What was the impact of the earthquake?
As of 15 February, the national Civil Protection Agency estimates that 217,366 people died from the 12 January earthquake. More than 500,000 people have left Port-au-Prince for outlying departments, including nearly 100,000 who have gone to Grand Anse and more than 160,000 to Artibonite. The Government estimates that 97,294 houses were destroyed and 188,383 were damaged.
What are the most pressing health challenges?
Immediately following the quake, trauma injuries were the most urgent medical concern, but the focus now is on follow-up of patients who have had surgery as well as basic primary health care services, including services for maternal-child health and chronic diseases including diabetes, heart disease, HIV, and tuberculosis, among others. TB is a particular concern, as care has been interrupted for many of the 3,000 patients who were on treatment before the quake.
Cases of acute respiratory infections, acute diarrheal disease and tetanus have been reported without any epidemic characteristics up to now. The rainy season will increase the risk for childhood diseases such as acute respiratory infections and diarrhea as well as the risk for vector-borne diseases including malaria. There have been reported suspected cases of measles, but laboratory tests so far have been negative for measles.
Rehabilitation, including physical therapy, for amputees and other injured survivors will be critical to prevent or limit future disabilities. The Ministry of Health's National Plan for Disability will deal with areas such as rehabilitation centers, prosthetics, orthotics, and accessible structures.
While there are no reliable statistics on mental health problems in Haiti prior to the earthquake, it is evident that demand for mental health care has increased dramatically, and resources are scare, thus creating a large need for clinicians in this area. Special efforts will be required to address the mental health needs of people who have had amputations, who have been victims of rape and/or violence, or who were unable to identify and properly bury family members who died in the quake. PAHO/WHO has been working with national authorities to improve mental health services, in particular through the completion of a mental health assessment that will support the development of a preliminary plan of action for the short, medium and long term.
What health facilities are in place to respond to health needs?
According to hospital assessments, there are 91 identified functioning hospitals, of which 59 are in the Port-au-Prince metropolitan area (4 public hospitals, 21 field hospitals, and 34 NGO- or private-run hospitals providing free health care since the earthquake). Fifty-six of these 59 have surgical capacity.
Mobile clinics are being deployed in 250 spontaneous settlements identified by the government. Also, 87 community outpatient care centers/mobile units for treatment of severe malnutrition are open throughout Haiti.
The Ministry of Health, PAHO/WHO and other partners have worked to establish an emergency surveillance system for disease control. A situation room was created for national and international partners to monitor and investigate cases and provide information to decision makers. Of particular concern are water-borne diseases and respiratory illness.
There are 52 government-defined sentinel sites to monitor diseases, 12 of which are located in Port-au-Prince and the surrounding area. Six of the 12 have begun reporting daily. Three mobile teams organized by the Ministry of Health, the US Centers for Disease Control and Prevention, and PAHO/WHO are conducting investigations. The Health Cluster subgroup on mobile health facilities has highlighted the need to include epidemiological surveillance in the activities of mobile clinics.
Is more healthcare relief needed?
Yes. 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. PAHO/WHO is maintaining a web-based database of volunteers, shared with other agencies, to help match skills to needs on the ground. Potential volunteers may register at www.paho.org/haitivolunteers.
To ensure continuity of care and better meet existing needs, Haiti's Ministry of Health has requested that all health partners currently working in Haiti provide information on where they are active and when they are leaving, and that organizations just arriving plan to stay between six months and one year.
What are future health challenges and what is being done to respond to these?
The impact of purely humanitarian relief interventions will soon reach its limit, and the focus is now shifting to ensuring that health services can be delivered while reconstruction and recovery efforts proceed. The international humanitarian community launched a revised Flash Appeal for Haiti on 18 February to respond to longer-term needs of Haitians, over a 12 month period, as they recover from the earthquake. PAHO/WHO and health sector partners are seeking US$134 million to fund a wide range of projects in various fields that will, in turn, strengthen the Ministry of Health's authority over the health sector and to re-establish the functionality of its health system.
