Coronavirus Outbreaks at Border Put Haitian Migrants at Risk

  • Posted on: 18 June 2020
  • By: Bryan Schaaf
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By David Waldstein

New York Times

June 16, 2020

As the coronavirus spreads across Latin America and the Caribbean, public health officials are flagging outbreaks cropping up in several border regions, particularly the one between Haiti and the Dominican Republic.  The Pan American Health Organization said on Tuesday that it was focusing its efforts in these rural frontier areas, where populations are on the move and medical facilities are lacking. Indigenous people and migrants, vulnerable under normal circumstances, face even greater risks now.  “The increase of transmission in these areas is cause for serious concern and immediate action,” Dr. Carissa F. Etienne, the director of the P.A.H.O., said.

In addition to the Haiti and the Dominican Republic, Dr. Etienne cited spikes in other border areas, including the one between Costa Rica and Nicaragua and the Amazon region that Brazil shares with its neighbors.  The Dominican Republic has seen a large outbreak of the coronavirus with 23,686 total cases, according to a New York Times database, and 615 deaths. Haiti has reported 4,441 cases and 76 deaths. Many Haitians live and work in the Dominican Republic, but after the outbreak there, thousands lost their jobs and moved back to Haiti. Some may have brought the virus with them.

According to the International Organization of Migration, there were more than 278,000 border crossings from March 17 to June 7, with a total of 51,000 going to Haiti, an unusually high number, according to Giuseppe Loprete, the I.O.M.’s chief of mission in Haiti. He added that the weekly average of 4,000 crossings is about double the normal figure. Dr. Etienne said that many migrants are day laborers or work in the so-called informal economy, without access to housing or protections against losing their jobs. She said they were not only among the most vulnerable, but also the least likely to have access to health care. The overall number of cases in the Americas has risen to 3.8 million with almost 204,000 deaths, Dr. Etienne said. Fifty-four percent of those cases were reported in the United States and 21 percent in Brazil. Dr. Etienne said the P.A.H.O. has worked to put in effect more robust safety and surveillance measures in these frontier areas.

The P.A.H.O. has established screening and quarantine centers at border crossings in the region; the organization also provides training, equipment and staff to supplement local medical services that can often be overwhelmed in the small border towns. She noted that these remote areas often lack adequate medical facilities and struggle to provide essential tools in the fight against the coronavirus, like testing and surveillance. For many migrants, the stigma associated with the disease has made some of those safeguards, like contact tracing, even more difficult. Mr. Loprete said that many people returning to Haiti leave inaccurate contact numbers because they do not want community members to treat them as sick.

“The stigma is high,” he said. Dr. Jean William Pape, who is a co-head of a presidential commission to fight the virus in Haiti, said there were 269 points of entry into Haiti from the Dominican Republic and only four formal border check points, making screening, quarantines and treatment especially difficult. He said that in Haiti, 80 percent of the initial reported cases were in the West of the country, but now they are seeing cases all over. He is heartened that there have not been as many deaths as might have been expected. But he thinks the number could be even lower. He said that misinformation spread on social media has dissuaded infected people with symptoms from seeking health, fearful that they will be injected with a fictitious vaccine that could kill them. “It is very disturbing,” Dr. Pape said. “There are young people waiting six days with severe breathing problems before they come in. If these people come to in sooner, we can save them.”

Photo Credit: New York Times

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BY JACQUELINE CHARLES

Miami Herald

JUNE 16, 2020 

A day after Haitian health officials declared that COVID-19 infections had peaked without sparking the alarming death toll some models predicted, regional health experts with the Pan American Health Organization continued to voice concerns that the pandemic could lead to a health crisis in Haiti.

Dr. Carissa Etienne, the director of PAHO, said “the spike” in COVID-19 infections that Haiti has been seeing over the past several weeks remains a serious concern along with the increasing flow of Haitian returnees crossing the country’s land border with the Dominican Republic despite restrictions.

“A much broader coalition to address a potential health crisis in this country is needed,” Etienne said Tuesday during PAHO’s weekly press update on how the virus is evolving in the Americas region.

Since the start of the outbreak, 47,000 Haitians have returned home from the neighboring Dominican Republic, according to the United Nations International Office for Migration. While some are crossing the 224-mile border using the four official entry points, where quarantine facilities have been set up and health workers are checking temperatures, many are crossing at unofficial points and bringing back the disease undetected.

As of Tuesday, the Dominican Republic had registered 23,868 cases of COVID-19 and 615 deaths. Haiti, which shares the island of Hispaniola with its Spanish-speaking neighbor, has 4,441 confirmed cases and 76 deaths. Both nations have roughly the same population of 11 million inhabitants, but the Dominican Republic has tested far more of its citizens than Haiti.

That gap in testing and the different evolution of the pandemic in each country continue to raise concerns among some health experts about whether Haiti, without increased testing, can say with certainty how COVID-19 transmissions are unfolding within its impoverished borders.

On Monday, the director of Haiti’s National Laboratory, Patrick Dely, told journalists that based on the 9,000-plus tests the country has conducted, a few trends have emerged — and the reality is far different than the modeling. To begin, the coronavirus, which has killed thousands in Brazil and Ecuador, has not been as deadly in Haiti. Secondly, while Haiti was expected to hit its peak at the end of June, he is seeing “a downward tendency in the numbers we are registering.” “That’s why we estimate, based on the information we have... we have a peak that began the 22nd week,” Dely said referring to the end of May. He also said “the virus, which has caused so much damage in other countries, is not behaving the same way here. The question now is why. That is what we are researching.”

Dely acknowledged that some of the conclusions could change if testing, which is limited and centralized in the capital of Port-au-Prince, were to increase. But for those questioning the country’s 1.7 percent fatality rate, Dely said if more Haitians were dying from COVID-19 than the system had captured, “we would have seen this... in the country, in the community.”

