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  • Nearly ten years ago, in the mid-afternoon of January 12, 2010, a magnitude 7.0 earthquake

  • hit just outside Port-au-Prince, Haiti, leveling a large part of the country and killing an

  • unimaginable number of people in a quick thirty seconds.

  • It immediately became clear that, although the earthquake lasted only seconds, the humanitarian

  • disaster would last for years because of three simple facts.

  • One was the earthquake's location.

  • In a twist of terrible luck, the quake hit shallow and just 16 miles or 25 kilometers

  • away from the country's capital and largest cityPort-au-Prince.

  • Two was Haiti's economic situation.

  • It is the poorest country in the western hemisphere with an estimated GDP per capita, at the time

  • of the earthquake, of just $665.

  • That meant that most Haitians had little money to relocate and reestablish their lives after

  • their homes were destroyed.

  • In addition, with a poorly funded government, emergency services were few and far between

  • and poorly equipped.

  • The third fact leading to the scale of the humanitarian disaster was just the pure scale

  • of destruction.

  • Most buildings in the island-nation were not nearly as stable as those in a developed nation

  • and therefore, whereas another developed country might have been able to weather the quake

  • quite well, the buildings of Haiti crumbled like dust.

  • With the scale of devastation, as soon as word of the quake reached the rest of the

  • world, the focus of every major disaster response organization in the world shifted to Haiti.

  • This whole world of disaster response is a nuanced and complex one.

  • Simply showing up and helping where one can just doesn't work.

  • Water isn't useful by itself.

  • Food isn't useful by itself.

  • Doctors aren't useful by themselves.

  • Every resource that might be needed following a disaster must be carefully coordinated and

  • managed or else it is useless.

  • Behind that management, there are professionals who spend their whole lives working on how

  • to best respond to moments like thesethe worst 30 seconds of Haiti's history.

  • I spoke to two of those professionals on how they do their jobsStephanie Kayden, “Kayden:

  • [00:00:26] I am a vice chair of emergency medicine at Brigham and Women's Hospital and

  • the director of the Humanitarian Studies Initiative at the Harvard Humanitarian Initiative,”

  • and Mike VanRooyen, “VanRooyen: [00:00:11] I'm the director of the Harvard Humanitarian

  • Initiative and I'm a professor at the Harvard Medical School and the School of Public Health.”

  • Both Stephanie and Mike helped establish and then worked on the ground at the what became

  • one of the largest field hospitals in Haiti following the 2010 earthquake.

  • Kayden: [00:09:53] It turns out that when you're a doctor responding to one of these

  • international disasters just having medical knowledge is not good enough.

  • In order to do this work properly you have to know what the international standards are

  • for giving humanitarian aid.

  • You have to know not only the medical side but how to give food and how to give clean

  • water and how to give proper shelter and those guidelines are already written down in something

  • called this sphere standards.”

  • In its 406 pages, the Sphere handbook has specific guidelines like that everyone needs

  • 15 liters of water per day; that a single hand pump at a flow rate of 17 liters per

  • minute can act as the water source for up to 500 people; it gives a clear step-by-step

  • guide to establishing a goods-delivery system; it defines that, in an emergency shelter situation,

  • everyone should have at least 38 square feet or 3.5 square meters of living space, but

  • that, in cold climates, that should be increased to 48 square feet or 4.5 square meters.

  • It takes out as much of the guesswork in humanitarian response as possible.

  • This is what much of the work by academics like Stephanie and Mike isdeveloping standards

  • and frameworks before a disaster happens so that, as much as possible, when disaster strikes,

  • people don't need to think, they just need to do.

  • This response does, of course, though, vary depending on the nature of the disaster.

  • VanRooyen: [00:45:35] An earthquake tends to cause a lot of death immediately and also

  • a lot of heavy injuries like fractures or head injuries.

  • They require intensive medical care and surgical care.

  • They overwhelm the hospital structures as well and so the immediate needs for a place

  • like Haiti for example are surgeons and people who could manage emergency wound care and

  • even things like dialysis or things like that.

  • Let's take another example of say a flood.

  • Right.

  • A flood can be amazingly devastating, move people out of their house, even sweep people

  • away, but a flood or a hurricane kills people but doesn't necessarily leave a lot of injured

  • people.

