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

the USNS COMFORT was based largely on resource considerations. Thus, once earthquakerelated
injuries levelled off and the non-earthquake related injured and ill began seeking
care from COMFORT 137 , the ship began a tacit program of “weaning,” whereby fewer and fewer
patients were accepted, even though COMFORT had additional capacity. COMFORT left on 09
March 2010 138 , 49 days after she treated her first patients.
DISCUSSION
30. Existing health facilities—already struggling to meet the needs of the population—were
devastated by the earthquake, especially at the secondary and tertiary care levels.
Hospitals, where they survived, were rapidly overwhelmed by patients. Military security and
military medical treatment facilities were used to temporarily strengthen the health system
and clearly provided net benefit to the Haitian population and in the immediate aftermath of
the disaster.
31. There were however some challenges faced by those providing security at existing
medical treatment facilities and those working at military hospitals. It is worth noting that
both military health facility providers considered in this narrative, although operating very
different facilities and from different nations under different mandates, faced similar
challenges. Many of these challenges were also faced by NGOs operating treatment
facilities. The following sections sum up the challenges faced.
Military security provision at indigenous health facilities
32. Initially, security did not appear to be a major concern on the ground: Haiti was not
involved in armed conflict at the time of the earthquake. The immediate-post-shock stage
affected everybody universally, an idea corroborated, for instance, by statistical data with
respect to gunshot wound interventions in MSF facilities; there were about the half as many
in the first month following the earthquake than in the following months. 139 As a
consequence, there was no evidence of civil unrest outbreak and no particular report of
violence against health facilities. 140 Due to the lack of coordination and the absence of police
forces during the first days, a military presence was helpful to secure the healthcare facilities
and allow service providers the opportunity to triage casualties, until transition to local police
or private security could be arranged.
Building situation awareness and coordinating
33. The early responders from the international community had to set up their facilities
without coordination or standardization. At the outset, newly-arrived responding healthcare
providers simply did not know what Haitian (or pre-existing non-Haitian) healthcare facility
capabilities existed—they did not have comprehensive knowledge of what prior capabilities
had existed to begin with and they did not know the current status of those capabilities. An
assessment of the status of existing capabilities is required for any provider seeking to
integrate with existing efforts. US military providers seemed to have among the best
situation awareness in this respect following extensive pre-deployment surveys. Some
private sector care providers sent personnel with handheld (e.g. Blackberry, Palm Pilot, etc.)
communication devices to get data and develop a database of needs and capabilities. It
seems that little information sharing took place in the early days and at least one observer
felt this ad hoc effort to create a common operating picture ultimately took too long to set up.
“By the time it could be up and running, need was over”, one US Government representative
said.
34. One surprising but undeniable feature of the effort to coordinate and standardize efforts
and build situation awareness was the role of personal knowledge and informal contacts
among key players. Military contributions benefitted significantly from the ad hoc capability
provided by informal contacts. It seems likely there will be a lack of coordination and
standardization to cope with at the start of any crisis response and informal contact networks
are a pragmatic solution to overcome this challenge and should be encouraged.
B-6