1. Background. Already the poorest nation in the Americas, Haiti suffered a series of recent disasters and was battered by hurricanes in 2008. Four big storms, Tropical Storm Fay and hurricanes Gustav, Hanna and Ike pounded Haiti in August and September 2008, killing a total of 793 people and leaving more than 300 others missing. The country was gripped by a tense political standoff in April 2008 amid riots over skyrocketing food prices. UN troops are a regular sight throughout much of the country. Seventy percent of Haiti's population lives on less than two dollars per day and half of its 8.5 million people are unemployed. Food insecurity already affects more than a quarter of Haiti's population, some 1.9 million people, with women and children the worst affected. The Food and Agriculture Organization designated Haiti one of the world's most economically vulnerable countries. The WFP serves one meal a day to more than 500,000 Haitian schoolchildren, providing them with what is often their only meal of the day. The organization also feeds 100,000 women who are pregnant or breastfeeding and 50,000 children under the age of five. Since mid-2004, the Brazilian-led MINUSTAH has been keeping the peace in the impoverished Caribbean island nation.
2. 2010 Haitian Earthquake. Over 50,000 earthquakes occur every year. About one thousand of are over magnitude 5 on the Richter scale. About 17 reach magnitude 7 or above. The 2010 Haiti earthquake was a catastrophic magnitude 7.0 M earthquake centered approximately 16 miles west of Port-au-Prince (PAP), capital of Haiti, striking 16:53:09 local time Tuesday, 12 January 2010. The earthquake occurred at a depth of 8.1 miles. The US Geological Survey recorded 6 aftershocks 2-hours after the main earthquake; and another 26 aftershocks within the first 9-hours. The International Red Cross estimated that about three million people were affected by the quake. A UN spokeswoman declared the quake the worst disaster the UN ever faced, since so much government and UN capacity in the country was demolished. In that way, Elisabeth Byrs said in Geneva, it's worse than the cataclysmic Asian tsunami of 2004, because the organizational structures of the UN in Haiti and the Haitian government were destroyed.
3. Infrastructure Damage. Haiti is one of the poorest nations in the world; construction standards are low. Like many islands in the Caribbean the country has no building codes. Engineers stated it is unlikely many buildings would have stood through any kind of disaster. Structures are often raised wherever they can fit; some buildings were built on slopes with insufficient foundations or steel. A representative of Catholic Relief Services estimated that about two million Haitians live as squatters on land they do not own. Secretary-General of the UN Ban Ki-moon estimated that fifty percent of the buildings in the affected regions were destroyed.
Port au Prince. The earthquake caused major damage to Port-au-Prince. Most major landmarks were significantly damaged or destroyed, including the Presidential Palace, National Assembly building, Port-au-Prince Cathedral , main jail, buildings of the finance ministry, ministry of public works, ministry of communication and culture, Palace of Justice, Superior Normal School, National School of Administration, Institut Aimé Césaire, Parliament and Port-au-Prince Cathedral were damaged to varying degrees. A hospital in Pétionville, a wealthy suburb of Port-au-Prince, also collapsed from the earthquake. The main prison in Port-au-Prince collapsed during the earthquake. The headquarters of MINUSTAH at Christopher Hotel was destroyed and offices of the World Bank. The quake affected the three Médecins Sans Frontières medical facilities around Port-Au-Prince, causing one to collapse completely. The building housing the offices of Citibank in Port-au-Prince was destroyed. Most hospitals in the area were destroyed.
PAP Seaport. Damage to the Port-au-Prince seaport includes the collapse of cranes and containers into the water, structural damage to the pier and an oil spill, rendering the facility unusable for immediate rescue operations; the Gonaives seaport, in the northern part of the country, remains operational.
Towns west of Port-au-Prince. Jacmel, Carrefour, Léogane, Petit-Goâve, and Gressier reported extensive and perhaps catastrophic damage. Furthermore they are isolated by debris blocking connecting roads and unable to receive supplies that are slowly getting into the capital.
Towns in the eastern Dominican Republic began preparing for tens of thousands of refugees. By 16 Jan 10 hospitals around the Dominican Republic border were filled to capacity with Haitians.
