Haiti: Treatment of individuals with COVID-19 or perceived as such, including those returning from abroad; state protection (2020–June 2021)
1. Overview
According to sources, Haiti was considered to have fewer cases and deaths related to COVID-19 during 2020 than expected (Associate Professor 1 June 2021; UN Mar. 2021, 92, 93) or compared to elsewhere in the Americas (Al Jazeera 9 June 2021; UN Mar. 2021, 92, 93). A report from Haiti's Ministry of Public Health and Population (ministère de la Santé publique et de la Population, MSPP) states that there were 12,669 confirmed cases and 250 deaths between the first confirmed cases in March 2020 and the beginning of March 2021 (Haiti 10 Mar. 2021, 1). According to another report from the same source, as of 10 June 2021, these figures have risen to 16,662 confirmed cases and 358 deaths (Haiti 10 June 2021, 1). Sources report that, given the lack of testing, the number of cases could be higher (Al Jazeera 9 June 2021; The New York Times 13 June 2021; The New Humanitarian 16 Mar. 2021).
1.1 Societal Attitudes
Sources report that misinformation and the spread of conspiracy theories [coupled with a lack of trust in state institutions and the authorities (Reuters 11 May 2020; The New Humanitarian 16 Mar. 2021)] have influenced societal attitudes in Haiti regarding the virus (Lawyer 15 June 2021; Reuters 11 May 2020; The New Humanitarian 16 Mar. 2021). Sources report that Haitians (Lawyer 15 June 2021) or "some" Haitians (Reuters 11 May 2020) believe they have to fend for themselves in response to COVID-19 (Lawyer 15 June 2021; Reuters 11 May 2020).
Sources report that there is ["widespread" (CMMB 13 Oct. 2020)] denial among the Haitian population of the existence of COVID-19 (CMMB 13 Oct. 2020; AFP 15 June 2020) or of the severity of the illness (INURED Dec. 2020, 44). According to sources, the lack of official information regarding the virus has contributed to this phenomenon (CARE International and UN 25 Sept. 2020, 32; ICDH 21 June 2021; INURED Dec. 2020, 44), particularly in remote areas of the country, where many residents do not have access to a means of communication (CARE International and UN 25 Sept. 2020, 32). According to a June 2020 report by Agence France-Presse (AFP), this denial is characterized by a [translation] "number of individuals [who, allegedly,] have a 'mild fever,' [and who refuse] to be tested" (AFP 15 June 2020). According to an account from a Doctors Without Borders (Médecins sans frontières, MSF) patient in Port-au-Prince, many individuals complained of "fever" and stated they would rather die at home than go to the hospital because they feared receiving "a deadly vaccine" (MSF 6 July 2020). According to MSF, this "contradictory" phenomenon regarding COVID-19 where many Haitians "don't believe in it, but at the same time, ... fear it," is coupled with fear and stigmatization where "for fear of being infected, people do not want a sick person near them. It is a means of protection" (MSF 6 July 2020).
2. Treatment by Society of Certain Groups During the COVID-19 Pandemic
2.1 Individuals with COVID-19 and Their Families
Sources report that individuals with COVID-19 or perceived as such face social stigmatization (CARE International and UN 25 Sept. 2020, 38; INURED Dec. 2020, 45). According to sources, this stigmatization has caused violent reactions (CARE International and UN 25 Sept. 2020, 38; Reuters 11 May 2020). During an interview with the Research Directorate, a human rights lawyer in Port-au-Prince stated that people [translation] "tend to want to reject, intimidate [and] chase away individuals who have it" (Lawyer 15 June 2021). In correspondence with the Research Directorate, a representative of the Citizens' Initiative for Human Rights (Initiative citoyenne pour les droits de l'homme, ICDH), a Haitian human rights organization (ICDH n.d.), noted that Haitians are [translation] "hostile" to individuals perceived as having COVID-19, and that "if you come from Port-au-Prince, people living in the countryside will automatically think you are infected" (ICDH 21 June 2021).
