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Nearly ten years ago, in the mid-afternoon of January 12, 2010, a magnitude 7.0 earthquake

hit just outside Port-au-Prince, Haiti, leveling a large part of the country and killing an

unimaginable number of people in a quick thirty seconds.

It immediately became clear that, although the earthquake lasted only seconds, the humanitarian

disaster would last for years because of three simple facts.

One was the earthquake's location.

In a twist of terrible luck, the quake hit shallow and just 16 miles or 25 kilometers

away from the country's capital and largest city—Port-au-Prince.

Two was Haiti's economic situation.

It is the poorest country in the western hemisphere with an estimated GDP per capita, at the time

of the earthquake, of just $665.

That meant that most Haitians had little money to relocate and reestablish their lives after

their homes were destroyed.

In addition, with a poorly funded government, emergency services were few and far between

and poorly equipped.

The third fact leading to the scale of the humanitarian disaster was just the pure scale

of destruction.

Most buildings in the island-nation were not nearly as stable as those in a developed nation

and therefore, whereas another developed country might have been able to weather the quake

quite well, the buildings of Haiti crumbled like dust.

With the scale of devastation, as soon as word of the quake reached the rest of the

world, the focus of every major disaster response organization in the world shifted to Haiti.

This whole world of disaster response is a nuanced and complex one.

Simply showing up and helping where one can just doesn't work.

Water isn't useful by itself.

Food isn't useful by itself.

Doctors aren't useful by themselves.

Every resource that might be needed following a disaster must be carefully coordinated and

managed or else it is useless.

Behind that management, there are professionals who spend their whole lives working on how

to best respond to moments like these—the worst 30 seconds of Haiti's history.

I spoke to two of those professionals on how they do their jobs—Stephanie Kayden, “Kayden:

[00:00:26] I am a vice chair of emergency medicine at Brigham and Women's Hospital and

the director of the Humanitarian Studies Initiative at the Harvard Humanitarian Initiative,”

and Mike VanRooyen, “VanRooyen: [00:00:11] I'm the director of the Harvard Humanitarian

Initiative and I'm a professor at the Harvard Medical School and the School of Public Health.”

Both Stephanie and Mike helped establish and then worked on the ground at the what became

one of the largest field hospitals in Haiti following the 2010 earthquake.

“Kayden: [00:09:53] It turns out that when you're a doctor responding to one of these

international disasters just having medical knowledge is not good enough.

In order to do this work properly you have to know what the international standards are

for giving humanitarian aid.

You have to know not only the medical side but how to give food and how to give clean

water and how to give proper shelter and those guidelines are already written down in something

called this sphere standards.”

In its 406 pages, the Sphere handbook has specific guidelines like that everyone needs

15 liters of water per day; that a single hand pump at a flow rate of 17 liters per

minute can act as the water source for up to 500 people; it gives a clear step-by-step

guide to establishing a goods-delivery system; it defines that, in an emergency shelter situation,

everyone should have at least 38 square feet or 3.5 square meters of living space, but

that, in cold climates, that should be increased to 48 square feet or 4.5 square meters.

It takes out as much of the guesswork in humanitarian response as possible.

This is what much of the work by academics like Stephanie and Mike is—developing standards

and frameworks before a disaster happens so that, as much as possible, when disaster strikes,

people don't need to think, they just need to do.

This response does, of course, though, vary depending on the nature of the disaster.

“VanRooyen: [00:45:35] An earthquake tends to cause a lot of death immediately and also

a lot of heavy injuries like fractures or head injuries.

They require intensive medical care and surgical care.

They overwhelm the hospital structures as well and so the immediate needs for a place

like Haiti for example are surgeons and people who could manage emergency wound care and

even things like dialysis or things like that.

Let's take another example of say a flood.

Right.

A flood can be amazingly devastating, move people out of their house, even sweep people

away, but a flood or a hurricane kills people but doesn't necessarily leave a lot of injured

people.

So at the end after people have died from a massive flood or a hurricane what's left

are people who have minor injuries maybe but they don't really overwhelm the surgical structures

of a hospital where they overwhelm is the public health.”

In an ideal world, the level of humanitarian aid given would be determined by the actual

need, but in reality, this is often not the case.

The reality is that often, but not always, the more accessible a disaster site is, the

more response it gets.

What that means is that, because Haiti was so close to the US, where many humanitarian

organizations are based, it was quite easy for them to mobilize after this earthquake

so Haiti got large numbers of responders quite quickly, but this principle can also leave

other countries without the help they need.

“VanRooyen [00:14:47] So take for example around the same time as the Haiti earthquake

there was a massive flood in Pakistan but it was very remote and very difficult to get

to.

So the difference in the responders is entirely different.

The only people that could respond in this distant area of Pakistan for this massive

flood were the major organizations that had lifting capacity and they could fly planes

in and they could land personnel in in the middle of someplace that's very remote.”

Haiti, on the other hand, received a massive response especially, in comparison, by smaller

organizations given the proximity to the US and also given the fact that individuals in

the US were particularly motivated to donate given the proximity.

Through NGO's and charities, Americans contributed about $4 billion to the relief effort in the

first three months.

Therefore, the real issue in Haiti was not getting a response, it was managing the response.

Because of that accessibility from the US, a huge number of less professional responders

showed up, and in order to be effective, these responders needed a high degree of management

from the professionals who did show up and were practiced on the international standards.

In addition, there was the issue of actually getting all these responders and their supplies

there.

