PAHO – Haiti earthquake health Q&As

Haiti earthquake health Q&As

Source: Pan American Health Organization (PAHO), 18 Jan 2010

What has been the health impact of the earthquake?

The earthquake has inflicted massive loss of life. The total number of people who have died in the disaster is not yet known but is believed to be in the tens of thousands, with hundreds of thousands injured or homeless.

What health care is available?

The earthquake damaged or destroyed at least eight hospitals and healthcare facilities in and around the capital, Port-au-Prince, and the remaining health facilities have been quickly overwhelmed by large numbers of survivors requiring a wide range of care, particularly for trauma injuries. Before the earthquake, there were 371 health posts, 217 health centers and 49 hospitals nationwide in Haiti. In Port-au-Prince there are 11 hospitals. The total extent of the damage to Haiti’s health sector is still unknown. Many hospitals have sustained damage but can continue to function, often with the help of NGOs. Health services are also being provided at various health centers along Haiti’s border with the Dominican Republic. Some injured are being evacuated to Santo Domingo or to other countries.

Local organizations, including the Haitian Red Cross, are supporting government efforts to treat the injured and ill. Additionally, at least 13 countries from the Americas and a number of countries from other regions are providing health relief, along with United Nations agencies and NGOs.

Why is the coordination of healthcare so crucial? \

Coordination between healthcare providers and first responders is crucial to enable effective and fast life-saving aid. If UN agencies, NGOs and other agencies work together and share expertise, medicines, staff and other capacities, while at the same targeting them to identified and commonly understood health needs, then there is a greater chance of reducing avoidable suffering and death in Haiti. Following previous disasters, including the Asian tsunami of December 2004, intensive efforts to deliver relief aid in some cases were not properly coordinated, resulting in wasted materials and/or materials not well matched to specific needs. Subsequent humanitarian reform efforts produced a new “Cluster” approach,” in which agencies performing humanitarian work are grouped together as clusters in their various areas of humanitarian response. The World Health Organization heads the Global Health Cluster and as such is the international lead for the health response to the Haiti crisis.

Is more healthcare relief needed?

Yes, but it needs to be introduced in a coordinated fashion so as not to overwhelm an already precarious situation characterized by damaged roads and infrastructure. 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.

What are the needs in relation to field hospitals?

Multiple field hospitals are operating and others are being sent to Haiti. The medical needs are great, but it is also important to properly coordinate the delivery of additional facilities so as not to overburden an already over-stretched situation.

How has the earthquake affected WHO activities?

The earthquake severely damaged the PAHO/WHO premises in Port-au-Prince and forced all staff to temporarily relocate their operational HQ to Haiti’s central medicine and vaccine storage warehouse near the airport, while the original HQ building is assessed for structural safety and telecommunications can be restored. PAHO/WHO also is establishing a field office in Jimani, Dominican Republic, located 1 ½ hours from Port-au-Prince, to serve as a bridge for the management of supplies and medical relief teams.

Do dead bodies pose a public health threat?

No. There is no risk of a communicable disease outbreak or any other public health threat associated with the presence of dead bodies. However, there is a clear mental and psychosocial imperative that we have to take into consideration when supporting the fast and proper management of dead bodies. Dead bodies in the streets are being taken to a central location for eventual identification and burial. It is important to avoid mass burials and to respect the rights of families to know the fates of their lost loved ones. For more information, go to www.paho.org/disasters.

What are the health threats?

A preliminary public health risk assessment issued 16 January details the main health threats and actions needed to address them. The assessment identifies the following as the most urgent public health threats: Wounds and injuries. Earthquakes cause high mortality due to trauma, and surgical needs are critically important in the first days and weeks. A significant number of people have suffered multiple fractures, internal injuries and crush syndrome requiring surgery.

The risk of wound infection and tetanus is high due to the disruption of health care and delays in obtaining treatment.

Water, sanitation, hygiene-related and foodborne diseases. Displaced people are at high risk from outbreaks of water-, sanitation-, and hygiene-related diseases, as well as foodborne diseases, due to reduced access to safe water and sanitation systems. Salmonella typhi (causing typhoid fever), hepatitis A and hepatitis E are present and have epidemic potential. Cholera is not endemic in Haiti. Diarrhoea is already a major contributor to the high rates of under-5 mortality; WHO estimates that diarrhoea accounts for 16% of under-5 deaths in Haiti. Leptospirosis is endemic in Haiti (see below, Vector-borne and zoonotic diseases).

Diseases associated with crowding. Population displacement can result in overcrowding in resettlement areas, raising the risk of transmission of certain communicable diseases spread from person-to-person, such as measles, diphtheria, meningococcal, and pertussis, as well as acute respiratory infections. Overcrowding can also increase the likelihood of transmission of meningitis, waterborne and vector-borne diseases in the weeks and months following the earthquake.

Pandemic influenza A (H1N1) 2009 is currently circulating in Haiti. Haiti also has the highest tuberculosis incidence in the Western Hemisphere, with significant incidence of coinfection with HIV.

Vaccine-preventable diseases. Tetanus has a case-fatality rate of 70–100% without medical treatment and is globally under-reported. Reports from the national authorities, WHO and UNICEF indicate 58% measles vaccine coverage among 1-year-old children in Haiti (2007), increasing the risk of measles outbreaks. Diphtheria outbreaks occurred in Haiti in 2004, 2005 and 2009; only 53% of 1-year-olds were fully vaccinated against DTP as of 2007.

Vector-borne diseases and zoonotic diseases. Dengue/dengue haemorrhagic fever, a viral disease transmitted by the A. aegypti mosquito, is endemic in Haiti. High transmission rates of all four dengue viruses have been reported in Haiti, with transmission occurring mainly during April/May through November. Malaria is a serious issue in Haiti and is exclusively due to P. falciparum mosquito, which exists throughout the year in the entire country. Risk in the main urban areas of Port-au-Prince is considered low but may increase in the current emergency situation. Human rabies transmitted by dogs is a priority disease in Haiti. Leptospirosis is endemic, and infection in humans may occur indirectly when the bacteria come into contact with skin (especially if damaged) or mucous membranes. Lymphatic filariasis is endemic throughout the island and is transmitted by the night-biting Culex quinquefasciatis mosquito.

Malnutrition. Earthquake-affected populations are at increased risk of moderate and severe acute malnutrition, especially in vulnerable groups such as young children, pregnant and lactating women and older persons. The risk may be increased by lack of support for breastfeeding and complementary feeding among mothers and caretakers.

Reproductive health is a major issue, with concerns including ensuring safe deliveries through access to basic and comprehensive emergency obstetric care, clinical management of sexual violence and prevention of HIV transmission and sexually transmitted diseases. Skin infections occur not only due to overcrowding but also as a result of a lack of water and reduced hygiene.

Noncommunicable diseases are an important health concern in Haiti. Chronic conditions such as cancer, cardiovascular disease including hypertension, diabetes, chronic respiratory disease and neuropsychiatric disorders account for an increasing proportion of the disease burden. With most of Haiti’s industry located around Port-au-Prince, environmental risks may exist from damaged hazardous installations such as industrial facilities, damaged oil and gasoline depots, warehouses that stockpile agro-industrial or other chemicals as well as damaged technical equipment.

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