What has been the health impact of the earthquake?
The earthquake has inflicted massive loss of life. The total number of people who have died in the disaster is not yet known but is believed to be in the tens of thousands, with hundreds of thousands injured or homeless.
What health care is available?
The earthquake damaged or destroyed at least eight hospitals and healthcare facilities in and around the capital, Port-au-Prince, and the remaining health facilities have been quickly overwhelmed by large numbers of survivors requiring a wide range of care, particularly for trauma injuries.
Before the earthquake, there were 371 health posts, 217 health centers and 49 hospitals nationwide in Haiti. In Port-au-Prince there are 11 hospitals. The total extent of the damage to Haiti's health sector is still unknown. Many hospitals have sustained damage but can continue to function, often with the help of NGOs.
Health services are also being provided at various health centers along Haiti's border with the Dominican Republic. Some injured are being evacuated to Santo Domingo or to other countries.
Local organizations, including the Haitian Red Cross, are supporting government efforts to treat the injured and ill. Additionally, at least 13 countries from the Americas and a number of countries from other regions are providing health relief, along with United Nations agencies and NGOs.
Why is the coordination of healthcare so crucial?
Coordination between healthcare providers and first responders is crucial to enable effective and fast life-saving aid. If UN agencies, NGOs and other agencies work together and share expertise, medicines, staff and other capacities, while at the same targeting them to identified and commonly understood health needs, then there is a greater chance of reducing avoidable suffering and death in Haiti.
Following previous disasters, including the Asian tsunami of December 2004, intensive efforts to deliver relief aid in some cases were not properly coordinated, resulting in wasted materials and/or materials not well matched to specific needs. Subsequent humanitarian reform efforts produced a new "Cluster" approach," in which agencies performing humanitarian work are grouped together as clusters in their various areas of humanitarian response. The World Health Organization heads the Global Health Cluster and as such is the international lead for the health response to the Haiti crisis.
Is more healthcare relief needed?
Yes, but it needs to be introduced in a coordinated fashion so as not to overwhelm an already precarious situation characterized by damaged roads and infrastructure.
Due to the large number of people needing medical care, more doctors, surgeons, nurses, midwives, and other health workers are needed to help provide medical care.
What are the needs in relation to field hospitals?
Multiple field hospitals are operating and others are being sent to Haiti. The medical needs are great, but it is also important to properly coordinate the delivery of additional facilities so as not to overburden an already over-stretched situation.
How has the earthquake affected WHO activities?
The earthquake severely damaged the PAHO/WHO premises in Port-au-Prince and forced all staff to temporarily relocate their operational HQ to Haiti's central medicine and vaccine storage warehouse near the airport, while the original HQ building is assessed for structural safety and telecommunications can be restored. PAHO/WHO also is establishing a field office in Jimani, Dominican Republic, located 1 ½ hours from Port-au-Prince, to serve as a bridge for the management of supplies and medical relief teams.
Do dead bodies pose a public health threat?
No. There is no risk of a communicable disease outbreak or any other public health threat associated with the presence of dead bodies.
However, there is a clear mental and psychosocial imperative that we have to take into consideration when supporting the fast and proper management of dead bodies.
Dead bodies in the streets are being taken to a central location for eventual identification and burial. It is important to avoid mass burials and to respect the rights of families to know the fates of their lost loved ones. For more information, go to www.paho.org/disasters.
What are the health threats?
A preliminary public health risk assessment issued 16 January details the main health threats and actions needed to address them. It can be found at: www.who.int/hac/crises/hti/who_rapid_health_assessment_15jan2010.pdf
The assessment identifies the following as the most urgent public health threats:
Wounds and injuries. Earthquakes cause high mortality due to trauma, and surgical needs are critically important in the first days and weeks. A significant number of people have suffered multiple fractures, internal injuries and crush syndrome requiring surgery. The risk of wound infection and tetanus is high due to the disruption of health care and delays in obtaining treatment.