“Kayden: [00:16:35] In the case of Haiti it's an island nation, so a lot of the heavy

things like fuel have to come in by ship but the earthquake severely damaged the port in

Port au Prince, and because the gas stations with their underground tanks had also been

damaged, the relief community couldn't use the fuel from those tanks without ruining

the engines in their cars and shutting down all the trucks, and so there was a big fuel

crisis early on and that meant it was hard to transport things.

So, while we were waiting for the port to be fixed, a lot of the supplies had to be

flown in either on airplanes that were landing at the Port au Prince airport or overland

from the Dominican Republic.”

In the early days of the response, both of those methods had their own unique difficulties.

Coming from the Dominican Republic, many of the roads were damaged, destroyed, or covered

in debris, so that was quite a slow option.

The airport therefore stood alone as the only high-speed link between Haiti and the world,

serving as the only route in for all the most time-sensitive supplies.

In the initial 24 hours after the earthquake, Port-au-Prince's airpot saw chaos as flights

poured in with no direction into an airport with essentially no control.

The first semblance of control came the morning after the quake when the US Coast Guard Cutter

Forward pulled into Port-au-Prince and just hours later started working as the airport's

air traffic control from the ship.

The airport's own air traffic control tower was badly damaged in the quake so it was far

from operational.

Soon after, that same afternoon, a team of US Air Force airmen landed at the airport

and assumed responsibility for its air traffic control.

Their operation was made up of, quite literally, a bunch of folding tables and handheld radios

set up at the end of the runway as they guided flights in.

With this setup, they handled up to almost 200 planes a day despite the fact that on

a normal day the airport receives no more than a dozen commercial flights.

Eventually, Haiti officially handed control of the airport over to the US, meaning the

Americans could settle in and set up formally for the long-haul, and a team from the American

FAA came down to take control as they set up a portable, temporary air traffic control

tower.

Of course, even working at full capacity, there was still an enormous backlog at this

small airport, leading them to set up a system where flights would be prioritized based off

what they carried with the highest demand humanitarian goods being allowed in first.

Of course, even once you get a plane with supplies on the ground, getting those supplies

to those in need is not a given because, in between the runway and the roads, there is,

of course, customs.

“[00:18:39] Often what happens is that the national government of the place where a disaster's

happened has a way of sort of relaxing customs efforts for relief supplies coming in and

trying to fast forward them through.

But that doesn't always happen especially with medical supplies which can include powerful

painkillers that might be particularly regulated by government and so a lot of times aid agencies

will face a backlog in their relief supplies coming in as they get, sort of, stuck in customs.”

Eventually, though, once a solid supply chain is set up, responders can actually get to

work.

Stephanie and Mike, of course, worked to set up that field hospital to start treating all

the most severe injuries from the earthquake.

While the Harvard Humanitarian Initiative, who they both work for, doesn't typically

itself actually respond on the ground to disasters, they did exceptionally in this case and, as

the literal experts in this sort of activity, they were able to set up a stellar operation.

As experts, they knew, once again, that doctors by themselves aren't necessarily useful.

Doctors are useful when placed where they're needed and so, the first step was to identify

what was needed.

“VanRooyen: [00:19:36] So in the Haiti Response the HHI team identified one major gap in particular

and that was the lack of rehabilitation resources for patients that had big operations like

orthopedic operations but had nowhere to go because there was no place to admit them and

to rehabilitate them.”

Therefore, the hospital had its focus and everything could go from there.

Again because of the specific nature of the disaster, the team knew that they couldn't

set up their temporary hospital just anywhere.

“Kayden: [00:29:01] After an earthquake in particular when the people who'd been injured

in the earthquake have seen all the buildings around them fall down, they do not want to

go into another building because there are a lot of aftershocks afterwards and they're

afraid that these buildings might have been damaged and that they might fall down and

either kill them or cause more injury.

That is a very reasonable fear and so even though the place where we were working had

buildings that were very strong and very well able to sustain all the aftershocks with little

or no damage, the people that we were helping were too afraid to go inside them.”

The hospital therefore had to be almost entirely built out of tents.

Despite the focus on acting as a rehabilitation center, the hospital did, however, still perform

surgery and therefore they needed a super-sterile environment to prevent infection or contamination

during surgery.

That's quite tough to create in a series of tents, so they used two solutions for this.

“Kayden: [00:30:33] One, the easier way was we had operating theater trucks.

So imagine a big delivery truck that you can open the doors and instead of finding boxes

inside you find an OR or an operating theater.

We had a couple of those and that was very useful because they come already sealed.

A lot of our surgeries though we had to do in what were classrooms in a school in Haiti

and what we had to do there was to actually tape up sheets over the windows—plastic

sheeting to make sure that no insects or dust would come from the outside while we were

doing the surgeries so that we can make it sterile and safe place to do them.”

Of course, the goal of responding to humanitarian disasters is to get the humanitarian disaster

to end, so that means there also has to be focus on the exit strategy.

“Kayden: [00:27:06] So when a disaster happens and we go in and start working even from the

first day we're always thinking about the day we're going to leave, and so what that

means is we do a number of things right from the start.

In Haiti, for example, we wanted to make sure that as we were caring for people's wounds

we were teaching the local doctors and nurses that we were working with how to do that kind

of care if they weren't already familiar with it so that when we left they would be able

to easily carry that forward.”

Getting to that finale—when the agencies pull out, when a country is back to normal,