In the wake of the devastating earthquake of 12 January 2010, which killed an estimated 222,000 people and left 1.5 million homeless in Haiti, Médecins Sans Frontières mobilised the largest emergency response in the organisation’s 40-year history. Just ten months later, our staff supported their Haitian colleagues in tackling a nationwide cholera outbreak that would infect more than 180,000 people in less than three months.

Before the earthquake struck, healthcare was out of reach for most Haitians, as fees charged by both public and private health facilities made it unaffordable. Public hospitals and clinics were plagued by management problems and strikes, and shortages of staff, drugs and medical supplies. Patients could be turned away because the hospitals were full, or would have to abandon treatment when they ran out of money. Giving birth was a risk: Haiti’s reported maternal mortality rate was 630 deaths per 100,000 live births.

Then the earthquake hit and threw Haiti into a period of turmoil that went beyond anything even its most beleaguered residents had known.

Thousands of Haitians, most of whom were directly affected by the disaster, mobilised along with hundreds of international staff to help Médecins Sans Frontières provide assistance. Médecins Sans Frontières’ regular deployment of 800 field staff in Port-au-Prince quickly expanded to 3,400 people working in 26 hospitals and four mobile clinics. From 12 January to 31 October, medical teams treated more than 358,000 people and performed more than 16,500 surgeries.

Treating the wounded

Sadly, 12 Haitian Médecins Sans Frontières staff members were killed in the earthquake. Our obstetric and trauma hospitals were destroyed. Only the Martissant emergency facility, in south Port-au-Prince, was still operational, but it was quickly overwhelmed. Within hours of the earthquake, more than 400 critically injured patients had arrived at Martissant.

At the Médecins Sans Frontières centre in Pacot, which provided post-operative care, only one operating table was available for minor operations. In and around the collapsed La Trinité hospital, surgery was carried out in tents and, after a few days, in a converted shipping container. Within approximately 48 hours, we identified available rooms and a dressing station at the Ministry of Health’s Choscal hospital and managed to start surgical activities in two operating theatres there. By 15 January, major surgery was also being provided in tents around Carrefour hospital. Our surgeons performed more than 5,700 major surgical procedures during the first three months, 150 of which involved amputations.

Emergency field hospitals were set up in all kinds of structures – a dental clinic at Bicentenaire, a school in Carrefour, and semi-permanent buildings in Léogâne, west of Port-au-Prince. An inflatable tent hospital replaced the destroyed La Trinité hospital and provided emergency medical care as well as more specialised trauma and orthopaedic surgical care. In Sarthe, we opened a centre for post-emergency surgery and post-operative care. More than 500 patients underwent specialised orthopaedic or reconstructive surgery. Handicap International physiotherapists worked in collaboration with Médecins Sans Frontières to help patients recover and adapt to prosthetics. Mental healthcare was also provided.

Jacmel, a town on the south coast, was also badly hit by the earthquake, and our teams started supporting the 80-bed Saint Michel hospital on 22 January. Staff carried out 662 surgical operations and delivered 1,443 babies over the course of the year.

Emergency obstetric care

As Médecins Sans Frontières’ emergency obstetric hospital had been destroyed, we started offering staff, drugs and obstetrics expertise to support the Ministry of Health maternity hospital, Isaïe Jeanty, which had not been damaged by the earthquake. Isaïe Jeanty treats pregnant women with medical complications such as eclampsia and malaria, and provides neonatal and postnatal services and a blood bank. In Léogâne, our team set up a 120-bed field hospital, which was later replaced with a more permanent container hospital. More than 15,000 babies were delivered in Médecins Sans Frontières-supported facilities in 2010.

Specialised care

When La Trinité hospital was destroyed, Haiti lost its only specialised treatment unit for severe burns. Re-establishing this unit became a priority, especially given the dangerous living conditions. By late March, a new 30-bed burns unit had been set up under canvas within the nearby Saint Louis hospital compound.

Psychiatric care was also organised at Saint Louis hospital for patients who required mental health services and could be referred from other Médecins Sans Frontières programmes or other health providers. Our teams gave psychosocial or psychiatric support to more than 40,000 people during the initial emergency phase.

Non-medical assistance

By the end of June, we had distributed more than 28,640 tents, approximately 2,800 rolls of plastic sheeting, and close to 85,000 relief supply kits (made up of items such as cooking utensils, hygiene products and blankets) to people living near the epicentre of the earthquake. In Léogâne, for example, Médecins Sans Frontières made distributions to 3,000 families.

Much of Médecins Sans Frontières’ water and sanitation work focused on creating the appropriate hygiene conditions to carry out medical and surgical programmes. Teams ensured the supply of safe water, constructed or rehabilitated latrines, and set up the safe evacuation of waste at Médecins Sans Frontières’ 26 facilities.

Cholera outbreak

In mid-October, suspected cases of cholera, a disease not reported in the country for decades, emerged in the Artibonite region, western Haiti. Médecins Sans Frontières dispatched teams to the town of Saint Marc and they immediately began treating patients for severe dehydration from diarrhoea in the Ministry of Health hospital.

The outbreak would eventually touch every province in the country. From 22 October until the end of the year, our team treated more than 91,000 of the 171,300 people reported as having cholera nationwide. Specialised treatment centres were set up for pregnant women in Isaïe Jeanty hospital and in Léogâne. Teams established over 4,000 beds in 47 facilities around the country. More than 1,000 tons of medical and logistical supplies were delivered, and more than 5,500 staff dedicated to cholera treatment.

In 2011, we will relocate our medical activities – including the obstetric centre and the only burns treatment unit – into three newly constructed hospital facilities in Port-au-Prince. Outside the capital, we will continue to operate a 120-bed general hospital that it has built in Léogâne.

Médecins Sans Frontières has worked in Haiti since 1991.