There has been some discussion on the Internet about the search and rescue (SAR) cost and benefit with respect to the recent disaster in Haiti. Approximately 62 international search and rescue teams with a total of 1,800 workers rescued 132 people out of the rubble over an 11 day period. While everyone seems to think that some type of SAR response is needed as part of the relief effort, what that response looks like is subject to debate. Some have criticized the search and rescue efforts in Haiti on the ground that they have prioritized the good of the one over the good of the many. In counterpoint, others have argued that a life saved should not be judged by the cost of the rescue. They have argued something like: “If your mother was one of the lucky few pulled out of the rubble, you wouldn’t be having this discussion.”
I think the critique is worth considering. Although it is certainly true that if my mother were rescued, I would rejoice, I believe I would care just as much, if not more, if my rescued mother then proceeded to die from her wounds due to lack of medical facilities in the affected zone. Indeed, this exact scenario has occurred in Haiti. According to news reports, 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.
I highlight this story not to say we don’t need SARs, but rather to argue that the subject of SARs is not as simple as many might think and that disaster relief efforts would benefit from a more nuanced 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.
In Haiti, 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. Since the damaged Port-au-Prince airport could handle only so many inbound relief flights, we believe the SAR-focused relief effort carried a very real opportunity cost.
What I have not yet seen in these discussions is actual dollar figures. What did it cost those 1,800 rescue workers to go to Haiti? What does a well-equipped and well-staffed field hospital cost? 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.
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. Using this number, we estimate that the 1,800 SARs workers cost approximately $10.8 million USD, or $81,818 per person rescued.
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.
I admit that, on one level at least, this is nothing more than an academic exercise. However, the numbers are compelling enough to suggest that international relief organizations should conduct a more particularized analysis of their commitment to SAR efforts before the next disaster strikes. I cannot say with certainty how dollars should have been allocated in Haiti. But as a public health practitioner, and someone dedicated to outcomes measurement, I am concerned that SAR-focused relief efforts improperly subordinate the good of the many to the good of a very few. On balance, my training would suggest we begin erring on the side of the good of the many.