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Mona Gable

Mona Gable

Posted: January 18, 2010 07:22 PM

Doctors Without Borders in Haiti: Why Couldn't They Land?

What's Your Reaction:

Bill Clinton is on the ground in Haiti with Chelsea touring the rubble. I'm elated the former president was able to get permission from the Defense Department to fly in. It's no small feat, I'm telling you. Because apparently not everyone can.

Take Doctors Without Borders (MSF), the highly respected international medical humanitarian organization. You know, the one Sandra Bullock gave $1 million this week before she won the Golden Globe? They've been in Haiti for years. They have hundreds of medical staff in place, and are working in five hospitals in Port-au-Prince. They know the country. They're experts in delivering medical aid. These are the people you want on the ground after a killer earthquake? Am I right?

Then why was an MSF cargo plane carrying, among other badly needed supplies, an inflatable surgical hospital, not allowed to land in Port-au-Prince on Saturday and re-routed to the Dominican Republic? Despite assurances from the United Nations and the Defense Department that its planes would be allowed in?

If this is an air traffic control problem, they need to fix it now. Maybe Bill could help?

The inflatable hospital included two operating theaters, an intensive care unit, 100 beds, an emergency room and equipment for sterilizing material. The supplies had to be sent by truck, so the hospital didn't arrive in Haiti until a day later.

To be fair, a plane carrying supplies for the other half of the field hospital did arrive in Port-au-Prince on Sunday. But for a while even that looked sketchy. And as Isabelle Jeanson, an MSF Emergency Communications Officer wrote in an email from Haiti on Sunday: "MSF is still concerned that delivery of vital supplies is being delayed."

As the crisis in Haiti drags on survivors are dying. Even if they're rescued, they're slowly and painfully dying from their wounds because they can't get into surgery quickly enough. And they can't get into surgery because the hospitals have collapsed and the makeshift ones aren't equipped to do surgery. That is, except for the Israelis. They had a modern field hospital up and running in seconds. But they can't treat 2 million people.

The MSF plane that was dispatched to the Dominican Republic was carrying medical supplies for Choscal hospital in Cite Soleil, which had barely a 24-hour supply left for the 500 patients waiting to have surgery. Even under horrific conditions, MSF teams performed more than 90 operations in the day after their operating theatre was functional.

Like other aid groups in Haiti, Doctors Without Borders is hurting too. Some of their Haitian staff members died. Some they haven't been able to reach.

And then there is the frustration of trying to help. Of not having the right equipment. The heartache of watching people die when you know you could have saved them.

As Jeanson wrote in her email on Sunday: "Patients who were not critical only three days ago are now in critical phases. This means that people will die from preventable infections. It's horrible. It's really so terrible that people are begging for help and we can't help them all to save their lives!"


 

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08:02 PM on 01/24/2010
«It appears that the Scientologist flight to Haiti that was allowed to land this week while planes carrying medical supplies to major aid organizations were turned away may have been arranged by John Travolta. The actor told Entertainment Tonight earlier this week: “I have arranged for a plane to take down some volunteer ministers and some supplies and some medics»

Cults, sects are indeed an immediate priority after any disaster, they know no better opportunity to subdue injured and weakened individuals...

cf. http://thelede.blogs.nytimes.com/2010/01/21/updates-on-the-crisis-in-haiti/
10:11 PM on 01/20/2010
Department of Defense Briefing: General Keen explained why a mobile hospital being flown in by Doctors Without Borders was turned away from the airport. Apparently, a plane on the tarmac was having maintenance issues couldn't take off as scheduled, preventing the plane with the hospital equipment from landing. Eventually, the medical plane had to divert to Dominican Republic due to fuel issues and bring the supplies over land.
"That's extremely unfortunate, and it certainly is not what we want to see. And clearly, we wanted that field hospital on the tarmac," said Keen, adding, "This has happened a number of times."

