A battle to save the living

Haiti's health system was already in a fragile state and its impoverished population vulnerable to a range of lethal infectious diseases before the earthquake. But the lack of clean drinking water, food or access to medication in a city littered with decomposing corpses could create the conditions for an unprecedented health calamity, according to experts.

Stefano Zannini, of Médecins Sans Frontières, speaking from the capital Port-au-Prince yesterday, said emphasised the number of injured people in urgent in need of surgery and that was just in the charity's own centres. "Thousands need immediate surgical intervention. Most of the wounds are open fractures. But in some of our centres we have seen burnt people in a very very bad condition too."

Hard-pressed medical staff are still struggling to provide basic first aid to the huge numbers who have overwhelmed those ill-equipped clinics that are still functioning. "It is a race against time because infected wounds need rapid interventions," Mr Zannini said. Even minor injuries and fractures can become infected and life threatening if left untreated. Amputations are in many cases required to save lives but the possibility of orthopaedic surgery for most victims is remote.

MSF has managed to fly only two cargo planes directly into the Haitian capital. Two inflatable operating theatres were also due to be brought in last night and ready to begin carrying out operations within the coming days. "But there are major issues of access and transport, with the staff delayed in the air and on the roads" he added.

The MSF chief said the few hospitals which had not collapsed were "crowded with patients" who had been transported on all manner of vehicle from private cars, to pick up trucks and in some cases on makeshift "stretchers" made out of doors.

The presence of so many dead bodies in the streets is an obvious hazard for sanitation and public health. In the initial hours after the tremor many of the badly injured died in the hospitals before they could even be treated, so medical staff found themselves with the task of having to clear away the corpses before they could tend to the living.

Yesterday, there were reports of trucks operated by the public authorities moving about the city clearing the dead for burial in mass grave. But eyewitness acccounts and photographic evidence from the streets indicated that the problem was still critical.

"There are so many corpses on the streets, it is really starting to smell now," said Prospery Raymond, the country director for Christian Aid, who was himself trapped under the rubble of his collapsed office for several hours and had to rescue two colleagues.

Mr Raymond said the absence of medicines was causing grave problems. "My wife, who is a doctor, went to a hospital to volunteer her services but there was nothing there, no medicines to give the people."

The massive human displacement following the destruction of so many homes has grave health implications. Ad hoc tent communities have begun springing up but the inevitable overcrowding combined with a lack of proper sanitation is a recipe for the spread of infectious and respiratory diseases.

The US is sending a military hospital ship to dock off the Haitian coast. But it won't arrive until the end of next week, too late for many in Port-au-Prince.

Eyewitness: Tales from the epicentre

One boy got here yesterday afternoon. He had been trapped under blocks at his house. His right left was broken in two places. He left leg was smashed below the knee. It was cold and turning black. His father walked into the yard and just fell apart. He lost his wife and four other children. He was so thankful that he was able to pull out the son above. He just wanted to go someplace other that back to Port-au-Prince. We had to tell him he had to return to the hell he had just left. He son's leg needs to be amputated for him to survive.

Licia Betor Real Hope For Haiti Rescue Centre blog

Driving in the dark! Going Home! The city is in ruins!! The future is darker!! Wish u could feel what I feel! It's hard to believe! Who Will Give The Order? When Are We Going To Have Food And Water?

Carel Pedre, Radio presenter, via twitter

Today we are beginning to prepare for mobile medical clinics and try to discern a safe and smart way to begin to do this in our area. Haiti is disorganised and without infrastructure on the best day. For the aid to work and the teams of search and rescue workers to be able to do their job there is going to need to be a major effort of all people to lay down their own fear and personal need and allow the help to get to the worst off. Pray that people will think of others as best they can and that relief will begin to get to the places it is needed most.

Tara Livesay, aid worker, livesay family Haiti blog

One firetruck is doing water distribution on ChampMars. Bodies are being burned...As difficult as the Port-au-Prince plan is, there has to be a plan for Jacmel. How is Aux Cayes? Are roads cleared to Jacmel yet? Is heavy equip coming? What to do, what to do, what to do with all these bodies that are starting to decompose? People are starting to wear masks.

Ramhaiti, Hotel owner, via twitter

Been up for 48 hours straight, running at full tilt. I'm a bit frail. I am starting to run ... literally, run ... every time an aftershock hits. Seen far too many bodies. Don't wanna add to that number. Report in: Bodies are starting to burst. Thousands of bodies still in the streets. We either care and will help or we don't and won't. It's just that simple. These Haitians have less than u and are helping 1 another. Let's stop calling them "looters" and start admitting that we're failing at distributing aid. They are "survivors", not criminals! The supplies in the UN warehouse were given for Haitians. When Haitians take what's theirs, we call them looters. We suck.

Luke Renner, American aid worker, via twitter

The people are sleeping in the road at night because they feel more safe than in their homes. It is bad. You know the mud huts are leaning and the rock houses have big holes and walls are falling and cracks so large that it could fall on them while they sleep with just a little jarring. I am so tired. But I must stay strong for the people.

David McDaniel, American aid worker, via cnn.com post

Please contact your local officials and tell the Haiti is in a State of Emergency!! We need immediate AID!!! LET'S GO!!! NO EXCUSES!!!

Wyclef Jean, Haitian musician, via twitter