In Haiti, Conflict, Displacement, and Health Challenges Converge

Health providers, data experts and community leaders convened last week to outline some of the health challenges in Haiti, compounded by gang violence, food insecurity and mass displacement.

The event was moderated by Andrew Schroeder, co-founder of CrisisReady and Vice President of Research and Analysis for Direct Relief. CrisisReady, a research-response initiative at Harvard and Direct Relief, has been tracking trends in Haiti, where Schroeder said the current situation is the most dire since the 2010 earthquake, with violent attacks on hospitals, police stations, and financial institutions becoming increasingly commonplace, along with widespread food insecurity. Nearly 5 million Haitians are experiencing acute food insecurity, according to the United Nations.

"It's impacted every area of society and caused a mass displacement event," he said.

Dr. Natalie Colas, Internist and Medical Director at St. Luke Family Hospital in Port-au-Prince, described challenges at every level of the health system in Haiti, from health providers leaving the island to patients putting off coming to the hospital to existing staff being unable to get to work due to kidnapping risk.

St. Luke Foundation operates 10 health facilities, about half of which are in the capital. The organization has taken safety measures for employees, including allowing them to stay at a guest house for up to a week if demonstrations prevent them from getting home safely.

When able, health providers will give patients a three-month supply of prescription medication instead of monthly to limit trips that could put them at risk of gang violence, she said. But supplies and medications are scarce.

"Without an immediate option to refill them in the coming days, I don't know what we're going to do… It's really difficult for us to run the hospital," she said. "For now, we have a little bit of reserve for emergency patients."

Only two or three public hospitals in the metro area remain open, she said.

St. Luke's has oxygen production capability, an asset that allows them to continue treating patients with respiratory needs without having to make dangerous trips outside the facility to fill up oxygen canisters. Direct Relief supported the facility with oxygen canisters during the Covid-19 pandemic, and recently supported the hospital with emergency operating funds.

A noticeable spike in gang-related violence and fatalities has occurred in the country since the 2021 assassination of President Jovenel Moise, said Sandra Pellegrini, Latin America and Caribbean Regional Specialist with the Armed Conflict Location and Event Data, or ACLED. The nonprofit has been tracking news events in the country to identify trends.

Pellegrini said that civilians are bearing the brunt of the violence of armed groups and increased use of kidnapping and sexual violence, which is underreported but still "striking" in the data set.

The number of active gangs has also increased in recent years, and violence has expanded beyond the capital into the Artibonite and Centre regions, where violence has doubled. Gangs have focused on taking control of major highways and sea access with interceptions of supply boats.

Xavier Vollenweider, Director of Mobile Data Partnerships with Flowminder.org, a platform that has processed mobile data from cell provider Digicel, the main cell provider in Haiti, and has been monitoring population movement. Port au Prince has seen its population decrease since 2021, while cities like Cap Haitien and Les Cayes have increased. Large scale displacement

Marie Rose Romain Murphy, Co-Founder and Board President of the Haiti Community Foundation and ESPWA Inc., focused on humanitarian and disaster response. The International Office of Migration has been monitoring displacement, and more than 116,000 people have fled the capital for Haiti's southern peninsula, where Roman Murphy's foundation operates.

The destabilization and destruction of infrastructure have been decades in the making and compounded by natural disasters, she said. Romain Murphy encouraged keeping local communities and organizations at the table where decisions are being made instead of from a distance. "It starts with community and ends with community," she said

Direct Relief, which has a long history of supporting Haitian health facilities through crisis and natural disasters, recently committed $1 million to local health facilities to support operating expenses and staff costs.

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