MSF in Haiti: Managing the risk of communicable disease outbreaks

Guest blog by Dr. Greg Elder, Deputy Operations Manager, Médecins Sans Frontières/Doctors Without Borders (MSF), New York

Now in the fourth week after Haiti’s catastrophic January 12th earthquake, approximately 700,000 internally displaced people (IDPs) in Port-au-Prince are living in temporary shelters at nearly 600 relief sites. Displaced populations are also living in resettlement camps just outside Port-au-Prince and in other affected areas such Léogâne and Jacmel.

Understanding the epidemiology of mass displacement, including strategies to control disease spread among displaced and migrant populations, has been a cornerstone of MSF’s work in IDP (and refugee) health. IDP settlements are often overcrowded with inadequate sanitation, potentially leading to poor hygiene among the population. These environmental factors can multiply the risk of outbreaks of communicable diseases such as acute diarrhea and respiratory tract infections, or vaccine-preventable diseases like measles, in a population already exhausted and vulnerable.

Outbreak risk is not linked directly to the earthquake itself but rather to the overcrowded, unsanitary conditions of large, displaced populations living in makeshift camps. Indeed historically, major disease epidemics have not been seen after natural disasters like the earthquake in Haiti.

Most of the medical attention during the first weeks focused on the immediate trauma care, enormous surgical needs, and huge burden of follow-up and post-operative wound management to prevent long-term disability due to poorly managed injuries. However we cannot now neglect the large populations resettled in poor and overcrowded camps. As is common in such situations, in recent days our clinics have started to see cases of acute diarrhea and respiratory infections in younger age groups in the resettlements. A small number of measles and varicella (chickenpox) cases have been reported in Port-au-Prince, Léogâne, and Jacmel.

In response, health organizations led by the Haitian Ministry of Health and PAHO/WHO have set up a surveillance system with 52 sentinel sites across Port-au-Prince. This involves standardized reporting of communicable diseases of epidemiologic importance into a centralized system to inform response interventions. On February 2, UNICEF launched a vaccination campaign against diphtheria, tetanus, and pertussis in Port-au-Prince, targeting more than 500,000 children <7 years old overall, including 250,000 in the displacement camps.

MSF is following up on the suspected cases of measles reported in Léogâne and has sent a team of epidemiologists from Epicentre (epidemiology and research division of MSF) to develop data management systems across our health facilities and to link our outreach health activities to this surveillance system. This team is mapping the camps around our fixed clinics, while other teams try to support the population through water and sanitation activities and distribution of relief items in these areas.

Health assessment, provision of water and sanitation, measles vaccination, and surveillance are among the top 10 priorities for health interventions in such a setting, learned from years of experience in similar emergencies. Improvements in water, sanitation, food, and nutrition support, as well as strengthening basic primary health care and obstetric care, are among the priorities for the next phases of this emergency response.

Updates on MSF’s response to the earthquake can be found here.

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