Medical needs evolve while a million people still face a precarious fate living against the backdrop of devastation
 
The massive 7.0 magnitude earthquake that struck Haiti on January 12 brought even greater uncertainty to a population that was already extremely vulnerable. Doctors Without Borders / Médecins Sans Frontières (MSF) has been working in Haiti since 1991 and was therefore able to react immediately to the earthquake, working out of temporary facilities after its own structures were damaged, performing emergency triage and surgical interventions wherever possible, and bringing in hundreds of tons of supplies on an almost daily basis, including an inflatable hospital, as part of one of the largest responses in the organization’s history. All of this was done with the active and tireless participation of Haitian staff members who had themselves suffered great losses in the earthquake.

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 health care sector, medical services were limited and inequitably provided even before the January 12 earthquake killed hundreds of thousands of people, injured hundreds of thousands more, and left more than one million homeless. 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.

MSF’s response to the Haiti earthquake in numbers:
 

(Figures as of April 4, 2010)
                                                              

Staff 3,228
Operating theaters 16
Number of beds 1,237
Patients treated 92,486
Surgical interventions 4,961
Patients treated, Post-operative care 10,829
Patients treated, violent trauma 1,024
Patients treated, non-violent trauma 6,225
Patients treated, Mental Health 40,246
NFI Kits distributed 33,281
Tents distributed 21,937
Number of fixed sites 19
Number of mobile clinics 3
Water distributed / day in cubic metres 870
Latrines built 450
Showers built 101
The earthquake 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 effected 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 3 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.
 
Needs change over time but basic access to care remains vital
 
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. 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 health care. 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: from pledges to concrete action
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 $2 per day, and work is even scarcer now than it used to be.
 
As the Haitian government, the international community, and 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.

March 2010. A tattered shelter sits at a makeshift displaced persons camp outside the Cite Soleil slum in Port-au-Prince, Haiti. Photo: Michael Goldfarb

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:
 
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:

  • Insuring 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 insure 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.