important to remember that this is an airport with one runway that sustained damage and has little ramp space. In response to suggestions the U.S. military is ill-prepared to handle this situation, there are very few organizations capable of conducting a logistical operation in response to a natural disaster of this magnitude. The USNS COMFORT just arrived with a medical staff (upped to 1,000 Sailors), 11 operating rooms and 1,000 patient beds. It is one of the largest trauma centers in the United States. The USS Carl Vinson has operating rooms aboard (Navy surgeons with civilian surgeons recently saved a 12 year-old girl by removing a chunk of concrete from her brain). The U.S. military works hand-in-glove with volunteers, first responders and NGOs to mitigate loss of life and suffering from natural disasters. This is a difficult operating environment for everyone.
04:04 PM on 01/20/2010
There is no reason on earth that these MSF planes are denied landing. Not one.
This user has chosen to opt out of the Badges program
09:12 PM on 01/20/2010
There is no reason in your comments. That's the only certainty I see.
08:26 PM on 01/19/2010
My guess is that either the pilots didn't reserve a landing "slot," or there were problems unloading and turning around an aircraft already on the ground - leaving no room for the inbound plane. There are so many variables in aircraft handling, and the facilities in PaP are so primitive, any screwup can have major consequences. I suggest that the French, rather than whining and accusing the US of invading or "taking over" Haiti, send their own aircraft carrier to the DR with its deck loaded up with heavy lift helicopters, and ferry the rerouted supplies back to Haiti. I don't see the French doing this however - easier to complain.
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ideasmatter
Knowledge is free
05:15 PM on 01/20/2010
You clearly don't know what you are talking about ("My guess is"), and have a strong anti-French attitude -- how could it be that the Americans ever did anything wrong, not?

Explain to me why first Hillary Clinton with company, and thereafter Bill Clinton with entourage had no problem landing in Haiti, but a plane carrying an inflatable hospital could not? What's more important?

About your "solution", the French obviously don't have a carrier nearby.
05:35 PM on 01/20/2010
well stated!
HUFFPOST SUPER USER
copestir
07:19 PM on 01/19/2010
There is no organized effort. As a result there is no organized effort to prioritize and triage. As a result people that could wait did not. Those that could not wait perished. But on the other hand, these child are safe.
This country has to be rebuilt from the very bottom up.
04:42 PM on 01/19/2010
However, having a known track record doesn't mean you are offering what's needed at that moment, nor does it that there aren't other NGOs with known track records also trying to get stuff in. I have read in several places that the French government is declining to make formal complaints on behalf of MSF, so it may not be such a big issue...

MSF is an excellent NGO , but perhaps their organization wasn't perfect. Maybe they didn't provide enough info on their cargo, took off without making sure there was runway space or they didn't have the proper equipment to unload the cargo at PaP.

It's also worth noting that MSF is hardly the only medical NGO working in Haiti, so the lack of one inflatable hospital may not be so crucial. Through the coordination of Partners in Health, the Haitian government & other NGOs now have 12 working ORs & 24hr electricity at HUEH in PaP, and PIH is running 5 ORs in their other clinics/hospitals around Haiti, plus there other existing hospitals in Haiti and many clinics set up by other NGOs/governments. PIH and other groups have also med-evaced some patients & flown in surgical teams. PIH, Catholic Relief Services and others have also been trucking supplies in from the Dominican Republic from the beginning - perhaps MSF should have been thinking of that option sooner.
06:36 PM on 01/19/2010
Of course the Gi's are more organised than the nobel peace price MSF who is working on dire straits countries for decades!

takes your sun glasses ppls away of this airport, and lets the medical ppls do thier jobs!

