Health Impacts of the 2010 Earthquake in Haiti

Makeshift hospital camp after the 2010 Haiti Earthquake. Source: http://commons.wikimedia.org/wiki/File:Haiti_earthquake_camp.jpg

On January 12, 2010, a 7.0 Richter Scale magnitude earthquake struck Haiti. The epicenter was near its capital Port-au-Prince^[1]. The Haitian government estimates that between 217,000 and 230,000 people were killed, roughly 300,000 people were injured, and about 1,000,000 became homeless^[2] The majority of the infrastructure in Port-au-Prince and surrounding areas was destroyed. Emergency medical sites that were able to function in the absence of supporting infrastructure and resources were overwhelmed by great numbers of people with serious injuries ^[1]

Immediate Health Consequences

In the initial days following the earthquake, emergency medical personnel in Haiti were primarily focused on conducting life-saving surgeries such as mass amputations to prevent sepsis, the setting of fractured bones, and the treatment of open wounds, infections, and other crush injuries^[3][4][5] The Haitian government reported that 6000-8000 people lost limbs or digits as a direct consequence of falling building structures at the time of the earthquake^[6] These numbers were compiled based on information provided by hospitals that were not keeping reliable tallies6 and hence could be an under or overestimate. Handicap International estimates that between 2000-4000 people then had amputations conducted as a life-saving procedure^[7] Amputees will require long-term medical assistance in the form of physiotherapy and access to prostheses and wheelchairs^[7]In addition, the reconstruction of public and private infrastructure will need to take into account the special needs of these disabled persons^[7]

There is currently a high unmet need for psychological first aid and emergency psychiatric treatment ^[8] . The earthquake has caused psychological reactions ranging from anxiety to psychosis. Some people are experiencing "earthquake shock", the persistent sensation that the earth continues to shake, which can cause heart racing and chest pain ^[8]. The Mars and Kline Psychiatric Center in Port-au-Prince, which is the country's only hospital for acute mental illness, has two psychiatric triage tents in its courtyard. Patients seen in these triage tents have shown post-traumatic symptoms such as nightmares, memory lapses, sleep disturbances, and loss of appetite^[8] Many of those who had mental illness before the quake have lost homes, caretakers, and medications. Those who were institutionalized have also been displaced. For example, Mars and Kline had to evacuate most of its 100 acutely ill patients, and only a few have returned ^[8]

Longer Term Health Consequences

As the requirement for emergency medical responses has subsided, there has been a gradual shift towards the rehabilitation of the Haitian people, focusing on addressing the longer-term health consequences of this catastrophe and the rebuilding of the country’s infrastructure.

Haiti’s health indicators predating the earthquake demonstrate that the country had been facing a serious health crisis. Data from 2008 indicate that a little more than half of the children aged one year had received the third dose of Diptheria, Pertussis and Tetanus vaccine and only 50% of newborns were protected against Tetanus^[9]Twenty-two to twenty-nine percent of children under five years of age suffer from moderate to severe undernutrition ^[10] Haiti has a generalized HIV epidemic, with 2.2% of adults between the ages of 15-48 living with HIV^[11] Haiti also has the highest rates of tuberculosis in the western hemisphere, a problem closely linked to the HIV epidemic^[12] Furthermore, 42% of the population lacks access to improved drinking water sources, and 81% of the population lacks access to improved sanitation facilities ^[10] Because of a lack of toilets in the camps, people must defecate and urinate without these devices^[13] The authorities are building latrines, portable toilets, and hand-washing stations ^[13]. In the interim period, contamination of drinking water sources and a lack of adequate sewage systems have the potential to greatly increase risk of water and food-borne diseases such as diarrhea, typhoid, and hepatitis A ^[12] The close proximity of living quarters also puts people at risk for transmission of communicable and infectious diseases such as pneumonia, tuberculosis, influenza, and meningococcal disease, as well as vector-borne diseases such as dengue and malaria^[12] Doctors have already witnessed a spike in illnesses from contaminated food and water, such as typhoid and shigellosis^[14]

According to the United Nations, about 900 camps have emerged in and around Port-au-Prince, varying in size from a few families to more than 40,000 people^[15] In the face of a humanitarian crisis, women are often disproportionately impacted due to existing gender inequalities that are exacerbated by mass displacement and competition for limited health and economic resources^[16] The large-scale displacement of women and girls and the lack of secure living environments have increased the vulnerability of girls and women towards gender-based violence (GBV), as seen through the rise in reports of GBV after the earthquake^[17] Haiti’s maternal mortality ratio (630 per 100,000 live births ^[18]) has been a cause of serious concern. It is estimated that at the time of the earthquake, 197,840 Haitian women were pregnant or lactating^[17] With the destruction of the previously existing fragile healthcare infrastructure and competition with other medical needs of the country, the unmet healthcare needs of pregnant women, mothers, and their infants are expected to rise^[16] Furthermore, in a country already plagued by under-nutrition, the lack of access to a consistent and regular food supply will increase morbidity and mortality among mothers and children.

