Attachments
This update of the emergency response operation in Haiti was prepared following the publication of the second revision of the Emergency Appeal, published 9 December 2022, and the revised operational strategy, published on 23 February 2023. These revisions integrate the response to the 2022 cholera outbreak. The IFRC, on behalf of HRCS, expresses its sincere gratitude to all donors for the generous humanitarian contributions received. Additional financial contributions are needed to enable the National Society, with the support of the IFRC, to provide humanitarian assistance to Haitian populations affected by the 2021 earthquake and 2022 cholera outbreak. The overall funding requirement to mainstream cholera remains at CHF 19.2 million with the following changes:
-
Additional geographical areas are included.
-
The number of people to be assisted was increased to 45,100.
-
The implementation period has been extended to 28 months (until 31 December 2023)
-
New Health, WASH and CEA activities have been included to control the cholera outbreak and prevent further infections.
After the Emergency Appeal timeline ends, IFRC plans to continue response activities under the IFRC Country Plan for Haiti.
A. SITUATION ANALYSIS
Description of the crisis
Regularly exposed to natural hazards, Haiti faces recurring socioeconomic and political challenges stemming from deep-rooted structural problems. Indeed, according to the Haiti Humanitarian Needs Overview Report released in March 2022, approximately 3.8 million people are expected to require assistance to meet their basic health needs. This increase in needs is mainly due to numerous crises, such as the COVID-19 pandemic, the 7.2 magnitude earthquake in 2021, which affected more than 800,000 people in the country, and the resurgence of cholera cases in 2022. Between the consequences of a climate of insecurity that causes the total dysfunction of health institutions in several neighbourhoods of the capital and some provincial cities, the damage caused to several health structures in areas affected by the earthquake, access to quality health care is becoming a major concern, and the secondary consequences to this situation so bleak, have had a negative impact on the population and further limit access to essential health services.
Between October 2010 and February 2019, more than 820,000 cases of cholera, including nearly 10,000 deaths, were reported in Haiti. After more than three years without any reported cases of cholera in Haiti, national authorities through the Ministry of Public Health and Population (MSPP), reported as of 2 October 2022, two confirmed cases of Vibrio cholerae 01 in the greater Port-au-Prince area and in the commune of Cité Soleil. During Epidemiological Week (ER) 39 of 2022, health facilities in certain areas of Port-au-Prince and Cité Soleil communes reported an increase in cases of severe acute diarrhea among hospitalized patients, including children and adults. More than 20 suspected cases of cholera, including 7 fatal cases, preceding these areas have been detected by health personnel.
As of 28 February 2023, more than 33,661 suspect cases had been reported by the Ministry of Public Health (MSPP), with 2,439 confirmed cases and 594 deaths. Suspected cholera cases that were initially concentrated in certain areas of the capital are now 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 56 percent of reported suspected cases are male and 44 percent female. The age groups 1-4 years old (20 percent) and 5 -9 (16 percent) are the most affected among the confirmed cases, followed by the group 20-29 (14 percent). 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.
Considering the magnitude and wide spread of the cholera epidemic ongoing in Haiti, in conjunction with the complex humanitarian crisis the country is currently facing, the limited resources to control the epidemic, as well as the constant migratory flow towards the Dominican Republic, PAHO assessed the risk of spread across Hispaniola as remarkably high. The situation is being closely monitored by PAHO, also supporting the government of the Dominican Republic with an awareness and vaccination campaign against cholera to contain the number of cases. Since October, the Dominican Republic has registered 88 cases, including 71 in the capital Santo Domingo area and none have died from the disease
The earthquake and the resurgence of cholera in the country are crises within a global crisis, as Haiti continues to experience high levels of social, economic, and public health crises that add to the initial dire situation of those affected and constitute a challenging humanitarian environment to provide services. Over the past months, gang violence has reached new heights and grounds, with everyone and institutions a potential target for attacks, kidnapping and murders. Extreme violence and gross human rights violations, including mass incidents of murder, gang rapes and sniper attacks, have increased sharply. The United Nations Office on Drugs reports alarming figures on Haiti’s criminal markets and crimes.
