Rapid Establishment of an Internally Displaced Persons Disease Surveillance System After an Earthquake --- Haiti, 2010

Rapid Establishment of an Internally Displaced Persons Disease Surveillance System After an Earthquake --- Haiti, 2010
Weekly
August 6, 2010 / 59(30);939-945


On January 12, 2010, a 7.0-magnitude earthquake in Haiti disrupted infrastructure and displaced approximately 2 million persons, causing increased risk for communicable diseases from overcrowding and poor living conditions. Hundreds of nongovernmental organizations (NGOs) established health-care clinics in camps of internally displaced persons (IDPs). To monitor conditions of outbreak potential identified at NGO camp clinics, on February 18, the Haiti Ministry of Public Health and Population (MSPP), the Pan-American Health Organization (PAHO), and CDC implemented the IDP Surveillance System (IDPSS). The Inter-Agency Standing Committee (IASC) "cluster approach" (1) was used to coordinate the Haiti humanitarian response. One of 11 clusters, the Global Health Cluster (GHC), builds global capacity, whereas the country-level cluster (in this case, the Haitian Health Cluster [HHC], led by PAHO) responds locally. During the Haiti response, HHC engaged NGOs serving large camps, established IDPSS, followed trends of reportable conditions, undertook epidemiologic and laboratory investigations, and fostered implementation of control measures. This report describes the design and implementation of IDPSS in the post-earthquake period. The primary challenges to implementing IDPSS were communication difficulties with an ever-changing group of NGO partners and limitations to the utility of IDPSS data because of lack of reliable camp population denominator estimates. The IDPSS experience reinforces the need to improve local communication and coordination strategies. Improving future humanitarian response requires advance development and distribution of easily adaptable standard surveillance tools, development of an interdisciplinary strategy for an early and reliable population census, and development of communication strategies using locally available Internet and cellular networks.

Pre- and post-earthquake capacity

In 2009, before the earthquake, an estimated 55% of Haitians were living in extreme poverty (2). A total of 45% of the population lacked access to safe water, and 83% lacked access to sufficient sanitation (3). The public health-care system had inadequate infrastructure and no emergency medical system. NGOs provided much of Haiti's health services. A January 2010 World Health Organization (WHO) risk assessment of public health services in Haiti estimated that approximately 250 NGOs were operating within the health sector before the earthquake (3).

Before the earthquake, public health surveillance in Haiti was carried out by two independent systems. The Haitian Health Information System was implemented in 749 health facilities serving the general population. The primary purpose of this system was to monitor health service provision and administrative indicators; data flow was too encumbered to provide timely surveillance. The HIV Monitoring, Evaluation, and Surveillance Interface (MESI) is limited to monitoring the health events of human immunodeficiency virus (HIV)-infected patients.

Haitian government officials estimated that the earthquake resulted in approximately 230,000 immediate deaths and caused 1.5 million persons, approximately 15% of the nation's population, to be displaced to IDP camps. Within days, nearly 900 overcrowded camps were established spontaneously in Port-au-Prince, and an additional 400 further west in Leogane, Jacmel, and Petit-Goâve (Figure 1). Health-care services and humanitarian aid were provided by a huge influx of international and local NGOs. Although approximately 400 health organizations registered officially with the Haitian government, an additional unknown number of organizations also were providing services. Services ranged from general outpatient care to specialized surgical services. Most medical care was provided in temporary tented structures or mobile clinics operating in or around the large camps. The majority of clinics did not possess laboratory capacity, and specimen collection materials were scarce.

The cluster approach was developed by IASC after the 2004 Indian Ocean tsunami to strengthen partnerships among humanitarian organizations and to improve coordination of humanitarian response activities during an emergency (1). The approach has 11 global clusters to be activated locally, as needed, in an emergency: Health, Camp Coordination and Camp Management (CCCM), Water/Sanitation/Hygiene (WASH), Agriculture, Logistics, Early Recovery, Nutrition, Education, Protection, Emergency Shelter, and Emergency Telecommunications. WHO is the lead agency for GHC, which includes 31 United Nations agencies and NGOs. In Haiti, all 11 clusters at the local level were activated.

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Rapid Establishment of an Internally Displaced Persons Disease Surveillance System After an Earthquake --- Haiti, 2010