Four months after Haiti's devastating earthquake, MSF's teams continue to adjust their activities to meet the changing, but still major, medical needs. The organization continues to provide primary and secondary care to the population at no cost, working out of approximately 20 sites and operating several mobile clinics.

"More than one million people are still living in deplorable conditions, beneath tents or plastic sheeting, without a clear sense of what's ahead in the coming months," said Stefano Zannini, MSF's head of mission in Haiti. "In the meantime, the rains are intensifying, flooding the sites where earthquake victims live several times a week."

These conditions produce heightened health risks. Since January 12, MSF has provided medical care to 137,000 patients. The diseases treated in primary health care facilities today specifically include respiratory and waterborne illnesses, such as malaria and diarrhea. Since late March, 71 suspected cases of typhoid fever, a disease linked to poor hygiene conditions, have been treated at the Choscal Hospital, in the Cité Soleil neighbourhood.

In a country where 60 percent of the medical facilities suffered serious damage or were destroyed, MSF is working to meet second-line medical needs by managing or supporting hospitals and specialised medical facilities.

"There are patients who were wounded during the earthquake and need orthopaedic and revision surgery, but everyday medical needs – such as automobile accidents and domestic accidents -- are also returning to the fore," explained Dr. John Pratt, who practices at MSF's Saint-Louis Hospital in Port-au-Prince.

Treating obstetrical cases is also a priority. In April, 635 complicated deliveries – including 131 cesarean births – were performed at the Isaie Jeanty medical cent in Port-au-Prince. In Léogâne, MSF performed 514 surgeries, most of them obstetrical.

MSF has set up the country's only specialised department for severe burn victims at the Saint-Louis Hospital. The unit includes three tents and 27 beds for severe burn patients, both children and adults. Most are children who were burned during household accidents that occurred in the makeshift shelters that often house large families.

Three specialised MSF facilities continue to provide functional rehabilitation therapy, including physical therapy, psychological assistance and other follow-up services. This post-operative care, both in-patient and out-patient, is also provided in the other facilities that MSF manages or supports in Haiti. Over the last four months, the organization has provided post-operative care to more than 14,600 patients.

Psychologists have treated 69,000 earthquake victims at MSF medical facilities and in camps. "Four months after the earthquake, many Haitians still feel the earth move and the noise is ever-present," says MSF psychiatrist, Dr. Maryvonne Bargues. "We see many people who are experiencing an onset of acute psychosis. There is a collective depression behind the smiles that pre-earthquake Port-au-Prince evokes. People know that the unsettled nature of their lives will not be resolved for a long time. They are discouraged, but not resigned."

In April, MSF treated 81 victims of sexual violence in its Port-au-Prince facilities. Care includes psychological and medical assistance, specifically including vaccination against Hepatitis B and HIV/AIDS preventive treatment.

With the arrival of the rainy season and, in August-September, the hurricane season, MSF is gradually shifting its medical activities from tents to permanent or semi-permanent structures. In Léogâne, for example, construction of a 120-bed hospital, built out of containers, began in early May to replace the hospital destroyed by the earthquake. In Jacmel, where the hospital was largely destroyed, the surgery, maternity, internal medicine and pediatrics departments have now been organised into a semi-permanent structure. Extensive rehabilitation work has also been performed at public medical facilities that MSF supports.

The areas outside of Port-au-Prince were not affected by the earthquake, but experienced an influx of hundreds of thousands of people who fled the capital. To evaluate the situation and the medical needs, an MSF team went to several towns, including Gonaives, Port-de-Paix, Cap Haitien, Fort-Liberté, Saint-Marc and Les Cayes. These regions do not have earthquake-related needs, but access to health care in rural areas remains limited. After a more detailed analysis of the results of these evaluations, MSF may decide to expand its activities in some areas.

Finally, three months prior to hurricane season, MSF is preparing to meet a possible increase in needs for emergency treatment related to the arrival of the rainy season and a possible worsening of the medical situation in Port-au-Prince and throughout the country. Additional medical and logistical supplies have been ordered and will be available in the coming weeks based on the needs that may arise.