The emergency phase for Haiti at the national level—both in terms of post-earthquake activities and cholera response—is now near completion. This conclusion has led many national and international NGOs to reduce their staff and end operations. On the one hand, such a development represents a positive benchmark for Haiti as agencies transition towards reconstruction and early recovery. On the other hand, the current situation remains extremely volatile, with potential for disasters at both the local and national level in the year ahead.
Nearly 800,000 people are still living in tents and shelters following the earthquake, and hazards remain from a lack of clean water, unhygienic living conditions, insecurity, and a weakened education sector. Health services are the same, or in some cases worse than before the earthquake and access will continue to decline as national and international partners reduce their resources. A serious concern during reconstruction and early recovery is that the threshold which might trigger new emergencies remains low at the same time that available humanitarian resources are being reduced.
Within this new reality, PAHO will continue to maintain an emergency team in Haiti that is lean, agile, and responsive to a fluid situation on the ground. The goal is for this team to bolster national response by the Government of Haiti during future emergencies. Limiting the impact of future disasters will require action, and maintaining the cholera alert and response mechanism established by PAHO and the Ministry of Health during 2011 will be a cornerstone of early interventions. The Health Cluster will work to support emergency response as well as carrying out reconstruction projects. Beyond PAHO, other health partners should acknowledge the fragile state of Haiti and continue to allocate human and material resources for emergency response in the year ahead.
In the aftermath of the earthquake an unprecedented humanitarian operation was launched to support the Haitian government in its efforts to respond. Since January 2010, virtually all national and international resources have been dedicated to emergency response. In the short term, this meant that more people were able to access health services than before the earthquake, as demonstrated by subsidized health visits for high risk populations.
The government led the cholera response efforts from the outset. This involved the design of a national plan, with support from PAHO, and the creation and operation of an alert and response system. In addition, to improve response capacity the government installed a National Emergency Operations Center in the presidential palace, under the chairmanship of the Haitian president.
PAHO has mobilized over 100 specialists to complement some 50 staff in PAHO’s country office. They are providing technical assistance to the government, UN agencies, and all Health Cluster members at the national and departmental levels.
Coordination of more than 400 organizations and agencies involved in earthquake and cholera response was the responsibility of the Health Cluster. The formation of sub-clusters following the earthquake harnessed expertise of leading NGOs in areas such as mobile clinics, mental health, and providing prostheses where virtually nothing existed for amputees before the earthquake. Humanitarian actors collaborated on important initiatives such as post-disaster needs assessments, flash appeals, the consolidated appeals process (CAP), mobilization of health funds, and implementation of the national cholera response plan.
In the face of administrative, security, and logistical challenges, critical medical supplies have been provided without interruption since January 2010 through PROMESS, the central national pharmacy created in the mid-1990s and operated by Haiti’s Ministry of Health, with technical and managerial support from PAHO/WHO.
The current health situation in Haiti remains uneven. It is characterized by improvements in some areas and persistent threat from cholera, measles, and other diseases. There is a potential for deterioration in coverage for the majority of the population if the government lacks funds to provide free health care to children under five and an expansion of the free health care package for pregnant women. Securing this funding is an essential bridge for the health of the Haitian population because reconstruction of health services is still years away.
As of today, it appears the number of cholera cases and the case fatality rates have peaked. However, the conditions that precipitated the spread of cholera and could cause other water-borne disease have not been addressed. In addition, rural communities have only recently received access to cholera care and still need help. It is anticipated that the PAHO/WHO alert and response system will continue to be in demand going forward.
What is next?
Although the cholera epidemic has stabilized, urgent action is needed to accomplish the following:
- Set up new Oral Rehydration Posts (ORP), especially in hard-to- reach areas;
- Improve quality care and case management to further reduce the fatality rate;
- Undertake social mobilization campaigns emphasizing prevention and response activities;
- Increase the presence of health professionals in remote and underserved areas;
- Set up a local response mechanism at central and departmental levels to provide a minimum response capability for future disasters or epidemics.
Going forward, the most pressing issues are the reestablishment of “routine” programs and acceleration of reconstruction programs, both of which need strong and unwavering support from UN agencies and national and international partners. Actions in these areas include:
- Provide clean water, proper hygiene, sanitation, and safe waste disposal;
- Ensure access to free-of-charge basic health services for the population as the foundation of a social protection scheme;
- Promote massive social mobilization with other partners;
- Strengthen surveillance systems to identify trends in disease occurrence and outbreak control;
- Establish small stocks of essential supplies to deal with other natural disasters or epidemics which are to be expected in this fragile socio-political and natural environment;
- Improve quality of care and case management to continue to reduce the fatality rate;
- Re-establish “routine” programs such as vaccination, HIV/AIDS programs, protection of vulnerable groups, and others;
- Start reconstruction programs immediately while taking into account risk reduction measures.