Remarks by Dr. Jon Andrus, PAHO Deputy Director

The earthquake that struck Haiti last week has caused massive loss of life, thousands of injuries and displaced persons, and has essentially crippled the country's already fragile infrastructure.  On the ground, communication and transportation remain incredibly difficult, if not nonexistent in most neighborhoods.  Scarcities of the bare necessities, such as food, water, and fuel are everywhere. Rubble and dead bodies clog the streets. And, we really still cannot define the extent of the damage accurately.

These conditions are imposing enormous difficulties in managing the supply and distribution of the massive amounts of aid that generous people and organizations are pouring into the country. We are working with our sister organizations in the UN and other health agencies to remedy this situation as rapidly as possible.

PAHO/WHO has been designated by the United Nations with support from its partners to be the coordinating agency of the health sector response. PAHO is doing so from its operation bases in Port-au-Prince and Santo Domingo, the Dominican Republic. An operations center is also being set up in Jimaní along the Haiti-Dominican border.

We know that before the earthquake, there were 371 health posts, 217 health centers and 49 hospitals nationwide in Haiti, including 11 hospitals in Port-au-Prince. The total extent of the damage to Haiti's health sector is still unknown.  We know the earthquake destroyed or damaged 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.

Some of the many hospitals that sustained damage are continuing to function, often with the help of NGOs, and field hospitals are helping fill the gaps. Israel has set up a mobile field hospital with 60 bed capacity, and has been requested to serve as a referral hospital for severely injured patients. A Russian hospital is now operational and new field hospitals are due to arrive from Turkey, France, MSF, Indonesia and the USA. The US Navy hospital ship USNS Comfort, with a 1,000-bed capacity, is also on its way.

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 such as Jamaica. Local organizations, including the Haitian Red Cross, are supporting government efforts to treat the injured and ill.

Additionally, at least 13 countries from the Region of the Americas and a number of countries from other regions are providing health relief, along with United Nations agencies and NGOs. Spain is supporting PAHO's efforts with a 2.75 million advance in Euros.

A comprehensive assessment of the damages is underway but not yet completed. Preliminary data are being shared among all involved.  Inter-agency health assessment teams have started to systematically visit existing hospitals and report to the Health Cluster meetings held daily.

To date epidemiological reports indicate that there is no increase in reportable diseases either within Haiti or along the border of Haiti and the Dominican Republic.

I want to reiterate that there is no risk of a communicable disease outbreak or any other public health threat associated with the presence of dead bodies, which are being taken to a central location for eventual identification and burial. It is important to respect the rights of families to know the fates of their lost loved ones. Reports of dumping bodies into mass graves is disheartening. PAHO/WHO is making every effort to prevent such misguided efforts.

The most urgent public health threats resulting from this massive disaster include the initial emergency treatment of wounds and injuries. Earthquakes cause high mortality due to trauma, and surgical needs are critically important in the first days and weeks. Many 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.

From the start PAHO/WHO has mobilized our entire organization to respond. Our Emergency Task Force has deployed 20 PAHO/WHO international staff from the Americas region and elsewhere in the organization's global network to Haiti. They are assisting in public health actions, mass casualty management, dead body handling, coordination, logistics and communications. These staff members are supporting the approximately 52 staffers who were already working in out Haiti country office. In addition, in the Dominican Republic PAHO has 20 staff actively engaged.

As the coordinating agency for the Health Cluster response, we are supporting Haiti's Ministry of Public Health with its initial response using rapid health assessment tools. We are also engaging the military to optimize the use of their logistics capacities and use of heavy equipment. There are 9,000 UN troops in the country, and 10,000 US soldiers are expected to be deployed.

Looking at the long haul, we are all working with the Haitian government and partners to embark on recovery and reconstruction efforts, assessing, rebuilding and helping the people of Haiti on the road to recovery.

By any stretch of the imagination, it will not be an easy road. The population in Haiti was already vulnerable and faced innumerable health threats. The earthquake increases the risk of malnutrition, especially in vulnerable groups such as young children, pregnant and lactating women and older persons. 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. Diarrhea is already a major contributor to the high rates of under-5 mortality; WHO estimates that diarrhea accounts for 16% of under-5 deaths in Haiti.

Population displacement can result in overcrowding in resettlement areas, raising the risk of transmission of certain communicable diseases such as measles and acute respiratory infections.

Reports from the national authorities, WHO and UNICEF indicate 58% measles vaccine coverage among 1-year-old children in Haiti, increasing the risk of measles outbreaks.  Overcrowding can also increase the likelihood of transmission of meningitis, waterborne and vector-borne diseases in the weeks and months following the earthquake. Haiti also has the highest tuberculosis incidence in the Western Hemisphere, with significant incidence of coinfection with HIV.

Tetanus, which has a case-fatality rate of 70-100% without medical treatment, is a potential risk with open wounds and contamination. 

Vector-borne diseases such as dengue and malaria are significant threats in Haiti. Malaria risk in the main urban areas of Port-au-Prince is considered low but may increase if we don't support the vector control program. 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.

Reproductive health is another major issue. We must ensure safe deliveries through access to basic and comprehensive emergency obstetric care. On average, Haiti has 70.000 babies born each year, so obstetric care and follow-up are also essential services during this critical time.

The Haiti earthquake continues to be an evolving tragedy, but the response has been extraordinary. We have seen Presidents Obama, Bush and Clinton uniting to raise funds for Haiti relief. We have seen individuals and nations around the world sending assistance, and the international mobilization and response have been extraordinary.

Brazil has sent plane-loads of equipment, medical supplies and staff; Chile sent a medical team to support an Argentine military hospital already operating on the ground; Ecuador, Peru, and several others sent medical supplies; Cuba sent medical teams. Jamaica is receiving the overflow of patients into its nation's hospitals and sending several medical staff by its Coast Guard directly to Haiti. The Dominican Republic is receiving and caring for patients who have evacuated; Venezuela has sent plane loads of staff and fuel; and the response from the US and Canada has been extraordinary. European countries including the UK, France, Italy, Belgium and Spain in particular have sent support, as have countries as far away as Israel and China.

The list of countries goes on and on. This represents a regional and global effort to the response. Obviously, no one nation or agency can do this alone.

Many representatives of smaller aid missions, and even individuals, want to join these efforts, many of them offering valuable skills. However, at this stage the situation is so difficult on the ground in Haiti that all outside aid teams must be completely self-sufficient.

We all have been incredibly saddened and humbled by this disaster. We must work hard to mount an effective response and help Haiti respond and rebuild hospitals and health centers, making sure they can withstand future disasters, which are always inevitable. In 2008, Haiti suffered the onslaught of 4 hurricanes.

One of the main lessons we have learned over the years is the importance of hospitals in the aftermath of a disaster, and how to avoid hospitals becoming  victims of disasters themselves, unable to provide their services precisely when they are most needed. This has happened in Haiti, but it can be prevented from happening again. We know hospitals can be built to withstand the impact of disasters and can be planned and equipped to remain functional after disasters. We will strive to apply that important lesson.

In ending, we fully acknowledge that financial contributions to the health response are the most effective support that people around the world can provide, through reputable organizations working on the ground in Haiti. Information on donating to the Pan American Health and Education Foundation's Haiti appeal can be found on the PAHO web page at www.paho.org . Thank you for your time and attention.