;)
08:30 PM on 01/19/2010
Yes, they are. Sunglasses protect vision from damaging UV rays, and to some extent dust and debris. Anything else?
06:19 AM on 01/19/2010
I understand 2belinda's frustration; after days there is still an aid bottleneck.
However, considering after the earthquake there was no way to get anything in, the airport control tower knocked over and debris everywhere, it is amazing aid is flowing as well as it is. Before the quake, the airport had a dozen or so flights a day. Days after the airport already met this. This morning the FAA certified it for 80 flights. By afternoon, that raised to 100. In the end, there were 120!
Doctors Without Borders are heroic. Can't we consider the logistics efforts by those working so hard at the airport heroic? Why not view everybody working so hard constructively?
Headline - "Doctors without borders- Why couldn't they land?" -
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/18/AR2010011804059.html
Traffic backed up. The Doctors Without Borders plane could not wait. Hopefully this will be avoided with things less chaotic, and their planes have appropriate priority.
The above linked article says the Haitian government set landing priorities. Negative comments abound regarding running the airport; people should be helping Haiti not occupying it; comments not consistent with Haiti setting priorities. I wish they would stop! All aid workers, in medicine, logistics, search and rescue, etcetera, are heroes!
Finally, everyone emphasizes increased coordination. President Obama designated Presidents Clinton and Bush with a role in leading US coordination. So why criticise Clinton's presence? He's there to do a job, like the doctors and the air traffic controllers.
12:30 PM on 01/19/2010
I have been following this terrible tragedy as much as anyone. I don't claim to have all the facts. What I do know is that this situation is everyones worst nightmare. Everyone on the ground there is doing the best they can with what they have to work with. I'm tired of hearing everyone complaining about the US. We are always front and center when anyone is in need. Everyone likes to trash talk us every chance they get, but as soon as they need something they come crying to the US. Things would not be running any better if someone else was trying to keep things moving at the airport.
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ideasmatter
Knowledge is free
04:26 PM on 01/19/2010
Clinton could have done his coordination over the phone, or have flown in via the DR, but no, we had to be treated to a nice photo-op of Bill unloading bottles of water from a plane. Perhaps that is the best use if his capabilities though.....
06:03 PM on 01/20/2010
and the best use of your capabilities is to run your mouth, and say absolutely nothing.
04:55 PM on 01/21/2010
Bill Clinton WAS delivering medical supplies to one of the worst off hospitals in Port-au-Prince. I saw him interviewed when he was discussing a checklist of the supplies that he had been able to bring with him.....
05:10 AM on 01/19/2010
This is not an air traffic control 'problem.' This is an air traffic control DECISION, which was made by the Haitian government. A USAF specops team established air traffic control and tripled the capacity of a single runway airport. In making prioritization decisions, they consulted with Haitian officials. According to the Wall Street Journal, the Haitians chose to put food and water deliveries at the highest priority. Per the US AIr Force, "Priorities and landing times are determined by the Government of Haiti in consultation with the United States government and the UN Mission in Haiti based on current needs."

If US military controls the airport, they find it difficult to say no to a former commander in chief. Balance this against the increased throughput at the only major logistics node still functional near Port-au-Prince. Think of that one flight (out of hundreds) as the PR budget.

Thousands of people are in grave danger of dying of thirst. In a hard choice between watching badly hurt people die (which some would anyway) and healthy children dehydrate and die when it could have been prevented, my sympathy is with MSF but my brain goes with the Haitian officials.

See these articles:

http://airforcelive.dodlive.mil/index.php/2010/01/air-forces-management-of-haiti-airport-essential-to-humanitarian-operations/

http://online.wsj.com/article/SB10001424052748704541004575011403710933576.html?mod=article-outset-box

http://www.af.mil/news/story.asp?id=123186022

I posted about the logistics at http://drewkitty.livejournal.com
06:40 AM on 01/19/2010
I think it is more complicated than this. Initially there were severe communications limitations at the airport, after all the old control tower was knocked over. The air traffic controllers could not get good knowledge of exactly what was on individual planes, so they used priorities based on generally cargo classifications for the different flights, as set up by the Haitians. Now that better equipment is available, communication is improving and the priorities can be adjusted.
After all, there are tons of water bottles already at the airport waiting to be delivered, the port should be open in a few days to bring in much more as well as substantial food and desalination facilities, and there appear to be more people immediately threatened by medical needs than water or food as of yesterday. Hopefully better surveys and coordination can find a way to save all those who have survived this far!
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ideasmatter
Knowledge is free
04:33 PM on 01/19/2010
We get a different and conflicting story every time: first it is that the US Military has taken control of the airport, then that the Haitian gov't sets the priorities for incoming flights, then that initially the traffic controllers did not know what cargo was in incoming planes (So what is the point of priorities then? And don't they have radio contact with incoming planes?), now in this article it is that the Haitian gov't is *consulted* on priorities, and I just saw an interview with the Haitian defense minister saying that their gov't was not involved at all in setting these priorities, and that he wanted them done differently.

