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Brian Lehrer: Brian Lehrer on WNYC. We're going to end the week on the show by talking about the catastrophic earthquake in Turkey and Syria, and taking some of your calls if you're in the community related to those countries or with questions about how to help, we'll have a guest here from Doctors Without Borders in just a second. The latest number, shocking, more than 22,000 people are now confirmed dead.

This means it is, I think, by far, the most deadly natural disaster of the 21st century. We're going to talk about it and we're going to talk about how to help with Avril Benoit, Executive Director of Doctors Without Borders in the United States. Avril, thank you so much for coming on. Welcome to WNYC.

Avril Benoît: Thanks, Brian.

Brian Lehrer: Listeners, we do invite your calls if you have ties to Turkey or Syria in the affected regions. What would you like your fellow listeners to know about the catastrophic nature of this earthquake or the rescue operation? Obviously, if that many people are dead, then so many other people need help. You can also ask questions about the medical response for Doctors Without Borders guest or you can tweet @BrianLehrer. Our phone number though, if you want to tell a story if you're connected to the community at all, or ask a question, 212-433-WNYC, 212-433-9692. What is Doctors Without Borders' presence in the region at this point?

Avril Benoît: Well, Brian, as you know, the situation on the ground is devastating. Doctors Without Borders is on the ground and has been for many years in northwest Syria, working with local partners, local colleagues to respond to this emergency. Just to give you a bit of an overview, or providing medical care and assistance around the clock and have been since the early hours, right after the earthquake, the first earthquake.

We're supporting medical facilities to treat patients, facilitating transporting patients with a vast ambulance service, and providing immediate relief items such as blankets and hygiene kits to the people affected. Mostly, we're working with local partners to meet these needs. We're looking at the longer-term needs as well and preparing for the psychological aspects that will be longer-term. In the meantime, the focus is on setting up mobile clinics in the shelter and reception camps and offering psychological first aid, which is something just to help people get through the day-to-day.

Brian Lehrer: Amid all the devastation, all the rubble, how do you even begin to assess the medical needs of injured people?

Avril Benoît: Well, for sure, because we have worked so long in Idlib, and Aleppo governorates since the war has continued for rounded dozen years, Doctors Without Borders was already working in many facilities. Those very facilities where we have our staff and our staff that we're supporting received 3000 injured people, and in the early day, 551 dead. They are treating people and that's the way to have a scope of what is needed.

Now, the distributions that we've been able to do, more broadly speaking, are emergency kits; so trauma kits for emergency surgery, surgical kits. We've sent medical staff, including our surgeons to support other hospitals, beyond the ones where we normally work to add to the capacity of the trauma, emergency work but also in setting up triage tents in the outside wards, because, of course, many hospitals have been damaged. Some hospitals were worried that if there are more aftershocks. Everyone is worried about being indoors anywhere. Despite the cold, the tent setups will at least cover the gaps in the short term.

Brian Lehrer: Yes. I mentioned how big this earthquake is in recent historical terms. I probably should have just said the biggest or the most deadly earthquake of the 21st century. Few people are pointing out that Indian Ocean tsunami in the early part of the century, I think it was 2004 killed, I think I said more than 200,000 people, right? Doctors Without Borders was perhaps involved with that.

Avril Benoît: Yes. Of course, the one that is very memorable in my mind is the earthquake in Haiti in 2010. The death toll from that one was also extraordinary. We had, if I recall, 300,000 was the official count of how many people died during that earthquake and the aftermath. This is, for sure, something that we have seen before in other places. That's one of the reasons that we feel so confident, but also committed and determined to be able to do as much as we can.

Not only in northwest Syria, where we already had a substantial presence with roughly 500 staff but also in Turkey, where we are ready to provide assistance and to mobilize emergency capacities which we have. Our teams are assessing the needs, and of course, are very much in touch with the Turkish authorities. We're just waiting to hear back from them.

Brian Lehrer: It's not the only mass casualty earthquake in that region. In 1999, an earthquake in Turkey left more than 17,000 dead from what I read, in 1988, in Armenia, which is in this region an earthquake killed more than 25,000 people. What makes that region so prone to these mightily powerful earthquakes?

Avril Benoît: Well, you'd have to speak to seismologists for that insight. For us, the experience tells us though, as we always know, when you're working in a zone that is prone to this particular natural disaster, you have to have supplies at the ready. That's something that we have the experience and the warehousing and the logistical capacity, the supply chain to do.