Airport. The quake seriously damaged the control tower at Toussaint L'Ouverture International Airport. Haiti airspace control handed over to US forces for 72 hours starting 152300Z Jan 10 to hasten and ease flight operations, made worse by the damaged air traffic control tower. Port-au-Prince's airport, can currently handle 90 flights a day, far short of what is needed. President Préval and government ministers used police headquarters near the Toussaint L'Ouverture International Airport as their new base of operations, although their effectiveness was extremely limited.
4. Casualties. The earthquake struck in the most populated area of the country and the International Red Cross has stated that as many as 3 million people are affected by the quake. One factor that compounded the number of casualties in the early days of the earthquake was a lack of medical and rescue infrastructure and personnel. Estimates of the number of dead range from 30,000 to 500,000. http://en.wikipedia.org/wiki/2010_Haiti_earthquake - cite_note-LeonardJan13-70 Haitian sources reported 20,000 bodies had been recovered by Haitian government crews on 16 Jan 10. Medical facilities had been badly damaged in the earthquake and both Haitian and foreign medical staff, police and military personnel were casualties. A reported 9,000 corpses were cleared off the street by Haitian government crews and buried in mass graves, with thousands more awaiting burial in the streets and outside the morgue.
5. International Response. Transportation into the affected areas remained problematic, as a bottleneck blocked aid arriving from the Port-au-Prince airport. Ships were also unable to render aid because the port facilities had been too damaged. Some organizations landed in Santo Domingo and drove into Haiti on rugged dirt roads. Pilots were told that any flights coming in to Port-au-Prince should expect to circle the airport for at least an hour, and that no jet fuel was available. Cuba lifted airspace restrictions to allow U.S. airplanes to save time transporting critically wounded Haitians to the US.
Neighboring Dominican Republic (DO) was the first country to provide aid to Haiti. DO sent food, bottled water and heavy machinery to remove rubble. The hospitals in DO were made available, as well as the airport to receive aid for distribution to Haiti. The DO Red Cross and the International Red Cross have been coordinating health relief services. The DO government sent eight mobile medical units along with 36 doctors including orthopedics, traumatologists, anesthesiologists and surgeons.
The State of Qatar sent a strategic transport aircraft (C-17), loaded with 50 tons of urgent relief materials and 26 members from the Qatari armed forces, the internal security force, police force and the Hamad Medical Corporation. The team will set up a field hospital and provide assistance in Port-au-Prince and other affected areas in Haiti.
Partners in Health (PIH) is the largest health care provider in rural Haiti; it oversees some 10 hospitals and clinics, all far from the capital and all still intact. PIH is currently serving the flow of patients from Port-au-Prince.
The Argentine Air Force deployed a field mobile hospital at Port-au-Prince. On 13 Jan 10 only the Argentine military field hospital remained open in Port-au-Prince, struggling to support the huge numbers of injured. Argentine helicopters from the United Nations force were helping evacuate the gravely injured people to Santo Domingo.
Médecins Sans Frontières (Doctors Without Borders) reported at least two hospitals were still in good shape.
Cuba. Rescue teams from Cuba arrived in Haiti.
The Peruvian government sent rescue teams, dogs and 50 tons of food transported by two Peruvian Air Force airplanes.
International Committee of the Red Cross in Haiti distributed medical aid, assessing water needs and prepared for arrival of several Emergency Response Units sent by Red Cross societies from across the world. These include a field hospital, mobile health units and water and sanitation units.
French Navy vessel Francis Garnier left Martinique on 15 Jan 10 carrying 60 Army personnel, land vehicles, and excavators.
Columbia deployed a field hospital.
6. US Response. On 14 Jan 10, the US Government announced a large relief fund effort for Haiti. US President Barack Obama said America would donate $100 million to the aid effort and pledged the people of Haiti "will not be forgotten".
US State Department.
