The population of 11.3 million has access to 64 ventilators and somewhere between 30 and 123 ICU beds, some malfunctioning. Experts warn that many hundreds of thousands may die from Coronavirus.
By Jeb Sprague and Nazaire St. Fort
Haitian President Jovenel Moïse announced on March 19 that two individuals in Haiti had tested positive for Covid-19 (Coronavirus). The government has closed Haiti’s border, ports, and airports to the movement of people but kept supply chains open. Only a small number of tests have been administered, and there are rising fears that a health catastrophe will unfold over the coming weeks and months.
News and commentaries inside the country spread quickly over WhatsApp and local media. Under mounting stress many know they are not ready for this pandemic that has also arrived in other Caribbean countries, such as the neighboring Dominican Republic.
The latest reports indicate that 859 people have tested positive in the Dominican Republic, with 39 deaths. One of the country’s main hospitals, in the second largest city, Santiago de los Caballeros, reportedly no longer has beds available.
Many families in Haiti have relatives residing in the Dominican Republic and receive updates regularly. The virus appears to have initially been brought to Haiti through Toussaint Louverture International Airport in Port-au-Prince. Since the first two cases, the official number has risen to 15 (March 30), although that figure is surely an undercount. Dozens have been placed into quarantine.
Haiti now faces a looming pandemic with an almost non-existent public healthcare system, whose dysfunction has deep historical roots.
The Caribbean region has gone through four centuries of slavery and colonialism and a fifth century of economic dependence. Accelerating globalization and technological developments have brought profound change to the region over the past 20 years, including no-cost digital communications, hi-tech remittance networks, low-cost mass travel and tourism, and new banking and financial arrangements. But it has also brought soaring inequality and climate shocks, principally stronger hurricanes and rising sea-levels.
Globalization and automation have caused billions of people to be cast into capitalism’s “surplus population”. Under this system’s relentless logic, vast portions of the world’s people, even entire countries like Haiti, are condemned to rampant crime, unemployment, and inflation, alongside disintegrating infrastructure and government services. It sinks destructively into the social fabric of society.
To preserve “social order” and “good governance,” Western institutions resort to severe austerity measures and military intervention, further debilitating the neo-colony whose economic life-blood is being sucked out to enrich the transnational bourgeoisie.
This is how Haiti has become a nation which today is completely unprepared for the Coronavirus pandemic.
Unemployment is already sky-high. With six million of Haiti’s 11 million citizens living below the poverty line of $2.41 a day, according to the World Bank, most will face a grueling dilemma of how to feed themselves and their families while avoiding virus infection.
Dr. John A. Carroll, who has worked in clinics, hospitals, and orphanages in Haiti since 1995, has written that:
“…there is no treatment in Haiti that will be accessible by the masses. But there is quarantine to stop transmission. But how do we isolate people in the Haitian slum where the population density is so high and people need to have human contact in order to survive?…the breadwinners in the house need to score some bread because they all need to eat. And this family’s neighbors next door don’t have the time or abilities to help out because they have equally severe challenges surviving the slum also.”
This is the reality that the earth’s poorest and most marginalized face as the virus spreads. They don’t have the option to stay inside. Many have little or no savings or stocks of food and often live in cramped, overcrowded neighborhoods.
▶️Haiti has confirmed its first two cases of COVID-19, and the president declared a state of emergency, Thursday.
— The Voice of America (@VOANews) March 20, 2020
While the Haitian government is officially promoting confinement and social distancing, the stark reality is that most of the population are likely heading toward collective (or so-called “herd”) immunity, where many will die infected in the street but not by hunger at home. Some, like Dr. Carroll, think that this steep, as opposed to flattened, infection curve may result in fewer deaths.
Building “herd immunity” is an approach that the UK government actually suggested for its own people weeks ago but quickly rejected as a result of a fierce public backlash. Instead, the British state has imposed “social distancing” measures and (despite a right wing government being in office) committed to pay the majority of the payroll costs of businesses whose workers stay home.