Water, sanitation, hygiene-related and foodborne diseases. Displaced people are at high risk from outbreaks of water-, sanitation-, and hygiene-related diseases, as well as foodborne diseases, due to reduced access to safe water and sanitation systems. Salmonella typhi (causing typhoid fever), hepatitis A and hepatitis E are present and have epidemic potential. Cholera is not endemic in Haiti. Diarrhoea is already a major contributor to the high rates of under-5 mortality; WHO estimates that diarrhoea accounts for 16% of under-5 deaths in Haiti. Leptospirosis is endemic in Haiti (see below, Vector-borne and zoonotic diseases).
Diseases associated with crowding. Population displacement can result in overcrowding in resettlement areas, raising the risk of transmission of certain communicable diseases spread from person-to-person, such as measles, diphtheria, meningococcal, and pertussis, as well as acute respiratory infections. Overcrowding can also increase the likelihood of transmission of meningitis, waterborne and vector-borne diseases in the weeks and months following the earthquake. Pandemic influenza A (H1N1) 2009 is currently circulating in Haiti. Haiti also has the highest tuberculosis incidence in the Western Hemisphere, with significant incidence of coinfection with HIV.
Vaccine-preventable diseases. Tetanus has a case-fatality rate of 70-100% without medical treatment and is globally under-reported. Reports from the national authorities, WHO and UNICEF indicate 58% measles vaccine coverage among 1-year-old children in Haiti (2007), increasing the risk of measles outbreaks. Diphtheria outbreaks occurred in Haiti in 2004, 2005 and 2009; only 53% of 1-year-olds were fully vaccinated against DTP as of 2007.
Vector-borne diseases and zoonotic diseases. Dengue/dengue haemorrhagic fever, a viral disease transmitted by the A. aegypti mosquito, is endemic in Haiti. High transmission rates of all four dengue viruses have been reported in Haiti, with transmission occurring mainly during April/May through November. Malaria is a serious issue in Haiti and is exclusively due to P. falciparum mosquito, which exists throughout the year in the entire country. Risk in the main urban areas of Port-au-Prince is considered low but may increase in the current emergency situation. Human rabies transmitted by dogs is a priority disease in Haiti. Leptospirosis is endemic, and infection in humans may occur indirectly when the bacteria come into contact with skin (especially if damaged) or mucous membranes. Lymphatic filariasis is endemic throughout the island and is transmitted by the night-biting Culex quinquefasciatis mosquito.
Malnutrition. Earthquake-affected populations are at increased risk of moderate and severe acute malnutrition, especially in vulnerable groups such as young children, pregnant and lactating women and older persons. The risk may be increased by lack of support for breastfeeding and complementary feeding among mothers and caretakers.
Reproductive health is a major issue, with concerns including ensuring safe deliveries through access to basic and comprehensive emergency obstetric care, clinical management of sexual violence and prevention of HIV transmission and sexually transmitted diseases.
Skin infections occur not only due to overcrowding but also as a result of a lack of water and reduced hygiene.
Noncommunicable diseases are an important health concern in Haiti. Chronic conditions such as cancer, cardiovascular disease including hypertension, diabetes, chronic respiratory disease and neuropsychiatric disorders account for an increasing proportion of the disease burden.
With most of Haiti's industry located around Port-au-Prince, environmental risks may exist from damaged hazardous installations such as industrial facilities, damaged oil and gasoline depots, warehouses that stockpile agro-industrial or other chemicals as well as damaged technical equipment.
What needs to be done to address these threats?
The WHO preliminary public health risk assessment outlines a range of actions needed to protect public health, which include:
Ensuring access to surgical, medical and emergency obstetric care and proper case management, particularly trauma, wound and burn care
Shelter and site planning
Provision of sufficient and safe water, and sanitation.
Priority immunizations, including for measles
Communicable disease surveillance and response, including outbreak preparedness for epidemic-prone diseases
Support for appropriate infant and young child feeding and malnutrition management
Continuity of care for chronic diseases (including HIV and TB)
Public health communication.
What is WHO doing?
Around 20 WHO international staff from the Americas region and elsewhere in the organization's global network have been deployed to Haiti to assist in public health actions, mass casualty management, dead body handling, coordination, logistics and communications. These staff are supporting the approximately 52 staff working for the WHO Haiti country office.
