Storm clouds gather over a camp for displaced people in the Boulos neighborhood of Port-au-Prince, Haiti, February 26, 2010. Dozens of makeshift camps dot the city, home to hundreds of thousands of people made homeless after a devastating earthquake struck Port-au-Prince on January 12, 2010. Many of the camps do not have adequate shelter, water and sanitation services, and regular supplies of food.
Now, three months later, MSF is continuing to develop strategies to respond to the evolving realities on the ground and serve both the immediate and the longer-term needs of the Haitian people. As a medical humanitarian organization, MSF has been focused on the health-care situation, which, in this case, has included consideration of current living conditions and their potential health implications.
It is important to remember that, despite recent improvements in Haiti’s healthcare sector, medical services were limited and inequitably provided even before the earthquake that killed hundreds of thousands of people, injured hundreds of thousands more, and left more than one million homeless.
Even before the earthquake, the healthcare situation was dire. The country had the highest maternal mortality rate in the western hemisphere. Public hospitals lacked staff, drugs, and equipment, and numerous factors impeded access to services. Fees charged in health structures, for instance, rendered even basic care prohibitively expensive for the bulk of the population.
Trinity Hospital was one of the medical facilities that was destroyed in the earthquake.
The earthquake has worsened the situation, reducing to rubble much of Port-au-Prince’s infrastructure, damaging numerous health-care facilities - the Ministry of Health estimated that over 60 percent of the medical structures in the areas most affected by the earthquake were either damaged or destroyed - and forcing large swathes of the population into makeshift camps where food, water, hygiene and medical care were substandard at best and, at worst, non-existent.
At the start of this year, MSF was operating four health structures in Port-au-Prince, providing, among other things, primary and secondary care, trauma and emergency treatment, and surgical and obstetric services. After the earthquake, as MSF rushed to respond to overwhelming medical needs, that number rose to 26 - a number that included hospitals, post-operative care facilities, rehabilitation centers, and general medical centers. Following the consolidation of some facilities and a shift in priorities, MSF now manages 19 health structures along with three mobile clinics. MSF also runs 16 operating theaters and has more than 1,200 beds available at its various locations. Overall, since the earthquake, MSF has provided medical care to more than 92,000 patients and performed nearly 5,000 surgeries.
Evolving needs
In the days immediately following the earthquake, as people with complex fractures, head injuries, crush injuries and severe open wounds made their way to MSF facilities, emergency intervention and lifesaving surgeries were the clear priorities. Soon after, the imperative was to widen the scope of services offered and to locate and retrofit new facilities in which to work, be it under tents, inside shipping containers, in school rooms, in a tourism office, in an old bottling factory, even in an inflatable hospital that MSF shipped into Haiti and erected in a field in Port-au-Prince.
Garbage and human waste flow through an open channel in the Cite Soleil slum in Port-au-Prince, Haiti, March 5, 2010. The slum is crisscrossed with such channels, along which many residents reside. The devastating January 12, 2010 earthquake that struck the city exacerbated an already dire public sanitation system in the slum, which has no underground sewage system. MSF is restoring latrines, in some cases pumping out waste that has accumulated for years.
The needs shifted to post-operative care - meaning MSF dramatically scaled up the provision of medical services it offered before the earthquake - along with psychological care and physiotherapy, the distribution of tents and basic relief items, and water and sanitation activities.
Among the survivors are a great many people who suffered serious and complex injuries that required emergency medical intervention at the time and that necessitate long-term follow-up care. These patients must have access to quality healthcare. So, too, must several other groups of patients, including, but not limited to, those with chronic conditions that were being treated before the earthquake, women in need of obstetric care, children and people who have contracted, or will contract, illnesses linked to the dire living conditions in which so many now find themselves.
Access to care
As MSF has documented in the past, many Haitians with limited resources were forced to forego medical treatment because of the fee structure associated with basic care. Before the earthquake, some 70 percent of the population lived on less than US$2 per day and work is even scarcer now than it used to be.
As the Haitian government, the international community, donor nations and agencies continue to develop plans for relief and reconstruction in Haiti, MSF urges all involved to make a priority of using the resources that have been pledged to build the kind of sufficiently funded, supplied and staffed medical infrastructure that can address the nation’s health care needs and remain widely accessible to the Haitian population. The expressed will to do so must be maintained and transformed into concrete actions.
MSF's objectives
MSF’s objectives have remained consistent, combining the work it was doing in Haiti before January 12 and the work made necessary by the earthquake and its aftermath. MSF aims to provide primary and secondary health care for victims of the earthquake - including surgery, post-operative care, trauma services, pediatrics, management of chronic conditions and general healthcare - and to support improvements in the dire living conditions of the displaced through water and sanitation services and the distribution of necessary non-food items. MSF is meeting these objectives in the following ways:
Emergency response
- Maintaining the ability to provide comprehensive health care services for those most in need;
- Maintaining capability to carry out surgical procedures, as existed both before and immediately after the earthquake, when surgical services were in great demand (to date, MSF has carried out nearly 5,000 surgeries);
- Providing comprehensive post-operative care, including rehabilitation, physiotherapy, psychological counseling and other follow-up services;
- Continuing to re-establish services for people with chronic conditions, trauma and maternal health along with programs that tend to victims of sexual violence;
- Distributing tents and other non-foods items, and providing some water and sanitation services to displaced peoples;
- Continuing to assess the needs outside Port-au-Prince, both those that were caused by the earthquake and those that pre-dated it
Post emergency response
- Ensuring as best it can the continued access to health care for the majority of Haitians who do not at present have the capacity to pay for it (and were not able to afford it before the earthquake);
- Remaining prepared to respond to outbreaks of disease or subsequent natural disasters;
- Adapting temporary facilities to transition to more permanent structures that MSF can manage and operate for the time being and possibly turn over to the Haitian Ministry of Health in the future;
- Working with the Haitian government, NGOs, and civil society, along with other actors, to ensure the ongoing delivery of services
MSF’s Operational Expenditures
In an extraordinary display of public support, MSF offices worldwide received private donations amounting to more than 87 million to support the victims of the earthquake in Haiti. MSF is extremely grateful for this generosity, as these funds have allowed our teams to bring medical, psychological, logistical, and water and sanitation assistance to the most affected people and help them recover from the devastation.
As of April 1, MSF had spent or committed to spend approximately 40 million on its medical humanitarian work in post-earthquake Haiti. It is currently defining the shape and scope its work will take beyond the emergency phase and in the years that follow. Based on available information, MSF currently estimates that it will spend approximately €70 million in 2010. Expenditures are based on current and projected needs. MSF will continue to focus its activities within the organization’s competency and capacity in order to provide medical assistance to the Haitian people as long as it is required.
Assessments and transport of some supplies were by helicopter as ground transport was severely damaged.