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Haiti: Looking Back at MSF's Response, Looking Forward to the Work Ahead
July 29, 2010
This article is part of the Spring 2010 issue of the MSF Alert newsletter.
Haiti 2010 © Andreas H. Dekkers/MSF
The first reports that trickled out contained only the slightest hint of the destruction that had occurred, or the massive response that would follow. Soon, though, the immediate consequences of the earthquake that struck Haiti on the evening of January 12 were made devastatingly clear, and Doctors Without Borders/Médecins Sans Frontières (MSF) launched what would quickly become one of the largest emergency efforts in the organization’s history.
Haiti 2010 © Julie Remy/MSF
From those first, vague bits of news that something had happened in Haiti, however, MSF operations and emergency desk personnel knew that the situation needed to be watched closely. MSF already had a long history in Haiti. It was, at that moment, running three programs in the country—a maternity
In the best of times, life in Haiti was precarious. Much of the capital, Port-au-Prince, was built haphazardly, structure stacked atop structure or hurriedly erected with little regard for the few building codes that existed. Thousands upon thousands of people lived in shanty-filled slums that were often rendered all but inaccessible by the mud flows that followed heavy rains. Economic opportunities were few, unemployment was widespread, and underemployment evenmore so, but residents were well accustomed to spasms of organized violence and political upheaval. Outside Port-au-Prince, seasonal storms, hurricanes, and cyclones regularly disrupted everyday routines and, in some instances, cost people their homes and their lives. The earthquake, therefore, hit in just the right place, and with more than enough power, to throw Haiti into a period of turmoil that went beyond anythingeven its most beleaguered residents had known.
The toll was staggering. Hundreds of thousands lay dead and injured. Millions were suddenly homeless. The headquartersof Haiti’s few functioning institutions were strewn with debris and rendered nearly inoperable. The organizations that would ostensibly coordinate a disaster response—the Haitian government, the United Nations—were themselves badly hit as well. The resulting authority vacuum severely hampered the ability of outside actors to get people and equipment into the country. There was no staging ground for the response and no one on the ground who could manage it.
A Flood Of Casualties
Haiti 2010 © Michael Goldfarb/MSF
There were, however, great swathes of the population in desperate need of help, and MSF, because it already had teams on the ground, began providing lifesaving emergency medical care immediately. Dr. Jeanne Cabeza, the medical coordinator for MSF’s operations in Haiti, wrote in The Wall Street Journal that even though she thought she was going to die when the earth started to shake, “five minutes after the quake, people were banging on our door in need of help.” She was at MSF’s rehabilitation center in the Pacot neighborhood and had, like some of her colleagues, sustained minor injuries. Nonetheless, they got started right away and worked through the night, attending to the crush wounds, fractures, concussions, and other injuries that had been visited upon men, women, and children in the surrounding area. What began as a trickle of patients quickly became a limping, bloodied deluge. “Within a few hours, there were hundreds of people in need of surgery,” Cabeza recounted.
Similar situations were unfolding at other MSF facilities in Port-au-Prince. Since the buildings had been damaged, much of the work took place outdoors, in courtyards or in the streets in front of MSF structures. Car headlights were used to illuminate procedures. A janitor helped Cabeza apply bandages. Medicines and supplies were collected from MSF medical and storage facilities, sheeting was hung from trees to create ad hoc operating theaters, and mattresses were spread out to fashion areas where patients could wait for treatment or recover from care they had received. Before long, an operating theater had been set up in a shipping container that had previously served as the hospital’s pharmacy. “In the first 24 hours, you need everything at once,” said Jordan Wiley, an MSF logistician who’d been in the country for five months before the earthquake hit. Given the conditions—several veteran MSF staffers likened it to doing surgery in a war zone in which everyone is injured at the same time—it was impossible to meet all those needs. “The patients kept demanding your attention,” said Dr. Philippe Brouard, a Haitian surgeon who has worked with MSF since 2006. “You do all you can, but there are always so many people calling you.”
Haiti 2010 © Michael Goldfarb/MSF
MSF offices around the world were mobilizing their resources, assembling new teams to buttress those on the ground and loading cargo planes with desperately needed supplies—including a 200-bed inflatable hospital that had been deployed to Pakistan following the earthquake there in 2005. Dr. Greg Elder, MSF’s Deputy Operations Manager, later said that in those early hours, “we knew the team on the ground, if anything was still standing, would be able to do a couple of days work.” But with the perspective afforded by distance and past experience, he also knew that they would soon need reinforcement and, after that, relief.
"We cannot accept that planes carrying lifesaving medical supplies and equipment continue to be turned away while our patients die."
—Rosa Crostini, MSF Medical Coordinator
It was, Elder said, “the single most concentrated response I can remember,” an effort fueled by the energy and commitment of MSF field personnel and staffers in numerous country offices. When the delivery of shipments was stalled by congestion at the Port-au-Prince airport, and MSF planes were not allowed to land, the organization not only re-routed cargo through the Dominican Republic but also spoke out to demand that aircraft carrying lifesaving emergency medical equipment be given priority by the Haitian and American authorities coordinating incoming air traffic. “We cannot accept that planes carrying lifesaving medical supplies and equipment continue to be turned away while our patients die,” said Rosa Crostini, one of MSF’s medical coordinators in Haiti, at the time. Thanks to MSF’s reputation, we insured that this message was widely broadcast both by the mainstream media and also on newer channels of communication, such as Twitter and Facebook.
Reinforcements Begin To Arrive