The Haiti crisis: health risks
Context
The intensifying socio-political crisis in Haiti is having a negative impact
on the health of the Haitian population. Haiti has the highest infant and maternal
mortality, the worst malnutrition and the worst AIDS situation in the Americas.
The general mortality rate was 1057 per 100,000 population during the 1995-2000
period, also the highest in the Americas. A quarter of the children suffer from
chronic malnutrition, 3 to 6% of acute malnutrition. About 15% of newborns have
a low birth weight. Acute respiratory infections and diarrheas cause half of
the deaths in children under 5 years of age. There are complications in a quarter
of the deliveries. The coverage of services is very low: 40% of the population
has no real access to basic health care, 76% of deliveries are made by non-qualified
personnel, more than half of the population has no access to drugs, and only
half of the children are vaccinated.
The current intensification of the crisis is accompanied by an increase of
the violence, particularly during confrontations between opposing gangs. The
international press has reported approximately 70 deaths since the beginning
of the crisis. However, the humanitarian situation evolves according to the
local situation. Insecurity is highest in Artibonite and Centre, but all the
departments (regions) are affected by the crisis, and often isolated by roadblocks
from the capital and its supply centers. There are demonstrations, occasionally
violent, in the capital.
To face this complex crisis and to respond to its mandate of defense of the
public’s health, the PAHO/WHO Representation initiated a dialogue between
the main partners in health in the country, in coordination with the United
Nations system, the country’s health authorities, the bi- and multi-lateral
cooperation agencies and Non-Governmental Organizations.
A Health Sector Emergency Cell was established to ensure the best possible
cohesion in the definition, planning, management and execution of the actions
to face this crisis.
Critical elements for the health sector
1. Disregard for the health institutions’ neutrality and immunity
Several hospitals were the target of violence. Patients were assaulted in some
institutions and the staff providing care is worried about exercising their
duties safely. In some health institutions, the staff does not report for work
on the day of demonstrations. Some of the patients in need of emergency care
do not go to hospitals anymore for fear of violence. The Port-au-Prince University
Hospital, one of the main hospitals in the country, has been almost at a standstill
for weeks, for lack of personnel.
2. Supply difficulties in health institutions
It is increasingly difficult to supply hospitals with drugs, medical surgical
consumables, water, propane gas, and diesel. Stocks of drugs are not renewed
in peripheral warehouses located in zones of difficult access. As a result,
emergency care and other essential services are not guaranteed.
3. Precariousness of the access to care
Certain hospitals strongly decreased their activities due to the lack of equipment
and human resources. Most of those remaining operational are private institutions
with limited access for the financially needy. Emergency care has also become
the privilege of private institutions and access for the poorest is compromised.
It has been reported that in some areas, home care has replaced hospitalization
for those avoiding hospitals. Problems for routing the injured and sick patients
to hospitals are becoming more acute, particularly in the department of Artibonite
due to the lack of ambulances.
4. Risk of a destabilization of the already weak health care system
Difficulties of access to certain zones complicate or impede vaccination activities.
These pockets of non-vaccination may affect national vaccination efforts and
heighten the risk of a recrudescence of outbreaks of vaccine-preventable diseases.
There has not been any notified case of measles or polio for two years and this
absence of cases could be threatened by an interruption of vaccinations.
Certain blood transfusion centers set up in different areas of the country
had to stop their activities, in particular in the zones of highest tensions
where they are most needed.
The national programs for tuberculosis and HIV/AIDS have reported difficulties
in the follow-up of patients and fear an acceleration of drug resistance in
the long run. In Artibonite, a group of patients receiving anti-retroviral drugs
had to suspend their treatment due to a lack of access to the supplying institutions.
5. Increase of emergencies linked to violence
The care of the injured saturates the existing capacity of emergency services.
There have been reports of cases of unattended obstetrical emergencies. On the
other hand, some institutions suspect an increase in the incidence of rape.
Most of the victims are not informed about the measures to take in those circumstances
and do not have access to preventive treatments.
6. Focalization of the media on the crisis
The mass media report almost exclusively on the political information and assign
very little space to the other categories of information. Health messages in
support of disease prevention and control programs have become much less apparent.
This is a problem since prevention seems to loosen in times of crisis and the
media coverage of these issues should be accentuated.
7. Deterioration of the potable water installations
Most hospitals are old, badly maintained buildings with decrepit water installations.
Hydraulic pumps are often out of order for lack of electricity. The cities most
affected by the violence, Gonaives and Cap Haitien, are supplied water through
an electrical pumping system, and those two cities have been out of electricity
for several weeks. The water distributed by the public institutions is only
chlorinated in Port-au-Prince.
8. Lack of precise information
The health effects of the crisis are not documented properly due to a failing
routine health information system and difficulties of access to zones most exposed
to the violence. This lack of information is a major obstacle to the elaboration
of a reponse adapted to the needs arising from the crisis.
9. Necessity of a coordination of interventions
The sudden rise of a multiplicity of speakers to face the emergency situation
requires a coordination and follow-up mechanism in the health sector.
For more information on the situation in Haiti, see: http://www.paho.org/English/DD/PED/haitisituation2004.htm.
Contact at PAHO: haiti@paho.org.
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