Remarks by Dr. Jon Andrus, PAHO Deputy Director
The earthquake that struck Haiti last week has caused massive loss of life, thousands of injuries and displaced persons, and has essentially crippled the country's already fragile infrastructure. On the ground, communication and transportation remain incredibly difficult, if not nonexistent in most neighborhoods. Scarcities of the bare necessities, such as food, water, and fuel are everywhere. Rubble and dead bodies clog the streets. And, we really still cannot define the extent of the damage accurately.
These conditions are imposing enormous difficulties in managing the
supply and distribution of the massive amounts of aid that generous
people and organizations are pouring into the country. We are working
with our sister organizations in the UN and other health agencies to
remedy this situation as rapidly as possible.
PAHO/WHO has been designated by the United Nations with support
from its partners to be the coordinating agency of the health sector
response. PAHO is doing so from its operation bases in Port-au-Prince
and Santo Domingo, the Dominican Republic. An operations center is also
being set up in Jimaní along the Haiti-Dominican border.
We know that before the earthquake, there were 371 health posts,
217 health centers and 49 hospitals nationwide in Haiti, including 11
hospitals in Port-au-Prince. The total extent of the damage to Haiti's
health sector is still unknown. We know the earthquake destroyed or
damaged 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.
Some of the many hospitals that sustained damage are continuing to
function, often with the help of NGOs, and field hospitals are helping
fill the gaps. Israel has set up a mobile field hospital with 60 bed
capacity, and has been requested to serve as a referral hospital for
severely injured patients. A Russian hospital is now operational and
new field hospitals are due to arrive from Turkey, France, MSF,
Indonesia and the USA. The US Navy hospital ship USNS Comfort, with a
1,000-bed capacity, is also on its way.
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 such as Jamaica.
Local organizations, including the Haitian Red Cross, are supporting
government efforts to treat the injured and ill.
Additionally, at least 13 countries from the Region of the Americas
and a number of countries from other regions are providing health
relief, along with United Nations agencies and NGOs. Spain is
supporting PAHO's efforts with a 2.75 million advance in Euros.
A comprehensive assessment of the damages is underway but not yet
completed. Preliminary data are being shared among all involved.
Inter-agency health assessment teams have started to systematically
visit existing hospitals and report to the Health Cluster meetings held
To date epidemiological reports indicate that there is no increase
in reportable diseases either within Haiti or along the border of Haiti
and the Dominican Republic.
I want to reiterate that there is no risk of a communicable disease
outbreak or any other public health threat associated with the presence
of dead bodies, which are being taken to a central location for
eventual identification and burial. It is important to respect the
rights of families to know the fates of their lost loved ones. Reports
of dumping bodies into mass graves is disheartening. PAHO/WHO is making
every effort to prevent such misguided efforts.
The most urgent public health threats resulting from this massive
disaster include the initial emergency treatment of wounds and
injuries. Earthquakes cause high mortality due to trauma, and surgical
needs are critically important in the first days and weeks. Many 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.
From the start PAHO/WHO has mobilized our entire organization to
respond. Our Emergency Task Force has deployed 20 PAHO/WHO
international staff from the Americas region and elsewhere in the
organization's global network to Haiti. They are assisting in public
health actions, mass casualty management, dead body handling,
coordination, logistics and communications. These staff members are
supporting the approximately 52 staffers who were already working in
out Haiti country office. In addition, in the Dominican Republic PAHO
has 20 staff actively engaged.
As the coordinating agency for the Health Cluster response, we are
supporting Haiti's Ministry of Public Health with its initial response
using rapid health assessment tools. We are also engaging the military
to optimize the use of their logistics capacities and use of heavy
equipment. There are 9,000 UN troops in the country, and 10,000 US
soldiers are expected to be deployed.
Looking at the long haul, we are all working 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.
By any stretch of the imagination, it will not be an easy road. The
population in Haiti was already vulnerable and faced innumerable health
threats. The earthquake increases the risk of malnutrition, especially
in vulnerable groups such as young children, pregnant and lactating
women and older persons. 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. Diarrhea is already a major contributor to the high
rates of under-5 mortality; WHO estimates that diarrhea accounts for
16% of under-5 deaths in Haiti.
Population displacement can result in overcrowding in resettlement
areas, raising the risk of transmission of certain communicable
diseases such as measles and acute respiratory infections.
Reports from the national authorities, WHO and UNICEF indicate 58%
measles vaccine coverage among 1-year-old children in Haiti, increasing
the risk of measles outbreaks. Overcrowding can also increase the
likelihood of transmission of meningitis, waterborne and vector-borne
diseases in the weeks and months following the earthquake. Haiti also
has the highest tuberculosis incidence in the Western Hemisphere, with
significant incidence of coinfection with HIV.
Tetanus, which has a case-fatality rate of 70-100% without medical
treatment, is a potential risk with open wounds and contamination.
Vector-borne diseases such as dengue and malaria are significant
threats in Haiti. Malaria risk in the main urban areas of
Port-au-Prince is considered low but may increase if we don't support
the vector control program. 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.
Reproductive health is another major issue. We must ensure safe
deliveries through access to basic and comprehensive emergency
obstetric care. On average, Haiti has 70.000 babies born each year, so
obstetric care and follow-up are also essential services during this
The Haiti earthquake continues to be an evolving tragedy, but the
response has been extraordinary. We have seen Presidents Obama, Bush
and Clinton uniting to raise funds for Haiti relief. We have seen
individuals and nations around the world sending assistance, and the
international mobilization and response have been extraordinary.
Brazil has sent plane-loads of equipment, medical supplies and
staff; Chile sent a medical team to support an Argentine military
hospital already operating on the ground; Ecuador, Peru, and several
others sent medical supplies; Cuba sent medical teams. Jamaica is
receiving the overflow of patients into its nation's hospitals and
sending several medical staff by its Coast Guard directly to Haiti. 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. European
countries including the UK, France, Italy, Belgium and Spain in
particular have sent support, as have countries as far away as Israel
The list of countries goes on and on. This represents a regional
and global effort to the response. Obviously, no one nation or agency
can do this alone.
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.
We all have been incredibly saddened and humbled by this disaster.
We must work hard to mount an effective response and help Haiti respond
and rebuild hospitals and health centers, making sure they can
withstand future disasters, which are always inevitable. In 2008, Haiti
suffered the onslaught of 4 hurricanes.
One of the main lessons we have learned over the years is the
importance of hospitals in the aftermath of a disaster, and how to
avoid hospitals becoming victims of disasters themselves, unable to
provide their services precisely when they are most needed. This has
happened in Haiti, but it can be prevented from happening again. We
know hospitals can be built to withstand the impact of disasters and
can be planned and equipped to remain functional after disasters. We
will strive to apply that important lesson.
In ending, we fully acknowledge that financial contributions to the
health response are the most effective support that people around the
world can provide, through reputable organizations working on the
ground in Haiti. Information on donating to the Pan American Health and
Education Foundation's Haiti appeal can be found on the PAHO web page
at www.paho.org . Thank you for your time and attention.