Sources report that individuals with COVID-19 or perceived as such are treated in secret for fear of being stigmatized by those close to them (Lawyer 15 June 2021; MSF 6 July 2020). A report published by the UNDP and the EU states that, according to a study conducted by the UNDP, the Haitian Institute of Statistics and Informatics (Institut haïtien de statistique et d'informatique, IHSI), and the National Coordination Agency for Food Security (Coordination nationale de la sécurité alimentaire, CNSA), the results of which were released in November 2020, among the factors contributing to reluctance in Haitian households to get tested, [translation] "fear of the risk of infection in the hospital" (65.5 percent) and "fear of being targeted by those close to them" (44 percent) were the most prevalent (UN and EU 31 Jan. 2021, 39). A report on a survey of 510 Haitian households conducted between 1 June 2020, and 14 August 2020, by the Interuniversity Institute for Research and Development (INURED), an organization that is part of an international network of universities and research centres and whose mission is "improving the educational, socioeconomic and political condition of Haiti's people" (INURED n.d.), indicates that due to stigma, [INURED English version] "some" respondents stated that "people tended to keep cases of COVID-19 infection in their families a secret, as a way to protect themselves against potential acts of violence" (INURED Dec. 2020, 1, 17, 45–46). Sources report the case of a singer who had the virus and received threats that the homes of his family members would be burned down (Haiti24 29 Mar. 2020) or that his own home would be burned down; he had to flee to protect his family (ICDH 21 June 2021).
2.1.1 Vulnerable Groups
A study conducted by CARE International in Haiti, an organization that [CARE International English version] "works around the globe to save lives, defeat poverty and achieve social justice" (CARE International n.d.), and the UN Entity for Gender Equality and the Empowerment of Women (UN Women) in Haiti, based on documentary evidence, interviews conducted in June 2020 with 90 community members, health personnel, state institutions, and local and international organizations, and a household survey including 565 women and 500 men, notes that stigma regarding COVID-19 [translation] "is also expressed" towards members of certain minority groups, including individuals of different sexual orientations, gender identities and gender expressions (SOGIE) (CARE International and UN 25 Sept. 2020, 13–15, 38). The report states that, according to one interviewee, the stigmatization of individuals with diverse SOGIE and those living with HIV would lead to difficulty in finding [translation] "someone to help them if they need it" during the pandemic (CARE International and UN 25 Sept. 2020, 38). According to an article published by Willy Dunbar, a doctoral student in health policies and systems at the Université Libre de Bruxelles, and Yves Coppieters, a professor at the Université Libre de Bruxelles's School of Public Health (École de santé publique), the pandemic has [translation] "exacerbated" stigma towards individuals living with HIV on the part of healthcare workers specialized in HIV care who "do not treat HIV patients fairly" (Dunbar and Coppieters 14 May 2020). Sources report that COVID-19 is perceived by some as [translation] "divine punishment" (Lawyer 15 June 2021) or a "punishment from God" (CARE International and UN 25 Sept. 2020, 38). According to the testimony of a human rights activist for individuals with diverse SOGIE gathered by CARE International and UN Women, this community is considered [translation] "responsible" for disasters that affect the country, and "[t]hat is why ... it is important that individuals in this community are cautious when an unfortunate event similar to the COVID19 pandemic occurs so they can protect themselves from possible attack from the population" (CARE International and UN 25 Sept. 2020, 38–39).
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), individuals with disabilities are one of the five groups [translation] "among the first to be affected by violence and abuses," including stigmatization, and, due to multiple security and health crises during 2019 and 2020, this community is "affected by ... difficulties in accessing medical services and are at risk of human rights violations" (UN Mar. 2021, 39, 46). The Care International and UN Women report states that, according to one interviewee, stigmatization is [translation] "often" characterized by abandoning children in this situation (CARE International and UN 25 Sept. 2020, 39). According to the OCHA, 1.6 million Haitians, 50 percent of whom are children, have disabilities (UN Mar. 2021, 40). The same source adds that due to multiple security and health crises that marked 2019 and 2020 in Haiti, [translation] "women and girls with disabilities have experienced increased physical, sexual, mental and economic violence" (UN Mar. 2021, 22, 46).