  • So at the end after people have died from a massive flood or a hurricane what's left

  • are people who have minor injuries maybe but they don't really overwhelm the surgical structures

  • of a hospital where they overwhelm is the public health.”

  • In an ideal world, the level of humanitarian aid given would be determined by the actual

  • need, but in reality, this is often not the case.

  • The reality is that often, but not always, the more accessible a disaster site is, the

  • more response it gets.

  • What that means is that, because Haiti was so close to the US, where many humanitarian

  • organizations are based, it was quite easy for them to mobilize after this earthquake

  • so Haiti got large numbers of responders quite quickly, but this principle can also leave

  • other countries without the help they need.

  • VanRooyen [00:14:47] So take for example around the same time as the Haiti earthquake

  • there was a massive flood in Pakistan but it was very remote and very difficult to get

  • to.

  • So the difference in the responders is entirely different.

  • The only people that could respond in this distant area of Pakistan for this massive

  • flood were the major organizations that had lifting capacity and they could fly planes

  • in and they could land personnel in in the middle of someplace that's very remote.”

  • Haiti, on the other hand, received a massive response especially, in comparison, by smaller

  • organizations given the proximity to the US and also given the fact that individuals in

  • the US were particularly motivated to donate given the proximity.

  • Through NGO's and charities, Americans contributed about $4 billion to the relief effort in the

  • first three months.

  • Therefore, the real issue in Haiti was not getting a response, it was managing the response.

  • Because of that accessibility from the US, a huge number of less professional responders

  • showed up, and in order to be effective, these responders needed a high degree of management

  • from the professionals who did show up and were practiced on the international standards.

  • In addition, there was the issue of actually getting all these responders and their supplies

  • there.

  • Kayden: [00:16:35] In the case of Haiti it's an island nation, so a lot of the heavy

  • things like fuel have to come in by ship but the earthquake severely damaged the port in

  • Port au Prince, and because the gas stations with their underground tanks had also been

  • damaged, the relief community couldn't use the fuel from those tanks without ruining

  • the engines in their cars and shutting down all the trucks, and so there was a big fuel

  • crisis early on and that meant it was hard to transport things.

  • So, while we were waiting for the port to be fixed, a lot of the supplies had to be

  • flown in either on airplanes that were landing at the Port au Prince airport or overland

  • from the Dominican Republic.”

  • In the early days of the response, both of those methods had their own unique difficulties.

  • Coming from the Dominican Republic, many of the roads were damaged, destroyed, or covered

  • in debris, so that was quite a slow option.

  • The airport therefore stood alone as the only high-speed link between Haiti and the world,

  • serving as the only route in for all the most time-sensitive supplies.

  • In the initial 24 hours after the earthquake, Port-au-Prince's airpot saw chaos as flights

  • poured in with no direction into an airport with essentially no control.

  • The first semblance of control came the morning after the quake when the US Coast Guard Cutter

  • Forward pulled into Port-au-Prince and just hours later started working as the airport's

  • air traffic control from the ship.

  • The airport's own air traffic control tower was badly damaged in the quake so it was far

  • from operational.

  • Soon after, that same afternoon, a team of US Air Force airmen landed at the airport

  • and assumed responsibility for its air traffic control.

  • Their operation was made up of, quite literally, a bunch of folding tables and handheld radios

  • set up at the end of the runway as they guided flights in.

  • With this setup, they handled up to almost 200 planes a day despite the fact that on

  • a normal day the airport receives no more than a dozen commercial flights.

  • Eventually, Haiti officially handed control of the airport over to the US, meaning the

  • Americans could settle in and set up formally for the long-haul, and a team from the American

  • FAA came down to take control as they set up a portable, temporary air traffic control

  • tower.

  • Of course, even working at full capacity, there was still an enormous backlog at this

  • small airport, leading them to set up a system where flights would be prioritized based off

  • what they carried with the highest demand humanitarian goods being allowed in first.

  • Of course, even once you get a plane with supplies on the ground, getting those supplies

  • to those in need is not a given because, in between the runway and the roads, there is,

  • of course, customs.