Per Dept of State Task Force Haiti Consular Affairs, SECSTATE is flying from Haiti to Kingston, Jamaica to drop off 28 AMCITs (American Citizens); then, continue on to Andrews AFB (Air Force Base) with 22 Haitian citizens characterized as "elderly". No word on case-severity mix but 79th MED WING Readiness Officer believes a nurse is on board aircraft and believes the 22 patients are probably ambulatory; patients will be kept at the Aeromedical Staging Facility (ASF) at Andrews AFB over night pending disposition; ETA Andrews AFB is o/a 162300R JAN10. All AMCITs are ambulatory and don't require any medical attention. DHHS is going to pick up AMCITs rampside, put them up in hotels, and coordinate their follow-on civilian flights.
7. US Department of Defense. Dubbed Haiti relief Operation UNIFIED RESPONSE to coordinate the Pentagon's relief efforts.
JTF-HAITI Surgeon has not been named but all indications are this individual will be a three-star Flag/General Officer.
RFF for USNS Comfort (6100025) is at JFCOM for sourcing
JTF-B alerted to produce COAs for self deployment/STRAT deployment (10 x UH-60/4 x MEDEVAC/ 4 x CH-47 Helicopters at Soto Cano Air Base, Honduras. Approximately 2- Days to self deploy to Haiti
- MINUSTAH and HNP conducting some ad hoc relief and security missions
- 800 additional Canadian troops to be deployed
- Police presence/effectiveness remains marginally effective
- Absent of relief supplies, violence expected to increase in the next 24 hours -Increased reporting of anger from desperation -Limited MINUSTAH / HNP patrols
- Current US forces have experienced growing crowds of AMCITs and Foreign Nationals at the PAP Airport. The crowd is made up of individuals eager to depart. Crowds are growing larger and becoming restless.
- MINUSTAH and HNP conducting some relief and security missions
- Expect increased violence and gang activity
- 4,000 prisoners escaped and acquired weapons from the prison armory
- Increased violence and gang activity; HNP attempting to make arrests
- Reports of aid workers assaulted for relief supplies
- Communications are severely degraded; power grid, radio, landline/cellular telephone services are not working
- There are small pockets that have cell phone connectivity
- Diesel fuel distribution affecting cell phone coverage
- Main road arteries clear (< 50% obstructed)
- Concentration of relief efforts in PAP is triggering internal migration
- 3 new field hospitals are operational in PAP (Israel, Spain, and Russia)
- 2 key medical facilities treating foreign aid workers and Haitian nationals, Hospital du Canape Vert and Hospital Adventiste de Haiti
- Roads remain largely impassable except by motorcycle/foot traffic
- Ministry of Health priorities outlined to US EMB; medical supplies, body bags, formaldehyde and diesel fuel for generators. De-mortification is an issue as survivors are moving victims to the street for pickup
- Perception of US change in policy (TPS) may hasten migration
DoD and DHS forwarded recommendation to POTUS to begin reserve activation IOT source the mission in Haiti, and to source NORTHCOM supporting the mission of opening Intermediate Staging Base (ISB) and prepare for MASCAL support in CONUS.
82d Airborne Division. Elements of the U.S. Army's 82nd Airborne Division deployed 15 Jan 10 with the aircraft carrier USS Carl Vinson to set up a base for distributing water and food as the number of dead remains unknown.
US Coast Guard deployed helicopters and several aircraft and cutters to the region to aid in relief workhttp://en.wikipedia.org/wiki/2010_Haiti_earthquake - cite_note-105 and perform reconnaissance flights over Haiti.
USS Carl Vinson. Transferred 35,000 gallons of fresh water to shore on Day One. Has the capability to distill 400,000 gallons/day; will also provide medical, air transport and food preparation facilities; deployed with 19 helicopters. The carrier is transporting 600,000 emergency food rations and 100,000 ten-liter water containers; 20,000 containers of water were distributed on 15 Jan 10.
USS Bataan deployed to Haiti, along with three large dock landing ships and two survey and salvage vessels, intending to create a "sea base" for the rescue effort.
USNS Comfort hospital ship departed Baltimore, MD on 16 Jan 10.
