Reflections on Haiti. Natural disasters, conflict, or disease-which is the biggest threat?
The horrors of the recent earthquake in Haiti have dominated the news media worldwide, making the UN label it as the “worst disaster it has ever faced”. Obama has enlisted the help of his two immediate Presidential predecessors (Bush and Clinton) to tackle this tragedy. Given George W Bush’s success in global conflict creation and resolution, I am not sure why President Obama felt that he was the best man to deal with such a humanitarian catastrophe. Estimates of the number of deaths in Haiti are around 200 000 at this point and the human toll in terms of future ill health and further deaths is likely to be much more. A massive, international fundraising and humanitarian mission is being mobilised to try to help what was already a troubled state, but is now literally a state of emergency.
It got me thinking about the scale of other public health emergencies that the world has recently faced. Ten years ago, at the turn of the millennium, the UN first recognised that a disease could be a threat to human security with respect to HIV/AIDS. A vicious circle connects ill health, poverty and lack of development, and there is no doubt that the global scale of HIV/AIDS and several other diseases such has coronary heart disease causes a massive burden that threatens the security of whole populations. UNAIDS, the UN’s only organisation devoted to a specific disease, was founded in 1996. Whether or not you agree with the prioritisation of one disease over another, this move by the UN definitely increased the profile of the disease in political, health and wider spheres, in a way that had not been seen before. AIDS is the fourth leading cause of death world-wide (2.9 million deaths per year) and the leading cause in Africa. The top three causes of death globally are ischaemic heart disease (7.2 million deaths), stroke (5.5 million) and lower respiratory diseases (3.9 million).
5 years ago, the South Asian tsunami resulted in “more than 150,000 people dead, tens of thousands of people missing, thousands of miles of destroyed coastline, and loss of livelihood for millions of distraught survivors”. The humanitarian responses to the tsunami in the short and long-term will hopefully give our leaders lessons in how best to deal with the terrible situation in Haiti. There were concerns regarding better data collection in the humanitarian disaster setting and whether the funds raised by the relief effort were: (a) reaching the desired targets, and (b) being spent on long-term as well as short-term healthcare provisions. These concerns are there with respect to the Haitian earthquake as well, making some people very sceptical of fundraising by the many charities that are now clamouring to support Haiti’s crumbled infrastructure.
Conflict and civil war are the other massive killers of our time. For example, in Darfur 1.3 million people were displaced from their homes and least 30,000 people were killed. The Iraq war is estimated to have killed 100 000 civilians. It is very difficult to get similar figures for the conflict in Afghanistan.
This quick comparison leads to two conclusions. Firstly, the devil is in the detail. We have to pay attention to the numbers to get an idea of scale of tragedy, especially in the weeks and months following such disasters. Better data and surveillance is always required. Secondly, although development assistance for improving health in countries of low and middle income has greatly increased in the past 20 years, the scale of the response often does not match the scale of the tragedy. The gap between the scale of the problem and the response cannot be better illustrated by the case of swine flu, and the hunt for the culprit has already begun.