That's the typical story development that one sees when there is a cover up going on. Keep your eyes on The New Yorker or The Nation for the real story to come out.
12:39 AM on 01/19/2010
A blogger on Huffpost asked, we can organize for Haiti, why can we not do the same thing for Congo? Congo is another issue, and it does not translate. Some facts that worked do translate, such as texting donations, and it can be done internationally. But to prevent natural and ongoing disasters, and stop the increasing mayhem and disorganization, more than money is needed. It takes many heads and ideas to turn minds from creating disasters- or turning a blind eye on possible impending disasters, as was the case with Katrina - and preventing them. Something to do with the marvels of facebook, cell phones, international teleconferencing. We could create platforms to lower from helicopters for helicopters to land on, moveable roads for transport. It will create new jobs, and help save life. During WWII german soldiers marched, singing, while taking apart tanks and putting them back together. Can we pull off this trick with bulldozer parts, transported by air?
12:28 AM on 01/19/2010
Mona, did you mention there is only one runway? That streets were blocked everywhere? Can we get the details on why Israel was able to *set up a field hospital in seconds" - it probably took a little longer than that. And what can we learn from all this? The U.S. Press attaches itself to the rescue operations and publishes human stories, but it is all focussed on U.S. effort. Nothing wrong with that, but we need international effort and cooperation in natural and man-made disasters. What worked? Texting to collect donations. Cellphones to communicate where landlines were disconnected and to show pictures of missing persons. Young people and their friends in my family immediately passed on the texting message and donated, and now they ask, will the effort be sustained? How are we going to sustain and organize readiness for the next event, which, given the increasing parade of events, is going to occur like clockwork while sustaining relief to Haiti and new disasters. Israel did not get attention in the press, but apparently they did something right. What is it? A baby was born, and the mother called it Israel. An Israeli team delivered it. Life, and something good and hopeful to report on too. There was a plane from Qatar. Donations were pledged, and someone needs to see that they are delivered and what they achieve. A model can be construed and passed on to build on.
02:26 PM on 01/20/2010
Mommamia, as you pointed out there are other countries on the ground providing aid. Add Cuba to the list, even though its role has not received much press coverage. Can anyone explain the feasibility of designating specific areas so that MREs meals could be dropped off, organized, and distributed in an orderly fashion to the people of Haiti. Would it be a better means of getting food to those who need it since it's so difficult for planes to land?

"The Christian Science Monitor in a second article, quoted Laurence Korb, former assistant secretary of defense and now based at the Center for American Progress, as saying that the US, which is leading the relief efforts in Haiti, should “consider tapping the expertise of neighboring Cuba,” which he noted, “has some of the best doctors in the world--we should see about flying them in."

"In fact, left unmentioned was the reality that Cuba already had nearly 400 doctors, EMTs and other medical personnel posted to Haiti to help with the day-to-day health needs of this poorest nation in the Americas, and that those professionals were the first to respond to the disaster, setting up a hospital right next to the main hospital in Port-au-Prince which collapsed in the earthquake, as well as a second tent-hospital elsewhere in the stricken city."

http://www.counterpunch.org/lindorff01192010.html
11:22 PM on 01/18/2010
It is NOT hard to prioritize. The possibility, the hope of saving a life trumps celebrity photo op.

If Clinton had some important info to impart he could have done via cell phone or internet until he was able to get into P au P, if that is where he needed to be. Bill Clinton and Chelsea should have landed in the Dominican Republic and the plane carrying supplies and medical personnel should have landed in P au P. He is touring the rubble - there's lots and lots of photos and video of it he could have referenced

If even one plane carrying help was diverted or delayed so the Clintons could land it was the wrong thing to do. People are suffering, dying slow and painful deaths.

