Courtesy of Jean Marc de Matteis/GHESKIO

A girl sleeping under an umbrella at GHESKIO Refugee Camp in Port-au-Prince.

The Weill Cornell Medical College (WCMC)-affiliated GHESKIO clinic in Port-au-Prince, Haiti, has been coping with the medical needs of thousands of refugees, ever since the devastating Jan. 12 earthquake.

"Security is now our biggest concern," write WCMC Drs. Jean William Pape, Warren Johnson Jr. and Daniel Fitzgerald in an online article in the New England Journal of Medicine that describes the success and the challenges in medical care that the doctors are experiencing in Port-au-Prince.

"Five thousand prisoners escaped from the National Penitentiary, which was a short distance from our clinic. They have infiltrated our refugee camp. They are armed and organizing. The U.S. Army protects the Department of Health and Human Services field hospital but is not responsible for the refugee camp or the GHESKIO clinic. The walls around our facility collapsed, and our clinics are open to the streets."

GHESKIO was the first institution in the world dedicated to the fight against HIV/AIDS, providing continuous medical care in Haiti since 1982 -- never once shutting its doors or charging fees. However, since the earthquake, GHESKIO has been providing humanitarian assistance to 5,000 refugees, emergency care to thousands affected by the disaster and continues to provide life-saving medications to people with HIV/AIDS.

The doctors write in the NEJM: "Piles of bodies lay in the streets. The only useful places for providing medical care were empty spaces -- parks and fields. A city in need of hundreds of trauma centers had two or three.

"We must provide food, water, sanitation and security to thousands of earthquake refugees. We obtained food from relief agencies but hesitated to distribute it directly for fear of a riot. We therefore hired 40 women who work as street vendors. We provide them with cooking oil and food, which they prepare and distribute free of charge. Our water comes from a well at GHESKIO.

"The devastation is incomprehensible."

Pape is the founding director of the GHESKIO clinic and professor of medicine at WCMC; Johnson is the B.H. Kean Professor of Medicine and director of Weill Cornell's Center for Global Health; and Fitzgerald is associate professor of medicine.

The NEJM Perspective piece is available online now and will appear in the Feb. 18 print edition.