World Report
Haiti’s health woes intensify
Assassination, after months of violence, fuel shortages, and protests, has led to instability in Haiti,
causing interruptions to normal care and the COVID-19 response. Joe Parkin Daniels reports.
When Haiti’s president, Jovenel Moïse,
was assassinated in his home outside
the capital, Port-au-Prince, in the early
hours of July 7, 2021, the country was
already in crisis. Gang violence, fuel
shortages, and street protests had been
intensifying for more than a year in
much of Haiti, the western hemisphere’s
poorest nation. Not a single dose of
any vaccine against COVID-19 had
been administered when allegedly
Colombian mercenaries rained down
gunfire on Moïse. Natural disasters
and political turmoil regularly rattle
Haiti, and medical workers say that the
current instability has only exacerbated
long-existing health challenges.
Widespread gang violence, often
politically motivated, continues to
roil Port-au-Prince and other cities,
with sporadic roadblocks of rubble
and burning tyres, complicating the
movement of health professionals and
patients alike. National pro­grammes
to prevent and treat HIV/AIDS,
tuberculosis, and malaria have been
interrupted, and ambulances are often
stuck in blockades.
Non-governmental organisations
(NGOs)—which often make up
the shortfall of the underfunded
health ministry—are struggling to
operate. Doctors Without Borders
(MSF) announced on Aug 2 that it
had permanently closed its clinic in
Martissant neighbourhood in the
capital amid shootouts between
rival gangs. The hospital offered
free medical care to 300 000 people,
and had been hit by stray bullets in
early June. “MSF continues to call on
armed actors in Haiti to respect the
safety of health personnel, patients,
equipment and medical facilities”, the
NGO said in a statement following
the announcement of the hospital
closure. “Vehicles and ambulances
must also be able to circulate safely”.
www.thelancet.com Vol 398 August 14, 2021
Another NGO, Partners In Health—
which operates primarily across Haiti’s
remote and impoverished Central
Plateau and Artibonite regions—also
expressed concern about how freely
its workers can circulate. “We are
very worried about the situation”,
Kenia Vissieres, a physician working
“Doctors Without Borders
announced on Aug 2 that it had
permanently closed its clinic in
Martissant…The hospital
offered free medical care to
300 000 people...”
with Partners In Health, told The Lancet.
Vissieres added that the security crisis
has compounded the problems caused
by Haiti’s crumbling or non-existent
health infrastructure. “The general
hospital, which is Port-au-Prince’s
primary health-care facility, is still
under construction, and rural centres
are not fit to receive many patients.
Facilities across the country must be
renovated as they are the basis of a
strong national health-care system.”
GHESKIO—another health centre
near Martissant originally founded
to tackle Haiti’s HIV/AIDS epidemic—
remains open but has seen daily
patient visits decrease from 2134 in
2019, to 1535 today, amid fears of
being caught in escalating violence,
according to workers there. Health
professionals now carry out visits into
nearby slums to administer health care
rather than have patients make risky
journeys.
On July 14, 1 week after Moïse’s
assassination, Haiti received its
first batch of 500 000 COVID-19
vaccines from the USA via the COVAX
programme. Although COVID-19 has
troubled Haiti, where sanitation and
infection prevention measures are
difficult to implement, fewer than
600 deaths have been reported. This
situation could change, however,
as new strains reach the country.
Since May, a third wave driven by
the Gamma variant has caused more
deaths than the previous two waves
combined.
The vaccination campaign con­tinues,
although it faces acute challenges,
including safe transport within the
country, keeping vaccines refrigerated
amid rolling power outages, as well as
convincing people to get inoculated.
Preliminary results of a UNICEF-
supported study carried out in June by
the University of Haiti found that only
22% of Haitians would get vaccinated.
Jean William Pape, director of
GHESKIO and professor of medicine
at Weill Cornell Medical College, said
that one reason for vaccine hesitancy
is that many vulnerable people do not
recognise the severity of COVID-19.
“For AIDS and cholera epidemics,
it was different; they saw people
dying around them—their parents and
friends—but this is not the case for the
COVID-19 pandemic”, Pape said. “In
a recent survey carried out by Safitek,
85% of people did not know anyone
who had COVID-19”.
Health workers are at least able
to celebrate the near eradication of
cholera. According to the country’s
Ministry of Public Health and
Population, 819 000 people showed
symptoms of the disease from
October, 2010, to December, 2019,
initially brought to the country by aid
workers following the catastrophic
earthquake in January, 2010. “We’re
happy to report that with the addition
of contact tracing and interventions,
and WASH [water, sanitation, and
hygiene] we have had not a single
cholera case in 2 years”, Pape said.
Joe Parkin Daniels
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