HAITI SITUATION UPDATE Updated: 10/14/2010 NINE MONTHS OF ACTION BY HANDICAP INTERNATIONAL
ACKNOWLEDGEMENTS
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INTRODUCTION
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SUMMARY OF ACTIONS & LOCATION OF PROJECTS
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KEY FIGURES
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HEALTH
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HUMANITARIAN LOGISTICS AND MEETING BASIC NEEDS
For more information: www.handicap-international.us
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ACKNOWLEDGEMENTS Handicap International would like to thank the tens of thousands of individual donors who have responded to its fundraising appeal since January 12, 2010 and who continue to support its actions in aid of people in Haiti affected by the earthquake. On February 3, the French ambassador to Haiti, Mr. Didier Le Bret, was awarded the Claude Erignac prize for his efficient and courageous handling of the crisis. He decided to give half of the prize money to Handicap International to support the association’s aid effort in Haiti, while the other half established a fund for the French Embassy’s Haitian staff. Since the launch of Handicap International's response to the earthquake of January 12, 2010, the organization’s actions have been supported by: - Public bodies: The City of Annecy, the City of Lyon, the City of Munich, the Conseil Régional d’Ile-de -France, the European Commission (European Commission Humanitarian Office - ECHO), the Flemish Government, the French Ministry for Foreign Affairs, Grand Lyon, the Luxembourg Ministry for Foreign Affairs, the Région Rhône-Alpes, the Swedish International Development Cooperation Agency (SIDA), the U.K. Department for International Development, the World Food Programme, USAID/OFDA, USAID/War Victims Fund, and the World Health Organizations. - Private institutions and companies: Aktion Deutschland Hilft (ADH), American Academy of Orthopaedic Surgeons, American Friends Service Committee, American Red Cross, Fondation Abbé Pierre, Fondation de France, Foundation Eden, Fondation EDF, Fondation SEB, Fondation Soros, Fundación León Jimenes, Grande Mosquée de Lyon, Hôpital Assistance Belgique, le Lycée Français de New York, the Midler Family Foundation, Mutualité française, MV Transportation/Freedom of Mobility Foundation, Inc., the NPD Group, Inc. Emergency Fund, the Rheingold Family Foundation, Sanofi Aventis, ShelterBox, T. Rowe Price Foundation, Inc., and all who contributed to the “Another Chance to Dance” event, including Café 76, Heidi Latsky Dance and the cast of the GIMP Project and the Jewish Community Center in Manhattan, among many others.
Photo credits: Pages 1, 2, 3, 4, 5, 9, 11, 13, 14, 15, 16 © William Daniels / Handicap International Page 4 © Sami Ul Haq Sami / Handicap International Page 10 © A. Bourgeois Hadir / Handicap International Page 12 © T. Calvot / Handicap International Pages 17, 21 © L. Radick / Handicap International Pages 18, 19 © O. Dorighel / Handicap International Page 20 © D. Sacca / Handicap International
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INTRODUCTION An earthquake measuring 7 on the Richter scale hit Haiti at 4:53 PM (local time) on January 12, 2010. Handicap International’s 100-strong team, present in the field when the earthquake struck, escaped unharmed and launched an immediate response to the emergency. Over the following weeks, Handicap International rolled out a vast program of emergency aid - the biggest in its history. Nine months after the earthquake, the association’s response is continuing and evolving. The association places a particular emphasis on mobile teams whose task is to ensure the followup of the most vulnerable people, amputees, quadriplegics and paraplegics. The goal is to ensure that these people, who are particularly vulnerable or have been weakened by the disaster and who live in highly disadvantaged situations, have access to a complete range of services and benefit from aid specific to their needs. Handicap International is committed to a three-year to five-year strategy designed to ensure the long-term sustainability of its actions and the emergence of local skills, particularly in relation to the case-management of people severely affected by the earthquake. An unprecedented disaster The earthquake was the most violent to hit the region in 200 years. Its epicenter was located 9 miles (14.5 kilometers)* from the capital, Port-au-Prince. It is thought that more than 230,000 people were killed (as many as during the tsunami on December 26, 2004) and more than 300,000 were injured. To date, according to the World Health Organization (WHO)1, more than 1.3 million people are still living in more than 1,350 temporary encampments. More than 660,000 others have been displaced to the provinces, most of whom are staying with host families. Handicap International has developed extensive expertise in earthquake situations, including our most recent operations in El Salvador and India (2001), Iran (2004), Pakistan (2005) and China (2008), as well as Indonesia (2005 and 2009). In the hours following the earthquake, the association’s headquarters (Lyon, France) decided to release emergency funds and to expand its team in Haiti. A project manager specializing in the case-management of people injured during disasters arrived in the field on January 14. She was quickly joined by physical rehabilitation professionals and logisticians. Our team of local staff has also increased.
