Health reporter, BBC News
Prosthetic organisations and charities worldwide have warned of the huge task facing Haiti as it struggles to rehabilitate hundreds of thousands of amputees resulting from the island’s earthquake.
Doctors say they are already struggling to cope with the sheer numbers of people needing amputations after being trapped in rubble.
Some surgeons estimate that as many as 200,000 Haitians will end up losing one or more limbs – in a country where the few rehabilitation facilities that existed before the earthquake have largely been destroyed.
And in a country where an estimated 800,000 people were already living with disability before the disaster struck, meeting all the needs of the amputees may be impossible.
Dominic Hannett, director of clinical services at Opcare, a private company that provides prosthetic services to the NHS, says many more amputations will be carried out over the coming days and weeks because of potentially fatal infections in people, who had initially fairly minor wounds or fractures.
"They will need to re-equip the rehabilitation centre, find out who out of the staff is still alive and train more people and there are international guidelines on how to do that"
Sandra Sexton, University of Strathclyde
And he warned infection will remain a major risk in those who have had surgery to remove parts of or whole limbs.
He said: "It’s fairly common sense but the more someone loses of their limb, the more complex the amputation and prosthesis is going to be – if someone loses a leg at the hip, that’s a massive problem."
Prosthetic devices need to be fitted as soon as possible after healing to get people mobile and will need refitting in the first few weeks and after that at least once a year, he said.
"Amputation is a life-long rehabilitation – in the UK we still treat amputees from the Second World War because they need ongoing care."
But limbs are easy to make and the sheet of plastic needed to remould and fit a socket joint on a prosthetic costs as little as £15.
"The requirements for a prosthetics team to set up and fairly simple and local people can be trained to manufacture and provide prosthetics," he said.
Sandra Sexton, director of the National Centre for Prosthetics and Orthotics at the University of Strathclyde, said there were some rehabilitation services in Haiti, but like everything else they have been destroyed by the quake which killed 200,000 people, according to some estimates.
Ms Sexton added survival was currently the top priority for medical teams, but once the focus shifted to reconstruction, a vital step will be getting the local rehabilitation services up and running once again.
"It is a gigantic and very serious problem and the post-amputation period will be critical in terms of post-operative support, physical therapy and the fitting of prostheses"
Eric Doubt, Healing Hands for Haiti
"What we saw after the Pakistan earthquake was the importance of having a co-ordinated approach – it’s about knowing who has had an amputation, and who is undergoing treatment."
"We know from places that have been in conflict, for example after the Ethiopian civil war, there was a very practical way forward.
"They (aid agencies) built rehab centres in five areas then they trained people up to do local provision but the local population there had not been as devastated as it has in Haiti and it’s going to be a lot more difficult.
"They will need to re-equip the rehabilitation centre, find out who out of the staff is still alive and train more people."
Ms Sexton stressed the disaster in Haiti was of an "unprecedented" scale.
"This is devastation in a very poor country," she said. "They had rehabilitation services before but they weren’t even touching the sides and it’s hard to comprehend how to help – they really will need sustained long-term support."
Eric Doubt, executive director of Healing Hands for Haiti – a US-based charity set up 10 years ago to provide rehabilitation for people with disabilities – said three-quarters of their facilities in the country have been destroyed.
The charity is now accelerating plans to open Haiti’s first Physical Medicine and Rehabilitation Institute later this year.
"We have 150 medical specialists, construction crew, translators and volunteers flying out next week," said Mr Doubt.
"Following that we will be joined by a team of 30 professionals from Handicap International.
"Whether that addresses all of the previous and new needs is highly unlikely, but we’ll be working in conjunction with all the other physical medicine and rehabilitation organisations who will also be setting up operations." </p
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