2.2 Healthcare Personnel
Sources state that stigma related to COVID-19 affects healthcare workers (CARE International and UN 25 Sept. 2020, 38; NPR 29 Aug. 2020) because of their alleged [translation] "collusion" with the state to infect patients (CARE International and UN 25 Sept. 2020, 38). The OCHA reports acts of violence against healthcare personnel since the beginning of the crisis (UN Mar. 2021, 35). A Reuters article reports that, according to the Director of the Pan American Health Organization (PAHO), healthcare workers received threats of attacks (Reuters 11 May 2020). In two cases reported by sources, police had to escort ambulances because individuals were threatening those they feared were infected (INURED Dec. 2020, 45; Reuters 11 May 2020).
2.3 Repatriated Haitians
According to a report published by the UN International Organization for Migration (IOM), 810,812 Haitian migrants returned to Haiti from the Dominican Republic between 17 March 2020 and 31 May 2021, of which 300,109 returned voluntarily (UN 10 June 2021, 2). According to a UN report on implementation of the UN Integrated Office in Haiti (BINUH) mandate, returns had [BINUH English version] "nearly" tripled between March and November 2020 compared to 2019 "owing mainly to the loss of jobs in the tourism, agriculture and construction sectors" (UN 11 Feb. 2021, para. 48). According to the IOM, 3,817 Haitian migrants were repatriated from other countries in the Caribbean, North America and South America between 1 June 2020 and 31 May 2021, of which 3,521 were forcefully repatriated (UN 10 June 2021, 3).
Sources report that there are "at least 100" (MIDEQ 4 June 2020) or 100 (UN n.d.) points of passage at the border between the Dominican Republic and Haiti (MIDEQ 4 June 2020; UN n.d.). The same sources state that only five (MIDEQ 4 June 2020) or four (UN n.d.) of these are official points of entry (MIDEQ 4 June 2020; UN n.d.). According to a Washington Post article, the medical team at the Haitian border did not have access to COVID-19 tests in May 2020 (The Washington Post 15 May 2020). The OCHA indicates that [translation] "many returning migrants, especially women, who were in the Dominican Republic in search of a source of income, are now finding it difficult to resume their lives and activities in Haiti" (UN Mar. 2021, 49). The same source adds in its report published in March 2021 that in the Central, North-Eastern and Western departments, there are 43,000, 64,000 and 7,000 [translation] "displaced/returned/repatriated" individuals, respectively (UN Mar. 2021, 53).
Some sources report that anyone returning to the country may be perceived as a carrier of the illness (Lawyer 15 June 2021; Associate Professor 1 June 2021). According to the lawyer, returning from abroad is the primary factor that puts a person at risk of stigmatization regarding COVID-19 (Lawyer 15 June 2021). According to CARE International and UN Women, Haitians returning from the Dominican Republic are one of the three main groups of people stigmatized because of COVID-19, along with individuals with COVID-19 and healthcare personnel (CARE International and UN 25 Sept. 2020, 38).
In one of several cases reported by sources, a Haitian pastor returning home from a trip who had contracted COVID-19 stated he was accused on social media of spreading the disease [carelessly (Reuters 11 May 2020)] and was threatened with violence (INURED Dec. 2020, 45; Reuters 11 May 2020) in March 2020 and had to seek refuge with friends (Reuters 11 May 2020). In another case reported by INURED, a university professor returning to the Limonade region following a trip to the US in March 2020 was suspected of having contracted the virus and individuals threatened to burn down his home (INURED Dec. 2020, 45).
