Death toll in Haiti may reach 200 000
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c331 (Published 18 January 2010) Cite this as: BMJ 2010;340:c331All rapid responses
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The earthquake which hit Haiti on 12 January has been devastating,
its impact magnified by the vulnerability of the population it affected.
The destruction exacerbated the fragility of the area’s infrastructure
making disaster response logistics especially challenging. In disasters
much of the initial life-saving rescues are done by the local population
and those organisations already on the ground but, after this initial
period, specialised skills are required to implement and coordinate an
effective disaster response.
Amongst the first international responders on the scene was the
search and rescue team from the UK’s Fire and Rescue Service, a nationally
coordinated and supported body [1]. Several days later and almost a week
after the earthquake, Channel 4 News reported on the firefighters’
frustration, utilising their first aid skills in the absence of doctors to
meet the vast need for medical intervention [1].
The UK relies largely on international non-governmental organisations
(NGOs), coordinated by the UN agencies, to deliver aid in international
disasters but in Haiti, as in certain previous disasters, journalists
reporting freely from areas unvisited by international assistance, have
demonstrated the inadequacy of this approach in terms of speed and reach.
The effectiveness of this model of intervention has been questioned
both in the general media [2] and in evaluations of disaster response. The
report of the Tsunami Evaluation Coalition, a collaboration including the
NGOs involved in the response, found that coordination was weak, staff
lacked skills and experience and poor quality relief work was reflected in
inappropriate aid [3].
Quality NGOs have a strong history of dedicated and often very brave
staff motivated by humanitarian principles, battling to provide aid in
terrible conditions where the need is greatest but the competitive nature
of funding restricts how they can operate and, in massive disasters on the
scale of Haiti, most lack the level of resources which could be provided
by a nationally coordinated response.
A nationally coordinated medical and surgical response to
international disasters could help bridge this gap by maintaining a roster
of appropriately skilled and experienced doctors and surgeons, with the
required equipment and support to deploy a rapid response field hospital
into disaster situations at short notice. The availability of key staff
could be protected as with the NHS’s support to the territorial armed
forces.
At present the humanitarian medical community’s focus should be on
providing immediate assistance where it is needed most. In the aftermath
of the disaster response, however, there is a case that the debate,
contributed to by many including Lord Nigel Crisp [5], on whether a
coordinated UK international disaster response could improve our ability
to help those afflicted by disaster should be re-opened.
1. Department for International Development [webpage online]. [cited
2010 Jan 19]; Available from: URL: http://www.dfid.gov.uk/Media-Room/News-
Stories/2010/Haiti-Earthquake/
2. Channel 4 News. 18 January 2010.
3. Glasser R. Wherever there is strife in the world, there's a non-
govermental organisation there to help. But how much good are they doing?
The Guardian 2008 Mar 2 [newspaper article online]. [cited 2010 Jan 19];
Available from: URL:
http://www.guardian.co.uk/commentisfree/2008/mar/02/howeffectiveisdisast...
4. Cosgrave J. Synthesis Report: Expanded Summary. Joint evaluation
of the international response to the Indian Ocean tsunami. London: Tsunami
Evaluation Coalition; 2007.
5. Crisp N. Global Health Partnerships; The UK contribution to health
in developing countries. London: COI; 2007.
Dr James IDM Matheson, Mr Zahid Mukhtar.
Centre for Trauma, Conflict & Catastrophe.
St George’s, University of London.
Competing interests:
None declared
Competing interests: No competing interests
Donation drug in emergence pharmacy after the earthqake
Haiti earthquake is so unimaged with the wenchuan earthquake China in
2008. According to our experiences, from the second week a lot of emergency
medical aid would be added. During the process, emergency pharmacy is as
important as emergency medicine[1].
From then on donations including drugs, cashes and so on from in and
out of China have started to pour into Haiti, especially the quake-hit
areas. It is well known for us that donation drugs have the special
character different from other donations such as cash, food, and so on.
And donation drugs may be a novel thing for Haiti goverement.
According Guidelines for Drug Donations(WHO, revised in 1999), four
core principles that should be respected and guaranteed: (1) maximum
benefit to the recipient; (2) respect for the wishes and authority of the
recipient; (3) no double standards in quality; and (4) effective
communication between donor and recipient[2]. Although he practice of
donation drugs in Wenchuan earthquake is partly poor, most same problems
about donation drugs in other countries seen in the annex of the
Guidelines occurred again in China. According the rare experiences, we see
three principal principles by which these recommendations could be
enforced for Guidelines to maximise the potential benefit of drug
donations: (1) unity coordination for the recipient; (2) economic
accounting for the recipient; (3) stand record of donation drugs for the
recipient. We hope that WHO and other countries will study Chinese lessons
in these practices and reform the corresponding drug policy.
According our experiences in the total process of administration
donation drugs, we also recommend again that the drug donation should: be
based on an expressed need and be relevant to the disease pattern in the
recipient country; not be sent without prior consent by the recipient; be
on the national or WHO list of essential drugs, in strength and
formulation similar to those used in the recipient country; be obtained
from a reliable source and comply with quality standards in both donor and
recipient country; not include returned drugs or drug samples; have a
shelf-life of at least 1 year after arrival; be labelled in an
understandable language, including the International Nonproprietary Name
(INN) or generic name, batch number, dosage form, strength, name of
manufacturer, quantity in the container, storage conditions, and expiry
date; be presented in larger quantity units and hospital packs; be packed
in accordance with international shipping regulations, and be accompanied
by a detailed packing list which specifies the contents of each numbered
carton by INN, dosage form, quantity, batch number, expiry date, volume,
weight, and any special storage conditions; not be mixed with other
supplies in the same carton, with weight per carton not exceeding 50 kg;
have a declared value based on the wholesale price of its generic
equivalent in the recipient country, or, if such information is not
available, on the wholesale world-market price for its generic equivalent;
inform recipients of proposed donations; pay costs, unless specifically
agreed otherwise with the recipient in advance.
References
1. Richard stone. Lessons of Disasters Past Could Guide Sichuan's
Revival. Science 2008; 321:476.
2. Geneva. Essential drugs and medicines policy: guidelines for drug
donations
[Interagency Guidelines]. WHO; 1999 (WHO/EDM/PAR/99.4).
3.Michael M. Medical supplies donated to hospitals in Bosnia and Croatia,
1994-1995 -- report of a survey evaluating humanitarian aid in war. JAMA
1996;276:364-368.5.
Competing interests:
None declared
Competing interests: No competing interests