I'll tell you, Brian, our warehouses, which immediately did distribute because we're working in an earthquake zones, we had the tents, we had the blankets, we had the things ready to be distributed. We've been doing that. We are running out. That's one of the reasons that we're especially concerned with what may be the limitations of the local market to be able to buy what else we need. Some of the strictures in terms of being able to import goods into those zones that were most affected by the earthquake in northwest Syria.

Brian Lehrer: In Syria, do US sanctions complicate the medical response?

Avril Benoît: Well, a variety of political factors are complicating the response, to be honest. There is a lot of activity around making sure that the one UN-sanctioned access road from Turkey remains open. There are also numerous calls to open up other access points and because this region has been somewhat isolated for years due to the war, and due to all the political pressures, these are discussions that are urgent. They have to be resolved as quickly as possible so that we have more possibility, more angles, more ways to bring supplies where they are located, and where we can acquire them and bring them in and have them reach the people most in need in the earthquake zone.

Brian Lehrer: What comes next? I saw the Turkish President Erdogan has announced a three-month state of emergency. I think it's fair to say that Haiti, to this day, after significantly more than a decade, has not fully recovered from that earthquake. Will recovery of three months be any kind of recovery at all?

Avril Benoît: Well, certainly not from our perspective, from the medical side. There will be reconstruction. You can see the devastation in all the images coming through from this. In the longer term, we have to look after the wounded. Those who have received trauma surgery, for example, who may have amputations or severe orthopedic injuries, they require long-term care.

The post-operative care includes infection prevention control to make sure that if they had open wounds, or if they require frequent changing of bandages, that that is done in a proper way to limit the risks of an infection, which could lead to catastrophic health outcomes. For sure, there will be lots of need to rebuild housing and shelter, but we will be mostly focused, of course, on the health sector. You can only make do with tents for so long.

Then beyond that, the management of disease outbreak. Cholera has been in this zone before it's endemic, it's possible that it could return and that's why a lot of the effort from our side is to continue the water and sanitation activities. Just making sure that we are leveraging the capacity we already had in the region, which was working in camps for internally displaced people from the war and now being able to do what we can to support water and sanitation.

For the longer term, it's, of course, management of chronic diseases and mental health needs, even to continue the everyday medical services such as maternity wards, delivering babies, burn units, all these services will make the difference. When you have a natural disaster in all the focuses on, say trauma wounded, if all the resources are focused on that, there's always a risk that you deprioritize what can really be lifesaving medical care for people with diabetes or blood pressure issues and things just to make sure that their medications are ongoing and that you're monitoring their conditions.

Brian Lehrer: This may not be in your area exactly as a medical relief organization but are there infrastructure problems in that region that make it more susceptible to the worst effects of a strong earthquake? Is that an issue in terms of the rebuilding that people are likely to undertake?

Avril Benoît: I have heard that it is insofar as these areas in northwest Syria were pummeled during the war. Aerial bombardments have been a continuing factor. Then, of course, they're trying to rebuild quickly. Maybe the integrity of the structures that people were living in were already damaged to some extent by the war. I think it's just logical to conclude that the vulnerability factor is just off the charts for an area that's already been suffering through the various calamities of 12 years of war.

Brian Lehrer: A listener tweets. The Nature Conservancy for years has been encouraging people to move away from fault lines, away from shorelines, et cetera. People just rebuild. It's not so easy to leave your home or your hometown but is this something you have a view on?

Avril Benoît: Reconstruction is really going to be for the local people to work with the capacity that is leveraged by the international community. I don't think the people themselves have the resources to be able to do everything that is needed to rebuild. For sure, when it comes to hospitals, clinics, we will be very mindful in any reconstruction of whatever norms the authorities put in place, presumably and hopefully, well-monitored to make sure that they can withstand these shocks in the future. Certainly, there's always an opportunity when you're rebuilding to do things better.

Brian Lehrer: Avril Benoît is Executive Director of Doctors Without Borders in the United States. Thank you so much for joining us and for your work.

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Avril Benoît: Thank you, Brian.

Brian Lehrer: That's the Brian Lehrer Show for today, produced by Mary Croak, Lisa Allison, Amina Srna, Carl Boisrond, Esperanza Rosenbaum and Shweta Watwe today. Zach Gottehrer-Cohen produces our Daily Politics podcast. Our interns this time are Trinity Lopez and Briana Brady. Megan Ryan is the head of Live Radio. Have a great weekend, everyone. I'm Brian Lehrer.

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