In a telephone interview with the Research Directorate, an associate professor at the Université de Montréal Department of Anthropology, whose research focuses on the moral and epistemological dimensions of medical practice and who began conducting ethnographic studies in Haiti in 1997, stated that Haitians who are deported to Haiti are [translation] "often" perceived as having committed criminal acts and these individuals
[translation]
end up isolated, either because their network [is] no longer there, or [because] they are no longer accepted. For these reasons, regardless of whether or not they are healthy when they return, they are very vulnerable in terms of health, as much of their care [is] traditionally provided in the home by members of their network. (Associate Professor 1 June 2021)
According to an August 2020 article in Sapiens, an American anthropological journal, written by Chelsey Kivland, an associate professor of anthropology at Dartmouth College in the US, who conducted a study of the resettlement experiences of Haitian nationals over a seven-month period in 2020, Haitians deportees are perceived as [Kivland English version] "unwelcome outsiders," who, according to a Haitian immigration officer interviewed, "'can bring crime and a bad manner ... to the country'" (Kivland 6 Aug. 2020). The same source adds that returning migrants who have lived outside of Haiti for a long time may find it difficult to rebuild a social network due to the perception that they are [Kivland English version] "immoral or even dangerous," a perception that may also hamper their ability to find work and housing and to access healthcare (Kivland 6 Aug. 2020).
3. Access to Healthcare
Sources report that access to healthcare services is limited in Haiti (Miami Herald 14 June 2021; UN 11 June 2021, para. 51; Associate Professor 1 June 2021). According to the Associate Professor, public institutions are often outdated and lack [translation] "personnel, security, electricity and even drinking water and are therefore considered a last resort" (Associate Professor 1 June 2021). According to the INURED report, Haiti has [INURED English version] "just under 1,000" health institutions, of which "nearly half" are in the Port-au-Prince region (INURED Dec. 2020, 43). The Associate Professor indicated that distance from institutions poses an additional challenge in rural areas (Associate Professor 1 June 2021). Sources report that since June 2021, certain hospitals in Port-au-Prince have had to close their doors to new COVID19 patients due to overcapacity (Al Jazeera 9 June 2021; ICDH 21 June 2021; The New York Times 13 June 2021).
The lawyer stated that the procedure followed by medical staff impacted access to healthcare services:
[translation]
The way in which individuals with COVID-19 are managed has also created fear among the public. For example, when an individual is suspected of having COVID19, they should call an emergency number, 2020. A medical team then picks them up and takes them away, alone. Contact is not maintained with their family. Nobody knows where the individual is, which medical institution they are in, or what is happening to them until they are released. This is very frightening. (Lawyer 15 June 2021)
According to a Reuters report, in May 2020, a patient being treated for COVID-19 in a public hospital north of the capital was sent home in the dead of the night "for her own safety" (Reuters 11 May 2020). According to the same source, opposition from residents who feared contamination resulted in the cancellation of several healthcare projects dedicated to treating COVID-19 patients (Reuters 11 May 2020).
Sources state that access to healthcare is further hampered by the resurgence of armed violence perpetrated by criminal gangs (Al Jazeera 9 June 2021; Le Nouvelliste 9 June 2021; MSF 11 June 2021). Sources report that clashes between criminal gangs in Port-au-Prince in particular are limiting access to hospitals in the capital and to the roads used to distribute medical supplies (Le Nouvelliste 9 June 2021; MSF 11 June 2021). According to the MSF head of mission in Haiti, "'[a]t a time when we should be scaling up because of COVID-19 and other needs, we are struggling to keep our existing facilities open due to insecurity'" (MSF 11 June 2021). For further information on the security situation and criminal gangs in Haiti, see Response to Information Request HTI200655 of July 2021.
The media reports that the government has agreed to send vaccines to the country, but no vaccines have been administered as of June 2021 (Al Jazeera 9 June 2021; The New York Times 13 June 2021).
4. State Protection
4.1 Legal Measures
The Decree Setting the General Rules for Protecting the Public in the Event of a Pandemic or Epidemic (Décret fixant les règles générales de protection de la population en cas de pandémie / épidémie) published in May 2020 provides the following:
[translation]
Article 13.- All forms of stigmatization and discrimination are prohibited under penalty of sanctions provided by law.
Article 14.- Taking photographs, videos and using any other technique to capture the image of a patient with the pandemic/epidemic virus is prohibited without their authorization, under penalty of a fine of ten thousand (10,000) Gourdes [approximately C$136], fifteen (15) days' imprisonment or thirty (30) days of community service to be determined by the Municipal Council.
