The surgical units set up by Médecins Sans Frontières (MSF) in Port-au-Prince continue to work around the clock to treat the vast numbers of patients with injuries from the earthquake. Prioritizing the most serious cases, the teams have been performing cesarian sections and amputations. Experienced MSF medical staff say they have never seen so many serious injuries. In Choscal hospital, where MSF relocated after its original facilities were so badly damaged, staff in the operating theatre have been working non-stop since early on Friday. In the Trinité trauma centre, where the team is treating people under canvas on the grounds of the medical facility that was hit by the earthquake, surgery has been taking place in an improvised theatre. Then in Carrefour, a district that was very badly affected, MSF has just started working in a hospital with two operating theatres. One of MSF’s operational coordinators in Port-au-Prince, Hans van Dillen, says there was an immediate reaction. “When people found out that we were starting medical activities in Carrefour, they began crowding round the entrance. Patients are being brought in wheelbarrows and carried on people’s backs.” There are other hospitals in the area but they are already overflowing with injured people and have limited numbers of Haitian staff or supplies. The struggle to find yet more buildings that could be used for this work is continuing, as are the efforts to get more medical staff and supplies into the country. The major difficulty here is the bottleneck at the airport, which has turned away a number of vital cargo flights. Lack of authorization to land at the airport has already caused a 24 hour delay to the planned arrival of MSF’s much needed inflatable hospital. MSF has managed to get more than 70 extra international staff into Port-au-Prince but mostly through neighbouring Dominican Republic. They are beginning to take some of the strain off the 30 who were already there when the quake struck. It has become clear that a number of Haitian MSF staff did not survive the devastation. MSF is still trying to confirm the whereabouts of others and is increasingly concerned about their welfare. The teams say that food and water are also serious concerns and lack of these is contributing to tension in the city. There has been little sign of significant aid distribution and there are increasing reports of looting, although not accompanied by violence. MSF’s activities are rapidly scaling up and the next move will be to assess different parts of the city, where needs are expected to be equally high. To help address the massive scale and variety of the assistance required, MSF hopes to start other medical activities as soon as possible, including mobile clinics where there is no functional health structure, and mental health care for people who have been traumatized.