On March 29, local media experts interviewed on Radio Kiskeya, one of the country’s most important radio stations, suggested that in a worst case scenario up to 800,000 Haitians could perish from the virus in a worst case scenario.
The Grayzone spoke with Dr. Ernst Noël, of the Faculty of Medicine and Pharmacy (FMP) in Port-au-Prince, who stated that the claims on Kiskeya were not an exaggeration, and that many hundreds of thousands could die. In his view, many people will likely perish due to Coronavirus, and it is possible in larger numbers than those that were lost in the 2010 earthquake.
He added that large-scale foreign investment and monumental local efforts would need to be undertaken to soften the blow of the oncoming pandemic.
However a Haitian government official Patrick Dely, head of the Department of Epidemiology, Laboratory and Research of Haiti’s Ministry of Public Health has suggested that deaths could reach 20,000 and with up to 3 million getting the Coronavirus disease.
Struggling on the edge of a meltdown
It is an understatement to say that Haiti’s health-care system is ill-prepared for the looming catastrophe.
According to Haiti’s National Institute of Statistics, the country has only 911 doctors. A mere 4.4% of the national budget is allocated for national health, which translates to ill-equipped hospitals with woefully insufficient unpaid or underpaid staff. State-run hospitals often face labor strikes, and some medical staff appear not to be showing up to work, as they are lacking masks, gloves, and gowns and fear contracting the virus.
Haiti's government has steadily reduced national health spending in recent years. In the last approved budget, more funds were allocated to parliament than toward the health sector. https://t.co/pYrHrdhsUs pic.twitter.com/nQwUS1VLop
— Jake Johnston (@JakobJohnston) March 27, 2020
According to Haiti’s most read newspaper, Le Nouvelliste, the country has only 130 ICU beds (but most of these are older models). Dr. Paul Farmer, a co-founder of the Boston-based health care organization Partners in Health, has suggested the country may actually have less than 30 fully functioning ICU beds.
Meanwhile there are an estimated 64 ventilators inside the country, though some are likely not working.
Dr. Farmer has pointed out how people living in the Global South face significantly more risk due to underdeveloped healthcare infrastructure:
…in affluent economies, doctors don’t have to go to the hospital and say, is there going to be electricity today, or will the oxygen concentrators work? …All these mechanics of a hospital, we [in affluent nations] don’t have to deal with them. The oxygen is piped right into every room. But the dread of responsibility for my coworkers in Haiti is that they have to worry: Where do we get the oxygen, the IV solutions, can we space the beds for intensive or supportive care in a way that doesn’t infect the caregivers? And we’ve exhausted a lot of supplies as health-care workers are more attentive to putting on gloves, changing gloves, gowning up. We’re seeing real supply chain challenges.”
Last week, doctors (both interns and residents) assigned to the State University of Haiti (HUEH), the country’s biggest medical facility, reportedly barely escaped from a suspected Covid-19 outbreak. They had not received personal protection equipment nor the test kits prescribed for testing Covid-19 patients. Even running water is lacking in some medical facilities.
#Haiti has less than 130 ICU beds for a population of more than 10 million. A fast moving #Covid-19 and a crumbling medical infrastructure are recipes for disaster. #coronavirus pic.twitter.com/RquC8yNHlb
— Etant Dupain (@gaetantguevara) March 20, 2020
We spoke with Dr. Ulysse Samuel, currently appointed to an external HUEH clinic receiving outpatients. He explained that before the Covid-19 pandemic he had “never seen ventilators at the HUEH facility,” and now, as a wave of Covid-19 cases threatens to swamp the hospital, ”I have no idea if there are any.”
As Dr. Carroll warns, “Haiti does not have a functional health care system on a good day let alone a system that can effectively fight this virus.”
After years of foreign intervention and neoliberal structural adjustment, Haiti has increasingly been forced into a desperate situation and has no choice but to rely on international funds during periods of catastrophe.
