Health response to the earthquake to in Haiti, January response Health 2010 The 12 January 2010 earthquake was the most devastating of many major sudden-impact natural disasters affecting Haiti in the last 10 years. The health impact of the earthquake in absolute terms Health response to (number of dead and injured) was among the highest in recent times. When the needs are com- pared to the country’s response capacity, this disaster was truly unprecedented. The level of response, especially in the health sector, was generous, even overwhelming. Organi- the earthquake in Haiti zation of the massive, global response was challenging, and many of the problems seen in past disasters were replayed in Haiti. Information was scarce, decisions were often not evidence-based, and there were serious gaps in overall or sectoral coordination. This book presents lessons to be learned from Haiti with the aim of improving the health sector’s January 2010 response in major, sudden-onset disasters in the future. It also identifies opportunities provided by the disaster for making significant changes in health services in Haiti. One of the key lessons of the Haiti tragedy is that coordination can only be effective where national authorities are equipped to assume leadership and establish relief and recovery priorities. Lessons to be learned for the next The authors have drawn on their own extensive experience in international disaster management, massive sudden-onset disaster and synthesized material from reports, evaluations, peer-reviewed scientific publications, and over 150 interviews. A review group was convened by PAHO/WHO to corroborate the findings and conclusions of this publication. The book gives particular emphasis to those lessons that are of general interest, i.e., not specific to sudden-onset the next be learned for massive to disaster Lessons the case of Haiti. The international community has much to learn from the response in Haiti where it has shown an ability to repeat its errors and shortcomings from past disasters. This document can be viewed on the Internet at: www.paho.org/disasters Area on Emergency Preparedness and Disaster Relief www.paho.org/disasters [email protected] Health response to the earthquake in Haiti January 2010 Lessons to be learned for the next massive sudden-onset disaster Claude de Ville de Goyet Juan Pablo Sarmiento François Grünewald 2011 PAHO HQ Library Cataloguing-in-Publication Data Pan American Health Organization Health response to the earthquake in Haiti: January 2010 Washington, D.C.: PAHO, © 2011 ISBN: 978-927513252-4 I. Title 1. EARTHQUAKE 2. VULNERABILITY ANALYSIS 3. DISASTERS 4. PREVENTION AND MITIGATION - methods 5. EDUCATION IN DISASTERS - policies 6. RISK MANAGEMENT 7. HUMAN RESOURCES IN DISASTERS 8. HAITI NLM WA 295.DH2 The Pan American Health Organization welcomes requests for permission to reproduce or trans- late its publications, in part or in full. Applications and inquiries should be addressed to Editorial Services, Area of Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, D.C., U.S.A. The Area on Emergency Preparedness and Disaster Re- lief; phone (202) 974-3399; email [email protected] will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. ©Pan American Health Organization, 2011. All rights reserved. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or con- cerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. The printing of this publication was made possible with the financial support of the Canadian Interna- tional Development Agency (CIDA), the Office of U.S. Foreign Disaster Assistance of the U.S. Agency for International De velopment (OFDA/USAID), the Department for International Development of the United Kingdom (DFID), the Spanish Agency for International Development Cooperation (AECID), and the European Commission’s department of Humanitarian Aid and Civil Protection (ECHO). Graphic design and cover photo: PAHO/WHO, Victor Ariscain Table of contents Foreword ..............................................................................................................V Acknowledgments ............................................................................................VII About the authors ............................................................................................... IX Preface ............................................................................................................... XI Chapter 1 Haiti prior to the earthquake ................................................................................. 1 Chapter 2 The earthquake: 12 January 2010 .......................................................................11 Chapter 3 The health impact ............................................................................................................... 19 Chapter 4 Who provided assistance? .................................................................................................... 37 Chapter 5 The life-saving response ...................................................................................................... 53 Chapter 6 Beyond trauma care ...........................................................................................81 Table of contents Chapter 7 Information management .............................................................................111 Chapter 8 Coordination .................................................................................................125 Chapter 9 Key strategic lessons for the next sudden-onset disaster ...................................................137 Bibliography ..................................................................................................144 List of acronyms .............................................................................................156 Annex 1. Conditions in Haiti prior to the earthquake .......................................159 Annex 2. Chronology of events following the Haiti earthquake ........................169 Foreword Every disaster brings new lessons of general application that we must learn before the next sudden-onset disaster strikes. The Haiti earthquake is no exception. This publication, for practical reasons, focuses on the first three months of the response. A similar study might be needed for the mid- and long-term recovery and reconstruction process that occurs after the first three months. The key lessons outlined in this publication are not merely the views of the author, Claude de Ville de Goyet, and co-authors, Juan Pablo Sarmiento and François Grünewald. They reflect the collective vision of a large number of partners and experts. International experts of the review group made significant contributions to the findings and conclusions of this important publication. The 12 January 2010 earthquake could not have occurred in a more vulnerable environment than the capital of Haiti. The immediate health impact of the earth- quake in absolute terms— number of dead and injured—was among the highest in recent times. When the needs are compared to the national response capacity, this disaster was truly unprecedented. The international community responded rapidly with an outpouring of generos- ity. Beyond traditional global donors, relief came from Haiti’s immediate neigh- bors, as well as from every country in Latin America and the Caribbean. Such support offered an encouraging example of solidarity in the true spirit of Pan- Americanism. If the impact was unprecedented, the organization of the response was not. It fol- lowed the same chaotic pattern as in past disasters. Information was scarce, deci- sions were often not evidence-based, and overall sectoral coordination presented serious shortcomings. Management gaps noted in past crises were repeated and amplified in Haiti. The humanitarian community failed to put in practice the lessons learned. The “proliferation of actors”, to borrow an expression used in the evaluation of the tsunami, ensured a massive offer of services from competent partners. The overwhelming number of people in need of immediate assistance ensured that each minimally prepared and equipped health responder provided valuable