Posted in Issue 113 - May 2010 Perspective
The January 12 earthquake in Haiti left in its wake more than 300,000 persons with injuries, many of whom are now temporarily or permanently disabled. Combined with the estimated 800,000 persons living with disabilities before the earthquake, this results in a significant proportion of the population in a situation of extreme vulnerability.
People with disability and other vulnerable groups are always among the most seriously affected during and after crisis. They are often “invisible” to mainstream relief organizations and lack proper access to the relief activities deployed, therefore facing major challenges and protection issues. With the urgency to provide large-scale humanitarian relief to the Haitian population, many vulnerable people find themselves excluded from the relief efforts. Handicap International’s strategy is thus two-fold: to provide specific support to persons with injuries and disabilities, and to ensure this population has equal access to all mainstream relief services.
Fractures account for the most frequent major injury following the earthquake in Haiti, followed by amputations, spinal cord injuries (SCI), burns, and head injuries. Some of the injured—such as those with amputations or spinal cord injuries—are immediately faced with disabling consequences and need specialized services and care to mitigate their disability. The earlier these services are started, the more impact they will have. Early rehabilitation can prevent potentially life-threatening pressure sores in a person with SCI and can ensure that a person with amputation can be fitted with a prosthesis at a later date.
A larger proportion of injured persons face a significant risk of becoming permanently disabled due to secondary complications from infected wounds and poorly managed fractures, including contractures, paralysis due to nerve lesions, or secondary amputations. Immediate implementation of rehabilitation services following the earthquake is vital—providing mobility devices to persons with fractures to restore movement and stimulate recovery, teaching exercises to prevent contractures, providing simple advice to families and caregivers, etc. Emphasis on regular wound care and appropriate hygiene is essential to prevent infection.
Starting on January 14, Handicap International (HI) and its partners immediately carried out rapid assessment of the situation and simultaneous provision of relief in hospitals and in the community. Essential services included: provision of post-surgical care and early rehabilitation at hospital level; setting up a link from hospitals to communities to guarantee continuity of care and assistance; and ensuring that vulnerable people had access to information on services available to assist them with basic and specific needs. In an emergency situation, HI’s strategy comprises specialized services such as rehabilitation alongside general humanitarian assistance to ensure that specific and basic needs are covered both for persons with injuries and disabilities as well as the larger vulnerable population.
Actions in hospitals:
- Teams of Haitian and expatriate physiotherapists, occupational therapists, nurses, and community workers have provided more than 11,000 rehabilitation sessions in 19 hospitals in the Port-au-Prince area since the earthquake.
- Assistive devices such as wheelchairs, mattresses, crutches, and walkers have been distributed, and education sessions provided to caregivers and family members.
- These activities are being implemented in collaboration with the Christian Blind Mission (CBM), an international NGO specializing in disability.
Actions in the community:
- Nine temporary assistance points (antennes handicap) have been set up at community level to provide information and services for persons with injuries and disabilities and to the elderly. To date, approximately 4,000 people have benefited from these services and more than 1,000 assistive devices have been provided.
- These antennes ensure the link from hospital to community and provide services such as wound care, rehabilitation, distribution of assistive devices, psychosocial support, provision of temporary shelter, information on humanitarian services, referral to other actors for specific or mainstream assistance (e.g., surgery, food distribution), etc. Mobile teams provide home-based services for people unable to reach the antenne sites.
- These antennes are implemented in partnership with the Haitian Secretary of State for the Inclusion of Persons with Disabilities and CBM.
Prosthetic and orthotic services:
- HI, with partner Healing Hands for Haiti, has opened a rehabilitation center in Port-au-Prince for fabrication and provision of prosthetics and orthotics, along with related rehabilitation and psychosocial services.
- The center provides prosthetic devices to persons with amputations, as well as orthotic devices for persons with spinal cord injuries and complications from fractures and for others requiring postural supports or splints.
- The center is currently following 150 patients and has a target of reaching 450 patients by the end of July.
In addition to the above specific services, HI has been distributing emergency humanitarian aid (food, temporary shelter, and non-food items) with a strategy to ensure appropriate inclusion of vulnerable persons.
To promote a coordinated response for persons with injuries and disabilities, an Injury, Rehabilitation and Disability Working Group has been set up under the UN Health Cluster. This working group is led by HI, CBM, the Haitian Secretary of State for the Inclusion of Persons with Disabilities, and the Ministry of Health.
It is evident that during the emergency response phase, actions targeting persons with injuries and disabilities are absolutely necessary to prevent or mitigate disability and to ensure access to all humanitarian assistance programs. Immediate activation of rehabilitation teams at hospitals and in communities can have a very strong impact on prevention of disability in injured persons and is an essential component of the emergency medical response. A coordinated response is crucial to maximize impact of rehabilitation and other services for persons with disabilities and injuries.
* Emergency Response Specialist, Handicap International