Haiti Earthquake Medical Aid May Take 'Military'-Style Operation

Jan. 14, 2010— -- Doctors and health care workers familiar with Haiti say it will take the type of resources, organization and execution found in a sophisticated military operation in order for aid workers to succeed in the unfolding chaos of Port-au-Prince.

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The magnitude 7.0 earthquake that hit the nation's capital Tuesday afternoon not only destroyed most of the nation's fragile medical infrastructure, it blocked roads and existing communication networks aid workers will need to help earthquake victims, doctors told ABCNews.com.

At least 19 countries, including the United States, Ireland, China, the United Kingdom and Brazil have pledged manpower, supplies or financial aid to Haiti, according to The Associated Press.

But "With this disaster, the biggest challenge is going to be finding places to care for people," said Alison Lutz, the Haiti program coordinator for the nonprofit Partners in Health, which has a permanent presence in Haiti.

"We are seeing wave after wave of vehicles coming from the Port-au-Prince area and bringing patients," said John Walton, board chairman of the Hôpital Albert Schweitzer, a 120-bed facility in the rugged Artibonite Valley of central Haiti, about 40 miles north of the stricken capital

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Normally, aide workers would set up at a nearby hospital, but the quake destroyed Port-au-Prince's main hospital -- a 700-bed facility -- and left other smaller hospitals inoperable. Doctors Without Borders reported Maternité Solidarité hospital, a 75-bed facility, had to move patients out of the building, fearing it would collapse from structural damage.

Lutz said the capital city has very little open space because buildings are built side by side, surrounded by unstructured shanty towns that take up most of the open areas. Roads have been destroyed and she said finding a structurally safe building or open space to set up aid operations will be a problem.

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A Crowded Haitian City Makes It Hard to Treat People

"It's a very crowded city, it's people building shacks, squeezed up against each other, so there aren't any big open spaces where you can put a field hospital," said Lutz. "As far as I've heard, they haven't been able to get in the big equipment."

Doctors who routinely visit in Haiti agreed that the lack of infrastructure will be the biggest challenge to health care workers within the first few days of the tragedy.

"What you're going to see on TV soon is a lot of 'Bidonvilles,' which are slums, they're shanty towns," said Dr. Arthur Fournier, associate dean for community health at the Miller School of Medicine at the University of Miami, which has a long-standing program to bring medical aid to Haiti.

"The reason why this was a particularly nasty disaster is that the city is full of poor people who are squatting and building in the city," he said. "There's going to be not just landslides, but there's going to be houseslides."

Fournier thought the crowded wreckage on roads and lack of an organized health infrastructure would mean "we need something like a military-like operation geared for relief."

"It needs strategy, tactics and logistics. We need all three," he said.

Lutz said aid workers would prefer to go through Haiti's government to organize relief efforts, but noted the Ministry of Public Health and the existing United Nations outreach have been struck by the earthquake as well.

"It is leaving a communication gap," said Lutz.

Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University Mailman School of Public Health, said natural disasters of the past have shown what can go wrong without proper communication.

"The lessons we have taken from events like Katrina is the coordination and organization of response so we can respond faster," said Redlener.

Redlener says, "Fatality rates well in excess of 100,000 are likely," considering the extent of damage and the current poor health of the population in Port-au-Prince.

Relief Tactics in Haiti's National Disaster

In his research, Redlener found emergency response works best if it goes in stages; first, with a search and rescue phase; then, assurance of social order, providing shelter and general care for survivors, assuring clean water and food, preventing and treating secondary injuries, and finally, controlling public health hazards and infection.

Doctors are especially concerned about waterborne diseases, such as diarrheal illness.

"And we also know, as a general lesson that we continually experience is, the worse the preconditions, especially poverty and infrastructure, the worse the disaster will be," said Redlener.

That is not to say the relief organizations already on their way aren't organized.

President Barack Obama has already dispatched several U.S. ships, including the Navy's aircraft carrier USS Carl Vinson, which will serve as a ferry to helicopters dropping supplies.

First to arrive would be the U.S. Air Force 1st Special Operations Wing which will help provide air traffic control at Port-au-Prince's crippled airport for the expected relief flights full of supplies.

In addition, four U.S. Coast Guard cutters were due to arrive Wednesday, loaded with food, water and medical supplies.

Doctors say Haiti has such a poor infrastructure, that any medical assistance would fill a gap.

"I know very few physicians who practice in Haiti full time. If they are physicians, they often come to practice in the states. There aren't subspecialties in Haiti, either, like we are accustomed to in the states," said Dr. Mojitaba Gashti of Union Memorial Hospital in Baltimore. Gashti travels to the northern city of Milot, in Haiti, every year for surgical missions.

"Really, this is the last place you want something like this to happen," said Gashti. "The level of poverty is worse than what you think."

Fournier believes any efforts in Haiti will not do lasting good unless international efforts focus on the economic issues that led to the weak infrastructure -- namely, poverty. Fournier said that Haiti's traditional rural economy has not been able to provide basic sustenance for its people, and as a result, families crowd the city's capital looking for a way to survive.

"It's time to stop Band-Aid crisis management in Haiti. We have to go to long-term solutions," said Fournier.

ABC News' Bradley Blackburn and MedPage Today's Michael Smith contributed to this report.