In the short term, Haiti’s injury victims need urgent medical attention just to survive. On the US Navy’s huge hospital ship Comfort, anchored off Port-au-Prince, we treated critically injured children, men, and women, many with horrendous injuries. Some arrived on Comfort already paralyzed from head and spine wounds. Others had fractures of the pelvis, vertebra and arms and legs.Skin gaped open over many wounds, leaving the bones exposed and causing infections. Bacteria had entered the blood stream, causing a life-threatening condition called sepsis. Gangrene – tissue death and decay caused by lack of blood flow – had sometimes set in.

Gangrene and wound infections can kill people. The only thing doctors can do to save lives is amputate limbs or the affected body parts. Some Comfort patients refused these amputations. They said that without arms and legs their lives would be over anyway, so they might as well die. Some people who refused treatment died shortly thereafter. For those with amputations or paralysis who survive, the question is what happens next.

These survivors have few options. Even before the earthquake, Haiti offered little assistance to those with disabilities. Steep mountainous terrain and treacherous unpaved streets made it difficult for people with walking problems – even those few who owned wheelchairs – to get around.

Haiti has no rehabilitation hospitals to help people learn how to function again after major injuries, strokes, or other disabling health problems. Few health care professionals specializing in rehabilitation, including physiatrists and physical therapists, are available to teach patients how to walk again, perform basic activities of daily life, or work despite their disabilities.

Since the earthquake, prospects look even bleaker for Haitians with disabilities. Major cities and the surrounding countryside are in rubble, making access and mobility impossible. We could not find enough wheelchairs for the patients we discharged from the Comfort. We heard of situations where people could not find canes or crutches to help them get around. The country has no one making prostheses and in a country where the average person earns $1 a day, buying such items from abroad is beyond the reach of most.

People with paralysis or amputations need long-term rehabilitation treatments to maximize their physical functioning. For example, after amputation wounds heal, people must keep their muscles around the amputation as strong as possible so that the prosthesis will work its best. A few mobile health teams have arrived to provide rehabilitation services and plans are underway to begin producing prostheses for amputees. While these are good starts, the massive need of thousands of newly disabled Haitians is simply overwhelming.

Haiti’s minister of health has identified support for newly disabled Haitians as a priority. The United States must join this effort. The top priority must be to ensure that no further deaths or other disabilities occur because of infected wounds or other acute medical problems. These patients also need shelter that is accessible and can accommodate their disabilities. They need basic equipment like canes, crutches, and wheelchairs with adequate strength and cushioning. They need rehabilitation therapy to maximize their long-term physical abilities.

The earthquake leaves Haiti with thousands with significant disabilities. Some of the victims are young children, so this legacy will stretch for decades ahead. Over the long-term, Haiti must build a medical system that includes rehabilitation services and trains rehabilitation professionals. As Haiti rebuilds its towns, every aspect of that new physical environment must accommodate the needs of persons with disabilities. This will ultimately improve quality of life for all Haitians with disabilities and allow them to contribute to their own and their country’s future.

Dr. Lawrence Ronan is director of the Mass General Hospital Durant Fellowship. Dr. Lisa I. Iezzoni is professor of medicine, Harvard Medical School, and director of the Mongan Institute for Health Policy at Mass General.