Political Unrest and Public Health Crisis in Haiti
Photo via Reuters
SARA MEDINA: Heightened gang violence, unstable governance, and natural disasters have intensified the health crisis in Haiti, exacerbating inequalities in health care access amidst an ongoing cholera outbreak. Cost-effective, intersectoral interventions to improve health care services as well as water, sanitation, and hygiene must be prioritized in Haiti to avert the threat of an even greater public health crisis.
Formerly a French colony built off of slave-based sugar and coffee industries, Haiti was ruled by a succession of dictators following its independence in 1804, many of whom were ousted or assassinated in response to repression or human rights abuses. More recently, Haiti has been plagued by both political instability and devastating natural disasters. Particularly between 2017 and 2021, gang violence, human rights violations, and attacks on the press grew in intensity. President Jovenel Moïse, who took office in 2017 in the wake of a Category-4 hurricane, was assassinated in July 2021.
A main concern over the past year has been the rise of gangs, which have gained control of over 80% of Port-au-Prince, Haiti’s capital. The estimated 200 gangs operating in Haiti have consolidated into seven coalitions, most notably G9, a coalition of nine gangs in Port-au-Prince that have blockaded many of Haiti’s primary ports and fuel terminals. Haiti’s current political climate has been further complicated by the recent resignation of acting Prime Minister Ariel Henry and the creation of a transitional council.
Haiti’s chronic instability has cultivated a worsening humanitarian crisis due to a lack of adequate public goods and services. The United Nations estimates that food insecurity is affecting more than 4 million Hatians, while the blockades in Port-au-Prince have obstructed the distribution of humanitarian aid, including food and medical supplies.
Haiti’s health system is also suffering. The recent surge in instability, as well as poor conditions and salaries for healthcare workers, have accelerated the emigration of skilled health personnel from Haiti. The country’s health system is funded primarily by out-of-pocket payments and external aid. Most of this external aid is disease-specific and short-term, and thus unable to support sustainable improvements. Furthermore, only two out of five hospitals in Haiti are operational, for a population of nearly 12 million.
Haiti’s low functioning health system and widespread food insecurity are detrimental to maternal and child health. The country’s maternal mortality ratio (MMR) is 350 deaths per 100,000 live births as of 2021, the highest of any country in Latin America and the Caribbean, and four times higher than the average MMR in the region. The current unrest has also increased the prevalence of severe acute malnutrition (SAM) among children by 19%. SAM can quickly escalate into dangerous and potentially fatal complications, including hypothermia, dehydration, and infection.
The instability in Haiti had especially profound impacts during the COVID-19 vaccine rollout, causing a wide disparity in vaccination coverage. The latest available data suggests that only 1.4% of Haiti’s population has completed the primary vaccination schedule for COVID-19, compared to 69.5% in the United States.
Haiti’s political crisis has also exacerbated its ongoing cholera outbreak. Cholera is an acute diarrheal illness, which in severe cases (about 1 in 10) can result in dehydration and kidney failure. Without treatment, this can escalate into coma or death within hours. In October 2022, two cases in Haiti were confirmed. Because of G9’s blockade, only one-third of fuel supplies needed for cholera treatment centers could actually be used for their intended purpose. Coupled with the healthcare worker shortage, the outbreak could not be properly contained. As of Jan. 31, Haiti’s Ministry of Health reported 4,608 total confirmed cases, almost 80,000 suspected cases, and at least 1,000 deaths.
Cholera is transmitted via a fecal/oral route. This means that if feces from cholera patients contaminate food or water, the Vibrio cholerae bacteria can infect others. Though the number of reported new cholera cases in Haiti seems to be subsiding, access to sanitary conditions and potable water is still scarce. According to UNICEF, 45% of Haiti’s population has no access to basic drinking water, and 61% lack access to basic sanitation facilities. These gaps not only have the potential to further the cholera epidemic, but may also foster the resurgence of other infectious diseases.
Beyond its physical health impacts, Haiti’s vulnerability to natural disasters has furthered a mental health crisis stemming from the psychological distress of enduring these catastrophic events. A study of survivors of the 2010 Haiti earthquake found that loss of loved ones was the primary root of mental health concerns. Survivors who lost one or more family members were five times more likely to develop symptoms of anxiety and depression than those whose families remained intact. This had far-reaching effects, considering that the death toll of the earthquake was over 300,000.
The combination of mental illness, communicable disease, maternal mortality, child malnutrition, and more poses a grave threat to public health in Haiti. Foreign humanitarian aid must prioritize on-the-ground service and capitalize on global health cooperation among private and public organizations. For example, nations can work closely with Partners in Health, an existing healthcare NGO founded in Haiti with an effective community-based care model.
Assistance should also come through the training of skilled health personnel to increase health care accessibility within communities, as well as the sustainable improvement of water and sanitation systems. Without greater international intervention, the health of Haiti’s population will only decline further as instability continues.
Sara Medina is a freshman in the School of Health studying Global Health. She is from Southborough, Massachusetts. She is interested in the impact of world politics on population health.