In addition to the short-term and emergency mental health impacts on earthquake survivors, the trauma of living through the earthquake, subsequent loss and separation of family members, displacement from the home, loss of livelihoods, and uncertainty about the future will have enormous long-term mental health consequences. Previous research has indicated that the prevalence of post-traumatic stress disorder (PTSD) is high among earthquake survivors, which requires targeted mental health interventions^[19].

Humanitarian responses to address long-term impacts of the earthquake

International aid and non-profit organizations are currently working with national and local agencies in the reconstruction, rehabilitation, and restoration of the lives and infrastructure of the country. Based on a situation report released by the United Nations Office for the Coordination of Humanitarian Affairs, 12 clusters will work in a coordinated fashion to address various components of the reconstruction process^[20]. These clusters are Camp Coordination and Camp Management (CCCM), Education, Emergency Shelter and Non Food Items, Food, Logistics, Nutrition, Protection, Water, Sanitation and Hygiene (WASH), Agriculture, Early Recovery, Emergency Telecommunications, and Health^[20].

Resettlement

Given the current unsanitary and overcrowded living conditions of displaced persons in earthquake-affected regions, the CCCM cluster is working with the government of Haiti on the allocation of land for resettlement of these populations^[20]. The hurricane season in Haiti can lead to flooding, landslides, and mudslides in regions where temporary settlements have been built^[20]. The resettlement will take place in stages, with those living in areas that are at greatest risk for flooding receiving priority^[20].

Restoring Livelihoods

The Food and Agricultural Organization (FAO) is conducting formative research on the capacity to implement agricultural livelihood interventions. It is currently distributing seeds and agricultural equipment to farmers in preparation for the spring and summer planting seasons ^[12]

Nutrition

In order to address the problem of under-nutrition, particularly among children and women, the WFP, along with other NGO partners, is distributing nutritional supplements under the Blanket Feeding Program (BFP)^[21] The Clinton Foundation has pledged to provide 6000 cartons of Plumpy’nut, a high protein and high energy peanut-based food, for this purpose. Meals for school-going children are also being provided ^[12].

Vaccination

As of March 11, 2010, the Ministry of Health in Haiti, along with other partners, has vaccinated 58,000 children between the ages of nine months and seven years against DPT, measles, and rubella. It is also disbursing vitamin A supplements ^[17].

Security

To address the problem of GBV and child security, the Haitian National Police, along with the UN and other partner organizations, has developed patrolling systems to increase security in the camps^[17] Demarcated safety zones are being developed within camps where people can seek a safe environment if they feel threatened ^[15]. Public service messages geared towards women on issues of protection, security, and what to do when faced with GBV continue to be aired on public radio channels^[17]

Rehabilitation of Amputees

Handicap International, CBM (an international Christian development organization), and the Haitian government have been coordinating the rehabilitation effort for amputees, providing post-surgical care and physical therapy and also setting up a prosthetics workshop^[6] As of March 8, 2010, 15 people were fitted with prostheses, and approximately 300-400 emergency prostheses are expected to be developed for use in the first six months after the earthquake ^[7].

Gaps to be Filled

Operations to address the needs of a large, displaced population are currently underway, yet there are still gaps and constraints that need to be addressed. The need to set up a functioning permanent healthcare system is acute. This will be necessary for the long-term rehabilitation of those impacted by the earthquake as well as for the regular healthcare needs of the country’s population. The current lack of a mental healthcare infrastructure is a cause for concern as issues related to mental health will escalate in the coming months and years. Prior to the earthquake, Haiti had only 15 psychiatrists ^[8]. Foreign psychiatrists are seeing patients, setting up mental health programs, and training Haitian doctors, nurses, and community workers on topics such as psychopharmacology and group relaxation techniques ^[8]. The re-establishment of chronic disease management specifically for HIV positive and TB patients is also essential.

The long-term reconstruction package for Haiti is estimated to be $11.5 billion ^[12]. Ensuring that the health needs of Haitians are adequately addressed will require a strategic and coordinated approach of government and international stakeholders in charge of the rebuilding of Haiti.