  • “[00:18:39] Often what happens is that the national government of the place where a disaster's

  • happened has a way of sort of relaxing customs efforts for relief supplies coming in and

  • trying to fast forward them through.

  • But that doesn't always happen especially with medical supplies which can include powerful

  • painkillers that might be particularly regulated by government and so a lot of times aid agencies

  • will face a backlog in their relief supplies coming in as they get, sort of, stuck in customs.”

  • Eventually, though, once a solid supply chain is set up, responders can actually get to

  • work.

  • Stephanie and Mike, of course, worked to set up that field hospital to start treating all

  • the most severe injuries from the earthquake.

  • While the Harvard Humanitarian Initiative, who they both work for, doesn't typically

  • itself actually respond on the ground to disasters, they did exceptionally in this case and, as

  • the literal experts in this sort of activity, they were able to set up a stellar operation.

  • As experts, they knew, once again, that doctors by themselves aren't necessarily useful.

  • Doctors are useful when placed where they're needed and so, the first step was to identify

  • what was needed.

  • VanRooyen: [00:19:36] So in the Haiti Response the HHI team identified one major gap in particular

  • and that was the lack of rehabilitation resources for patients that had big operations like

  • orthopedic operations but had nowhere to go because there was no place to admit them and

  • to rehabilitate them.”

  • Therefore, the hospital had its focus and everything could go from there.

  • Again because of the specific nature of the disaster, the team knew that they couldn't

  • set up their temporary hospital just anywhere.

  • Kayden: [00:29:01] After an earthquake in particular when the people who'd been injured

  • in the earthquake have seen all the buildings around them fall down, they do not want to

  • go into another building because there are a lot of aftershocks afterwards and they're

  • afraid that these buildings might have been damaged and that they might fall down and

  • either kill them or cause more injury.

  • That is a very reasonable fear and so even though the place where we were working had

  • buildings that were very strong and very well able to sustain all the aftershocks with little

  • or no damage, the people that we were helping were too afraid to go inside them.”

  • The hospital therefore had to be almost entirely built out of tents.

  • Despite the focus on acting as a rehabilitation center, the hospital did, however, still perform

  • surgery and therefore they needed a super-sterile environment to prevent infection or contamination

  • during surgery.

  • That's quite tough to create in a series of tents, so they used two solutions for this.

  • Kayden: [00:30:33] One, the easier way was we had operating theater trucks.

  • So imagine a big delivery truck that you can open the doors and instead of finding boxes

  • inside you find an OR or an operating theater.

  • We had a couple of those and that was very useful because they come already sealed.

  • A lot of our surgeries though we had to do in what were classrooms in a school in Haiti

  • and what we had to do there was to actually tape up sheets over the windowsplastic

  • sheeting to make sure that no insects or dust would come from the outside while we were

  • doing the surgeries so that we can make it sterile and safe place to do them.”

  • Of course, the goal of responding to humanitarian disasters is to get the humanitarian disaster

  • to end, so that means there also has to be focus on the exit strategy.

  • Kayden: [00:27:06] So when a disaster happens and we go in and start working even from the

  • first day we're always thinking about the day we're going to leave, and so what that

  • means is we do a number of things right from the start.

  • In Haiti, for example, we wanted to make sure that as we were caring for people's wounds

  • we were teaching the local doctors and nurses that we were working with how to do that kind

  • of care if they weren't already familiar with it so that when we left they would be able

  • to easily carry that forward.”

  • Getting to that finalewhen the agencies pull out, when a country is back to normal,

  • once life goes on as normal after a disasteris a delicate science that doesn't always go

  • to plan.

  • No matter how many frameworks, handbooks, and guidelines one has, a disaster is a disaster

  • and does not follow plans.

  • The role of all the planning and preparation, though, is to provide structure where there

  • is none.

  • People like Stephanie and Mike spend their entire careers studying and educating others

  • on this field since certain help is certainly better than other help and, in a case when

  • the worst has happened, only the best help is enough.

  • Working in disaster response clearly requires that your problem solving and critical thinking

  • skills are quick and accurate.

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B1 US haiti disaster humanitarian earthquake response port

The Logistics of Disaster Response

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    joey joey posted on 2021/06/10
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