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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.

Countries most affected by disasters are often those with limited local capacity to respond. When local capacity is overwhelmed, international humanitarian response often provides needs-based emergency response. Despite global progress in education and the development of international humanitarian response standards, access to training and integration of local actors in response mechanisms remains limited. In May 2017, the Haiti Humanitarian Response Course (HHRC) was implemented in Mirebalais, Haiti to increase local capacity and allow for effective future engagement with international humanitarian actors in a country prone to disasters. In collaboration with the Hôpital Universitaire de Mirebalais' (HUM; Mirebalais, Haiti) Department of Medical Education and Emergency Medicine (EM) residency program, four physicians from the Division of Global Emergency Care and Humanitarian Studies at Brigham and Women's Hospital (Boston, Massachusetts USA) facilitated the course, which included 53 local physicians and staff. Following 15 hours of online pre-course preparation, through didactics and practical small-group exercises, the course focused on key components of international humanitarian response, minimum standards for effective response, and the roles of key response players. The course was free to participants and taught in English and French. The HHRC reduced the barriers often faced by local actors who seek training in international humanitarian response by offering free training in their own community. It presents a novel approach to narrow critical gaps in training local populations in international humanitarian response, especially in environments prone to crises and disasters. This approach can help local responders better access international humanitarian response mechanisms when the local response capacity is exhausted or overwhelmed. The HHRC demonstrates a potential new model for humanitarian and disaster training and offers a model for similar programs in other disaster-prone countries. Ultimately, local capacity building could lead to more efficient resource utilization, improved knowledge sharing, and better disaster response.

First-aid and triage stations were essential in the first hours. [...]in order to improve program monitoring and evaluation, the ESC could encourage its members to agree upon a standard database with standard typology, as has been promoted by other organizations [13]. The ESC, comprising key players from major surgical humanitarian agencies, is a proposal to improve surgical delivery in emergencies and could support collaboration between surgical actors in an effort to minimize delay and duplication in the deployment of essential surgical services in future disasters.

Humanitarian health programs frequently focus on immediate relief and are supply side oriented or donor driven. More emphasis should be placed on long-term development projects that engage local community leaders to ensure sustainable change in health care systems. With the Emergency Medicine Educational Exchange (EMEDEX) International Rescue, Recover, Rebuild initiative in Northeast Haiti as a model, this paper discusses the opportunities and challenges in using community-based development to establish emergency medical systems in resource-limited settings. Bloem MM , Bloem CM , Rosentsveyg J , Arquilla B . Emergency medicine systems advancement through community-based development. Prehosp Disaster Med. 2014;29(1):1-5.

Background: The earthquake that struck Haiti on 10 January 2010, killed 200,000 persons and injured thousands more. Working with Partners in Health, a non-governmental organization already present in Haiti, Dartmouth College, and the University of Pennsylvania sent multidisciplinary surgical teams to hospitals in the villages of Hinche and Cange. The purpose of this report is to describe the injuries seen and evolution of treatments rendered at these two outlying regional hospitals during the first month following the earthquake. Methods: A retrospective review of the database maintained by each team was performed. In addition to a list of equipment taken to Haiti, information collected included patient age, American Society of Anesthesiology (ASA) physical status, injuries sustained, procedures performed, wound management strategy, antibiotic therapy, and early outcomes. Results: A total of 113 surgical procedures were performed in 15 days by both teams. The average patient age was 25 years and average ASA score was 1.4. The majority of injuries involved large soft tissue wounds and closed fractures, although 21–40% of the patients at each hospital had either an open fracture or amputation wound. Initially, wound debridement was the most common procedure performed, but after two weeks, skin grafting, fracture fixation, and amputation revision were the more commonly needed operations. Conclusions: Academic surgical teams can ameliorate the morbidity and mortality following disasters caused by natural hazards by partnering with organizations that already have a presence in the affected region. A multidisciplinary team of surgeons and nurses can improve both mortality and morbidity following a disaster.

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.

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)

In an international ranking of quality of life based on poverty, civil rights, nutrition, and other markers, Haiti was ranked between Afghanistan and Sudan in the category of “extreme human suffering.” 1 Haiti placed 149th of 182 countries on the 2009 Human Development Index, a ranking based on economics, life expectancy, and education produced annually by the United Nations (UN) Development Program's Human Development Reports.2 Much has improved in Haiti during the past decade. National and international nongovernmental organizations and civic organizations provided shelter, public health interventions, education, and gender-based violence prevention. The 12 UN clusters that are active in Haiti are Camp Coordination and Camp Management (lead agency: the International Organization for Migration), Education (UN International Children's Emergency Fund [UNICEF]), Emergency Shelter and Non-Food Items (International Federation of the Red Cross and Red Crescent), Food (World Food Programme [WFP]), Logistics (WFP), Nutrition (UNICEF), Protection (Office of the High Commissioner for Human Rights with UNICEF for Child Protection and the UN Population Fund for gender-based violence), Water, Sanitation, and Hygiene (WASH; UNICEF), Agriculture (Food and Agriculture Organization), Early Recovery (UN Development Program), Emergency Telecommunications (WFP), and Health (World Health Organization/Pan American Health Organization).