The largest program in Handicap International’s history Handicap International now has a team of 580 people in Haiti, including some 80 expatriate staff, making it the association’s largest mission ever. Almost all the intervention areas in which the association has developed an expertise have been, are or will be represented during this mission.
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Report published by the Pan American Health Organization Regional Office of the WHO, 4 October 2010. *All currency and measurements are given in both European (Euros and metric system) and American (U.S. dollars and the English system) formats, as this situation report is distributed globally.
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Handicap International’s response to the disaster currently centers on three key activities: 1. Assisting the injured and most vulnerable individuals with rehabilitation and other medical care, 2. Providing temporary and transitional shelter and 3. Managing a humanitarian aid transport logistics platform. At the end of February, the association began producing temporary emergency orthopedic devices for amputees, followed by permanent devices, complemented by psychosocial support. “Cash for work” initiatives were also organized; Handicap International has provided emergency shelters and has begun producing transitional shelters adapted to conditions in Haiti and accessible to the most vulnerable people. The needs in this largely devastated country are immense, particularly since new disasters continue to threaten the island: the hurricane season is expected to end in late November. The situation in Haiti, one of the poorest countries in the world, was already a source of major concern before the earthquake. The impact of the earthquake will be felt for many years to come and will include deterioration in health conditions for part of the population - linked to more deprived living conditions - and an increase in poverty resulting from a reduction in economic activity. Lastly, Haiti has a long history of excluding people with disabilities, commonly known as “kokobés” (“good for nothings”). It is expected that people with disabilities, despite their large number and the exceptional circumstances, will continue to be severely marginalized.
The importance of coordination The destruction of decision making centers and the consequential disorganization that resulted, in addition to the arrival of multiple humanitarian aid agencies, made it challenging for Handicap International to organize its emergency relief efforts. However, Handicap International has been working closely with numerous organizations. These include direct partnerships with Chistoffel Blindenmission (CBM), Healing Hands for Haiti, the Secretariat of State for the Inclusion of People with Disabilities (SEIPH) and World Food Programme (WFP). Handicap International has also worked with ACTED, Action contre la Faim, la Chaîne de l’espoir/Alima, Douleurs sans Frontières, Médecins du Monde, Médecins sans Frontières, Merlin, the International Organisation for Migration (IOM), Partners in Health and ShelterBox, along with numerous Haitian stakeholders, including health facilities and associations.
As part of the management of its humanitarian logistics platform, consisting of a fleet of 70 trucks under the auspices of the WFP, Handicap International has transported humanitarian aid for some 100 organizations.
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On January 26, 2010, the United Nations and the World Health Organization requested two international nongovernmental organizations, Handicap International and CBM, to lead the Injury, Rehabilitation and Disability Working Group within the U.N. Health Cluster in coordination with the Haitian Secretariat of State for the Inclusion of People with Disabilities. This Working Group is coordinating all activity in Haiti concerning the rehabilitation of injured persons, the fitting of orthopedic devices and the provision of assistance to people with disabilities. Within this framework, Handicap International and CBM are working with the Haitian Ministry for Public Health and Population (MSPP) and the Secretariat of State for the Inclusion of People with Disabilities (SEIPH) to coordinate international and national aid stakeholders operating in disability-related fields. Handicap International is organizing the coordination of international aid operators, while CBM is coordinating Haitian organizations working in these fields, under the general coordination of the WHO’s Health Cluster. Three to five years of action ahead Handicap International’s emergency response ended in August 2010. The association is gradually transitioning these actions into long-term projects designed to allow Haitian stakeholders to build their capacities and, eventually, to independently manage the projects. This is what we call the emergency/rehabilitation/development continuum, which is a classic model of international solidarity action. This requires long-term funding, particularly from institutional funding bodies. For Handicap International, the post-emergency phase is gathering momentum and will last for the next 12 to 15 months. It is now crucial to set up livable, hurricane-resistant and earthquake-resistant temporary accommodation accessible to isolated and vulnerable victims of the disaster. The association continues to provide support and physical rehabilitation services to the injured and psychosocial support to victims, but it is gradually focusing its attention on the most serious cases and people with disabilities. Handicap International has begun producing permanent prostheses and continues to deliver humanitarian aid. The association began implementing development transition actions within the last few weeks, which are set to continue until at least the end of 2011. Accessibility projects (opening and reopening of communication channels), disaster preparation and prevention activities, capacity-building for local partners and fast-track training for Haitian rehabilitation and orthopedic-fitting staff have already been launched or are scheduled to begin. The support and rehabilitation of the injured is expected to gradually focus on the most complex cases, particularly paralyzed persons. It is still too early to determine Handicap International’s long-term development actions. This activity phase is likely to begin by the end of 2011 and will most likely focus on supporting Haitian stakeholders, health facilities and association partners to assist people with disabilities.