I am no longer as understanding 6 days in, going on 7, as I was when this disaster hit and I am tired of all the delay and the excuses for the delays and the people in Haiti are sick, hungry,thirsty, broken and dying.
01:31 AM on 01/19/2010
Well put.
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ideasmatter
Knowledge is free
04:13 PM on 01/19/2010
Indeed. Shame on the Clintons.
billstewart
Not a micro-biologist
11:07 PM on 01/18/2010
According to NPR or Pacifica's radio coverage today, it was basically an air traffic control problem. The airport has very limited capacity due to the damage the earthquake did, and they're still trying to get unconfused about logistics. On the other hand, they've also realized that medical supply planes should get a very high priority, so MSF's requirements are probably fixed by now.
01:17 PM on 01/19/2010
Has anyone ever taken a good look at an airport in a developed nation? If you have, yjou noticed that there are several runways and plenty of "parking" for the planes. Now imagine having just one runway open and dozens if not hundreds of planes trying to land and take off. Imagine no control tower other than a desk on the side of the tarmak operated by US military airmen. Imagine no heavy equipment to unload and move the supplies. Imagine no reliable source of fuel or equipment if any plane should be in need. Imagine trying to "park" scores of planes for offloading when there is room for only a dozen or so. Imagine two way traffic on one runway combined with planes waiting to just get out of their spot to leave. Do you see any logistics problems here? I do. Everyone is trying really hard to get things done as quickly as possible. US had planes on the ground the next day and their makeshift control tower up 30 min later.
09:21 PM on 01/18/2010
The problem is that, once again, the U.S. is using the military, which is trained to fight wars, to provide emergency relief. Their first instinct follows their expertise, controlling and holding turf. What we needed, instead, was a less security conscious and more porous airport leadership - bent on helping people land, not on guarding against "security threats."
12:26 AM on 01/19/2010
May we assume you are experienced in the knowledge of disaster relief and recovery?
12:48 AM on 01/19/2010
Really -- So you know both the problem and have the answer? Were it not for the military the airport would still be landing 3 planes a day, the streets leading from the airport would still be clogged with people and debris and chaos would reign in the streets. Obviously, you have never been to Haiti!!
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NickHP
engineer, human, humane
08:03 PM on 01/18/2010
Mona I'm torn. Greg Palast made the same points in an email I got. But I'm having second thoughts. The logistics of getting stuff into a small airport is difficult to set up and schedule. They had to fix the airport runway. You'd think the US military or FEMA or USAID would have a portable air traffic control system ready to take with them. Maybe they do. Then they have to put in instruments and or lights for night landings. You can't land planes unless you can empty them quickly and get them out to make space for new ones.

After all that, who gets in? And where in the country do they go (hence the first wave of survey efforts). You could start by changing your question to answer whether or not arrivals are being scheduled effectively? I heard that MSF actually was trying to get a spot in the flight sequence, which they did. It was not denied all together.

Right now Haiti needs everything - water, food, doctors, medical supplies and equipment, technical support staff, emergency search teams, communications equipment, trucks, bulldozers, tents and more. And enough to scale up to 300 000 people. How would you prioritize this effort? Triage says you do what helps the most the fastest. I pray this is what they chose.

Then let's go back to US AID and FEMA and ask them to get more ready-to-go packages that can be shipped faster than these seem to have been sent.
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HUFFPOST BLOGGER
Mona Gable
09:56 PM on 01/18/2010
Thanks for your thoughtful comment, Nick. I do think it's tough to prioritize. The needs are so great. But I also think that organizations with a known track record should be at the front of the line. Especially since every time i turn on CNN they keep emphasizing how few doctors and supplies are there and the tremendous suffering.
06:27 PM on 01/19/2010
Well said Mona,

MSF isn't a new comer there, they works for years on day to day basis!
my brother is in one of this airplane, in fact half of the landing planes are supllies for the GI's and Medias and troops, why the US troops can't land in dominican Rep? Why thier C130J tactical planes can't land on land rather than airport tracks? they were designed for this!

No blame for US help, but each time you involve military on emergency it turns awfull, Let the Doctors do their jobs rather than covering US showing Flag mighty!

we only saw the Gi's with sunglasses there on report, and still ppls are dying because many hospital cargo planes were re routed!

We all know that Obama admin is eager to show thier flag and communicate, that's right, no problemo, but let those Doctors working and surgering, these ppls needs more health help than GI's and medias!

period
02:44 PM on 01/20/2010
I still would like to know if MSF had clearance, or just "assurances" from someone not responsible for clearing flights..

Also, given the known bottleneck at PaP, why did MSF not schedule their flight through DR and distribute their supplies overland?

Is the goal here to save lives in Haiti. or just to use the ongoing deaths and suffering in Haiti as a stick to beat other with?