References

1. ↑ ^{1.0 1.1} The New York Times. Haiti. February 22, 2010. Available at: http://topics.nytimes.com/top/news/international/countriesandterritories/haiti/index.html?scp=1-spot&sq=haiti&st=cse. Accessed March 30, 2010.
2. ↑ Associated Press. "Haiti raises earthquake's death toll to 230,000". February 10, 2010. http://www.google.com/hostednews/ap/article/ALeqM5hqoIN-dGauVPszOECabTi6YCMfuQD9DOU6HO2.
3. ↑ Partners in Health. Treating Earthquake Victims from Port-Au-Prince in Cange. Available at: http://standwithhaiti.org/haiti/news-entry/Treating-earthquake-victims-from-port-au-prince-in-cange/. Accessed March 25, 2010.
4. ↑ Delonnay, PB. Returning Home to Haiti-Providing Medical Care After the Earthquake. The New England Journal of Medicine. 362(10):e35
5. ↑ Ginzburg G et al., Rapid Medical Relief-Project Medishare and the Haitian Earthquake. 362(10):e31
6. ↑ ^{6.0 6.1} The New York Times. Countless lost limbs alter life in Haiti’s ruins. Deborah Sontag. January 22, 2010. Available at: http://www.nytimes.com/2010/02/23/world/americas/23amputee.html. Accessed March 26, 2010.
7. ↑ ^{7.0 7.1 7.2 7.3} Handicap International. Haiti Situation Update. March 19, 2010. Available at: http://www.handicap-international.us/in-the-world/states-of-intervention/programs/haiti/haiti-earthquake-documents/?dechi_programmes[selpays]=72&cHash=2ab3adb76b. Accessed March 25, 2010.
8. ↑ ^{8.0 8.1 8.2 8.3 8.4 8.5} The New York Times. In Haiti, mental health system is in collapse. Deborah Sontag. March 19, 2010. Available at: http://www.nytimes.com/2010/03/20/world/americas/20haiti.html. Accessed March 26, 2010.
9. ↑ WHO-UNICEF estimates of immunization coverage. The Republic of Haiti. Available at: http://www.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragebycountry.cfm?country=HTI. Accessed March 25, 2010.
10. ↑ ^{10.0 10.1} UNICEF. At a glance-Haiti. Statistics. Available at: http://www.unicef.org/infobycountry/haiti_statistics.html. Accessed March 25, 2010.
11. ↑ UNICEF. At a glance-Haiti. Statistics. Available at: http://www.unicef.org/infobycountry/haiti_statistics.html. Accessed March 25, 2010.
12. ↑ ^{12.0 12.1 12.2 12.3 12.4 12.5} WHO. Public health risk assessment and interventions. Earthquake: Haiti. January 2010. Available at: http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010_1/en/index.html. Accessed March 25, 2010.
13. ↑ ^{13.0 13.1} Los Angeles Times. As rains approach, a scramble to get latrines and hygiene supplies to Haiti. Ken Ellingwood. March 6, 2010. Available at: http://articles.latimes.com/2010/mar/06/world/la-fg-haiti-latrine6-2010mar06. Accessed March 26, 2010.
14. ↑ The New York Times. Poor sanitation in Haiti’s camps adds disease risk. Simon Romero. February 19, 2010. Available at: http://www.nytimes.com/2010/02/20/world/americas/20haiti.html. Accessed March 26, 2010.
15. ↑ ^{15.0 15.1} Voice of America. Sexual assaults in Haitian camps prompt security enhancements. Suzanne Presto. March 22, 2010. Available at: http://www1.voanews.com/english/news/americas/Sexual-Assaults-in-Haitian-Camps-Prompt-Security-Enhancements-88857522.html. Accessed March 30, 2010.
16. ↑ ^{16.0 16.1} Jean-Charles RM. Cracks of Gender Inequality: Haitian women after the earthquake. Social Science Research Council. Available at: http://www.ssrc.org/features/pages/haiti-now-and-next/1338/1428/. Accessed March 25, 2010.
17. ↑ ^{17.0 17.1 17.2 17.3 17.4} UNICEF: UNICEF Haiti Emergency Response Update: March 17, 2010. Available at: www.unicef.si/FileBroker.aspx?Id=5977. Accessed March 25, 2010.
18. ↑ 1.UNICEF. Revised country program document. Haiti (2009-2011). February 5, 2009. Available at: http://www.unicef.org/about/execboard/files/Haiti-FRS2009-revised_feb2010-English.pdf Accessed March 25, 2010.
19. ↑ 1.Wang L, Zhang Y, Shi Z, Wang W. Symptoms of posttraumatic stress disorder among adult survivors two months after the Wenchuan earthquake. Psychol Rep. 2009; 105: 879-85.
20. ↑ ^{20.0 20.1 20.2 20.3 20.4} United Nations Office for the Coordination of Humanitarian Affairs. Haiti Earthquake. Situation Report #31. March 24 2010. Available at: http://www2.reliefweb.int/rw/rwb.nsf/db900SID/VVOS-83VRHY?OpenDocument. Accessed March 25, 2010.
21. ↑ World Food Programme. Earthquake in Haiti. External Situation Report. March 6, 2010. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/SKEA-82JCWV?OpenDocument, Accessed March 25, 2010.