Public health risk assessment and interventions - Earthquake: Haiti (21 January 2010)
On 12 January 2010, at 16:53 local time (GMT 21:53hrs) an earthquake measuring 7.0 on the Richter scale occurred in Haiti. The epicenter of the earthquake was 17 km from the capital Port-au-Prince (population approximately 2 million). Aftershocks measuring up to 6.0 on the Richter scale have been reported. Approximately 3.5 million people live in the earthquake-affected areas.
This is the strongest earthquake recorded in Haiti, a country that has already suffered years of humanitarian crisis and natural disasters including a series of hurricanes/tropical storms in 2008. The earthquake has inflicted significant damage, particularly to critical infrastructure including basic utilities (power, water, sanitation), transport, communication and health. Preliminary reports indicate many collapsed structures including hospitals and health centers in the Port-au-Prince area, with heavy loss of staff. As a result, the capacity to respond to this crisis has been severely compromised.
The transport infrastructure has been severely affected, including damage to the airport and harbour. Drinking water and sewer systems that were functional before the earthquake are no longer usable. Information about casualty figures is still provisional but reports indicate a significant loss of life. The UN mission and peacekeeping operations have also been severely affected.
Immediate health priorities include search and rescue for survivors trapped underneath the rubble, providing surgical/medical services to treat injured survivors, preventing wound infection and providing shelter, food, clean water and sanitation. International offers of humanitarian aid are presenting coordination challenges. Field hospitals are being deployed and once operational it is anticipated that these will be sufficient to meet the current needs.
1.2 Country context
Haiti is a Creole- and French- speaking Caribbean country with a total land area of approximately 27 750 square kilometres. It is the third largest country in the Caribbean. Haiti occupies the western third of the Island of Hispaniola, which it shares with the Dominican Republic (see Fig 1). The country has a tropical climate with some variation depending on altitude. There are two rainy seasons, April to June and October to November. The hurricane season is in August and September.
In 2007 the population of Haiti was 9.7 million. It is the poorest country in the western hemisphere, and ranks 149/182 on the UNDP Human Development Index 2007. In 2001, 55% of the population lived in households that were below the extreme poverty line of US$ 1 per person per day. Hospital and clinical facilities in Port-au-Prince have long been compromised by infrastructural deficiencies, electrical blackouts, water problems and general impoverishment.
Haiti experiences significant water and sanitation problems. In 2009, 45% of the population lacked access to safe water and 83% of Haiti's total population did not have access to sufficient sanitation (WHO/CCS). In 2007, 47% of the population lacked access to basic health care, with the majority of the population seeking care from traditional healers. An estimated 40% of households experience food insecurity, manifested by low birth weight and nutrient deficiencies.
The health system in Haiti is serviced by the public sector (Ministry of Public Health and Population and Ministry of Social Affairs); the private for-profit sector; the mixed non-profit sector (Ministry of Health personnel working in private institutions (NGOs) or religious organizations; the private non-profit sector (NGOs, foundations, associations); and the traditional health system. The Ministry of Public Health and Population encompasses 10 national bureaux and 4 coordinating units, addressing infectious and communicable diseases, EPI, nutrition, and hospital safety. There are 371 health posts, 217 health centres and 49 hospitals in Haiti. In 2009, there were >250 additional implementing partners in the health sector, further challenging health coordination (WHO/CCS).