The World Health Organization has dozens of staff in its Geneva headquarters and at the Pan American Health Organization headquarters in Washington, DC, working around the clock in support of the Haiti operations.
WHO is supporting Haiti's Ministry of Public Health and coordinating the Health Cluster response. The Global Health Cluster has developed rapid health assessment tools that can be quickly adapted and used.
WHO will engage with the military to best utilize their logistics capacities, heavy equipment, expertise and experience to swiftly respond to the disaster. There are 9,000 UN troops in the country. 10,000 US soldiers are expected to be deployed.
WHO will work with the Haitian government and partners to embark on recovery and reconstruction efforts, assessing, rebuilding and helping the people of Haiti on the road to recovery.
What are others doing?
Countries in the Americas and around the world are offering to send and are already sending a great deal of assistance. The international mobilization and response is really extraordinary.
Examples include: Brazil sending plane-loads of equipment, medical supplies and staff; Chile sending a medical team to support an Argentine military hospital already operating on the ground; Ecuador, Peru, and several others sending medical supplies; Cuba sending medical teams; Jamaica is now receiving the overflow of patients into its nation's hospitals and also sending several medical staff by its Coast Guard directly to Haiti; (as noted above) the Dominican Republic is receiving and caring for patients who have evacuated; Venezuela has sent plane loads of staff and fuel; and the response from the US and Canada has been extraordinary. Also countries from Europe (UK, France, Italy, Belgium and Spain in particular) and as far away as Israel and China are sending support.
Many representatives of smaller aid missions, and even individuals, want to join these efforts, many of them offering valuable skills. However, at this stage the situation is so difficult on the ground in Haiti that all outside aid teams must be completely self-sufficient.
Many WHO partners are already operating in the affected areas and are sending additional support. These include MSF, IFRC,
What is the situation regarding funding?
WHO has released almost US$300,000 (Pan American Health Organization US$220,000 and WHO Health Action in Crises US$75,000) to provide for urgent response needs.
WHO and Health Cluster partners (UNICEF, UNFPA, UNAIDS, IOM, Save the Children, World Vision, International Medical Corps, International Rescue Committee, Merlin, Médecins du Monde, and Handicap International) have appealed for US$ 34.3 million in the Flash Appeal launched 15 January.
Funding is being sought to support efforts to coordinate the health sector response, for disease outbreak control, to reactivate basic health care services, and for medicines and essential health supplies.
What can be done to reduce the impact of such disasters? What are the lessons learned?
In the health sector, one of the most important lessons we have learned-over and over again-is the importance of hospitals in the aftermath of a disaster.
All too often hospitals become victims of disasters themselves and are unable to provide their services precisely when they are most needed. This is exactly what has happened in Haiti.
But it is not inevitable. We know hospitals can be built to withstand the impact of disasters and can be planned and equipped to remain functional after disasters.
The additional cost of building hospitals to be disaster-safe is marginal, particularly in comparison to the cost of a failed hospital. Moreover, it is much less expensive to include earthquake safety measures at the design and construction stage than to retrofit a facility that has been damaged and is unable to function.
What was the humanitarian situation in Haiti like prior to the earthquake?
Haiti has already suffered from previous humanitarian crises and natural disasters, including a series of hurricanes that battered the country in 2008.
This has been the strongest earthquake ever recorded in Haiti along this fault line. Haiti is the poorest country in the Western Hemisphere and ranks 154th on the United Nations Human Development Index.
In 2008, Haiti was devastated by four major hurricanes/tropical storms: Faye, Gustav, Hanna and Ike, which wreaked havoc on physical and agricultural infrastructure. The storms killed almost 450 people, affected a million residents and left more than 150,000 living in shelters.
Haiti is in the group of 10 countries with lowest diphtheria toxoid, tetanus toxoid and pertussis vaccine (DTP3) coverage: 53% (2008) according to WHO/UNICEF estimates.
What can individuals do to support the international response?
Financial contributions to the health response are the most effective support that people around the world can provide. Information on donating to the Pan American Health and Education Foundation's Haiti appeal can be found at: https://www.pahef.org/donate/