Through the Flash Appeal, PAHO/WHO aims to do this through various projects, including:
- Making essential medicines and supplies available
- Ensuring surveillance and response to communicable diseases outbreaks
- Reactivating basic health services
- Coordination, assessment, disaster risk reduction
- Environmental health
- Supporting the Dominican Republic's health response to Haitians
- Post-earthquake rehabilitation
- Control of vaccine-preventable diseases
- Reactivating specialized health care in the Port-au-Prince metropolitan area
In the short term, the objectives are to make Haiti's health districts operational and to ensure essential health services are available in affected areas. But over the longer term, Haiti will need help to rebuild its damaged health infrastructure, build institutional capacity to improve the health system in affected districts, and create the foundations for a sustainable, permanent health system.
Haiti also needs continuing support to maintain critical lifesaving interventions and to accelerate the pace for attaining health and nutrition-related Millennium Development Goals.
For more information regarding health sector funding needs, see:
Donor update: http://www.who.int/hac/donorinfo/haiti_alert_17february2010.pdf
What is happening regarding vaccination?
On 2 February, 2010, the Ministry of Health, with support from PAHO/WHO, UNICEF and nongovernmental partners, began a targeted immunization campaign focused on populations in temporary settlements. The campaign includes measles-rubella and diphtheria-tetanus-pertussis (whooping cough) vaccines for children under 7 and diphtheria and tetanus for older children and adults.
The first phase of the campaign is ongoing in temporary settlements and targets approximately 1.5 million people.
This number includes 250,000 children aged 6 weeks to 7 years, of which 175,000 are located in the Port-au-Prince metropolitan area and the remainder in affected towns in the west of the country, namely Petit Goave, Grand Goave, Léogane, and Gressier, plus Jacmel in the south.
The remaining 1.2 million people, including children over 8, adolescents and adults of all ages (men and women), will be vaccinated against tetanus and diphtheria.
The second phase of the vaccination aims to vaccinate the entire population once the situation has stabilized.
All aid workers going to Haiti should be vaccinated against both measles and rubella to prevent any volunteer who is not immunized from bringing measles or rubella into the country.
What will be the impact of the upcoming rainy and hurricane seasons on Haitians affected by the earthquake?
Heavy rain on 11 February already affected earthquake survivors in the tent camps of the Haitian capital. The tropical rainy season could start within weeks, and the Caribbean hurricane season begins on June 1, with the drainage canals of the capital choked with trash and earthquake rubble. Haiti has been virtually stripped of trees and is prone to deadly flash floods and mudslides.
What is the situation regarding drug supplies to health facilities?
To meet the enormous health challenges posed by the earthquake, Haitian authorities, United Nations agencies and donor countries have provided tons of medicines to scores of health partners on a daily basis through a large-scale coordinated effort run out of Haiti's pharmaceuticals hub in Port-au-Prince, PROMESS (Program on Essential Medicine and Supplies), which is managed by PAHO/WHO. Established in 1992, PROMESS provided vital support for Haiti's health system even before the quake. Following the disaster, it became a critical first line of response.
The Ministry of Health has guaranteed that medical products will be free to all public health facilities throughout Haiti until 12 April 2010. Specifically:
- Public health institutions and Departmental Supply Centers (CDAI) will continue to have access to medicines and medical equipment at no cost through PROMESS.
- Health services, including mobile clinics in camps for displaced persons and spontaneous settlements that are not dependent on any international NGO and that are accredited by the Ministry of Health will also benefit from free medicines and medical supplies.
- International organizations, international NGOs, national NGOs, and charitable and religious organizations authorized to operate by the Ministry of Health will be able to obtain supplies from PROMESS and should defray the costs of under the payment modalities in effect prior to the disaster of 12 January.
- Medicines and medical supplies received by PAHO as donations will be distributed at no cost to public health facilities through PROMESS. (These donations must conform to the quality standards established by PAHO/WHO.)