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“Focusing on the most vulnerable in an emergency” In emergency situations, such as in Haiti, Handicap International pays particularly close attention to the most vulnerable members of the population. From post-traumatic care and the organization of aid to the coordination and management of camps and meeting people’s basic needs, everything possible is done to ensure the injured and the most vulnerable people are provided with support and that they are correctly case-managed. Jean Marc Boivin, Executive Director of Handicap International France, explains more. Why the most vulnerable? The association’s experience of emergencies has shown that people with disabilities and the most vulnerable members of the population are generally excluded de facto from humanitarian aid efforts developed during the first stages of an emergency. Weaker than others and unable to move around, people with disabilities, the injured, the elderly, the sick, pregnant women and young children find themselves in situations of great distress. The earthquake that hit Haiti last January is a prime example. The scale of the disaster, which devastated the capital of one of the poorest countries in the world, made the implementation of a response specifically targeted at the most vulnerable all the more necessary. Placing the vulnerable at the heart of our emergency response The approach taken in Haiti is a perfect example of the association’s strategy in action. • Present within the first days or even hours of a disaster or the end of a conflict, our teams ensure that the basic needs of those most at-risk are met. When the teams distribute hygiene packs to victims, they ensure that vulnerable people are identified and recorded and that type of aid provided is targeted to their needs. • It is this approach that the association intends to promote to other operational associations or structures coordinating aid efforts. Based on it advocacy activities, the association ensures the specific needs of people with disabilities and the vulnerable are correctly taken into account, even when its teams are not directly involved in the relief effort. • Handicap International also helps the injured by providing post-traumatic care and by setting up orthopedic services. Because the injured are in a position of greater physical and social vulnerability and require an immediate response and the prospect of case-management in the future, our emergency teams ensure that their responses are immediately operational, and work to ensure the medium-term to long-term sustainability of follow-up services. For this, we need to cooperate with national medical and emergency surgical associations and structures and to operate within existing hospital structures (physiotherapy, occupational therapy, the supply of technical aids and temporary orthopedic devices) and affected communities (identification and follow-up of patients). • In addition to these “life saving” services, the emergency teams also provide psychosocial support to affected populations. Handicap International has learned from more than 20 years of experience, that psychosocial support helps people weakened by the trauma of a disaster or conflict avoid developing serious and disabling psychological after-affects. • The protection of vulnerable people in crises also represents a major challenge for all actions taken in emergencies. In situations of extreme deprivation, heightened tension and social instability, vulnerable people, particularly people with disabilities, must be protected from the risk of violence, exploitation and abuse. Handicap International therefore monitors the implementation of specific protection measures as part of its actions and takes part in international coordination processes dedicated to these issues. • Disability Focal Points, a major focus for all of these emergency activities, aim to ensure that all of the needs of vulnerable people are identified and taken into account in the short-term to long-term. The focal point staff center their activities on identifying and referring patients and providing direct care, either directly or by referring patients to other facilities.
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SUMMARY OF ACTIONS Health •
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Assistance of people with injuries and disabilities and vulnerable people within communities, injury care, post-operative physical rehabilitation, hospital referrals, follow-up in communities and camps; training of community workers and rehabilitation technicians to perform these activities. Distribution of orthopedic devices, mobility aids and specific equipment. Psychosocial support: individual and family support and discussion groups for victims. Fitting of orthopedic devices: the fitting of temporary orthopedic devices began at the end of February in partnership with Healing Hands for Haiti; opening of the functional rehabilitation center in March, and the setting up of mobile teams from mid-April. Fitting of permanent orthopedic devices began in April. Assistance in hospitals: help with case management of the injured in hospitals in the days immediately following the earthquake. Activity completed in July.
Humanitarian logistics •
Transport of humanitarian aid and the management of the interagency logistics platform for the World Food Programme (WFP).
