospital on January 22. Staff performed 662 surgical operations and delivered 1,443 babies in Jacmel over the course of the year.

For a full breakdown of MSF's activities in Haiti current through May 2010, click here

Emergency Obstetric Care

As MSF’s emergency obstetric hospital had been destroyed, MSF started offering its staff, drugs, and obstetrics expertise at the Ministry of Health’s maternity hospital, Isaïe Jeanty, in the Chancerelles section of northern Port-au-Prince, which had not been damaged by the earthquake. Isaïe Jeanty treats pregnant women with medical complications such as eclampsia and malaria and provides neonatal and postnatal services, as well as a blood bank. In Léogâne, MSF set up a 120-bed field hospital, which was later replaced with a more permanent container hospital. More than 15,000 babies were delivered in MSF-supported facilities in 2010.

Specialized Care

When La Trinité Hospital was destroyed, Haiti lost its only specialized treatment unit for severe burns. Re-establishing this unit became a priority. By late March, a new 30-bed burn unit had been set up under canvas within the Saint Louis Hospital compound near what had been La Trinité.

MSF also organized psychiatric care at Saint Louis Hospital for patients referred from MSF programs or other health providers. In total, MSF gave psychosocial or psychiatric support to more than 40,000 people during the initial emergency phase.

Non-medical Assistance

By the end of June, MSF had distributed more than 28,640 tents and approximately 2,800 rolls of plastic sheeting to people living near the epicenter of the earthquake. MSF also distributed close to 85,000 relief supply kits made up of items such as cooking utensils, hygiene products and blankets. In Léogâne, MSF distributed supplies to approximately 3,000 families.

Much of MSF’s water and sanitation work focused on creating the appropriate hygiene conditions for medical care and surgery. Teams ensured the supply of safe water, constructed or rehabilitated latrines, and set up the safe evacuation of waste at MSF’s 26 facilities.

Cholera Outbreak

In mid-October, suspected cases of cholera, a disease that had not been reported in the country for decades, emerged in the Artibonite region in northwestern Haiti. MSF dispatched teams to the town of Saint Marc and immediately began treating patients for severe dehydration from diarrhea in the Ministry of Health hospital.

The outbreak would eventually touch every province in the country. From October 22 to the end of the year, MSF treated more than 91,000 of the 171,300 cholera-afflicted people nationwide. Specialized treatment centers were set up for pregnant women with the disease in Isaïe Jeanty hospital and in Léogâne. Teams established over 4,000 beds in 47 facilities around the country. Over 1,000 tons of medical and logistical supplies were delivered, and more than 5,500 staff were dedicated to cholera treatment.

For a virtual tour of a cholera treatment center (CTC), click here.

Finances and Accountability

MSF published Haiti: One Year After, a review of its own 2010 emergency response, on January 10, 2011, nearly a full year after the devastating earthquake. The report detailed MSF's activities and expenditures in Haiti since the earthquake and analyzed the gaps in medical care, shelter, water, and sanitation that would present challenges in the coming months. 

MSF received massive financial support for the Haiti emergency from hundreds of thousands of donors around the world. MSF spent a total of €94 million ($124 million) on the earthquake relief effort in 2010. Remaining private restricted funds raised for Haiti (approximately €10 million, or $13.2 million) were used to mobilize MSF’s cholera response. A detailed breakdown of expenses was published in the report.

For more on the emergency response, see MSF's teleconference and live webcast from January 13, 2011, in which MSF officials answer questions and speak about the realities on the ground.

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