Article 15.- The publication on social media of photographs, videos or any other images captured using other techniques of the corpses of individuals who died from the pandemic/epidemic is prohibited under penalty of a fine of twenty thousand (20,000) Gourdes, fifteen (15) days' imprisonment or thirty (30) days of community service to be determined by the Municipal Council.
…
Article 19.- Any inappropriate language or any form of disrespect towards doctors, nurses, auxiliary staff or any other healthcare staff is forbidden in treatment centres for people affected by the pandemic/epidemic.
Article 20.- The use of firearms on the premises of treatment centres for people affected by the pandemic/epidemic is prohibited unless authorized by the Chief of Police. (Haiti 2020, emphasis in original)
Regarding the article of the presidential decree on banning the sharing of images of individuals who died from COVID-19, Freedom House reports that anti-corruption activists and human rights groups have accused the Jovenel Moïse government [1] of trying to lay the groundwork "for the government to further restrict free speech in the future" (Freedom House 3 Mar. 2021, Sec. D1). According to one media report, a radio host was arrested following his on-air statement that there were no COVID-19 cases in Haiti (Haiti24 4 Apr. 2020; The Haitian Times 22 Apr. 2020).
4.2 Measures to Raise Awareness
According to Reuters, President Moïse denounced violence against COVID-19 patients, and stated he would not "tolerate" it (Reuters 11 May 2020). The OCHA also reports the creation of the Permanent Information Centre on Coronavirus (CIPC) tasked with conducting awareness-raising activities involving the Haitian population (UN Mar. 2021, 31). According to an article in the Haitian Times, an online American newspaper for the Haitian diaspora, health organizations have conducted educational activities with community members to dispel COVID-19 myths and misinformation, and the MSPP has made radio announcements and distributed flyers and posters (The Haitian Times 22 Apr. 2020). According to an NGO representative quoted in the same source who treats COVID-19 patients in Haiti, "lack of trust in the government, as opposed to the information's reach, is a more likely reason for public misperceptions about coronavirus" (The Haitian Times 22 Apr. 2020). According to the Centre for Analysis and Research in Human Rights (Centre d'analyse et de recherche en droits de l'homme, CARDH), a Port-au-Prince-based non-profit organization (CARDH n.d.), US$34 million was spent on emergency measures between March and August 2020 [translation] "in the greatest opacity," "yet the health system is not strengthened" (CARDH 10 Aug. 2020, 17). Corroborating information could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.
This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.
Note
[1] President Jovenel Moïse was assassinated on the night of 6 to 7 July 2021 (Le Monde 8 July 2021).
References
Agence France-Presse (AFP). 15 June 2020. "Haïti atteint un pic dans l'épidémie, moins virulente que prévu." [Accessed 14 June 2021]
Al Jazeera. 9 June 2021. "'Cautionary Tale': Haiti Sees COVID Surge as It Awaits Vaccines." [Accessed 16 June 2021]
Associate Professor, Université de Montréal. 1 June 2021. Interview with the Research Directorate.
CARE International. N.d. "Who We Are." [Accessed 7 July 2021]
CARE International and the UN Entity for Gender Equality and the Empowerment of Women (UN Women), United Nations (UN). 25 September 2020. "Haïti." Analyse rapide genre – COVID-19. [Accessed 21 May 2021]
Catholic Medical Mission Board (CMMB). 13 October 2020. "COVID-19 Response in Haiti." [Accessed 10 June 2021]
Centre d'analyse et de recherche en droits de l'homme (CARDH). 10 August 2020. L'état d'urgence sanitaire en Haïti : une opération de corruption, de paupérisation et de violation de droits humains. [Accessed 7 July 2021]
Centre d'analyse et de recherche en droits de l'homme (CARDH). N.d. "Qui sommes-nous : présentation du CARDH." [Accessed 9 July 2021]
Dunbar, Willy, and Yves Coppieters. 14 May 2020. "Le COVID-19 suscite une nouvelle stigmatisation des personnes LGBT+." The Conversation. [Accessed 18 June 2021]
Freedom House. 3 March 2021. "Haiti." Freedom in the World 2021. [Accessed 25 May 2021]
Haiti. 10 June 2021. Ministère de la Santé publique et de la Population (MSPP), Direction d'épidémiologie, des laboratoires et de la recherche (DELR). Surveillance de la COVID-19. Bulletin n˚ 468. [Accessed 14 June 2021]
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Haiti. 2020. Décret fixant les règles générales de protection de la population en cas de pandémie / épidémie. [Accessed 16 June 2021]
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Initiative citoyenne pour les droits de l'homme (ICDH). 21 June 2021. Correspondence sent to the Research Directorate by a representative.
