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

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During both the earthquake and the cholera responses, there were difficulties and missed opportunities in processing and sharing important situation awareness information among all actors, despite considerable efforts to do so. However, new ways and means of collecting, processing and visualizing data—for example, social media, cell phone tracking data, Geographic Information Systems, etc.—show significant potential to improve shared situation awareness. All of the above lead to the overarching finding from this case study: coordination mechanisms and institutional arrangements necessary to undertake a disaster response of this size and magnitude remain underdeveloped and inefficient. TAKEAWAYS As this report represents the first in a series of case studies, no specific recommendations are made. But three takeaways have been identified for consideration by global crisis responders to develop future frameworks for strengthening state health systems: • In an overwhelming, chaotic, disaster situation the security community might be an appropriate contributor to strengthen some elements of the health system: securing the supply chain; contributing to the health service delivery in providing surge secondary and tertiary care to assist health organizations regain their pre-crisis levels of functioning; supporting local and international leadership by providing security to health stakeholders. • Coordination among the key actors from the humanitarian and security community in the health sector is essential and requires long-term relationship to ensure that: there is mutual understanding among the security and humanitarian communities such that coordination mechanisms are in place prior to crisis responses; interoperability exists between the different coordination mechanisms; threats to health systems are detected and responded to quickly; Host Nation governance over the responders is clarified and supported by all means. • An efficient and pragmatic way for coordination among the humanitarian and security communities is to create, and for all actors to contribute to, a commonly shared health information picture which is essential for timely service delivery and early detection of health threats. New technologies have the potential to enhance a holistic picture to disaster response. IDEAS TO TAKE FORWARD Additionally, three key ideas will help shape the investigations to be carried out in subsequent case studies: • Weaknesses in other systems (e.g. security) may affect the health system and efforts to address these weaknesses will be considered alongside health system specific activities. • The most prominent challenge that hampers a coherent and effective response by the security, humanitarian and the development communities is insufficient coordination mechanisms at national/international political level to include the whole spectrum of governmental stakeholders in achieving a common goal. Military initiatives to develop venues on how to contribute to a comprehensive approach are not currently being fully supported by civilian actors either from the security or humanitarian and development communities. Consequently, other ways will be explored that members of all involved communities could be better engaged in common policy, plans, and standing mechanisms for interaction. • Ways and concepts that can better relate crisis response to longer term recovery and health system strengthening will be investigated. v
vi CONTENTS Foreword ................................................................................................................................ ii Acknowledgements ............................................................................................................... iii Executive Summary .............................................................................................................. iv 1 Introduction ........................................................................................................................ 1 Methodology ...................................................................................................................... 1 2 The Haiti Context ............................................................................................................... 5 Haiti—A Brief History ......................................................................................................... 5 A Crisis-Affected Fragile State ........................................................................................... 6 The Health System ............................................................................................................ 6 Contributions of Global Actors ........................................................................................... 8 3 Haiti After The Earthquake and Beyond ........................................................................... 10 The Disasters' Impact on Haiti’s Health System ............................................................... 11 Security Community and the Health System .................................................................... 14 Coordination Mechanisms for the Security Community .................................................... 16 Information Generating and Sharing Mechanisms ........................................................... 18 4 Ideas to Take Forward ..................................................................................................... 21 Key Takeaways ............................................................................................................... 21 Food for Thought ............................................................................................................. 22 Annex A Narrative: Re-Establishing Supply Chains ..................................................... A-1 Challenge to the Health System ..................................................................................... A-1 Responses to the Challenge .......................................................................................... A-1 Discussion ..................................................................................................................... A-5 Annex B Narrative: Military Contribution to Secondary and Tertiary Care Facilities .... B-1 Challenge to the Health System ..................................................................................... B-1 Responses to the Challenge .......................................................................................... B-3 Discussion ..................................................................................................................... B-6 Annex C Narrative: Cholera – The Second Shock ....................................................... C-1 Challenge to the Health System ..................................................................................... C-1 Responses to the Challenge .......................................................................................... C-2 Discussion ..................................................................................................................... C-4 Annex D Bibliography .................................................................................................. D-1 Annex E Glossary of Acronyms ................................................................................... E-1
Page 1 and 2: HARVARD MEDICAL SCHOOL DEPARTMENT O
Page 3 and 4: FOREWORD THE HAITI CASE STUDY 27 Ju
Page 5: iv EXECUTIVE SUMMARY An effective c
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
Page 53 and 54: 136 Strobel 137 The project team wa
Page 55 and 56: 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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