Devastation in Haití
The impact of the disaster caused by the consecutive passage of three hurricanes and a tropical storm - Fay, Gustav, Hanna and Ike -has but deepened the socio-economic crisis in which Haiti is immersed. In accordance with data provided by the government, 424 people died, between 850,000 and 1,000,000 were affected throughout the country and more than 150,000 are living in shelters. Serious damage has been incurred in all important sectors: housing, agriculture, infrastructure, health and education. The disaster caused by the hurricanes, especially Gustav and Hanna, represent the fourth most serious disaster to have occurred in Haiti since the beginning of the 20th Century.
Improvement to the warning system could have resulted in the cost in terms of human lives being lesser in relation to that recorded in 2004. Even so, 424 deaths are too many. All the Haitian territory was affected, but it was the Department of Artibonite with a population of 250,000 people, especially the city of Gonaives, which suffered the worst. There, some 50 thousand people were left without houses, and roads, paths and bridges were damaged, complicating the distribution of humanitarian aid, and in some cases making this impossible.
The health system was completely destroyed or seriously damaged. The main hospital in Gonaives could no longer function, no health centre could assist those affected because they themselves had been struck by the disaster. Medical equipment and medicines were lost. This is the second time in which the hospital in Gonaives has been seriously affected by floods.
One of the most complex issues in this emergency was logistics. Amazingly, resources to attend the first needs, such as emergency drugs and other medical supplies, were, in some cases, available in the country, but due to lack of access, it was difficult, if not impossible, to put these supplies together for the people in need.
The presence of NGOs such as Doctors without Borders, Doctors of the World, CARE and international agencies such as PAHO (which lead the health sector) and the International Committee of the Red Cross were essential in the response in the area of health. Without doubt, coordination and joint efforts on the part of the humanitarian actors in the tragedy hitting Haiti and the openness of the national authorities have been essential in the maximization and full benefit in the use of resources and efficiency of the immediate response.
A team made up of the World Bank, United Nations, the European Commission and civil society will carry out the assessment of post-disaster needs. The evaluation report will be issued in the form of a guide to orient investment in recovery and reconstruction. From there a Fund for Recovery and Reconstruction in Haiti will be developed which will provide the necessary resources to implement projects to address needs identified in the assessment.
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Recovery of the Primary Health Care System, Cuba's Challenge
Fay, Gustav and Ike unleashed floods and their heavy rains and winds left seven dead, 700,000 tonnes of food lost and 320,000 houses damaged and/or destroyed, crops and energy infrastructure damaged or destroyed. Ike passed over the entire territory of Cuba and resulted in the evacuation of 23% of the entire population. Organization, timely evacuations and preparation on the part of the community reduced the number of deaths. Economic losses, including those in the health sector, were initially calculated at 5,000 million dollars, that is 10% of the Gross National Product, a hard blow for a country which is facing an economic embargo with serious repercussions for its economy.
Damage to agriculture has reduced production (in the medium to long term). 500 thousand poultry and thousands of eggs were lost. According to the Civil Defence, road infrastructure, housing, electricity, food and health are priority areas for reconstruction.
Major hospitals in Pinar del Río, the Isle of Youth, Las Palmas and Gibará incurred serious damage, resulting in the need to refer patients to other institutions and to adjustments in the facilities themselves. In addition, over 1,400 health facilities, of different levels of complexity, suffered some kind of damage. The sector reacted rapidly, never became paralyzed and ensured appropriate response, putting into practice surveillance and control measures: it is now confronted with the challenge of recovering the capacity of the network to resolve health issues: the country has ideal personnel in sufficient numbers, but needs to replace its infrastructure and teams to ensure achievement of health indicators in the medium and long term.
The Cuban health system has been an example for developing countries. Its model based on preventive family medicine has enabled the country to benefit from good health indicators with wide population coverage. Recovery is an immediate challenge so that indicators do not deteriorate and the capacity of the sector to resolve health issues is quickly recovered.
After the disaster, the risk for community health is directly related to the deterioration of the environment given damage to water systems, difficulty in access to safe water, overcrowding in neighbour's and friend's houses or in temporary shelters (60 thousand houses were destroyed), health and hygiene constraints which can occur and the proliferation of vectors and rodents. In the same way, the sectors of water, food and housing will need to make a great effort to improve living conditions and maintain health and well-being in all the regions which have been hit.
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Health Vulnerability in the Dominican Republic
In 2007, the Dominican Republic suffered the brunt of the storms Noel and Olga when it was supposed that the hurricane season was over. Both killed 124 people and caused a great deal of damage to housing, roads, crops and water systems which resulted in the displacement of at last 175,000 people to shelters and refuges throughout almost all the national territory. When the hurricane season began in June 2008, much of this damage had not yet been repaired and many people were still living in precarious housing conditions or had returned to areas of high vulnerability to semi-destroyed houses, uninhabitable from a health point of view, and in an exacerbated situation of poverty. Additional damage caused by the intense rain associated with the nearby passage of Gustav, Hanna, Ike and Josephine, place the country in a complicated situation.
These emergency conditions accentuate the incidence of acute respiratory infections, diarrhoeal diseases and other vector-borne diseases. In fact, there is an increase in the incidence of malaria, fatalities as a result of dengue and leptospiroris have doubled in respect to last year and the cases of conjunctivitis and skin infections have risen, as a result of a lack of hygiene in the surrounding area. The soil is particularly saturated and the high level of the rivers and lagunes results in many communities which live on their banks and also on the river beds themselves needing to be evacuated with the occurrence of the slightest rainfall.
The authorities have opted for an appropriate preventive evacuation strategy which has saved many lives, but which also creates significant logistical needs for housing, food and conditioning of the shelter sites, which do not necessary have the best conditions to tend to immediate, basic needs and still less, for a prolonged stay given that many houses may remain under water for entire weeks.
To take refuge in the homes of family and friends has always been a recommended measure to reduce the numbers of people in shelters; but this becomes a two-edged sword given that medical and food assistance is provided to those officially in shelters and not to individual homes, which weakens the health control chain. In addition, homes which receive those displaced do not have either the space or the appropriate hygiene to shelter two or more entire families for long period.
It is important to point out that improved liaison between the bodies responsible for coordinating emergencies has been noted, which is reflected in proactive measures for the protection of the population exposed to risks. Along these lines, PAHO supports the Secretariat of State for Public Health and Social Assistance in its major efforts to return the epidemiological statistics to those prevailing before the storms and to provide more appropriate health and sanitation conditions for affected populations, in the unfavourable context of a permanent state of emergency which is on-going. In the same way, PAHO is promoting the review of urgent issues such as the improvement of housing conditions for those affected, access to safe water and the adoption of precautionary measures for risk reduction in general.
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