A large majority of the Haitian population remains extremely vulnerable to a variety of health emergencies such as infectious diseases, a lack of access to emergency health care and a shortage of treatment and essential medicines for chronic conditions. Haiti ranked last on UNDP’s Human Development Index and is also one of the Region’s most disaster-prone countries.
The last two years have been especially difficult for Haiti. A political crisis brewed for months, culminating in the departure of the president in February 2004 and causing hundreds of deaths or serious injuries due to the ensuing civil unrest. In May 2004, heavy rains caused landslides and floods in Belle Anse and Fonds-Verrettes, affecting 30,000 and leaving a death toll close to 2,000. Several months later, tropical storm Jeanne destroyed the most fertile areas of the country and flooded the city of Gonaives, once again causing thousands of deaths and leaving many more homeless and injured. Despite these grim situations, health disaster programs continue.
Even before the May 2004 floods, work was underway to set up an epidemiological surveillance system, composed of 37 sentinel sites in five departments. Unfortunately, a lack of security in many areas of Haiti made it extremely difficult to collect data. Nonetheless, national authorities and NGOs, in collaboration with PAHO and thanks to international support, have been working to control communicable diseases by creating a simplified epidemiological surveillance system to specifically monitor risks linked to floods. Other activities included providing medicines, medical supplies and equipment; vector control activities; providing drinking water; training in mass casualty management and emergency procedures and logistical support.
According to the UN, the security situation in Haiti continued to deteriorate over the course of 2005, with widespread kidnappings and an increased level of violence in many residential areas of the capital during the first six months of the year. In the last three months of 2005, more than 200 kidnappings were reported to authorities, although the actual number might be much higher. Despite this, UN agencies continued to work in Haiti under a UN Phase 3 level of security, which severely restricted the movement of staff, particularly from the capital to the provinces, but also within the capital itself. Some areas of Port-au-Prince remained off limits to UN staff.
In this climate of uncertainty, PROMESS, the PAHO/WHO-managed project that acts as Haiti’s pharmacy for essential medicines, attempted to continue meeting one of the country’s greatest health needs. However, as it is located in one of the most dangerous parts of Port-au-Prince, Cité Militaire, PROMESS staff was directly affected by the violence in early 2005. Consequently, very few beneficiaries (including hospitals, health departments, international organizations and international NGOs) were able to obtain a regular and reliable supply of pharmaceuticals. A security escort and an armed vehicle from MINUSTAH, the United Nations Stabilization Mission in Haiti, were required just to get to the PROMESS warehouse.
PROMESS supports its operations from the cost-recovery sale of medical supplies and equipment; however, decreased activity translated into reduced operating income. Efforts to save what is, in effect, Haiti’s main pharmacy from theft and financial collapse proved insufficient under these difficult circumstances. In the end, the solution was to relocate the warehouse to a more secure site with the financial support of the European Union (ECHO).