As of 2013, 64 percent of Haiti’s health budget was derived from international assistance, according to Dr. Georges Dubuche of the country’s Ministry of Public Health and Population. The percentage has remained high.
The Inter-American Development Bank (IDB) has thus far committed $50 million to the Coronavirus response. The IMF is also apparently considering an unprecedented influx of reserve assets for developing countries. Haiti is also one of 50 desperate countries that will have split between them some part of a $2 billion UN plan recently launched, which will take time though to materialize.
U.S.-blockaded Cuba, whose medical teams have been heavily active in Haiti since 1998, last week sent a brigade of 348 doctors and other health specialists to help fight the Coronavirus.
Au nom du Président de la République, S.E.M @moisejovenel, et du peuple haïtien, je remercie le gouvernement et le peuple cubains pour le déploiement d'une brigade médicale de 348 médecins et infirmiers en Haïti dans le cadre de la lutte contre le Conavirus. pic.twitter.com/SowsrKK7q5
— Claude Joseph (@claudejoseph03) March 25, 2020
As the virus hits countries worldwide, it is unlikely foreign governments will be able to marshall the Herculean support that Haiti needs. Haiti spends just $13 per capita on healthcare, compared to $180 by the Dominican Republic, and $781 in Cuba.
Some important private and donor-backed medical clinics do exist, such as the Partners in Health (PIH)-run hospital in Mirebalais. It is apparently one of the first major medical institutions that has been proactively testing for Covid-19. A variety of NGOs and smaller health-oriented groups have scrambled to prepare and educate people about the pandemic. It is going to take a lot of courage, on the part of Haiti’s doctors and healthcare specialists, standing together, to face this.
— Zanmi_Lasante (@ZanmiLasanteht) March 26, 2020
At UniFA (The University of the Aristide Foundation) in Tabarre, a Port-au-Prince suburb, the medical school has just begun to graduate students who are required to practice inside the country. In March, the University graduated its first 138 students. Among its faculty have been teachers from Cuba.
As its website explains, the
“medical school graduates are currently fulfilling their one-year government mandated social service residency in health care centers across the country. In many instances, these young professionals are the only health care providers for the entire community.”
#Haiti's health system is ill-prepared for COVID-19 outbreak due to corruption of current US-backed govt. The doctors & nurses of UNIFA stand ready to fill the gap and serve the Haitian people. https://t.co/3iPI4IghGF pic.twitter.com/IWK9k76gKw
— HaitiInfoProj (@HaitiInfoProj) March 21, 2020
Factories in Port-au-Prince were closed on March 20th. Most were assembling clothes and electronics for export. A few factories may soon be overhauled to produce things like surgical masks. For common people seeking to take precautions, one surgical mask costs approximately 50 Gourdes (about $0.53) but these are very hard to find.
Some business groups active in Haiti are beginning to prepare, including an association of Chinese enterprises.
2nd Shipment of the medical supplies (including 138000 masks) hv departed from China,donated by Association of Chinese Enterprises in Haiti. pic.twitter.com/lUTjmzkBCI
— 陳文(Chen Wen) (@ChenWen007) March 30, 2020
Responses and the difficulties ahead
Will the quarantine ordered by the Moïse government be mostly grand-standing? As of now it is in large part not being enforced, and it’s not clear if it even can be, given people’s day-to-day struggle for survival. Haiti’s state has put forward a preparation and response plan with an estimated $37.2 million budget, but it’s unclear how effective it can be. Local and international organizations have been meeting to coordinate a response, and government officials say they’ve made a large order for medical materials from China.
#Haiti's govt has forsaken its responsibility to its people. This just yesterday in downtown Port au Prince. Does this look like social distancing? If #COVID19 takes hold there is NO medical infrastructure to contain it. pic.twitter.com/VKZaTEbp3h
— HaitiInfoProj (@HaitiInfoProj) March 29, 2020
One street vendor woman (known as a “Ti Marchan”) said in an interview with Haiti’s Island TV that the present confinement is intolerable. Needing to earn money to feed up to eight family members, she exclaimed that she would rather be infected with the virus than not work, since her sole daily livelihood was now being taken away.
