Philanthropy Action

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Editor’s Note: This is a guest post from David Roberts, Executive Director of New Dominion Philanthropy Metrics.

In the first two weeks after the Haitian earthquake, a great deal of the news coverage focused on search and rescue efforts of international teams. Approximately 62 international search and rescue teams (totaling something approaching 1,800 people) traveled to Haiti. The footage of their efforts was gripping. The teams were able to rescue 132 people from the rubble over an 11 day period. President Obama mentioned the efforts of some of the American teams in his State of the Union address; a recent OpEd in the New York Times argued the United States should invest more in SAR teams as a form of international aid and goodwill generation.

I think that’s exactly the wrong lesson from the results of the highly specialized SAR effort in Haiti. I cannot say with certainty how dollars should have been allocated in Haiti, or in future urban disasters. But as a public health practitioner, and someone dedicated to outcomes measurement, it seems likely to me that SAR-focused relief efforts improperly subordinate the good of the many to the good of a very few. In other words, there are much better ways to direct disaster relief than SAR.

While there is not good data on costs available, I’ve put together some rough figures based on what I could find.

What did it cost those 1,800 rescue workers to go to Haiti? Given that SARs workers bring in all their own supplies and equipment, $6,000 per person seems like a reasonable figure, though I understand there can be significant variations in costs. The International Rescue Corps, in explaining why they did not go to Haiti, reported that it cost them $60,000 to send a team of 10 to Indonesia after the October, 2009, earthquake. Using this number, we estimate that the 1,800 SARs workers cost approximately $10.8 million USD, or $81,818 per person rescued. 

What does a well-equipped and well-staffed field hospital cost? Israel was the only country to send a field hospital to Haiti immediately. While it is difficult to determine the cost of such a hospital, I did find a news report suggesting that the Canadians allocated $1 million to set up a similar field hospital in Haiti. The Israelis sent 200 people to staff the hospital, which we can assume cost another $1 million. Over the first five days of their arrival, there were 1,000 people treated, 300 operations and 16 babies delivered. This translates into $1,519 per beneficiary. Realistically, these hospitals continue to benefit people longer than five days, which lowers the cost-per-beneficiary number.

If we stick with the $1,519 per beneficiary number, and assume that the money spent on the SARs had instead been spent on field hospitals, we move from 132 total beneficiaries to 7,110 beneficiaries.  In theory, therefore, over 53 times the number of quake survivors could have been helped if all the SAR money was diverted to establishing, equipping and maintaining field hospitals in the affected zone.

The base figures also don’t consider opportunity costs and dependencies. Some of the SAR efforts were wasted because the people rescued soon died from their injuries—because their was no medical care available to treat them. For instance, an eleven-year old girl rescued two days after the earthquake later died because the first aid station she was rushed to was “not equipped to deal with her injuries.“ There are, unfortunately, many more stories like hers.

Since the damaged Port-au-Prince airport could handle only so many inbound relief flights, the SAR-focused relief effort also carried a very real opportunity cost. Those survivors who had suffered injury but escaped the falling buildings were just as imperiled as those who were entombed in the rubble.  While the world watched footage of dramatic rescue efforts, they faced death due to shock and infections that could easily have been avoided with adequate medical care. Some have estimated that as many as 20,000 survivors died each day as a result of inadequate medical care. Every plane carrying a SAR team could have been carrying medical supplies, food, water and other equipment that may have helped stave off infections that led to a great deal of limb amputations.

Keep in mind too that thousands, if not tens of thousands of people were rescued from the rubble by their families and neighbors, not by international rescue teams. Indeed this is the case in all such disasters. While we typically only see the efforts of the professionals, average citizens do far more of the immediate response and rescue work.

Ultimately the point is not that we don’t need SAR in urban disasters, but rather to argue that the subject of SAR, like many aspects of disaster relief, is not as simple as many might think. All disaster relief efforts would benefit from an analysis of the relative costs and benefits of different support approaches. Put simply, we need to learn from what happened in Haiti. My former School of Public Health dean at Johns Hopkins, Alfred Summers, recently compared the rescue efforts in Port-au-Prince to the “girl in the well” phenomenon—in which, while the world is fixated on reports of a multi-day rescue, tens of thousands of children die unnecessarily from malnourishment or disease.

I admit that, on one level at least, this is nothing more than an academic exercise. However, the numbers are compelling enough that when the next disaster strikes, governments and relief agencies should seriously consider that focusing on SAR teams is the wrong response.

Update: The Chile earthquake happened shortly after I wrote this post. I found this quote from the Chilean Foreign Minister: “Experience over the years and in prior earthquakes, as well as from international cooperation efforts like in Haiti, have left us lessons,” Foreign Minister Mariano Fernández told reporters. “We have to be very precise about what our needs are in order for the assistance to be of any use.” Hopefully, the world will listen to what Chile requests which at this point includes field hospitals, water purification plants and communications equipment.



Ed. Note: This comment is from Michael Keizer, who writes about humanitarian logistics and other aid issues on his blog, A Humourless Lot

Similar points have been made by me and by fellow aid worker Tris Clements. However, one commenter has pointed out some of the very real side-effects a (by itself totally rational) decision to stop SAR activities can have, and which should definitely be taken into account.

March 08, 2010

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