Meeting basic needs • • • •
Distribution of tents, food and essential items to earthquake victims (while facilitating access to aid for people with disabilities and the vulnerable) completed in August 2010. Setting up temporary hurricane-resistant and earthquake-resistant shelters accessible to people with reduced mobility. “Cash for Work” activities in Port-au-Prince and the Mornes mountainous regions of Petit-Goâve and Grand-Goâve, completed in August 2010. Specific distributions to cover the needs of the most vulnerable people and people affected by the violent storm of September 24, 2010.
LOCATION OF PROJECTS
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KEY FIGURES
Human resources . Handicap International's team in Haiti currently numbers 80 expatriate staff. The Haiti team is composed of 500 people in total and the association coordinates the work of seven other staff employed by its partner organizations. . Since January 14, 170 expatriate staff from more than 20 different countries (including Australia, Austria, Belgium, Canada, Colombia, El Salvador, France, Finland, Japan, Lebanon, Luxembourg, Nicaragua, Pakistan, the Philippines, Switzerland, Togo and the United States) have been sent to Haiti by Handicap International. . Since January, more than 600 Haitian staff have been trained. Highly diverse, these trainings address many aspects of care-management of the injured (from the evaluation of patients to their mobilization, including the use of technical aids, such as wheelchairs and the care of residual limbs), as well as road safety for drivers and correct posture for handlers.
Health . More than 10,000 beneficiaries of Handicap International’s health actions. . More than 77,000 care and physical rehabilitation sessions for the injured have been performed. . Some 5,000 technical aids (mobility aids, orthopedic devices and specific equipment) have been distributed. . Prostheses: more than 380 beneficiaries recorded (fitted or currently being fitted). . Orthoses: more than 370 beneficiaries recorded (fitted or currently being fitted).
Psychosocial assistance . More than 23,000 beneficiaries, including 500 provided with regular follow-up care.
Logistics/distributions/“cash for work” . More than 17,000 tons of aid transported (food, water, various equipment) by a fleet of 70 trucks since January 14 (currently 360 tons a week) for around 100 organizations, including 15 Haitian organizations. . More than 5,000 tents distributed, benefiting more than 26,000 people, and 30,000 items of equipment distributed to more than 43,000 beneficiaries. . 36 tons of food distributed for more than 10,000 people. . More than 4,000 people have taken part in “cash for work” projects set up by Handicap International.
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HEALTH Handicap International’s health activities are coordinated with the Haiti government and other key national and international operators in the health sector.
Situation as of September 30, 2010: ●
Work in hospitals completed: Since January 17, the association has supported some 20 hospitals and medical facilities in Port-au-Prince and its suburbs.
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1,800 beneficiaries received follow-up care in hospitals and 9,500 beneficiaries were provided with follow-up care in “Disability Focal Points” and by mobile teams in communities.
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77,000 care or physical rehabilitation sessions for people with injuries performed (in hospitals, Disability Focal Points, communities and functional rehabilitation centers).
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More than 23,000 people benefited from psychosocial support sessions, 500 of whom receive regular follow-up.
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Fitting of orthopedic materials: - Prostheses: more than 380 amputees fitted or currently being fitted. - Orthoses: more than 370 people fitted or currently being fitted.
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Some 5,000 items of equipment have been distributed: - Mobility aids: crutches, walking sticks, wheelchairs, walking aids - Orthopaedic equipment: neck braces, corsets, splints - Specific equipment: anti-sore mattresses and cushions, incontinence packs - Basic equipment for the injured: mattresses, hygiene equipment
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The health team is currently supported in the field by 149 staff, including 23 expatriate staff, providing assistance in 7 Disability Focal Points2, 8 mobile teams in camps for displaced persons and communities, and within the functional rehabilitation center. Since mid-June, an additional mobile team, specializing in the case-management of paraplegics and quadriplegics, has been working in communities to provide specific care. Most recruited Haitian staff are nurses, rehabilitation staff and community workers. Initially, as part of an intensive training course, followed by daily practical experience, they have been trained to case-manage people with injuries (including fractures, crushed limbs, burns and brain injuries), amputees and paralyzed persons. They have also been taught how to lift patients and use mobility aids. Nine months after the earthquake, the association provides training to dozens of Haitians to supply the most severely affected victims with long-term support. Since January 14, several tons of freight have been transported from France, the United States and Belgium, including a dozen clinic tents, mobility aids and orthopedic equipment. These deliveries are ongoing.
300,000 people injured The Haitian government estimates the number of people injured in the earthquake to be more than 300,000. Humanitarian aid operators are therefore facing a challenge of historic proportions, given a lack of care capacity in Haiti following the disaster. During the weeks immediately following the earthquake, hospitals and other health facilities were faced with a flood of injured people and only the most serious cases were admitted. Some patients with closed fractures had to leave without treatment to allow the most urgent cases to be treated first. Many patients who had not received care the first time round arrived in hospitals again with complications and serious infections. As a result, amputations represented an exceptionally large proportion of the operations performed. Some amputations performed under extremely difficult circumstances required corrective surgery.