Many are asking if the government will be able to secure basic food staples to feed the majority of the population, as large parts of the population live on just a few dollars a day or less and are now being pressured to isolate themselves and not work. The government has announced food distribution measures for some districts, and this comes as the prices of some basic food staples has increased in recent months and the currency has rapidly depreciated.
To compound the problem, under the Moïse government, the country’s National Office of Old Age Insurance (ONA) has been grievously mismanaged. Funds for the elderly have been delayed or cut, further endangering those most at risk from Coronavirus.
Confusion reigns. Some have criticized recent moves by the government to push thousands of people to line up for National ID/voting cards, after officials declared the cards will be required to receive aid during the pandemic.
A large part of the Haitian population is clearly aware of the real dangers posed by the Coronavirus, but, at the same time, many confess they have no choice but to gain their daily livelihoods through the usual improvised and informal activities in the small scale economy. The overwhelming majority of these workers are forced to take very crowded public transportation to their workplaces.
The eastern side of the island
By comparison, in the nearby Dominican Republic, state officials have announced on national television that the nation’s poorest sectors will receive financial aid for food purchases via the government’s “solidarity debit cards.” They will start receiving an increase of 5,000 Pesos (about US$92) monthly, starting on April 1 and running through the end of May. The Dominican Republic though has become one of the largest locations for Foreign Direct Investment (FDI) in the Caribbean and among the region’s top tourist hotspots, so the government has many more resources to deal with such a crisis.
The first cases of Coronavirus in the Dominican Republic were officially acknowledged by its Health Ministry in late February. The Dominican government meanwhile has begun to take drastic measures such as a suspension of flights from Europe, a 5 PM to 6 AM curfew, which as of this writing is being contemplated to be extended to a draconian 24-hour curfew, but with exceptions for grocery shopping, buying prescriptions, etc.
Haiti is the Dominican Republic’s number-two export market after the U.S. and is heavily dependent upon Dominican exports for basic food staples such as rice, as well as manufactured consumer items, thus anything that impacts on Dominican Republic eventually affects life in Haiti. A number of Haitian migrant workers appear to have fled back home to be with family. Others, whose economic survival depends on it, have no choice but to find illicit ways to cross back and forth across the border.
Desperate times, desperate measures.
After #Haiti closed the border with the Dominican Republic, people crossed the river to buy and sell.
— Madame Boukman – Justice 4 Haiti 🇭🇹 (@madanboukman) March 17, 2020
Meanwhile, a kidnapping wave has traumatized people in Haiti, even affecting the transportation sector bringing in goods from the Dominican Republic. Last week, kidnappers abducted, on his way to work, Dr. Jerry Bitar, who co-runs the Bernard Mevs Hospital with his twin brother (also a doctor). Hospital workers went on strike, and Bitar was released shortly thereafter.
Multiple crises at once
The situation is made more difficult by the ongoing political crisis. Moïse now governs without parliament after failing to hold elections and had been facing a mass uprising threatening to chase him from office. Strong diplomatic support from the U.S. has been the lynchpin allowing his tenuous political survival.
The coronavirus though has put a pause on the giant anti-government protests that occurred throughout late-2019 and into early 2020. Yet these will undoubtedly return (as in many other countries around the world) given how the inhuman essence of capitalism (in Haiti and elsewhere) has been thrown into sharp relief by the crisis.
So far in the 21st century, Haitians have experienced one ordeal after another. Estimates as to the deaths from the January 12, 2010 earthquake range from the tens of thousands to upwards of one hundred and sixty thousand people, while many more were wounded and up to a million were displaced, tragedies from which the country has yet to fully recover. Some survivors to this day remain living in tent cities.
