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In October 2010, nine months after the massive earthquake that devastated Haiti, a second disaster began to unfold-soon to become the world's largest cholera epidemic in modern times. In a country that had never before reported cholera, the epidemic mysteriously and simultaneously appeared in river communities of central Haiti, eventually triggering nearly 800,000 cases and 9,000 deaths. What had caused the first cases of cholera in Haiti in recorded history? Who or what was the deadly agent of origin? Why did it explode in the agricultural-rich delta of the Artibonite River? When answers were few, rumors spread, causing social and political consequences of their own. Wanting insight, the Haitian government and French embassy requested epidemiological assistance from France. A few weeks into the epidemic, physician and infectious disease specialist Renaud Piarroux arrived in Haiti. InDeadly River, Ralph R. Frerichs tells the story of the epidemic, of a French disease detective determined to trace its origins so that he could help contain the spread and possibly eliminate the disease, and the political intrigue that has made that effort so difficult. The story involves political maneuvering by powerful organizations such as the United Nations and its peacekeeping troops in Haiti, as well as by the World Health Organization and the U.S. Centers for Disease Control. Frerichs explores a quest for scientific truth and dissects a scientific disagreement involving world-renowned cholera experts who find themselves embroiled in intellectual and political turmoil in a poverty-stricken country. Frerichs's narrative highlights how the world's wealthy nations, nongovernmental agencies, and international institutions respond when their interests clash with the needs of the world's most vulnerable people. The story poses big social questions and offers insights not only on how to eliminate cholera in Haiti but also how nations, NGOs, and international organizations such as the UN and CDC deal with catastrophic infectious disease epidemics. In October 2010, nine months after the massive earthquake that devastated Haiti, a second disaster began to unfold-soon to become the world's largest cholera epidemic in modern times. In a country that had never before reported cholera, the epidemic mysteriously and simultaneously appeared in river communities of central Haiti, eventually triggering nearly 800,000 cases and 9,000 deaths. What had caused the first cases of cholera in Haiti in recorded history? Who or what was the deadly agent of origin? Why did it explode in the agricultural-rich delta of the Artibonite River? When answers were few, rumors spread, causing social and political consequences of their own. Wanting insight, the Haitian government and French embassy requested epidemiological assistance from France. A few weeks into the epidemic, physician and infectious disease specialist Renaud Piarroux arrived in Haiti.InDeadly River, Ralph R. Frerichs tells the story of the epidemic-of a French disease detective determined to trace its origins so that he could help contain the spread and possibly eliminate the disease-and the political intrigue that has made that effort so difficult. The story involves political maneuvering by powerful organizations such as the United Nations and its peacekeeping troops in Haiti, as well as by the World Health Organization and the U.S. Centers for Disease Control. Frerichs explores a quest for scientific truth and dissects a scientific disagreement involving world-renowned cholera experts who find themselves embroiled in intellectual and political turmoil in a poverty-stricken country.Frerichs's narrative highlights how the world's wealthy nations, nongovernmental agencies, and international institutions respond when their interests clash with the needs of the world's most vulnerable people. The story poses big social questions and offers insights not only on how to eliminate cholera in Haiti but also how nations, NGOs, and international organizations such as the UN and CDC deal with catastrophic infectious disease epidemics.

The 2010 earthquake in Haiti was unprecedented in its impact. The dual loss of the Haitian government and United Nations (UN) leadership led to an atypical disaster response driven by the US government and military. Although the response was massive, the leadership and logistical support were initially insufficient, and the UN cluster system struggled with the overwhelming influx of nontraditional agencies and individuals, which complicated the health care response. Moreover, the provision of care was beyond the country's health care standards. The management of the US government resembled a whole-of-government domestic response, combined with a massive military presence that went beyond logistical support. Among the most important lessons learned were the management of the response and how it could be strengthened by adapting a structure such as the domestic National Response Framework. Also, mechanisms were needed to increase the limited personnel to surge in a major response. One obvious pool has been the military, but the military needs to increase integration with the humanitarian community and improve its own humanitarian response expertise. In addition, information management needs standardized tools and analysis to improve its use of independent agencies. (Disaster Med Public Health Preparedness. 2012;6:200–208)

Allegations that International Non-Governmental Organizations (INGOs) are not accountable to the populations they assist have followed several humanitarian operations, and the 2010 Haiti Earthquake was no exception. In response, initiatives such as the Humanitarian Accountability Partnership guided agencies' efforts to become more accountable. Results of mechanisms implemented by two INGOs showed that although conditions were created for people to raise concerns, the ability of Haitians to obtain a response from the agencies was limited. The research found that while in principle agencies have the best interests of affected populations as their aim, fragmentation and power asymmetries within the humanitarian sector create conditions wherein agencies define the limits of what they are responsible for and, consequently, what they can be held accountable for. This literature review shows that without agencies' recognition of the responsibility that comes with power, no initiatives will enhance a more coherent vision to improving their accountability.

This report examines how Joint Task Force-Haiti (JTF-Haiti) supported the humanitarian assistance and disaster relief efforts in Haiti. It focuses on how JTF-Haiti was organized, how it conducted Operation Unified Response, and how the U.S. Army supported that effort. The analysis includes a review of existing authorities and organizations and explains how JTF-Haiti fit into the U.S. whole-of-government approach and the international response.