Follow-up and medical care in communities Handicap International provides physical rehabilitation care in seven “Disability Focal Points”: five in Portau-Prince, one in Petit- Goâve and one in Gonaïves. These reception areas were set up in partnership with 2
Disability ocal Points enable us to provide the most vulnerable populations and people with disabilities with a local reception point to identify their needs and supply them with responsive aid.
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CBM, which manages two Disability Focal Points in Port-au-Prince, and with the Secretariat of State for the Inclusion of People with Disabilities and the support of Haitian disabled people’s organizations. Initially housed in clinic tents close to hospitals to provide patients with follow-up care once they had left the hospital, these focal points were transferred to communities in Port-au-Prince (Pétion-Ville, Champs de Mars, Carrefour, etc.), Petit-Goâve and Gonaïves to be closer to population centers. The Focal Point team now has a staff of 105, including five expatriate staff. Six mobile care teams use the focal points as a base for their visits. The composition of the teams varies according to the needs of the area covered and may include a focal point manager, a social worker and a physiotherapy assistant. They visit the districts and suburbs of the capital, including Carrefour, Delmas and the Champ de Mars, and work in a camp housing more than 40,000 people in Pétion-Ville. Because we are present in communities, we can provide nursing care, distribute mobility aids and equipment for day-to-day activities (or basic equipment such as mattresses and mosquito nets) and provide long-term physical rehabilitation care to people with disabilities. People with specific needs are identified and referred to medical facilities (for surgery in particular), to organizations responsible for targeted food distributions (to malnourished children, for example) and to organizations providing individual psychological support or performing psychosocial support activities.
Since the establishment of nine “Disability Focal Points” (opened by Handicap International and CBM) and mobile teams, in January and February 2010 respectively, their staff have facilitated the distribution of 3,341 items of equipment, provided support to 9,426 people, and performed 46,577 care or physical rehabilitation sessions for the injured.
Psychosocial assistance There has been a major increase in the number of psychosocial assistance activities performed over the last three months, particularly through the development of cross-disciplinary projects, to ensure better coverage of the most vulnerable populations; in total, 23,247 people have benefited from psychosocial assistance, 500 of whom are provided with regular follow-up care.
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Within the Disability Focal Points, a coordinator organizes activities to help people attending the center to talk about their situation and to open up and exchange experiences with one another. Psychosocial workers from each focal point visit communities to perform follow-up work. They measure the level of inclusion of people with disabilities, the family’s level of distress, identify conflicts and possible family problems, raise awareness and refer people to other facilities, if necessary. At the functional rehabilitation center, patients benefit from private consultations with psychosocial workers who assess their needs and plan their follow-up care throughout the orthopedic-fitting process, and beyond, when they return to their communities. Handicap International, part of the Mental Health working group, which brings together national operators in the psychosocial sector and nongovernmental organizations, is helping to draw up a national plan on this issue. As a member of the Inclusion, Rehabilitation and Disability working group, the association is also contributing to the development of a national inclusion plan. Handicap International will create a protection team shortly to intervene in the most difficult cases encountered in the community and to supply them with a responsive solution. It will also be responsible for improving and developing referrals to other institutions and ensuring all services are accessible to people with disabilities.
Home care team for paraplegics and quadriplegics Established at the end of June, this mobile team consists of a physiotherapist, an occupational therapist and a community worker that operates in Port-au-Prince and the surrounding areas. The team directs patients to hospitals or other NGOs to provide them with dedicated follow-up care, assesses their needs in terms of technical aids and basic equipment and ensures any distributions necessary are made. This team sometimes includes a member of the psychosocial team, whose task is to forge a link with the community. A team from the Healing Hands for Haiti association, consisting of a doctor and a nurse, regularly support this process by performing consultations. Healing Hands for Haiti opened a rehabilitation facility in October in Portau-Prince to provide long-term care adapted to people with disabilities.