Haiti also survived a cholera outbreak which killed close to 10,000 and sickened over 800,000. UN occupation troops were found to have caused the epidemic through their negligence, and a campaign demanding reparations from the UN continues.
The country has also suffered several devastating hurricanes, such as Hurricane Matthew in 2017, which extensively ravaged Haiti’s southern peninsula, wiping out crops and coastal towns.
Man-made disaster redux
While leaders across the country’s political spectrum are now requesting the population to self-quarantine and take precautions, the country has also had its share of man-made crises that need to be understood.
First, there were the 1991 and 2004 coup d’états, both of which sought to roll-back popular gains made after historic turnouts at the polls. Then in the 2010-2011 elections, Washington intervened using the Organization of American States (OAS) to effectively change the electoral results and install Michel “Sweet Micky” Martelly, thereby ushering in a decade of rightwing regimes.
Martelly’s successor, Moïse, appears to have pocketed millions of dollars stolen from funds meant to help build up the country through Venezuela’s PetroCaribe program. Funds from PetroCaribe have been used by many Caribbean states to plug budget shortfalls and invest in important infrastructure. Moïse is officially mentioned 69 times in the recent corruption report produced by the State Administrative Court and is considered one of the principal beneficiaries – both politically and financially – of the Petrocaribe funds corruption scheme.
Responding to protests, the government and its allies have also turned to violent repression against popular neighborhoods where anti-government sentiments run high.
US-backed Haitian government agents accused of conducting massacre
— The Canary US (@TheCanaryUS) December 20, 2018
Instead of investing in healthcare, the government has increasingly sought to strengthen its repressive capabilities.
With the support of planners at the Inter-American Defense Board, the Moïse government has begun rebuilding the military (which had been disbanded in 1995 after taking part in numerous coups, massacres, and campaigns of repression).
As Jake Johnson of the Center for Economic and Policy Research (CEPR) has written, “The Inter-American Defense Board, a body of the OAS, developed a ‘white paper’ in July [of 2015] focused on reinstating a Haitian defense force with the support of the UN.” By 2018 Haiti’s new army had six personnel being trained at the U.S. military’s School of the Americas (SOA) (renamed the Western Hemisphere Institute for Security Cooperation or WHINSEC).
The fundamental purpose of the country’s military, most loyal to the country’s rightwing, has long been for purposes of internal repression.
In recent days the Haitian government has put out on WhatsApp networks a snappily-produced public relations video that includes Haitian soldiers distributing bags of rice to the doors of people’s ramshackle homes.
Yet in February 2020 the newly reconstituted military (the so-called “defense force”) engaged in a deadly clash with police officers in Port-au-Prince. Hundreds of police were involved in a labor dispute with the government.
Battered by years of man-made and natural disasters, Haiti faces another historical ordeal with few resources to confront it. Systematically looted for years, Haiti now sits on the precipice of another major disaster of which the poor majority, sidelined and repressed, will again bear the brunt: Covid-19.
Nazaire St. Fort is a graduate of the State University of Haiti’s Faculty of Agronomy and Veterinary Medicine (FAMV). He has been the country director for the University of California Haiti Initiative and has helped to complete a human rights report for the UN Office of the High Commissioner for Human Rights. He has also developed a dairy cooperative in the South Department of Haiti, and has worked with, among others, Swiss TV, BBC radio, CVS national television, Al Jazeera, and has co-authored articles on Haiti for the Inter Press Service (IPS) and other outlets.
Jeb Sprague is a Research Associate at the University of California, Riverside and previously taught at UVA and UCSB. He is the author of “Globalizing the Caribbean: Political economy, social change, and the transnational capitalist class” (Temple University Press, 2019), “Paramilitarism and the assault on democracy in Haiti” (Monthly Review Press, 2012), and is the editor of “Globalization and transnational capitalism in Asia and Oceania” (Routledge, 2016). He is a co-founder of the Network for the Critical Studies of Global Capitalism. Visit his blog at: http://jebsprague.blogspot.com