View From the Ground
Lessons learned by an American assistance group on the ground following an international disaster
People were fervently occupied with finding family members, sifting through their homes and searching for water and food. They were also coming to terms with what was left of their lives. Finally, waiting preoccupied the day, as there was nothing left to do but survive on the side of the road or in makeshift tent camps crowded by thousands.
COORDINATION
Our assessment team had to determine where, based on its mission and capabilities, the organization could be most effective. Typically, relief organizations collaborate among themselves based on the particular needs of the event, building on the strengths of each group. In this experience, collaboration proved difficult.
Our team registered and participated in the U.N. Office for the Coordination of Humanitarian Affairs' cluster system, a method for grouping U.N. agencies, nongovernmental organizations and other international organizations around a sector or service provided during a humanitarian crisis. Several clusters met, bringing together groups such as health, sanitation, water, rescue, roads and engineering. As the response went on, the clusters divided into appropriate subgroups: The health group, for instance, divided into hospitals, mobile emergent medical clinics and medical supplies.
With coordination, different relief organizations could concentrate together on the effective distribution of appropriate and mission-specific services under the direction of the Haitian Ministry of Health and through the assistance and guidance of the U.N. At the beginning of operations, 34 organizations had registered. By the end of week two, there were more than 240.
As with all disasters, health system needs evolved from emergent to primary and then to preventive care. The size of the disaster, resources available and coordination efforts dictate how long each phase can take. Primary emergent initiatives included facilitating the operational readiness of field hospitals, evaluating and utilizing existing hospitals as possible, placing personnel for lifesaving surgical interventions in both, and sending out emergent mobile medical clinics within the city, outskirts and countryside.
As needs migrated, so did organizations and collaborations. Disaster situations require both short- and long-term missions in specific niches. For example, an Israeli surgical field hospital was operational within days of the earthquake and treated tens of thousands of people. Organizations brought patients there day and night. Once primary care became the predominant need, the Israelis' mission goals were completed, and they left to make room for the next set of organizations.
PREPARING FOR THE CLINICAL TEAM
In a disaster of this magnitude, organizations must be self-sufficient. Requiring external assistance with safety and security, shelter, food, water, transportation, supplies or communications is counterproductive and takes resources from those in need. Relief teams have to arrive ready to carry out their mission under their own power.
Safety is a major concern, but specifics are dictated by the type of disaster, climate, geography, politics, culture and human needs. For example, in the absence of food and water, crowds could potentially swell from tens to thousands in minutes if people thought your organization had any. Teams could not give out even a bottle of water, lest the vehicle be swarmed or the receiver mobbed; teams could only direct people to distribution sites. Although NYC Medics did not encounter any hostility, organizations must always prepare for the possibility by coordinating with local and international military or security forces in the region. Other safety concerns included aftershocks, the humid and hot environment, and tropical diseases. Further, the physical and emotional stress from such a situation cannot be underestimated.
Many relief organization teams stayed in tent shelters at the airport or throughout the city in secure areas staffed with 24-hour guards. People could not stay indoors, as there was danger of collapse. Many slept in roadways protected by rubble or in available open areas away from buildings.