On January 12, 2010, Port-au-Prince, Haiti, was shattered by a violent earthquake that killed or injured thousands of its citizens. Local emergency services became overwhelmed and international assistance was required. French relief teams were deployed to assist local hospitals in caring for the victims. The medical care activity of the team at Diquini Hospital from January 17-26 was analyzed. Priority was given to surgery, leading to the creation of a pre- and post-operative area and a medical care unit. Special attention was required for infection prevention, pain relief, minor surgery, and pre-surgery triage. The continual influx of accompanied victims necessitated the creation of a receiving area. In spite of the assistance from several foreign surgical teams, some patients had to be evacuated to French or American facilities, particularly children, patients with spinal cord injuries, and those needing intensive care. Analysis of the actions undertaken highlights the importance of well-prepared and flexible medical teams and the ability to provide local and regional anesthesia, including the necessary medical supplies and equipment. Medical care activity, especially post-surgical care, was a predominant, ongoing need. The ability to provide medical care required organization and cooperation among local health care providers and other relief workers. BennerP, StephanJ, RenardA, PetitjeanF, LargerD, PonsD, PaklepaB, DenielC, LeDreffP. Role of the French rescue teams in Diquini Hospital: Port-au-Prince, January 2010. Prehosp Disaster Med. 2012;27(6):1-5.

Population movements following disasters can cause important increases in morbidity and mortality. Without knowledge of the locations of affected people, relief assistance is compromised. No rapid and accurate method exists to track population movements after disasters. We used position data of subscriber identity module (SIM) cards from the largest mobile phone company in Haiti (Digicel) to estimate the magnitude and trends of population movements following the Haiti 2010 earthquake and cholera outbreak. Geographic positions of SIM cards were determined by the location of the mobile phone tower through which each SIM card connects when calling. We followed daily positions of SIM cards 42 days before the earthquake and 158 days after. To exclude inactivated SIM cards, we included only the 1.9 million SIM cards that made at least one call both pre-earthquake and during the last month of study. In Port-au-Prince there were 3.2 persons per included SIM card. We used this ratio to extrapolate from the number of moving SIM cards to the number of moving persons. Cholera outbreak analyses covered 8 days and tracked 138,560 SIM cards. An estimated 630,000 persons (197,484 Digicel SIM cards), present in Port-au-Prince on the day of the earthquake, had left 19 days post-earthquake. Estimated net outflow of people (outflow minus inflow) corresponded to 20% of the Port-au-Prince pre-earthquake population. Geographic distribution of population movements from Port-au-Prince corresponded well with results from a large retrospective, population-based UN survey. To demonstrate feasibility of rapid estimates and to identify areas at potentially increased risk of outbreaks, we produced reports on SIM card movements from a cholera outbreak area at its immediate onset and within 12 hours of receiving data. Results suggest that estimates of population movements during disasters and outbreaks can be delivered rapidly and with potentially high validity in areas with high mobile phone use.

On January 12, 2010, a magnitude 7.0 earthquake occurred approximately 10 miles west of Port-au-Prince, Haiti, and created one of the worst humanitarian disasters in history. The purpose of this report is to describe the types of illness experienced by people living in tent camps around the city in the immediate aftermath of this event. The data were collected by a team of medical personnel working with an international nongovernmental organization and operating in the tent camps surrounding the city from day 15 to day 18 following the earthquake. In agreement with the existing literature describing patterns of illness in refugee and internally displaced populations, the authors note a preponderance of pediatric illness, with 53% of cases being patients younger than 20 years old and 25% younger than 5 years old. The most common complaints noted by category were respiratory (24.6%), gastrointestinal (16.9%), and genitourinary (10.9%). Another important feature of illness among this population was the observed high incidence of malnutrition among pediatric patients. This report should serve as a guide for future medical interventions in refugee and internally displaced people situations and reinforces the need for strong nutritional support programs in disaster relief operations of this kind. (Disaster Med Public Health Preparedness. 2010;4:116-121)

The damage to medical facilities resulting from the Jan 2010 earthquake in Haiti necessitated the establishment of field tent hospitals. Much of the local medical infrastructure was destroyed or limited operationally when the Fast Israel Rescue and Search Team (FIRST) arrived in Haiti shortly after the earthquake. The FIRST deployed small tent hospitals in Port-au-Prince and in 11 remote areas outside of the city. Each tent was set up in less than a half hour.

On January 12, 2010, a major earthquake in Haiti resulted in approximately 212 000 deaths, 300 000 injuries, and more than 1.2 million internally displaced people, making it the most devastating disaster in Haiti's recorded history. Six academic medical centers from the city of Chicago established an interinstitutional collaborative initiative, the Chicago Medical Response, in partnership with nongovernmental organizations (NGOs) in Haiti that provided a sustainable response, sending medical teams to Haiti on a weekly basis for several months. More than 475 medical volunteers were identified, of whom 158 were deployed to Haiti by April 1, 2010. This article presents the shared experiences, observations, and lessons learned by all of the participating institutions. Specifically, it describes the factors that provided the framework for the collaborative initiative, the communication networks that contributed to the ongoing response, the operational aspects of deploying successive medical teams, and the benefits to the institutions as well as to the NGOs and Haitian medical system, along with the challenges facing those institutions individually and collectively. Academic medical institutions can provide a major reservoir of highly qualified volunteer medical personnel that complement the needs of NGOs in disasters for a sustainable medical response. Support of such collaborative initiatives is required to ensure generalizability and sustainability. (Disaster Med Public Health Preparedness. 2010;4:169-173)