USS Bunker Hill (CG-52) (guided-missile cruiser) headed toward Haiti, part of the US Navy's enlarging sea base directed at implementing disaster relief.http://en.wikipedia.org/wiki/2010_Haiti_earthquake - cite_note-146
By 18 Jan 10, approximately 10,000 US troops are expected to be off the shores of Haiti, while MINUSTAH retains primary responsibility for security in Port-au-Prince.
8. Partner Activities.
CRUDEM. An acronym for (Center for the Rural Development of Milot) was founded in 1968 by the Brothers of the Sacred Heart of the Montreal Province. In 1986, the Brothers constructed a hospital – Hôpital Sacré Coeur (HSC). This is the largest private hospital in the North of Haiti, located in the town of Milot, located 80 miles north of Port au Prince near Cap Hatian, about 8 miles from the airport in Cap Haitian and the sea port. HSC has a helicopter landing zone 200 yards from the hospital. The 73 bed hospital has provided uninterrupted service for 23 years. Indicated Hospital Sacre Coeur is available to take 100 patients from Port au Prince. Facility has 2 fully equipped ORs, 21 Haitian physicians and volunteer surgeons on site. Teams of trauma surgeons and orthopedic surgeons based in the US are prepared to deploy to the facility. Facility and staff capable of performing major surgery. Dr. Peter Kelly Indicated CRUDEM VOLS could also provide physicians and nurses for USNS Comfort upon arrival in PAP. Dr. Kelly reported 160100 Jan 10 the USN plans to bring 8 to 15 patients to the facility 16 Jan 10 for amputations. Surgeons at HSC reported helicopters offloaded 4 patients on or about 161640 Jan 10. All patients were in serious stages of gangrene; one with crushed leg, one with crushed arm. Indicated a second load of 4 patients in similar condition would be delivered to HSC. Pilot reported the scene in PAP is more desperate then shown on the news. People are "stacked up in piles" all in need of amputations. Damage to PAP also greater than noted thru media. CRUDEM has a general surgery team led by Steve Fletcher arriving 16Jan 10 and an orthopedic team arriving 17 Jan 10. Reported Caritas in Boston (Caritas Christi Health Care, established in 1985, is New England's largest community-based hospital network) is sending a team of ER docs and nurses and supplies on 19 Jan 10. Phillips medical is shipping equipment such as monitors, portable x-ray unit etc and technicians to assemble on 19 Jan 10. CRUDEM is coordinating volunteer teams arriving by private plane throughout the week. They need for cots or beds and tents or portable building to house the additional patients. They have access to the school courtyard across from the hospital to set up tents and portable buildings. They cleared the 2 schools on campus to be used for dormitories able to support up to 75 medical volunteers. The nutrition center will serve as a cafeteria for the volunteers. Soccer field serves as a helicopter landing zone. The community is filling in the ruts and potholes in the road so ambulances can transport the patients from the helos to the hospital smoothly. Town of Milot has secured houses in town to house families of patients. If patients can get to Cap Haitien, the town will send a bus to pick them up.
Johns Hopkins Medical Institution, Mr. Jim Scheulen, Chief Administrative Officer, Department of Emergency Medicine to partner. Coordinated with Dr. Christina L. Catlett, MD, FACEP
Director, The Johns Hopkins Go Team. She arranged an immunization clinic on 18 Jan 10 for Go Team members who volunteered for the first deployment missing any of the immunization requirements and need malarial chemoprophylaxis scripts. She also solicited extra surgeons and ICU folks in anticipation of needs. Appears a colleague of hers, is the mother of Doug Lane.
Massachusetts General Hospital. Dr. Malcolm R. Smith, MD, reported half physicians from MGH were in St Marc and Conch. Indicated they found about 18 femurs, some open since 13 Jan 10; multiple tibias, 2 dead limbs needing urgent amputation, 4 missed lower leg compartment syndromes, one in a small boy and 2 paraplegics; several forearm fractures. Lots of wounds needing dressing or debridement. Triage and basic nursing needed immediately. Trying to get OR working. Indicated they need the USNS Comfort ASAP to set up appropriate transfers. Indicated a need for ortho kit.
