Medical disaster response: A critical analysis of the 2010 Haiti earthquake

Introduction

On January 12, 2010, a 7.0 magnitude earthquake struck the Republic of Haiti. The human cost was enormous-an estimated 316,000 people were killed, and a further 300,000 were injured. The scope of the disaster was matched by the scope of the response, which remains the largest multinational humanitarian response to date. An extensive scoping review of the relevant literature was undertaken, to identify studies that discussed the civilian and military disaster relief efforts. The aim was to highlight the key-lessons learned, that can be applied to future disaster response practise.

Methods

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidance was followed. Seven scientific databases were searched, using consistent search terms-followed by an analysis of the existent Haitian literature. This process was supplemented by reviewing available grey literature. A total of 2,671 articles were reviewed, 106 of which were included in the study. In-depth analysis was structured, by aligning data to 12 key-domains, whilst also considering cross-sector interaction (Civilian-Civilian, Military-Military, and Civilian-Military). Dominant themes and lessons learned were identified and recorded in an online spreadsheet by an international research team. This study focuses on explicitly analysing the medical aspects of the humanitarian response.

Results

An unpreceded collaborative effort between non-governmental organisations, international militaries, and local stakeholders, led to a substantial number of disaster victims receiving life and limb-saving care. However, the response was not faultless. Relief efforts were complicated by large influxes of inexperienced actors, inadequate preliminary needs assessments, a lack of pre-existing policy regarding conduct and inter-agency collaboration, and limited consideration of post-disaster redevelopment during initial planning. Furthermore, one critical theme that bridged all aspects of the disaster response, was the failure of the international community to ensure Haitian involvement.

Conclusions

No modern disaster has yet been as devastating as the 2010 Haiti earthquake. Given the ongoing climate crisis, as well as the risks posed by armed conflict-this will not remain the case indefinitely. This systematic analysis of the combined civilian and military disaster response, offers vital evidence for informing future medical relief efforts-and provides considerable opportunity to advance knowledge pertaining to disaster response.

Implementing Online Discussion and Mind Mapping to Investigate a Disease Outbreak

The recent increase in online learning modalities due to coronavirus disease 2019 (COVID-19) has created a significant gap in real-time discussions on complex issues. This lack of enrichment from student discussions levies the concern of a deficiency in strong learning outcomes. This learning activity focused on mind mapping to facilitate small group discussions on the 2010 cholera outbreak in Haiti. Students learned about the disease triangle and cause-and-effect relationships on a large spatial and temporal scale. In this case, the three points of the triangle represented the pathogen (Vibrio cholerae), the environment (Haiti), and the hosts (Haitians). Each student in each small group was required to read a unique article to present to their group on the day of the activity. Using mind mapping, each group illustrated relationships that may have exacerbated the cholera outbreak. Learning outcomes were assessed through the evaluation of questions relevant to that week's exercise. Students were assessed on their ability to recognize relationships between the pathogen, environment, and hosts, as well as the ability to apply what they learned to the present-day COVID-19 pandemic. The disease triangle activity is readily accessible and can be easily implemented for identifying cause-and-effect relationships in large-scale systems. Importantly, this learning activity retained real-time discussion-based problem-solving for improving students' critical thinking skills and approaches to complex issues.

Sexual victimization, PTSD, depression, and social support among women survivors of the 2010 earthquake in Haiti: a moderated moderation model

BACKGROUND

In 2010, an important earthquake devastated Haiti and caused thousands of deaths. In a social context where women are particularly vulnerable, this cross-sectional study examined the associations between sexual assaults experienced by women before the earthquake, the earthquake exposure, the traumatic consequences, and their satisfaction of social support received.

METHODS

A total of 660 women aged 18 to 86 completed questionnaires assessing exposure to the earthquake, sexual assault victimization, peritraumatic distress, Posttraumatic stress disorder (PTSD), depression, and social support. A moderated moderation model was computed to examine associations between exposure to the earthquake, sexual assault, social support, and traumatic consequences.

RESULTS

Results showed that 31.06% of women were victims of sexual assault before the earthquake. They presented higher prevalence of peritraumatic distress, PTSD, and depression symptoms, compared to non-victims. The moderated-moderation model showed that sexual assault and exposure to the earthquake were positively associated with traumatic consequences (respectively, B = 0.560, p < 0.001; B = 0.196, p < 0.001), while social support was negatively associated with them (B = -0.095, p < 0.05). Results showed a triple interaction: women victim of sexual assault who were satisfied with received social support are less likely to develop traumatic consequences after being exposed to the earthquake(B = -0.141, p < 0.01).

