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Description of the crisis
On 14 August 2021, a 7.2 magnitude earthquake struck Haiti causing 2,248 deaths and injuring 12,763 people. The earthquake destroyed 53,815 homes and a further 83,770 were damaged1.1 The total area affected covers 500 square kilometers and over 800,000 people have been directly affected. Of 159 health facilities assessed, 28 have been severely damaged and 60 more have been damaged, with 456 schools impacted and 64 destroyed2 . Total economic damage and losses are estimated at USD 1.6 billion, or about 10 per cent of the gross domestic product (GDP). Haiti already has a deteriorating humanitarian situation with high levels of insecurity, violence, food scarcity, internally displaced people and significant population movement, and these are compounded by the current crises. Cholera also re-emerged in the country on 2 October 2022 after more than three years with no presence of the disease reported.
The national authorities reported two confirmed cases of Vibrio cholerae O1 in the greater Port-au-Prince area and in the commune of Cité Soleil. As of 06 November 2023,3, more than 69,992 suspect cases had been reported by the Ministère de la Santé Publique et de la Population (MSPP), with 4,080 cases confirmed and 1,054 deaths. The capacity of the epidemiological surveillance system to detect suspected cases is still considered low and confirmation of cases is minimal, due to scant resources and the difficulty in getting samples to labs due to lack of fuel and presence of roadblocks by armed gangs*.*
Throughout the period of implementation of this emergency appeal, the violence perpetrated by armed gangs against the Haitian population continued to spread across the country, reaching isolated rural areas as the presence of the State eroded. Existing structural fragilities were only exacerbated by the growing number of attacks on social infrastructures (hospitals, schools, places of worship, etc.), the hostage-taking of doctors and the forced displacement of several hundred teachers. The deteriorating security situation, the near collapse of basic services, the impact of years of drought and shocks linked to natural disasters will leave 5.5 million Haitians in a state of profound vulnerability by 2024. Murders, kidnappings, and rapes continue to rise for the fifth year running. In the first nine months of 2023, homicides and kidnappings took on exponential proportions, with increases of 72% and 71% respectively compared to the same period in 2022. Insecurity is gradually taking hold in the most remote rural areas, which are often cut off from urban areas by the lack of passable roads. At least 73% of the population of the Port-au- Prince metropolitan area has been affected by gang violence, with access to basic services drastically reduced.
The disruption of economic activities in the country has exacerbated poverty and made access to basic health services difficult. Even when these vulnerable groups do manage to access health services, they are often confronted with health facilities that lack essential equipment and medicines, or with a shortage of qualified medical staff, and emergency services that are not available to them. Access to health services, for both caregivers and patients, remains extremely difficult, as some doctors in the capital can testify, declaring that patients, in addition to being ill, face great challenges in getting to treatment centers and accessing care.
Hospitals, often caught in the crossfire of clashes between armed coalitions, are operating at best in slow motion. Staff are unable to get to their workplaces, and sick people are reluctant to seek treatment for fear of being hit by stray bullets or kidnapped. The elderly and disabled remain vulnerable to serious illness and abuse. And in general, the crisis is having an impact on the mental health of the affected populations. Several health facilities, such as the Médecins Sans Frontières hospital in Cité Soleil and Tabarre, the Albert Schweitzer hospital (Artibonite) and the Mirebalais University hospital (Centre), were targeted by gangs, forcing them to close temporarily. In the department of Artibonite, a quarter of health establishments report problems of physical access to health infrastructures, for both patients and staff, due to insecurity. Between January and August 2023, at least 40 doctors were kidnapped in Haiti. Even when health infrastructures do exist and function, they remain insufficient to provide the basic care required by those who desperately need it. When it comes to health needs, people living in remote areas don't often seek medical care, and only go to hospital as a last resort, when it's often too late. As a result, pregnant women, nursing mothers and young girls living in areas affected by insecurity must struggle daily to access services essential to their health, well-being, and survival.
This situation was particularly worrying at a time when the country has experienced a cholera epidemic that has spread to all departments since the first cases were confirmed on October 2, 2022. Cholera spreads very quickly in conditions of high vulnerability characterized particularly by the deterioration of hygiene conditions, lack of quality water and improper waste disposal. If not treated very quickly, the disease can be deadly in few hours mainly because of dehydration.
One year since the declaration of the Cholera outbreak, according to the epidemiological report published by the Ministry of Public Health on 31 January 20244, a total of 79,411 suspect cases had been reported with 4,608 confirmed cases, a total of 75,160 cases were hospitalized, and 1,172 deaths. Suspected cholera cases that were initially concentrated in certain areas of the capital are recorded in all 10 departments of the country, the majority still in the West (52 percent) although the growth rate is higher in the other nine departments. MSPP indicates that 53.04 per cent of reported suspected cases are male and 46.96 per cent female. The age group 50-59 years old (38 per cent) is the most affected among the confirmed cases. The number of cholera cases is underreported and underestimated as the capacity of the epidemiological surveillance system to detect suspected cases is still considered weak and confirmation of cases minimal, due to the lack of resources and the difficulty in transporting the samples to the laboratories due to lack of fuel and the presence of roadblocks by armed gangs which hamper access.