Functional rehabilitation center The functional rehabilitation center consists of 38 people, of whom 17 are expatriate staff, including a large team from the University of Don Bosco in El Salvador. Since the beginning of March, more than 380 people have registered with the center to receive a prosthesis and more than 370 others for an orthosis. To date, 322 prostheses and 411 orthoses have already been produced and some 4,000 rehabilitation sessions have been performed. 12
Prostheses Handicap International’s health team produced a report at the end of January on the situation facing people with injuries. The total number of amputations caused by the earthquake of January 12 is estimated at between 2,000 and 4,000, with 1,000 people requiring a lower-limb prosthesis. This conservative estimate is based on direct visits to 17 hospitals and data gathered by telephone or e-mail from most of the country’s other health facilities in which operations had been performed, and from the relevant authorities. We have not yet done another follow-up assessment. However, a large number of people need orthopedic devices. To meet this demand, Handicap International, in partnership with Healing Hands for Haiti, organized a specific response to case-manage amputees, in coordination with a dozen other organizations performing or planning to perform orthopedic-fitting activities.
From the end of February, the team began supplying temporary prostheses to lower-limb amputees. At the beginning of March, Handicap International opened a functional rehabilitation center in a central and easily accessible area of the capital, within the immediate vicinity of the Champs de Mars. This is where prostheses are produced and patients try them out. Follow-up rehabilitation care and walking exercises are also performed here. An essential stage in the orthopedic-fitting process, the temporary prosthesis -- or emergency temporary prosthesis -- enables patients to rapidly get back on their feet and prepares them to be fitted with a permanent 13
prosthesis. This is an essential step in preparing a patient to wear a permanent prosthesis and to promote their rapid inclusion in the community. The production of permanent prostheses began in April to ensure the orthopedic-fitting of people who had first been fitted with a temporary prosthesis and who were ready to be fitted with a permanent prosthesis. More or less sophisticated prostheses -- with knee joints, if necessary – are provided in accordance with the person’s lifestyle. These prostheses are designed to last three to five years for an adult and around six months for children whose prostheses need to be altered as they grow. The production of temporary prostheses ended in September. All ages of people are fitted with orthopedic devices. Out of 386 beneficiaries fitted or currently being fitted with an orthopedic device, more than half are female aged between 9 months and 76 years. Men fitted with devices are aged between 9 months and 67 years. A total of 56 children under 14 years of age have been fitted. In January 2011, the association plans to start the orthopedic-fitting of upper-limb amputees. At least 20 out of 70 people recorded should benefit from such a fitting. Merizil Bertin, supporter for amputees Amputated at the age of 19 after a car accident, Merizil Bertin is now a salaried staff member at the functional rehabilitation center. He provides support to amputees by talking with them and providing an example of someone whose life did not end after his amputation. Young people currently being fitted with an orthopedic device are also able to familiarize themselves with the prosthesis.
Orthoses The production of orthoses designed to support impaired limbs that were crushed or otherwise injured, and which restore patient mobility, has increased rapidly over the last few months. Eighty percent of orthoses produced at the functional rehabilitation center are for lower limbs. To date, 230 people were fitted with a device and 143 are currently being fitted.
Mobile teams The functional rehabilitation center has two mobile teams that visit communities and focal points to provide patients with follow-up care. They perform technical follow-up care for people fitted with orthopedic devices and they make minor repairs to devices (prostheses and orthoses) in homes. Mobile teams may also sometimes deliver or adjust orthoses. These visits also allow teams to study the person’s environment, assess their needs, distribute technical aids and basic equipment and refer patients to the psychosocial team. The team that visits Petit-Goâve, located far from Port-au-Prince, is able to take measurements and produce molds. The prostheses are then produced at the center before the team returns to try the device on the patient. The team from the Petit-Goâve focal point then organizes the patient’s rehabilitation care.
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A second orthopedicfitting center Handicap International Belgium is active in Sarthe, a working-class neighborhood of Port-au-Prince, in a hospital where the association provides physiotherapy and orthoprosthetic care to in-patients and regular outpatients. Patients continue to receive temporary prostheses and are then referred for fitting with a permanent orthopedic device. Patients waiting to be fitted with a device are accommodated in a mini village set up especially for them. In mid-September, 3,489 patients were case-managed at the center. The on-site team consists of a permanent staff of 30 people, including eight expatriate staff.
Training The association’s goal is to create and coordinate the country’s long-term capacity to provide rehabilitation and fitting services by training Haitian staff to ensure its future success. Expatriate technicians are working in collaboration with Haitian and expatriate staff from Healing Hands for Haiti for the time being, before other Haitian staff receive training. Six people are already taking ongoing training to become orthopedic-fitting technicians. Under the management of Handicap International, the training of four Haitian rehabilitation assistants began in October for a period of at least six months.