CONCLUSIONS

By demonstrating the role of sexual assault in the development of mental health problems after the Haitian earthquake, this study shows the importance for clinicians to investigate interpersonal trauma experienced before or following natural disasters among survivors. Results also indicate the key role of family and communities to help survivors build resilience and coping strategies with their social support.

Symptoms of posttraumatic stress disorder, depression, anxiety and other mental health problems following the 2010 earthquake in Haiti: A systematic review and meta-analysis

BACKGROUND

The 2010 earthquake in Haiti caused significant human and material damages, thousands of deaths and injuries, and 1.5 million homeless. This systematic review and meta-analysis aims to synthesize research on the prevalence and factors associated with PTSD, depression, anxiety symptoms, and other mental health problems among survivors.

METHODS

We searched six databases and retained 50 articles for the systematic review, 28 of which were included in three random effects meta-analyses on the prevalence of PTSD, depression, and anxiety symptoms in survivors.

RESULTS

Following the earthquake, more than one out of four individuals (28.44%,CI 95%,17.68%-42.37%; k = 24) reported severe symptoms of PTSD, one out of three reported severe symptoms of depression (32.16%,CI 95%,23.60%-42.11%; K=14), and one out of five reported severe symptoms of anxiety (20.49%,CI 95%,15.74%-26.24%;k=5). Studies revealed important rates of other mental health problems (including psychological distress and disturbance, suicidal ideations, and increased alcohol consumption) in survivors. Females were 41.38% more likely than males to experience severe symptoms of PTSD (OR = 1.41,CI 95%,1.22-1.64). Time was a moderator for depression and anxiety but not for PTSD, while the average age of participants only moderated depression.

LIMITATIONS

The studies included are observational and most used self-reported measures.

CONCLUSIONS

In a global context where natural disasters tripled since 1980, this first systematic review showed that human and material damages associated with the earthquake were sufficiently traumatic to induce severe symptoms of PTSD, depression, anxiety, and other mental health problems. Clinical and research implications are discussed.

PROSPERO REGISTRATION NUMBER

CRD42018115430.

Emotional and Physical Child Abuse in The Context of Natural Disasters: A Focus on Haiti

OBJECTIVE

To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake.

METHODS

Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter.

RESULTS

Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%).

CONCLUSIONS

The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.

Challenges to mobilising resources for disaster recovery and reconstruction: perspectives of the Haitian diaspora

Diasporas and diaspora non-governmental organisations (NGOs) are increasingly important as resource lifelines to their home countries, yet the resources that they mobilise, the types of challenges that they face, and their coping mechanisms are not well explored or understood in the context of disaster recovery. To fill this knowledge gap, this study employed an inductive qualitative methodological approach, using interviews to comprehend the role played by Haitian diaspora NGOs after the catastrophic earthquake in 2010. It found that resources take four common forms: event fundraisers; financial and material donations from supporters; remittances; and volunteer labour. Challenges include an overreliance on diaspora donors, competition among NGOs, and what is perceived as inequitable funding practices towards diaspora NGOs. The findings provide insights centred on better coordination among diaspora NGOs, as well as between diaspora NGOs and other local and international NGOs and local governments and international institutions, to ensure more efficient delivery of services to survivors.

Citizen participation in disaster recovery projects and programmes in rural communities: a comparison of the Haiti earthquake and Hurricane Katrina

This study investigates predictors of local participation in recovery projects and programmes following Hurricane Katrina in the United States in 2005 and the earthquake in Haiti in 2010. Using two sets of survey data, it examines whether disaster impacts and social capital (social trust and civic engagement) are associated with disaster recovery participation and compares predictors of such engagement in the two locations. Multivariate logistic regression results reveal that physical injuries, limited community mobility, and government trust increase recovery participation in Haiti (n=278), whereas emotional distress and homeownership decrease it. On the Gulf Coast of the US (n=259), physical injuries and higher civic engagement augment recovery participation, while homeownership and age reduce it. The confounding factors of national contexts and post-disaster time frames might explain the differences in the results. The discussion addresses the relation between country-specific vulnerability and recovery participation and suggests implications for policy and practice to improve local citizens' capabilities to participate in sustainable recovery processes.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake

BACKGROUND

This study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors.

