versão impressa ISSN 0042-9686
Bull World Health Organ vol.82 no.4 Genebra Abr. 2004
PAHO works to restore public health services in Haiti
The rebellion in Haiti which erupted in early February 2004 forcing President Jean-Bertrand Aristide into exile on 29 February has had a devastating effect on an already precarious health system, said officials from the Pan American Health Organization (PAHO), the WHO Regional Office for the Americas.
PAHO reported on 1 March that most of Haiti's public hospitals and health centres had ceased full operations - including the State University Hospital which takes care of the capital city's population - and that the situation was compounded by a lack of electricity and water, triggered by fuel shortages. Whilst most of the private hospitals were beginning to resume operations, the eight hospitals in the area surrounding the country's capital, Port-au-Prince, were unable to take care of patients, leaving many medical emergency cases unattended. Only about 60% of Haiti's 8 million people have access to health care and the vast majority relies on public hospitals.
According to WHO's Situation Report for Haiti on 8 March referring to the status of public health services in the capital, "there is no current capacity to assist patients either with injuries or with diseases."
"The situation in Port-au-Prince is serious because of the interruption of basic services, some of which were facing difficulties even before this crisis," said Dr Jean-Luc Poncelet, head of PAHO's Program on Emergency Preparedness and Disaster Relief. The agency has set up an emergency centre at its Washington DC headquarters to coordinate the work of 12 staff operating from Port-au-Prince. PAHO has about 70 people in the country as a whole working with numerous partners to restore Haiti's health system.
"PAHO continues to work to help alleviate Haiti's humanitarian crisis by coordinating the shipments of medical supplies to hospitals in the affected areas," said Poncelet. "The priorities continue to be to ensure the distribution of essential medicines and medical services to the most vulnerable sectors of the population, to strengthen the logistical support and to reactivate the monitoring stations for specific information about diseases."
In late February, in a joint operation with the International Committee for the Red Cross (ICRC), PAHO succeeded in sending two convoys with medicines and vaccines to the towns of Gonaives and Saint Marc, north of Port-au-Prince. Since then, the agency has been helping with the distribution of fuel supplies needed to restore services at ten Haitian hospitals. The disruption of fuel supplies has led to an interruption in the supply of drinking water which relies on fuel-powered generators and power stations. PAHO/WHO and ICRC are also working to respond to a shortage of propane gas which is needed to keep vaccines refrigerated.
Poncelet underlined the importance of incorporating the existing health infrastructure in efforts to help restore Haiti's health services.
"Haiti had an infrastructure, however limited, prior to this crisis, and efforts should be focused on putting that infrastructure back on its feet," he said. "We don't need to set up field hospitals, but rather concentrate on working with people who were already in the health services, as well as with nongovernmental organizations and other sectors."
The United Nations issued a Flash Appeal for US$ 35 million on 3 March calling upon the international community to provide urgent aid for the beleagured country. "The objective of the Flash Appeal is to respond to urgent and immediate needs of the Haitian population and to quickly establish the basis for rehabilitation of social services and economic recovery," said the UN statement accompanying the launch of the appeal.
The appeal noted that several hospitals and health-care centres had been the target of armed groups resulting in the lack of medicines, vaccines and medical personnel. It also cited problems surrounding reproductive health, nutrition, access to HIV drugs, water, food security and violence.
UNICEF issued an emergency appeal on 27 February for US$ 8.7 million to provide relief for children and women affected by the collapse in civil authority.
"We have to keep children alive now by vaccinating them and providing clean water," said UNICEF Executive Director, Carol Bellamy. "But we're also looking six months ahead … to ensure that children and mothers have basic life-saving medical care." UNICEF, along with PAHO/WHO is planning on the resumption of vaccination activities against polio, measles and tetanus for some 280 000 children.
According to UNICEF, even before the crisis, the country's health system was in a state of disrepair - the situation for Haitian children was among the worst in the world, said the agency in a statement. More than on in 10 Haitian children die before the age of five and more than 200 000 have lost one or both parents to AIDS. Maternal mortality in the country is among the highest in the world.
An integrated multi-disciplinary assessment mission led by the UN Department of Peacekeeping Operations was due to begin a two-week mission in the country beginning 12 March. The team will draw on participation from other UN agencies including WHO/PAHO.