Initiative citoyenne pour les droits de l'homme (ICDH). N.d. "Accueil." [Accessed 21 June 2021]
The Interuniversity Institute for Research and Development (INURED). December 2020. L'impact de la COVID-19 sur les familles haïtiennes urbaines et rurales. [Accessed 1 June 2021]
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Kivland, Chelsey. 6 August 2020. "Des Haïtiens expulsés des États-Unis et confrontés à une crise impensable en pleine pandémie." Sapiens. [Accessed 22 June 2021]
Lawyer, Port-au-Prince. 15 June 2021. Interview with the Research Directorate.
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Miami Herald. 14 June 2021. Jacqueline Charles. "Haiti Already Had a Child Hunger Problem. Now COVID and Gang Clashes Are Making It Worse." [Accessed 16 June 2021]
Migration for Development and Equality (MIDEQ). 4 June 2020. Olriche Fortin. "Forced Return Migration to Haiti During the COVID-19 Pandemic." [Accessed 16 June 2021]
Le Monde. 8 July 2021. "Après l'assassinat du président Jovenel Moïse en Haïti, quatre 'mercenaires' tués." [Accessed 9 July 2021]
National Public Radio (NPR). 29 August 2020. Diane Cole. "Why Scapegoating Is a Typical Human Response to a Pandemic." [Accessed 11 June 2021]
The New Humanitarian. 16 March 2021. Jessica Obert. "In Crisis-Hit Haiti, Rampant Distrust of Government Is Driving Vaccine Hesitancy." [Accessed 16 June 2021]
The New York Times. 13 June 2021. Catherine Porter. "Without Vaccines, Haiti Struggles to Contain Its Latest COVID Wave." [Accessed 16 June 2021]
Le Nouvelliste. 9 June 2021. "Pénurie d'oxygène dans les hôpitaux à Carrefour." [Accessed 18 June 2021]
Reuters. 11 May 2020. Andre Paultre and Sarah Marsh. "Gathering to Kill Me: Coronavirus Patients in Haiti Fear Attacks, Harassment." [Accessed 11 June 2021]
United Nations (UN). 11 June 2021. Security Council. Bureau intégré des Nations Unies en Haïti : Rapport du Secrétaire général. (S/2021/559) [Accessed 16 June 2021]
United Nations (UN). 10 June 2021. International Organization for Migration (IOM). Surveillance des flux sur 20 points de passage frontalier entre Haïti et la République dominicaine. Rapport de situation bi-mensuel n˚ 36. [Accessed 18 June 2021]
United Nations (UN). March 2021. Office for the Coordination of Humanitarian Affairs (OCHA). Humanitarian Response Plan: Haiti. [Accessed 14 May 2021]
United Nations (UN). 11 February 2021. Security Council. Bureau intégré des Nations Unies en Haïti : Rapport du Secrétaire général. (S/2021/133) [Accessed 20 May 2021]
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Additional Sources Consulted
Oral sources: Full professor at a university in Canada whose research focuses on the cultural and anthropo-sociological dimensions of healthcare in Haiti; Centre justice et foi; Haitian Global Health Alliance; Institute for Justice and Democracy in Haiti; UN – International Organization for Migration.
Internet sites, including: Amnesty International; Bureau des avocats internationaux; Centre justice et foi; Défenseurs plus; ecoi.net; Famine Early Warning Systems Network; Haitian Global Health Alliance; HaïtiLibre; Human Rights Watch; Institute for Justice and Democracy in Haiti; Reporters sans frontières; UN – Refworld; US – Department of State.