Haiti Case Study - The Department of Global Health and Social ...

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PROJECT TEAM Dr. Vanessa Bradford Kerry Harvard Medical School, Department of Global Health and Social Medicine Dr. Margaret Bourdeaux Division of Global Health Equity Brigham and Women’s Hospital Mr. John Crowley Harvard Humanitarian Initiative iii ACKNOWLEDGEMENTS Cdr. Dr. Christian Haggenmiller German Navy, NATO – JALLC Cdr. Luigi Ceppodomo Italian Navy, NATO – JALLC LtCdr Andre Thouvenel French Navy, NATO – JALLC Capt. Brad Holt, US Navy NATO – Allied Command Transformation CUSTOMER REPRESENTATIVE NATO HQ Supreme Allied Commander Transformation Capability Development Joint Deployment and Sustainment, Medical Branch Col. Toby Rowland, British Army and Col. Dr. Valerie Denux, French Military Health Service ADVISORY BOARD H.E. Ambassador Michel Rentenaar, NATO – Civilian Advisor to the Supreme Allied Commander Europe Rear Adm. Bruce Doll, US Navy, NATO – Medical Advisor to the Supreme Allied Commander Transformation Brig. Gen. Peter Sonneby, Royal Danish Air Force, NATO – Commander JALLC Col. Karlheinz Nickel, German Air Force, NATO – JALLC Prof. Michael Reich, Harvard School of Public Health – Taro Takemi Professor of International Health Policy Dr. Jennifer Leaning, Harvard School of Public Health – Director, FXB Center for Health and Human Rights Dr. Michael Vanrooyen, Director – Harvard Humanitarian Initiative Dr. Frederick Burkle, Senior Fellow – Harvard Humanitarian Initiative Dr. Stewart Patrick, Council on Foreign Relations – Senior Fellow and Director of the International Institutions and Global Governance Program Dr. Stephen Morrison, Center for Strategic and International Studies – Director of the Center on Global Health Policy
iv EXECUTIVE SUMMARY An effective comprehensive response to health system strengthening in crisis-affected fragile states demands coherent action by all participating actors. A particularly complex challenge in this regard is coordinating the desired outcomes and the required actions of the humanitarian & development and security communities. A joint team from NATO's Joint Analysis and Lessons Learned Centre and Harvard Medical School is engaged in a study with the overarching aim to infer elements of a strategic framework for health system strengthening in crisis-affected fragile states focusing on optimal use of all global contributions. The approach adopted by the team to meet this aim relies predominantly on case study research. This report documents the results from investigation of the first case study: Haiti. Haiti met all three criteria established for case study selection: it is a fragile state whose health system was threatened by a major earthquake followed by a major cholera outbreak; there was a global crisis response directed towards health system strengthening; and a multinational military force with a peace-keeping/peace-building or stabilization mandate was present. Four key themes are developed: the impact of the earthquake and the subsequent cholera epidemic on Haiti’s health system; security community participation in health system recovery and reconstruction; coordination mechanisms that facilitated or directed the security community’s involvement; and the information generating and sharing mechanisms that allowed the security community to best participate in health system strengthening. Investigations into these four themes were focussed through the use of the three narratives given in the Annexes to this paper. FINDINGS The Haitian government lost significant assets—personnel, infrastructure, communications, records and administrative systems—at a time when their citizens were in the greatest peril and counting on them the most. Additionally, the aid community, including the UN peacekeeping mission MINUSTAH, UN agencies, and aid organizations were also severely affected by the earthquake and were unable to offer robust support of the Haitian state. Nations responded principally by deploying military assets including logistics, security escorts, rubble clearance, engineering services, and tertiary care, all of which contributed significantly to the overall effort of the international community in responding to the earthquake; the US was the largest bilateral responder. A coordination architecture for the whole response existed at the strategic level (High Level Coordination Committee), the operational level (Coordination Support Committee), and at the tactical level (UN sector-based cluster system). The key military tactical level coordination mechanism was the Joint Operations and Tasking Center, formed by UN Office for the Coordination of Humanitarian Affairs, MINUSTAH and other key partners, to orchestrate the use of military assets for relief purposes. The US military created the Humanitarian Assistance Coordination Centre to interface with the Coordination Support Committee and the Joint Operations and Tasking Centre. Coordination among donor nations, the government of Haiti, UN agencies, militaries and relief agencies was a complex web. Personal relationships and friendships among leaders of response entities were instrumental in facilitating coordination mechanisms.
Page 1 and 2: HARVARD MEDICAL SCHOOL DEPARTMENT O
Page 3: FOREWORD THE HAITI CASE STUDY 27 Ju
Page 7 and 8: vi CONTENTS Foreword ..............
Page 9 and 10: 6. The fundamental unit of analysis
Page 11 and 12: feedback from the Advisory Board an
Page 13 and 14: law 11 . In 2006, Rene Préval agai
Page 15 and 16: CONTRIBUTIONS OF GLOBAL ACTORS 36.
Page 17 and 18: 3 HAITI AFTER THE EARTHQUAKE AND BE
Page 19 and 20: Haitians continued working in the p
Page 21 and 22: SECURITY COMMUNITY AND THE HEALTH S
Page 23 and 24: COORDINATION MECHANISMS FOR THE SEC
Page 25 and 26: of lowest common denominator, and a
Page 27 and 28: • Coordination among donor nation
Page 29 and 30: FOOD FOR THOUGHT 88. The following
Page 31 and 32: 24 ENDNOTES 1 WHO; Every Body’s B
Page 33 and 34: 45 Médecins Sans Frontières; Hait
Page 35 and 36: THE NARRATIVES
Page 37 and 38: 6. On the evening of 15 January, a
Page 39 and 40: programme were not functional. As a
Page 41 and 42: support for humanitarian assistance
Page 43 and 44: 111 UN Foundation; Disaster Relief
Page 45 and 46: Figure 3: Graph of Fatalities repor
Page 47 and 48: distance from the airport within ei
Page 49 and 50: the USNS COMFORT was based largely
Page 51 and 52: . The UMGI/PM field hospital propos
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and fatalities affected the ability
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Medical Supply Distribution and Man
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32. New technology offers an opport
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Health and Security 42. Environment
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C-10 ENDNOTES 148 ReliefWeb website
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198 Trenton C-12
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CIA; Haiti country profile; CIA Wor
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"Human Rights Liaison Unit; Human R
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Pape, J. W., W. D. Johnson, and D.
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UN Foundation; Disaster Relief 2.0
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E-1 Annex E GLOSSARY OF ACRONYMS AL
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