METHOD

We used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor-Davidson Resilience Scale (CD- RISC) RESULTS: Among our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (β=.366, p<.001) and Depression symptoms (β=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors.

Symptoms of PTSD in a sample of female victims of sexual violence in post-earthquake Haiti

BACKGROUND

Globally, sexual violence (SV) impacts 25-33% of women, is often perpetrated by intimate partners and occurs even post-disasters. The 2010 Haiti earthquake occasioned a SV epidemic in Cité Soleil, where over 50% of females are reportedly victims of SV via non-intimate partners/strangers (NPSV). Little is known about the psychological effects of SV perpetrated by NPSV; even less in known about the biopsychosocial consequences of NPSV on women in Haiti. Yet, the World Health Organization recently called for research on NPSV, particularly in poor and disaster-affected countries.

METHODS

As a first step in categorizing the consequences of NPSV on female victims in Haiti, we conducted 2 focus groups of 16 female residents of Cité Soleil who survived the earthquake and its aftershocks, along with ensuing hurricanes and cholera.

RESULTS

Participants reported rapes by strangers who intentionally "crush the uterus." All endorsed criteria for PTSD, including enduring physiological, neurological and psychological symptoms: significant intrusive, avoidance, arousal, cognitive, mood changes, as well as significant distress/impairment in various areas of functioning; and all but one became pregnant from the experience. All denied substance use and other illness that is not associated with the sexual violence.

LIMITATIONS

Our study was exploratory, targeting a small sample of women in one specific neighborhood and cannot be generalized to all SV victims in Haiti.

CONCLUSIONS

Following earthquakes, there should be vigilance by public health officials and rescue teams for prevention of SV against women. Women who survive SV in Haiti should be provided access to trauma-informed care that addresses biological consequences of the SV, as well as biological, neurological and psychological sequelae.

Kabrit ki gen twòp mèt: understanding gaps in WASH services in Haiti's IDP camps

Despite the enormous infusion of post-quake aid to Haiti, cholera had killed more than 8,000 people by January 2013. Based on two mixed-method studies of a random sample of 108 internally displaced person (IDP) camps and 168 interviews with agency representatives and recipients, this article examines the prevalence of factors that have proven most relevant to the rapid spread of cholera, particularly the provision of water and sanitation services in IDP camps. The study reveals that 30% of IDP camps had no toilets and 40% had no access to water before the outbreak, with only minimal progress after three months. Using bivariate and multivariate statistical analyses, this article explores patterns in the gaps of services with a range of variables such as NGO camp management, municipality and land-owners. It offers several theoretical and policy explanations for low level of services, concluding with a series of recommendations for better coordination and management.

Shelter recovery in urban Haiti after the earthquake: the dual role of social capital

This paper documents the culture-specific understanding of social capital among Haitians and examines its benefits and downsides in post-disaster shelter recovery following the 12 January 2010 earthquake. The case study of shelter recovery processes in three socioeconomically diverse communities (Pétion-Ville, Delmas and Canapé Vert) in Port-au-Prince suggests that social capital plays dual roles in post-disaster shelter recovery of the displaced population in Haiti. On the one hand, it provides enhanced access to shelter-related resources for those with connections. On the other hand, it accentuates pre-existing inequalities or creates new inequalities among displaced Haitians. In some cases, such inequalities lead to tensions between the haves and have-nots and instigate violence among the displaced.

The role of evidence in humanitarian assessment: the Seed System Security Assessment and the Emergency Market Mapping and Analysis

This paper reviews advances in the development and use of two evidence-based assessment toolkits: the Seed System Security Assessment (SSSA) and the Emergency Market Mapping and Analysis (EMMA). Both were created in the past five years and have been employed in a range of acute and chronic stress contexts across Africa, Asia, and parts of the Americas, in periods of civil strife, displacement, and drought, as well as following earthquakes, flooding, and political instability. The aims of this paper are threefold: to review advances with regard to each tool; to compare how each toolkit gathers and uses evidence, while considering possibilities for greater complementarity; and to reflect on the nature of 'evidence' used to guide humanitarian response in sudden-onset and chronic crisis situations. A comparison highlights the importance of triangulation and informed analysis for drawing conclusions from imperfect evidence, understanding the limitations of each assessment methodology, and confronting tacit assumptions.