Foreign responders often ignored guidance and authority of Haitian government, says new PAHO/WHO report
Washington, D.C., January 13, 2012 (PAHO/WHO) — The massive humanitarian response that followed Haiti's January 2010 earthquake was less effective than it could have been due to poor coordination and information sharing and widespread disregard among international groups for the authority of the Haitian government, according to a new report from the Pan American Health Organization/World Health Organization (PAHO/WHO).
To improve future relief efforts in low-income countries, the international community should help strengthen government capacity for coordination as part of support for risk reduction and disaster preparedness, the report concludes.
The new study, Health response to the earthquake in Haiti: Lessons to be learned for the next massive sudden-onset disaster, examines the health effects of the quake and the effectiveness of national and international health relief efforts. It was released on the second anniversary of the Jan. 12, 2010, quake.
The report says Haitians themselves responded swiftly and effectively, saving many lives before foreign help could arrive. However, the domestic response was severely limited by the devastation of the country's capital and the impact on government staff and facilities.
The 7.0-magnitude quake (MMS scale) was among the most damaging in recent times, leaving more than 220,000 dead, over 300,000 injured, and some 1.3 million forced into temporary shelters. This catastrophic outcome was the result of both socioeconomic and seismic factors: the vulnerability of Haitian housing and construction, the shallow hypocenter of the quake (close to the earth's surface), and its proximity to the country's most important urban center. Rural areas in the West and South-East departments were also badly affected.
"Admittedly, Haiti was not prepared for any type of mass casualties. But no country or system could have had an orderly response to a disaster of this magnitude that affected the political, administrative, and economic center of the country," the report notes.
For its part, the international community reacted quickly and generously, mobilizing a massive amount of resources to provide essential health services that were in urgent demand. This included valuable assistance from health authorities and facilities in the Dominican Republic and from other countries in the Caribbean, who sent assistance in the first hours after the quake. However, the overall effectiveness of international efforts was undermined because many foreign actors, including most NGOs, worked with minimal coordination and with little or no regard for the authority of the Haitian government.
"One of the key lessons to be re-learned from the Haiti earthquake is that coordination can only be effective if the national authorities (civil protection, health, and other line ministries) are equipped and truly assume the ultimate leadership and authority for coordination," writes PAHO Director Dr. Mirta Roses in the report's foreword.
A critical shortcoming of the response was the lack of information sharing among different care providers. This led to lapses in follow-up care for surgical patients, including amputees, and missed opportunities for quake victims to get specialized care. For example, a dialysis center set up to treat victims with crush injuries operated at only 20 percent of its 200-patient capacity because other care providers were unaware of its existence. Compiling and disseminating a list of health facilities and the services they provide should be one of the first priorities in any future disaster, the report recommends.
Other lessons and recommendations include:
- Strengthening local search-and-rescue (SAR) capacity should be a priority for disaster preparedness. Although international SAR teams reported saving 132 lives in Haiti, local people saved many more lives before foreign teams could arrive.
- The "cluster" system—in which different U.N. agencies assume lead responsibility for different areas (health, water and sanitation, logistics)—should be aligned with the host government's ministerial structure and based on a formal agreement reached prior to any disaster.
- Management of bodies—including identification and respectful burial—remains a critical area that few humanitarian organizations are equipped to address.
- Although some donated medicines arrived without labels, expired, or unsorted, overall drug donations appeared to be more in line with WHO guidelines than in past disasters.
- "Poaching" of national health staff by foreign groups offering higher salaries and better conditions was a problem in Haiti, as it has been in other disasters. Ministry of Health guidelines for payment of Haitian public staff by international actors were adopted by some groups but ignored by most.
- Health actors' relations with the media seemed more focused on public relations than on informing and educating the public. Practices such as embedding journalists in needs-assessment missions could benefit the affected population by better publicizing the local response and other success stories.
- A few unruly incidents during supply distribution were overblown by the media, and the notion that disasters produce social disorder and violence was once again proven to be a myth.
In addition to shortcomings in the response, the report highlights a number of successes. One example was PAHO/WHO's deployment of the logistics and supply management system LSS/SUMA, which provided critical information and was one of the few international instruments that was directly managed by national authorities.
The report also points to some longer-term positive outcomes that are contributing to Haitian reconstruction and development. These include:
- The provision of free obstetric and child care through two programs (SOG and SIG) developed by PAHO/WHO and the Ministry of Health and funded by Canada, Japan, the World Bank and the European Union.
- The decentralization and strengthening of health services at the departmental and community levels.
- Permanent improvements in some specialized areas of medical care, such as treatment for spinal cord injuries, thanks to the influence and resources of foreign medical groups.
- The establishment of a surveillance system and strengthening of the Epidemiology Department of the Ministry of Health.
- A new focus on community-based mental health services as a complement to hospital-based care.
- Greater awareness of and commitment to disaster risk reduction.
- A project to incorporate the concept of "safe hospitals" into Haiti's reconstruction efforts, funded by Denmark and the World Bank.
- A new national program for attention to victims of sexual violence, led by the Ministry of Health.
- Wider social acceptance of people with disabilities, following the large number of disabling injuries that affected Haitians from all walks of life.
"The disaster brought significant changes in mentality, behavior, and attitude," wrote the report's authors, Claude de Ville de Goyet, Juan Pablo Sarmiento, and François Grünewald. "It is up to the Haitians and the international community to ensure that those changes endure."
