Image: Haiti earthquake victim
Adriano Rosario  /  AP
An injured earthquake victim on a stretcher arriving from Haiti is taken to a hospital in Santo Domingo, Dominican Republic.
By Robert Bazell Chief science and health correspondent
NBC News
updated 1/13/2010 3:09:41 PM ET 2010-01-13T20:09:41

Even before the 7.0 earthquake that is believed to have killed thousands of people and crushed countless buildings , the medical infrastructure in Haiti was already almost nonexistent.

While the primary focus of the next 72 hours is rescue and saving lives, officials say, aid workers are facing countless critical medical needs for the millions who have been affected by the widespread destruction.

NBC's Chief Science and Health Correspondent Robert Bazell, who has reported extensively from Haiti on the AIDS epidemic and other infectious disease outbreaks, is heading to the country tonight to cover the ongoing rescue and recovery for "NBC Nightly News." Bazell offers an overview of the health crisis facing the devastated country. Read on for more.

What are the immediate medical concerns facing rescue workers?
Today we learned from Doctors Without Borders that there are no hospitals remaining in Port-au-Prince. All hospitals are either collapsed or abandoned, including the three run by the aid group.

According to Doctors Without Borders, there are enormous lines of people outside of these closed facilities, many with severe injuries, including fractured bones and crushed skulls waiting for treatment. But there's no medical treatment happening because the area has absolutely no facilities. Even before, the hospitals that existed had almost nothing that we would consider an intensive care unit. And Haiti has no system of frontline responders to rescue and revive people in emergencies.

The people from DWB said even trying to set up new facilities during the night and continuing into the day has been very difficult because there’s enormous amounts of rubble on the road — and when there’s rubble there are either injured people or dead bodies. So, it’s a particularly dangerous situation.

Haiti is the poorest country in the western hemisphere. In fact, it’s the fourth poorest in the entire world, with 85 percent of the population earning less than $1 a day.

All this combines to make what was a health nightmare already very bad.

Deadly diseases can develop in a few days without access to clean water or sanitation. What is the situation in the country?
Fewer than one-third of the population has access to sanitation facilities. Fewer than half have access to clean drinking water. There is enormous burden of diarrheal illnesses in the country, anyway.

In addition to that, malaria is very prevalent and so is starvation because of the poverty. You’re starting with a situation where it couldn’t be much worse for a crisis of this magnitude to strike, because the country has already been in an ongoing crisis for so long.

In the slums of Port-au-Prince, which is where most of the people live, open sewage exists. When you add that risk of infection to people with severe injuries and dead bodies, it becomes an almost unimaginably difficult situation.

These quake refugees will also likely face an increased risk of dengue fever and measles, both already problems there.   

Although aid is starting to come in, it will take a while to reach victims. A lot of people won’t survive in the meantime. Because Haiti already has about 450,000 people who are known to be infected with HIV, it’s also very difficult to ensure the safety of blood transfusions.

Further down the road, Haitians will also likely suffer from secondary infections. With hospitals and clinics destroyed, people seeking help for broken bones and other survivable injuries will not be able to get help and will develop complications.

What will be the key medical focus in the immediate aftermath?
The focus is everything at once — to get people who are trapped out buildings at once, to get whatever first aid can be given to people who are injured, to get whatever treatment can be administered to as many people as possible.

Then, there’s an added problem: Haiti has been very lawless for a long time. There are no reports of it yet in this disaster, but during the rescue efforts after hurricane Jeanne killed 3,000 people in 2004, aid workers were set upon by armed gangs, which are a constant presence in the country. 

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Video: Devastation

  1. Closed captioning of: Devastation

    >> this is a major humanitarian disaster . overnight, the red cross estimated that some 3 million people have been affected by the strongest earthquake to hit haiti in more than 200 years. the imagines coming out of there just show just how devastating the situation is there, matt.

    >> the epicenter of the earthquake only about ten miles from the haitian capital of port-au-prince, where this morning the injured are being treated right in the streets, surrounded by debris from collapsed buildings, including a hospital and the national palace . in a moment, we'll talk to an american who is in haiti . his wife was inside a mission when that building collapsed. she was, luckily, pulled to safety overnight. we also expect to hear from president obama a little later this morning, but let's begin with nbc's michelle kosinski . she's in the little haiti section of miami with the latest. michelle, good morning to you.

    >> reporter: good morning, matt. this powerful earthquake struck just before dark just outside haiti 's capital city and was said to have lasted roughly a minute. but here you have a place so vulnerable, still suffering in so many ways from disasters of the past, but the scope of this catastrophe is really only beginning to be realized this morning. the first pictures coming out of port-au-prince are of the grimly expected devastation and the instantly evident damage is both structural and human. victims lie in the streets with the rubble. some are attended to. for others, it was too late. buildings are down in the capital and beyond. there are fires. this was the presidential palace , heavily damaged now, though the president and his wife are reportedly fine. elsewhere, the loss of life is unknown and thought to be severe. in this video posted on the internet a terrified, young woman looks down from her hillside home at rising clouds of dust. she is okay.

    >> the world is coming to an end!

    >> reporter: the epicenter was about ten miles west of port-au-prince, a city of around 2 million people. and then there were the aftershocks, more than a dozen, some stronger than magnitude 5. new york-based nurse marie carmel michelle in haiti attending a funeral, spoke to nbc news by phone.

    >> this is a town house and it shook like a leaf. there is no other way of describing it. i heard people screaming. there's bodies all over the place.

    >> reporter: there have been reports of a hospital collapse with people trapped. the u.n. headquarters heavily damaged, hillside towns fallen. among those caught in buildings, two americans, one of them jillian thorpe, a missionary who called her family to say she was trapped, her legs crushed. around the capitol, rescuers pulled survivors to safety and citizens cried and prayed on the still trembling streets.

    >> when the earthquake happened not long ago, we definitely heard the uproar in the community. the home where we were at was shaking, the trees outside were just going crazy.

    >> reporter: one of the last flights out of haiti last night, just after the quake struck, landed in miami with passengers describing the helplessness, seeing and feeling their airport cracking around them.

    >> i thought it was the plane hitting the building, you know, because it was such a big impact that we really didn't know what was going on.

    >> i fall on the ground. about 15 people fell on top of me, you know. my passport went missing, my gray card went missing, my shoes, one of them were missing. people were crying, people were yelling, the kids were missing. so, that was a mess.

    >> reporter: and it was the worst quake here in 200 years.

    >> we expect to see a lot of damage. we expect there to be a lot of casualties. the quality of the buildings are going to be a big part of that.

    >> reporter: as rescue teams mobilize from around the globe, the u.s. is pledging its full support.

    >> we will be providing both civilian and military disaster relief and humanitarian assistance , and our prayers are with the people that have suffered, their families and their loved ones.

    >> reporter: we just got word overnight that the woman we mentioned, jillian thorpe, an american who works with off fans and was trapped in the rubble of a building has been rescued. know there will be more survivor stories over the next few days, and possibly even weeks, but we also know this disaster may not be over. there's still many fears of continued aftershocks that could go on into weeks or months, landslides and more building collapses in a city where it's been estimated that some 60% of the buildings may be poorly built, matt.

    >> as you heard michelle kosinski

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