WHO COORDINATES GLOBAL RESPONSE, RECOVERY TO HAITI EARTHQUAKE

PAUL GARWOOD, WHO

In the following accounts, WHO staff explain their roles in the response and discuss future health challenges.

Dr. Henriette Chamouillet, the WHO/PAHO representative to Haiti, was meeting with top Haitian government and health officials as disaster struck. “Suddenly everything shakes and we were able to leave the room safely and we waited until the earthquake had finished in the garden,” Dr. Chamouillet said.

How did the WHO office respond immediately after the earthquake?
“Since the earthquake we have not stopped distributing medicines. From the first day, we started distributing to a handful of groups and now we send to a hundred a day. We distribute to public hospitals, private hospitals, international aid whoever they are. We need two types of medical equipment: emergency equipment for orthopaedic surgery and medical equipment to replace what’s destroyed. Sterilisers fell and broke, we need autoclaves, operating tables, delivery and bandaging beds, and a lot of other equipment.”

What are key health challenges in coming months?
“We must ensure the wounds people have suffered are taken care of, this is the first priority. As we start entering the post-emergency phase, we will be forced to slowly resume our usual activities with the other emergencies not linked to the earthquake, such as appendectomies, Caesarean sections or road accidents. We have no outbreaks yet, but we have resumed vaccinations, in particular for children in temporary settlements.” Dr. Giuseppe Annunziata has been playing a key role for WHO since hours after the earthquake struck. He is the coordinator of emergency program support for the Health Action in Crises Cluster at WHO’s Geneva headquarters. Dr. Annunziata led the HQlevel response to support Dr. Chamouillet’s staff and the PAHO office in Washington D.C. The earthquake was the biggest natural disaster in terms of human suffering since the Asian Tsunami of late 2004. After the Tsunami, the humanitarian reform was undertaken, which revamped coordination of humanitarian work in emergencies and paved the way for the development of the health cluster and others. In Haiti, the cluster system has been a vital tool in coordinating hundreds of health providers and other humanitarian players.

Is there a “political” aspect to humanitarian crises?
Disasters are more and more political events and humanitarians must be able to analyse the complex context in which their response is implemented. They are no longer solely matters for “technical” health specialists expert in disaster response. We must be able to analyse the complex political dynamics associated with such emergencies. In Haiti, a key issue was, we had on one hand, a strong foreign military presence, and on the other hand, hundreds of international humanitarian actors. And they were all operating in a sovereign state. Understanding the different mandates and goals of these entities is crucial to best use available resources and make them consistent with the government’s response and early recovery process.

How did Haitians respond?
Everybody speaks about international aid but we must acknowledge the enormous effort by Haitians and national institutions. Haitians were helping their own people hours and days before many outside humanitarian aid providers stepped in.

What are the health challenges?
Post-surgical care and increased demand for addressing the needs of people with disabilities. This is not only a medical issue, but will imply also issues related to architecture, education, employment, psychosocial support, social services. It is not just about providing physical rehabilitation. The concerns we had for nutrition and maternal and child health before the earthquake were amplifi ed by the event. We need basic health services to be reactivated.

Dr. Daniel Lopez-Acuña, director of Health Action in Crises Strategy, Policy and Resource Management department, is involved with WHO’s efforts to help Haiti’s health system recover and rebuild from the emergency. The impact of purely humanitarian relief interventions will soon reach its limit and there is already a focus on ensuring that health services can be delivered while reconstruction and recovery efforts are being put in place, he said.

What are WHO and the Health Cluster’s key tasks to help Haiti?
We must maintain critical lifesaving interventions and accelerate the pace for attaining health and nutrition-related Millennium Development Goals. We are working to strengthen the Ministry of Health’s authority over the health sector and re-establish the functionality of the health system.

What are the short-term and longterm health objectives?
In the short term, the objectives are to make Haiti’s health districts operational and ensure essential health services are available in affected areas. But over the longer term, we are focused on helping Haiti rebuild its damaged health infrastructure and develop new rationalize the new hospitals and clinics, build institutional capacity to improve the health system in the affected districts, sustain the delivery of health services through “transitional schemes” and create the foundations for a sustainable, permanent health system. Olivia Lawe-Davies was among several dozen WHO staff who deployed to Haiti following the quake. A communications officer with WHO headquarters Child and Adolescent Health department, Ms Lawe- Davies provided a vital link between WHO’s country office and local and international media seeking information.

What were your impressions?
Having prepared for the worst, I was surprised when I arrived six days after the earthquake) to see streets cleared of the bodies and much of the rubble I had seen on the news. But the human suffering was evident. Hundreds of thousands of people had been killed and injured, and one million were homeless. Miraculously, no WHO staff member died or was seriously injured in the quake, but two lost children. The offi ce building remained standing, but was unsafe to occupy. WHO supports a government- run vaccines, medicines, and medical equipment store known as PROMESS. We slept in tents and the WHO team works in PROMESS’ offices.

I saw many heart-wrenching things. One little girl, around one or two years old, was waiting to be treated at a field hospital. Quietly curled up in her mum’s lap, she sucked on her finger to comfort herself (as virtually all kids do). But it was the only one she had left on her hand – her others had been amputated.