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HUMANITARIAN LOGISTICS AND MEETING BASIC NEEDS At the beginning of October, the World Health Organisation estimated the number of displaced persons in Haiti at more than 1.3 million, living in more than 1,350 encampments. Handicap International manages a logistics chain that transports humanitarian aid supplied by numerous organizations for these displaced persons, who have often lost all of their possessions. Direct distributions made by our teams to beneficiaries are now highly targeted to meet specific needs. The association organized a distribution to the most vulnerable people affected by a violent storm on September 24.
Management of the interagency logistics platform Handicap International has transported 17,700 tons of humanitarian aid since January 14, for 100 organizations (U.N. agencies, Action contre la faim, Caritas, Croix-Rouge, Food for the Poor, Médecins du Monde, Mercy Corps, Oxfam, Pompiers sans Frontières, Plan, Première Urgence, Save The Children, Secours Islamique, World Vision and others), of which 15 are Haitian organizations (including Acrecom, Haitian CroixRouge, Dinepa, Espoir de l’Horizon, Meyer, the Haitian Ministry for Public Health and the Population, Santo 19 and Signeau). Of the total tonnage transported, 9,000 tons consisted of food. After Haiti was hit by a series of hurricanes in 2008, Handicap International was put in charge of a logistics platform for the transport of humanitarian aid. This project, managed in partnership with the World Food Programme (WFP), was back in service on January 14, two days after the earthquake. Handicap International’s humanitarian logistics team in Haiti now numbers 160 people (including 5 expatriate staff) spread over four operational bases (Port-au-Prince, Cap-Haïtien, Gonaïves and Jacmel).
This team manages a fleet of 70 trucks, including 50 six-wheel drive vehicles each capable of transporting 3.5 tons of goods to areas that are difficult to access with other types of vehicles. The association also coordinates 20 flatbed trucks made available by the Clinton Foundation capable of transporting 8 tons of freight each, which are used mainly in urban areas. In addition to transporting food over the first three months, the fleet also carried basic equipment, tents, hygiene and health packs, seeds and tools. From mid-April, the main priority has been to house the homeless so temporary shelter construction materials have made up the bulk of transported items. In September, the association transported an average of 360 tons of humanitarian aid a week on behalf of 20 national and international organizations in some of the country’s least accessible areas. Over the last month, 732 tons of food, 510 tons of humanitarian items, 25.5 tons of medication and 153 tons of logistical equipment were transported. More than 150 Haitian members of the humanitarian logistics team benefited from training (particularly road safety training for truck drivers). 16
Since February, the association also managed two humanitarian aid storage warehouses with capacities of 26,910 square feet (2,500 square meters) and 32,292 square feet (3,000 square meters). The first closed in June and the second in September.
“Cash for work” activities “Cash for work” projects supply the population with a source of income through occasional work, generally as part of manual clearance operations. The workers are paid the Haitian minimum wage - 200 Gourdes ($5) a day.
Handicap International set up two main “cash for work” programs between May and August involving more than 660 people (4,000 direct beneficiaries): A rehabilitation site on the Route de Palmes, at the top of the Mornes mountain range in Petit-Goâve and Grand-Goâve, and a center producing temporary shelters in Portau-Prince. Other activities were launched in the Mornes at the end of April. They consisted of clearing and strengthening mountain paths for settlements isolated by landsides caused by the earthquake. At the same time, smallerscale demolition projects were completed in Petit-Goâve, which employed people with disabilities, among others. We also formed a partnership with the Civil Protection Department (DPC) to cover certain parts of the city center not accessible to machinery. A demolition and clearance operation, performed over an eight-week period, with an average of 60 people employed each day, enabled the clearance of 35 collapsed and dangerous houses in Petit-Goâve.
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Distribution of emergency packs, food and emergency shelters/construction of transitional shelters These distribution activities take into account the specific needs of people with disabilities, the vulnerable and elderly, particularly in terms of facilitating access to aid and adapting to individual mobility conditions.
Petit-Goâve and Grand-Goâve Located around 6.2 miles (10 kilometers) from the epicenter of the earthquake, 60 percent of these two intervention areas were destroyed, with some 50,000 people affected in these regions alone. The distribution of tents and basic equipment began in early February. Food items were also distributed from early February to mid-March. The setting up of temporary hurricane-resistant and earthquake-resistant shelters accessible to people with reduced mobility began in July. More than 1,000 ShelterBoxes, with a unit value of $1,047 (€750) were given by ShelterBox (see www.shelterbox.org) to Handicap International, which distributed them in the most acutely affected rural areas. ShelterBoxes are plastic boxes containing a 10-person tent and equipment suitable for daily life in this type of shelter for several months, including a floor mat, blankets, a stove, cooking utensils, jerry cans, a water purification system, a saw, an axe, a shovel, rope, a mosquito net and activity packs for children.