The number of gangs in Haiti is estimated between 150 to 200, with about half of them in Port-au-Prince (PAP) controlling approximately 60 percent of the metropolitan area in 2022. There are now sources indicating that since 2023, 100 percent of Port-au-Prince would be controlled by gangs. Gangs use commercial terrorism, sexual violence, massacres, extortion, and kidnappings daily to accumulate power and fund their operations. According to the UN, the country is well endowed and increasingly supplied with trafficked firearms and ammunition and remains a transshipment country for drugs. Kidnappings for ransom are now a constant with, among others, medical personnel and students kidnapped for ransom from their institutions.
Gang rivalries have proliferated beyond the PAP (Port-au-Prince) area, extending their reach to other parts of the country, encompassing both urban and rural regions, as they vie for control over territories and economic resources. These conflicts have resulted in significant population displacements, with people fleeing violence in threatened areas. For instance, in the Artibonite and Centre departments alone, over 3,000 individuals have been forced to relocate since February. The encroachment of criminal gangs has also posed a serious threat to agricultural production. In the metropolitan area of Port-au-Prince, as reported by the IOM (DTM: Displacement Tracking Matrix), over 155,100 individuals are in situation of displacement mainly due to urban violence, marking a staggering 77 percent increase from August 2022.
Urban gang violence continues to have an impact outside of Port-au-Prince, presenting operational challenges for humanitarian actors as well as security issues that result in access restrictions along the main land route in the South. The humanitarian corridor that allows vital supplies to reach the South after the earthquake remains disrupted due to continued gang violence and the overstretched capacity of the Haitian National police. The transport of supplies and materials is also severely hampered by the continued shortage of supplies (most of which are stuck at the port) and fuel across the country (caused by the blockade of the port of Port-au-Prince) causing delays and high operational costs of service providers. There has also been a notable increase in acts of violence against humanitarians and the structures they have put in place to support populations; and against the populations themselves in search of support.
On 3 March, the HRCS, the ICRC and the IFRC in a joint Press Release, made an urgent call for the protection of the medical mission, humanitarian access and respect for the Red Cross emblem. Over the last two years, the protracted crisis has led many humanitarian organizations to cease their activities, to repatriate part of their staff, and/or to reconsider the scale of their programs.
In the same vein, faced with intolerable risks and unable to guarantee the safety of its patients and staff, Doctors without Borders (MSF), which manages CTC and intervenes in hospitals, has twice had to suspend its activities in some areas since January, because of major incidents, which had never happened in the past for this institution. MSF has publicly appealed for the protection and respect for the protection and respect of medical activities, emphasizing the need for staff to be able to safely resume their critical work and continue providing essential care for the population.
According to WFP’s Haiti information booklet, the latest Integrated Food Security Phase Classification (IPC) covering September 2022 to February 2023, remains alarming and highlights that almost half the population in Haiti, or 4.7 million people are acutely food insecure (IPC 3+). Close to 1.8 million are now in Emergency phase (IPC 4), an increase of half a million since the previous analysis, and 19,200 people are facing catastrophic hunger (ICP 5), a first in Haiti and in the Latin America and the Caribbean region. Food security trends show a steady deterioration of the food security situation since 2016.
At the economic level, the Governor of the Central Bank of Haiti, declared that the country was in economic depression after several years of negative growth and inflation reaching 47.2 percent in October 2022. This situation leads to a significant increase in prices of necessities including foodstuffs.
In a press release issued in January, UNICEF raised concerns that amid growing armed violence in Haiti, at least 2.6 million children are expected to need immediate life-saving assistance in 2023; and 1 out of 2 children will depend on Humanitarian assistance to survive. The current crisis in Haiti affects children's right to protection and education. Most schools in Haiti were closed for seven months last year and only began to gradually reopen in October 2022. Trends in 2023 are showing that many schools are now closing under threats of ransoms and ambient insecurity.
On a more global perspective, the UN and its partners issued a press release on 18 March 2023 urgently calling for increased access and resources to reach those in desperate need. The Chief of the Humanitarian Field Support Section of UNICEF said: “The degradation of the humanitarian needs in Haiti is unprecedented. The suffering of a Haitian child today is not comparable to the suffering of a Haitian child a few years ago. As humanitarians, we are finding ways to reach those in need including in gang-controlled areas. For that to happen in a sustainable way, we also need the donor community to not give up on Haiti."