Haiti earthquake: health priorities and challenges in large-scale disasters

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While the ICRC is focusing its efforts on bringing medical aid to the most vulnerable and assessing water needs, it is also struggling to support a health-care system in ruins. Elisabeth Le Saout, the deputy head of the ICRC's health unit, describes health priorities and challenges when disaster strikes.

What is the health situation in Port-au-Prince and other earthquake-affected areas in Haiti?

In an earthquake, there are generally many injured people and they need to be quickly treated if they are to survive. Furthermore, people continue to experience 'routine' health problems, and the fact that they can no longer receive care due to the crisis only worsens the health situation.

We know that a large proportion of medical facilities in the affected area were damaged during the earthquake. Many doctors and nurses are missing from the health facilities that have already been assessed by the ICRC and thus many are functioning at lower capacity or not at all. Unfortunately, this disaster struck an already overburdened and under-resourced health-care system.

As water supplies were cut off by the quake, there is fear that diarrhoea may spread as transmission of the disease is linked with drinking unsafe water.

When an earthquake of this scale strikes, what are the immediate medical needs of the population?

The first priority is to extract survivors from the rubble and save lives. This is the main concern in the days following the earthquake. It is important to remember that the majority of lives are saved by first responders, who are often neighbours and people trained in First Aid from the local community.

The other top priority is to stabilize the injured and get surgical care to those in need as soon as possible in order to limit the risk of infection or even gangrene and tetanus. Access to basic health care for non-injured people, for example, pregnant women, and those with acute diseases, is very important as well.

The basic needs of survivors must be looked after as quickly as possible, such as shelter, safe water and food. Otherwise people will fall ill, often with diarrhoea and respiratory infections. Children under five are the most vulnerable, and are likely to fall ill first. The fact that people are forced to gather in areas that are not equipped to receive them increases the risk of disease.

Psychological support to the victims and to those who may develop psychological disorders is another priority. Attention will have to be paid in due course to the rescuers as well, who will likely need psychological support given the stressful situations they endure.

What sort of health assistance is the ICRC focusing on and what are some of the challenges the organization is facing on the ground?

The ICRC is primarily focusing on immediate support to functioning health facilities with the donation of dressings, medicines and medical material kits. The ICRC has donated to five large health structures and to some ad-hoc health centres set up in areas with high concentrations of earthquake survivors. In parallel, the ICRC is doing a rapid health assessment of the needs of the population focusing initially on health facilities and prisons. The ICRC regularly visited detainees in these prisons prior to the earthquake, to monitor their living conditions and treatment.

Assessments of the basic needs of the affected populations outside Port-au-Prince are planned for the near future.

ICRC humanitarian workers are facing many challenges on the ground, primarily with regard to security and access to the most vulnerable people. With regard to access, they face shortages of fuel, electricity and roads that are completely blocked by rubble.

Other challenges include lack of ministry of health staff to run the hospitals that are functioning and difficulties getting medical supplies into Port-au-Prince. Finally, there is the usual challenge of setting up coordination mechanisms between the different humanitarian actors following a disaster of such massive scale.

How is the ICRC working with the Haitian Red Cross, other Red Cross units and humanitarian organizations with regard to health and medical assistance?

The ICRC's goal is to act wherever our field presence and expertise can help to make a difference for the victims and their families, as part of a coordinated Movement response led by the Haitian National Red Cross Society (HNRCS) and the International Federation of Red Cross and Red Crescent Societies.

The ICRC set up a special website for Red Cross efforts to restore contacts between family members separated due to the earthquake and its aftermath. (Family Links)

The ICRC has been supporting the First Aid programme of the HNRCS since 2007 with a particular focus on the city of Port-au-Prince, to strengthen the skills of First Aid volunteers and improve their equipment. They are able to care for the wounded and sick and transport them to referral health-care facilities. The HNRCS provided First Aid services immediately after the earthquake and continues to do so at health facilities where the injured are being taken. This is happening through the mobilization of its staff and First Aid volunteers, who themselves have been directly affected by the quake.

The ICRC will take part in the health structure that will be created to coordinate support to Haiti's health-care system.