The association has also distributed more than 4,500 tents to more than 4,500 households (more than 23,000 beneficiaries), as well as 36 tons of food to more than 2,000 households (more than 10,000 beneficiaries) and almost 30,000 items of equipment to more than 8,000 households (more than 42,000 beneficiaries). The latter mainly concerned items essential to everyday life, such as plastic sheets, rope, jerry cans, cooking and hygiene packs, mattresses, blankets, mats and mosquito nets. In Haiti’s particularly inaccessible mountainous regions (the Mornes), Handicap International and its partners distributed aid, most often by helicopter, or by truck when possible.
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In the towns of Petit-Goâve and Grand-Goâve, the situation evaluation performed by Handicap International during its distribution operations revealed a need for the association to take a more long-term approach in Haiti, particularly in terms of reconstruction, given the extent of current needs. Distributions after the storm of September 24 Handicap International performed a specific evaluation of 500 “disability focal point” beneficiaries, who were among the most vulnerable individuals. Each person was contacted to identify their needs in terms of tents and plastic sheeting. Some 280 sheets, 60 four-person tents and 15 10-person tents were requested and distributed. A second evaluation was performed of beneficiaries who had received a tent. Out of 250 people contacted, 60 had a torn tent and 30 a slightly torn tent. They are expected to receive a new tent or plastic sheeting.
Port-au-Prince and the surrounding urban area In Port-au-Prince, where national and international aid meets a larger number of needs, the association has set up a database of particularly vulnerable persons (families with disabled members, for example). The data is supplied by the association’s health teams and its partners. The association aids this particularly fragile population through distributions and the provision of shelters. More than 660 tents have been distributed, providing shelter for 3,000 people. More than 1,300 items of equipment have also been distributed to more than 430 households (more than 2,100 beneficiaries). This also involves covering day-to-day needs. Between May and August, 45 shelters were built. These temporary shelters have a wooden framework, plastic sheeting or plywood for the walls and a corrugated roof. Each of these shelters is made accessible to people with reduced mobility. The distribution of tents and the construction of shelters is sometimes accompanied by small-scale clearance or layout projects, mostly performed as part of “cash for work” schemes.
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Building transitional shelter As part of its humanitarian aid effort, Handicap International plans to build 1,000 transitional, hurricaneresistant and earthquake-resistant shelters accessible to people with reduced mobility between July 2010 and September 2011. This project will affect 5,000 beneficiaries in Petit-Goâve, Grand-Goâve and the surrounding mountainous areas. These shelters are designed to last between three to five years but, if well maintained, they can last longer, since their structure is designed to resist climatic challenges. Handicap International’s unique design includes a wooden framework and walls of woven wooden slats, with a roof designed to stand up to strong gusts of wind. The floor is made from wooden planks or a raised concrete slab to protect occupants from humidity during the rainy season. If necessary, these shelters will be fitted with a ramp to ensure their accessibility. There are six types of available cladding (cement/sand, cement/cob, cob/lime, plywood, mosquito netting or plastic sheeting), allowing families to choose the solution best adapted to their needs. With a living area of 194 square feet (18 square meters) and a 65 square-foot (6 square-meter) covered terrace, each shelter is designed for a family of five. Modules of different sizes will also be made available to suit each size of family or construction area. The shelters are prepared in packs (prefabricated walls), which are transported to the area before being assembled with the families who will live in the shelters. Families will be involved in building the shelter to foster full “ownership” and to ensure they are able to maintain the structure. The first pilot shelter currently houses Handicap International’s disability focal point in Petit-Goâve. At the end of September, 50 shelters had been produced in a workshop set up by Handicap International in Petit-Goâve and 28 had been delivered. Among them, 26 were delivered to the urban areas of Petit-Goâve and Grand-Goâve. Several transitional shelters were or will shortly be assembled in the Mornes to be used by Médecins du Monde as clinics as part of their project organized in partnership with the Haitian Ministry of Public Health and Population.
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Accessibility Handicap International benefits several other associations with its expertise in the field of accessibility. It is also part of several working groups formed by humanitarian operators present in Haiti. Our task is to promote the accessibility of existing buildings (medical facilities, toilets in displaced persons’ camps, etc.) and to ensure the requirements and principles of accessibility are taken into account in building projects. The association raises the awareness of its partners, other NGOs and medical facilities by advocating for the need to include people with disabilities at each stage of an emergency response and to help persons with disabilities access aid. All of Handicap International’s projects, particularly transitional shelters, consider accessibility requirements.
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