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The Washington PostDemocracy Dies in Darkness

Twin epidemics in Haiti, violence and coronavirus, usher in ‘critical phase’ in wake of assassination

People walk through a street market in Port-au-Prince, Haiti, on June 5. (Joseph Odelyn/AP )

A lethal combination of street violence and coronavirus infections has ushered in a dark period for Haiti after decades of instability and misfortune. The assassination of President Jovenel Moïse early Wednesday injected further uncertainty into an already volatile security and health situation, aid groups say.

The killing of Haiti’s embattled president at his home by a group of gunmen followed months of escalating political instability and gang violence. Health and humanitarian organizations say the bloodshed has hamstrung efforts to combat a significant coronavirus outbreak in a country with weak health infrastructure and no access to coronavirus vaccines.

“This is creating a perfect storm because the population has lowered its guard, the infrastructure of COVID-19 beds has been reduced, the security situation could deteriorate even further and hurricane season has started,” read a statement by the Pan American Health Organization, sent by email Wednesday.

What to know about Haiti, where President Jovenel Moïse was just assassinated

Fighting between rival gangs and police in the capital, Port-au-Prince, in recent weeks has displaced thousands of people, according to the United Nations. At least 278 Haitians have died from gang-related violence so far this year, according to Pierre Espérance, director of Haiti’s National Human Rights Defense Network.

“The unprecedented level of violence and subsequent displacements is creating a host of secondary issues, such as the disruption of community-level social functioning, family separation, increased financial burdens on host families, forced school closures, loss of livelihoods and a general fear among the affected populations,” the U.N. Office for the Coordination of Humanitarian Affairs said in a report last month.

Also among those “secondary issues”: increased risk of covid-19 transmission and difficulty accessing medical care for those who fall ill.

Crammed makeshift shelters for people fleeing gunfire are prime ground for the coronavirus to spread, said Bruno Maes, UNICEF’s representative in Haiti. Some 1,100 displaced people, including 480 children, are packed into a sports center in Carrefour, a town south of Port-au-Prince. UNICEF said in June that it needed additional drinking water, sanitation facilities and coronavirus testing capacity, among other things.

The surge of violence and displacement has coincided with a major uptick in coronavirus cases and deaths. Haiti recorded 65 cases and five deaths in the past day, according to the Johns Hopkins University covid-19 tracker, bringing the total to 19,172 confirmed cases and 467 deaths. Health experts agree these are probably vast undercounts.

Inadequate testing has made it difficult to predict the epidemic’s course in Haiti, said Stephane Doyon, Haiti cell manager for Doctors Without Borders.

Two “variants of concern” — the alpha and gamma variants — have been detected in Haiti. Haiti’s National Laboratory has also sent samples to the United States to see whether the more infectious delta variant is circulating there, the New Humanitarian reported.

Along with case counts, hospitalization rates have ticked up in recent weeks, according to the PAHO, the Americas branch of the World Health Organization. Doyon said hospitals are in need of additional oxygen and beds.

Unpredictable bouts of gunfire around the capital have hampered the country’s efforts to ramp up capacity to treat coronavirus patients, Doyon said. Patients fear traveling to the hospital. And for health workers, dodging bullets has become routine.

Martissant, a neighborhood on the outskirts of Port-au-Prince, became the epicenter of gun battles between rival gangs last month. Doctors Without Borders was forced to suspend its work there and evacuate its staff in late June after its emergency center came under fire. Maes said the violence has hindered the ability of UNICEF and other organizations to provide basic aid to displaced people.

“We have an epidemic of covid, which is not under control and for which measures to control it are very difficult to recommend because the security situation is not enabling the rollout of activities that would be needed,” Doyon said.

Moïse’s assassination could make things worse. Doyon fears the gang war will intensify. Maes worries it may be difficult for medical and other supplies to enter the country. Haiti’s airports closed to commercial traffic, and the Dominican Republic shut its land border with Haiti on Wednesday.

New hospitalizations have leveled off in the past week for “reasons that are unclear,” a PAHO spokesperson said. But Maes said the coronavirus situation “remained critical.”

Haiti is one of a small number of countries in the world that has yet to rollout a coronavirus vaccination campaign — and the only country in the Americas. The country was among the 92 low- and middle-income countries offered doses through the Covax Facility, a WHO-linked effort to distribute doses. While other countries have moved forward, albeit with limited supply, Haiti has yet to receive any of the nearly 760,000 doses of the AstraZeneca vaccine allocated through the facility, a spokesperson for Covax confirmed.

The first batch was originally expected to arrive this spring but was delayed after Haiti reportedly missed an administrative deadline.

Lauré Adrien, general director of Haiti’s Health Ministry, also raised concerns in April that the country lacked the infrastructure needed to properly store the vaccines, the Associated Press reported. But back then, “we weren’t in the same situation as we find ourselves today,” he told the New Humanitarian.

A shipment of 130,000 doses was announced for June but never arrived. That shipment has been rescheduled to a still-to-be-determined date, according to the PAHO. A spokesperson said Haiti had “inquired about the possibility of sending a different vaccine due to high levels of vaccine hesitancy in the population” and is exploring alternative avenues to acquire vaccines.

But it’s the government’s hesitancy — not the Haitian people’s — that is primarily to blame for the delayed rollout, according to Paul Farmer, a Harvard University professor who co-founded Partners in Health, a global health organization that operates in Haiti.

Partners in Health has run other vaccination programs across Haiti and seen “very high rates of uptake,” he said. And the capacity is there, he said. But Moïse’s assassination highlighted the central reason for the delay: “There’s been so much political dysfunction going on for a long time.”

The Haitian Health Ministry did not respond to requests for comment.

In June, the White House announced allocation plans for the first 25 million doses it will eventually share with the world, including 6 million doses for countries in South and Central America. Haiti is on that list, though it remains unclear how many doses will reach the country and when.

Farmer, whose father-in-law died of the coronavirus in Haiti, said he was “heartbroken” to learn about Moïse’s assassination because of its potential implications for an already troubled vaccine rollout.

The country has struggled to recover from a 2010 earthquake that killed more than 200,000 Haitians, left 1.5 million homeless and destroyed dozens of health-care centers. And even before the earthquake hit, Haiti had suffered from “inadequate and insufficient health-care facilities” for decades, according to the U.S. Agency for International Development.

Without the instability, Farmer said he thinks Haiti could have pulled the vaccine campaign off. UNICEF and Partners in Health have worked with the government in recent weeks to facilitate vaccine delivery and ready vaccination sites and personnel.

In the wake of Moïse’s assassination, it’s unclear whether those preparations will come to naught. Amid the power vacuum, two men now claim to be in charge of the country.

“We were really so committed and engaged to ensure that even the most vulnerable populations hit by violence could benefit from the covid vaccines,” Maes said. “The whole situation now, it’s unpredictable.”

As a “state of siege” announced by interim prime minister Claude Joseph took hold and an unusual quiet descended over Port-au-Prince on Wednesday, Doyon said, his staff on the ground were bracing for what comes next.

“We are in a very critical phase in Haiti,” he said.

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