Earthquake in Morocco: post-emergency physical rehabilitation

Several months after the earthquake that struck the Kingdom of Morocco, the needs of the affected populations are still great. For a number of months now, HI has been working alongside its partners to provide assistance to communities whose lives have been shattered by this disaster through the deployment of mobile medical units called "caravans". Hicham Habibou, project manager, and Hélène Nigay, rehabilitation technical specialist, report on HI's post-emergency rehabilitation response.

Major rehabilitation needs and difficult living conditions

Continuity of care – crucial to recovery

The Moroccan authorities have done a great deal to meet the immediate needs of the population. However, rehabilitation treatment and specialists tend to be centralised in the big cities. As a result, even those survivors treated in hospitals after the earthquake returned home with no guarantee of continuity of care. 

"Amputations are fairly rare but, as is always the case in earthquakes, we have seen complex fractures that, even if they were treated quickly, have left the victims in a lot of pain. We have also seen a child who underwent a fasciotomy, and many people with head injuries... The needs are still very great, and these types of pathologies require specific case management," explains Hélène Nigay, HI’s rehabilitation specialist.

This is where the challenge lies for HI: reaching out to all these people to follow-up on their initial treatment, provide relief to those who have not received the proper care in order to avoid long-term disabilities and supply mobility aids (crutches, walking sticks, wheelchairs, etc.) to those who need them. 

“The mobility aids used by patients have often seen better days, and quite a lot of work needs to be done on them to make them fit for use. Cane tips have to be changed 80% of the time, for example, as worn tips increase the risk of injury. Without follow-up or precise instructions, people make do with what they have, with all the risks that this entails for their health," adds Hélène Nigay.

Conditions that put a severe strain on the injured

In the provinces hardest hit by the earthquake, Al-Haouz, Chichaoua and Taroudant, homes and infrastructure have been destroyed, leaving their inhabitants with no other choice than to live in tents. It's a harsh existence both because of the cold in this mountainous region and because the uncomfortable conditions prevent injured people from recuperating properly.The teams are also still operating in emergency mode, with all the difficulties involved in providing physical therapy in tents or outdoors. They adapt as much as they can, but the lack of privacy and proper treatment facilities makes the sessions more complicated for the patients. 

"Everything is made worse by living in tents in these very remote areas. Between 7pm and 10.30am the next day, everyone shuts themselves away; people stay in their tents to protect themselves from the cold as best they can. This is not an environment conducive to healing. We've come across patients whose surgeons have fitted them with external or internal fixators to treat their fractures, but they can't come out of their tents. It's complicated for them, and it makes our interventions more complex," Hélène Nigay points out.

Lastly, these areas are often quite remote and inaccessible. Today, although many of the roads have been repaired, it is still difficult to reach certain communities. This increases the isolation of injured people and the difficulty of providing care.

Deployment of post-emergency activities

Working with partners to cover a wide area

HI is working in three provinces (Al-Haouz, Chichaoua and Taroudant) and is currently collaborating with two Moroccan partners: the national community-based rehabilitation (CBR) network and an association called Migrations et Développement.

The CBR network is made up of Moroccan rehabilitation professionals who work with HI as volunteers. Migrations et Développement employs humanitarian workers specialised in the community approach. They are well established in the country and have sound knowledge of their ecosystem. In both cases, the teams work directly with the population. HI has taken charge of training their community workers and relays to enable them to adapt their interventions to the specific characteristics of caring for people with earthquake-related injuries and in a post-emergency context. This training is adapted to the profiles of the staff concerned.  

Complex organisation requiring considerable flexibility

Coordinating a "caravan" service presents a number of challenges. It always requires a significant amount of preparation and scoping to adapt it to the geographical area concerned and to its population. Because this type of mobile intervention is new, practices are constantly being improved to ensure that patients receive high-quality care. The teams have put a comprehensive care pathway in place with patient referral through to physical therapy sessions and more comprehensive mental health support. Detailed logistical preparation  for a “caravan” is also crucial: confirming that the volunteers will be available, identifying the precise site where the caravan will stop to provide treatment, identifying the route and determining the state of the roads, ensuring that the local communities have been informed, making a checklist of all the equipment needed to avoid wasting time travelling back and forth between Marrakech and the intervention zones, ensuring that the team's accommodation and meals have been arranged, and so on. 

"The organisation is quite intense for our teams; we work during the week and also at weekends to meet everyone's requirements and guarantee quality care for our patients. We quickly lose track of time," says Hicham Habibou, Project Manager at HI.

Six members of HI are involved in this project. They work alongside our partners' teams of around 25 people.

Encouraging results for the first caravans

After a period of training for the partners during the week of 23 December 2023, the first caravan was deployed from 29 to 31 December 2023 in the communes of Sidi Bedhaj and Amizmiz, in Al-Haouz province. Ideally, the teams are made up of two physical therapists, two psychologists and three CBR agents and see 20 people a day to meet quality standards. After this first “caravan”, six more were organised, reaching more than 210 people.

"Today, after three caravans, i.e. 9 days in the field, I think we’ve established a good working dynamic. The interventions are going well, and we've found our rhythm with all the partners and the patients. The results so far are positive and we'll be building on them over the coming months," concludes Hicham Habibou.