With help from the U.S. Government, a team of pharmacists and medical logisticians is sorting, classifying and checking expiration dates of donated drugs and getting them onto the shelves in PROMESS. The United States, Italy, Austria, Switzerland, Spain, Pakistan, Egypt, the Queen Sofia Foundation (via the Spanish Agency for International Cooperation), Chile, Taiwan and the Clinton Foundation, among many others, have provided medicines and supplies.
PAHO and WHO have clear guidelines on how to be a 'good donor.' These guidelines are available on the PAHO website www.paho.org/disasters (click on How to Donate).
What is the situation regarding amputees?
Among the many people injured in the earthquake, hundreds-if not thousands-suffered serious injuries that required amputations of limbs, hands and fingers. PAHO/WHO experts in disabilities are helping plan for the short- and longer-term needs of people who have undergone amputations and who require intensive wound care and rehabilitative services.
The Ministry of Health will complete a National Plan for Disability by 1 March that will encompass rehabilitation centers, prosthetics, orthotics, and accessible structures. Handicap International, Miami University, Healing Hands, and soon, CBM, are currently providing physical therapy in half or more existing hospital facilities.
Handicap International, CBM and the le Secretariat d'Etat a l'Integration des Personnes Handicapees (SEIPH) are currently working on funding to establish a common database and a hotline on disabilities. SEIPH has working with its counterpart in the Dominican Republic to help meet needs in Haiti.
What is the situation regarding malaria?
Malaria and dengue are widespread in Haiti during the rainy season (which begins in April), and the current conditions in which displaced Haitians are living will increase the risk of outbreaks. Thousands of anti-malarial bed nets have been provided to affected people. The Global Fund to Fight AIDS, Tuberculosis and Malaria is financing malaria programs in Haiti and has arranged to have an emergency supply of anti-malaria drugs sent to help Haiti maintain supplies in case of an increase in infections.
What is the role of the Health Cluster in Haiti?
The Health Cluster has helped coordinate the activities of, and the sharing of information among, more than 390 registered partners from the health field, including United Nations agencies, international organizations and NGOs.
PAHO/WHO is acting as the Health Cluster lead and coordinates the multiple partners and health actions in Haiti. Within the Health Cluster, several subgroups have been created to better meet the needs of the population, including: Primary Health Care/Mobile Clinics, Reproductive Health, Hospitals, Information Management, Mental Health, Epidemiology, Vector control, and Disability (led by Handicap International and CBM).
The Health Cluster also coordinates with other clusters, including those dedicated to logistics, water and sanitation, and nutrition. If UN agencies, NGOs and other agencies work together and share expertise, medicines, staff and logistics capacity, while at the same targeting identified and commonly understood health needs, there is a greater chance of reducing avoidable suffering and death in Haiti.
Why is sanitation a concern, and what is being done to address it?
Achieving "shelter before the rains" -that is, making sure everyone has some form of shelter- and improving sanitation and hygiene are top priorities for the humanitarian response.
Sanitation is a massive challenge that must be urgently resolved; an increasing number of diarrhea cases are being reported. If shelter and sanitation are not adequately addressed before the rainy season arrives, the risk of epidemic outbreaks of water-borne and other diseases will increase.
Sanitation in the temporary settlement sites remains a concern. The WASH Cluster estimates that a total of 1.1 million displaced people in Port-au-Prince, Leogane, Petit Goave, Gressier and Jacmel require emergency latrines. The interim plan is to provide 12,950 latrines by April (for approximately 650,000 people) and 21,000 more within six months (moving toward the goal of 1 latrine for every 20 people).
PAHO/WHO is helping to coordinate the delivery of water to affected communities and health facilities and is monitoring water quality in collaboration with the Direction Nationale pour l'Eau Potable et l'Assainissement (DINEPA). About 50 water tankers are providing water to healthcare settings and to the affected population.
Is there a concern regarding tuberculosis?
More than one year's supply of anti-TB medicines are available in Haiti. The Ministry of Health is implementing a TB control post-disaster intervention plan (January 25 through April 30) in coordination with key partners in Haiti to ensure that all TB patients have access to proper health care and treatment. A key goal is to reactivate and operationalize the National Program of Fight Against Tuberculosis.