IMVA (International Medical Volunteer Association) of Massachusetts. Chris Harding of IMVA offered to donate a pocket English/Haitian Creole Medical Dictionary in use by health volunteers to Haiti for several years.
American Society of Anesthesiologists is the world’s largest organization of physicians practicing anesthesiology and its subspecialties, including critical care medicine and pain medicine. Membership exceeds 44,000 in the United States and abroad. Alexander A. Hannenberg, M.D.
ASA President, extended their appreciation and admiration for the critical work done by Project Hope for the victims of the recent earthquake in Haiti. Members eager to contribute to the relief in Haiti. Recently used their website to encourage financial contributions to HOPE. ASA members expressed an interest in volunteering professional services in support of medical rescue work in Haiti.
The Cleveland Clinic indicated it supports the relief efforts in Haiti. They worked with Project HOPE on the USNS Comfort and in Haiti in 2007. Paul M Kempen, MD, PhD of the Cleveland Clinic indicated they were in a position to mobilize needed volunteers to “help maximize the provision of surgical services on the USNS Comfort”.
Virginia Hospital Center (VHC). Dr. Barry Beyer called to discuss his efforts to coordinate physician and nurse volunteers to serve aboard USNS Comfort. Provided names of several surgeons willing to deploy. Dr. Byer, who also serves as the CEO of the VHC Medical Brigade NGO serving Honduras, is willing to deploy as a Family Practitioner and to serve as a HOPE Medical Director.
Office of Preparedness and Emergency Operations HHS/OS/ASPR Office. Dr. Michael Vineyard, Deputy Director of Operations, Office of Preparedness and Emergency Operations HHS/OS/ASPR Office ASPR mentioned he has contacts through faith-based orgs and other voluntary organizations. Reported many US-Haitian physicians were interested in helping. Also mentioned HHS had not been contacted to support the USNS Comfort effort.
9. Project HOPE Activities Today.
HOPE ADVON Departed Baltimore, MD onboard USNS Comfort (MG USA Ret Harold Timboe, MD (serving a HOPE Medical Director); Dr. Laurence Ronan, Mass Gen Hosp (serving as HOPE Clinical Consultant); Matt Peterson, HOPE Operations Officer. Dr. Timboe called to report departure on or about 160900 Jan10. Anticipate arriving PAP Thursday 21 Jan 10.
Reviewed USSOUTHCOM daily SITREP.
Reviewed USAID Daily SITREP.
Link up with (WAMU, PBS, WDC) reporter. Matt Peterson linked up with male reported from WAMU embedded in USNS Comfort.
10. Director’s Evaluation/Assessment.
- Develop medical response options for presentation to BUMED/CNO/ASD(HA)
- Joint Staff is developing a Haitian MASCAL Plan at request of USSOUTHCOM. Plan involves bringing Haitian citizens to CONUS for medical care.
- BUMED working to source a 150-bed EMF (Expeditionary Medical Force) (overflow for COMFORT) and (1) EMF-10 (possibly for Haiti or GTMO). Develop position if asked to staff.
- BUMED working an additional plus-up for USNS COMFORT; the action is going to NAVMED-EAST for sourcing evaluation.
- Develop notional deployment plan lacking any plan provided by USN. Provide to SOUTHCOM. Include a minimum of six notional rotations (ROT), time duration (3-weeks) and EMB and Debark (DEB) locations.
- Develop Departure Arrival Control Group (DAACG) plan for reception of VOLS at designated POE (Port of Entry), likely to be Homestead Joint Air Reserve Base (HST) (formerly Homestead Air Force Base), a United States Air Force base located in South Miami-Dade County, Florida adjacent to the city of Homestead, about 28 miles from Miami.
- ADVON team members work with USN medical planners to develop clinical staffing requirements for USNS Comfort; establish ROT schedule and embark/debark plans.
- BUMED will push Joint Staff and ASD(HA) to approve 350+ plus up of uniformed staffing for USNS Comfort without considering impact on MHS and willingness of HOPE/NGOs to assist.
- BUMED/SOUTHCOM will allocate HOPE to staffing GTMO overflow field facilities and maintain sole uniformed staffing of COMFORT.
Director Special Projects