Story by Michael Anft
As the truck carrying Tom Kirsch crossed the Dominican Republic’s border into Haiti, the nation’s telltale signs of poverty—the primitive shacks, bare brown earth—came into view. There was no evidence of further catastrophe, of things that are even worse than the usual, grim day-to-day reality. That would change a few hours later when he wheeled into downtown Port-au-Prince, the Haitian capital. Two weeks earlier, on January 12, 2010, an earthquake had shaken the capital to its core, killing 237,000 people and leaving more than half of the city’s 2.5 million people homeless.
“The closer you got to downtown the more you saw people sleeping in any open space, including highway medians,” says Kirsch, MD, MPH ’87, an associate professor of International Health at the Bloomberg School and of Emergency Medicine at the Johns Hopkins School of Medicine. He serves both schools as an expert in disaster response. “Downtown itself was just horrible,” he recalls. Buildings were leveled. Streets were blocked by rubble, further hampering any relief efforts. The human toll was much worse, with harrowing examples of tragedy around each corner. An entire school of nursing students immersed in an exam—save one—was killed by the quake, which struck seven minutes before test time was up.
Even two weeks after the quake, one in three injured or ill Haitians had not been treated. “We’re talking about terrible bone breaks and deeply infected wounds,” Kirsch says. People needed water. Food riots had erupted when some earthquake victims thought aid wasn’t being distributed equitably enough.
“When a disaster happens, there’s a lot of attention paid. But after the news trucks leave, people are often left homeless and jobless for years. People forget that.” —Tom Kirsch
In the past year, Kirsch has traveled three times to Haiti, the poorest nation in the Western Hemisphere, not just to deliver emergency medical care but to ask questions about how the world and the Haitian leadership, also decimated by the quake, had responded to the crisis. Had there been enough concern about finding housing for people? How was aid being distributed? Why was health care being delivered so slowly? What were the nonprofit relief groups that regularly swarm to disaster sites doing right in Haiti? Where were they coming up short?
As co-director of the Center for Refugee and Disaster Response, a collaboration of the School of Medicine and the Bloomberg School, where it is housed, Kirsch oversees grant-funded research projects aimed at finding out what goes wrong after everything goes wrong. Which is to say, Center investigators look for ways to evaluate and, ultimately, improve the quality of relief efforts and government services during refugee crises and after tragic mega-events.
It’s painstaking work. “The trouble with trying to do research is that everyone is overwhelmed by the need to respond immediately,” says Kirsch. “It’s hardly an ideal situation to investigate things. What we want to do at the Center is improve the way we collect data in the midst of that chaos.” Because “disaster science” is an emerging field of inquiry, the Center is still working to figure out how best to do that, he adds.
In search of a method for evaluating how dire situations can be rapidly improved, Kirsch and the other 20 or so Center-affiliated investigators study the effects of disaster relief months, even years, later in hope of uncovering similarities between emergency responses in far-flung nations. They also train disaster responders to take advantage of the latest knowledge.
Too often, programs devised and carried out by NGOs, governments or the United Nations don’t do enough to get people back on their feet. Experts say that many countries don’t have the “capacity”—money or human resources—to deal with mass tragedies. Many developing nations lack disaster plans that would take full advantage of coordination and logistics. Security concerns slow the flow of aid to places where it is most needed. In many cases, getting people back to work isn’t emphasized, leaving people in poverty for longer than necessary. And even when a disaster elicits an outpouring of support, much of it never ends up on the ground. For example, only 20 percent of the $10 billion pledged by individuals, groups and governments to post-earthquake Haiti has been delivered.
What’s more, the lessons learned from one disaster often aren’t remembered during subsequent catastrophes. “What we’ll see is that different groups and nations will collect post-disaster information in different ways,” Kirsch says. “The field cries out for standardization.”
“We want to be able to describe the longer-term impact on people’s lives, health and economic status,” Kirsch says. “When a disaster happens and the CNN cameras are rolling, there’s a lot of attention paid. But after the news trucks leave, people are often left homeless and jobless for years. People forget that.”
Adds Courtland Robinson, PhD ’04, an assistant professor in International Health and at the Center: “What I’m hoping we can bring to this field are measures that go beyond profiles of a population or risk assessments, measures that can give us what I call a durable solution. Each time we do this, we shouldn’t have to reinvent the wheel. We should be able to take those approaches that have been validated by research and put them to work.”
Even though an earthquake in the Caucasus hardly resembles a drought in the Horn of Africa, the range of disasters presents many of the same challenges. “We want to be able to standardize what we do while having a customizable approach built in,” adds Robinson.
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