Looking at the latest figures for Haiti, Florida International University’s Carlos Espinal said that while Haiti went down from 1,300 new cases during the 23rd week of the epidemic to 368 cases by week 25, the critical question remains: How many tests is it conducting? “Week 25 starts today until June 21,” said Espinal, the director of the Global Health Consortium at the Robert Stempel College of Public Health at FIU. “We need to see sustainable reduction of new cases during several epidemiological weeks+; one is not enough.”

Etienne, the PAHO director, did not address Haiti’s cautious optimism. She instead focused on how border communities and uncontrolled migration continue to present huge risks for Haiti and other countries in the Americas as they try to contain the disease. “The increase of transmission in this area is cause for serious concern, and immediate action,” Etienne said. “To contain the spread of COVID-19 and to protect migrants and other vulnerable populations on the border, countries must work together to strengthen the health response within their territories and across frontiers.”

Haiti confirmed its first COVID-19 infections on March 19. The Dominican Republic, currently the epicenter of the outbreak in the Caribbean, did so about three weeks earlier on March 1. As the disease has spread in the Dominican Republic and the country went on lockdown, Haitians fled, both out of fear and lack of employment. With the Dominican Republic preparing to relax some of its measures, including reopening its airport ahead of its scheduled July 5 presidential elections, some are waiting to see what will happen.

“We want to see what will happen when the DR gets better and Haiti is still probably in the high phase of COVID. Are we going to see people crossing back into the Dominican Republic and stay there to find a job? Are we going to see more deportations? Because for sure the Dominican Republic is not going to accept Haitians going back,” said Giuseppe Loprete, IOM’s chief of mission in Haiti. “The different phase of the two countries, for us, is the thing we want to monitor very closely.”

IOM has been especially concerned about the movement along the border, which Giuseppe said has been increasing in some regions of the countries. At the onset, IOM pushed for isolation centers in towns like Ouanaminthe, just outside of Cap-Haïtien in the north, and Belladère in the Central Plateau where the medical charity Zanmi Lasante was doing rapid testing to help screen for the virus among returning migrants.

Between June 1 and June 13, Zanmi Lasante, which is the Haitian counterpart to Boston-based Partners In Health, has screened 768 returning Haitian migrants. Dr. Ralph Ternier, the director of programs for Zanmi Lasante, said the number of migrants crossing at Belladère has diminished in recent days, but it doesn’t mean they aren’t crossing elsewhere. There are various unofficial entry points along the porous frontier, he noted, adding that it has become increasingly difficult to hold people for observation.

Etienne said PAHO is working with several UN agencies to increase surveillance along the Haiti/Dominican Republic border where returning migrants are provided with information on preventing COVID-19 and screened. It has also distributed 85,008 personal protection equipment items to essential workers, including members of the Haitian Coast Guard in Cap-Haïtien, and trained 1,163 front line workers in COVID-19 management.

At the Ouanaminthe border, the surveillance plan consists of 60 field teams, made up of rapid-response teams and community health workers; 15 supervisors, two data analysts and a two-member call center. So far, more than 13,500 migrants crossing that border back into Haiti from Dajabón in the Dominican Republic have been screened, Etienne said. Of the number, 64 were suspected cases and of those, 49 were admitted to a quarantine center.

Calling for governments of bordering countries to work together to contain COVID-19, Etienne said, “We at PAHO remain vigilant of the evolving situation at that particular border and we are working urgently with Haitian health authorities and other partners.”

Thousands of Haitians have fled the Dominican Republic in the last several weeks due to the coronavirus. While some are coming to official border entry checkpoints like this at the Ouanaminthe-Dajabón border in northeast Haiti, where they are screened for the virus, others are crossing undetected along the 225-mile frontier despite the border’s closure. 

Jacqueline Charles has reported on Haiti and the English-speaking Caribbean for the Miami Herald for over a decade. A Pulitzer Prize finalist for her coverage of the 2010 Haiti earthquake, she was awarded a 2018 Maria Moors Cabot Prize — the most prestigious award for coverage of the Americas.
 

Miami Herald
BY JACQUELINE CHARLES
JUNE 19, 2020

The head of the United Nations office in Haiti took her controversial call for constitutional reform in the country before the international community Friday, telling the U.N. Security Council it is increasingly evident it “is required to break the cycle and create the characteristics for the country to thrive.” “Haiti has for too long resorted to expedient agreements to address political problems, to the detriment of the principles that undergird its Constitution,” Helen La Lime said.

But with the exception of Haiti, Germany and France, which left the question up to Haitians “if that is the path” they choose, most members’ concerns were focused elsewhere: Haiti’s lack of an electoral calendar, the ongoing political crisis, the proliferation of armed gangs and guns, persistent human rights violations, lack of government accountability, the prolonged detention of prisoners and the impact of COVID-19, which all agreed is threatening to aggravate an already dire situation.

On Friday, the government announced that Fritz Gerard Cerisier, an assistant to the government prosecutor, was assassinated in Port-au-Prince. “This is a time for action, not for talk,” U.S. Ambassador Kelly Craft said while raising concerns about the Haitian government’s failure to provide the Haiti National Police with a proper budget and to fully follow through on its March 27 decision to release pretrial detainees accused of minor crimes, as well as medically vulnerable prisoners nearing completion of their sentences.

Craft, who steered clear of the constitutional reform issue, said the U.S. found President Jovenel Moïse’s May 18 speech stressing his commitment to hold elections to be a positive step.
“We encourage the Haitian government and all political actors to reach a political accord to find a way forward, most importantly for the best interest of the Haitian people,” she said. While others also called on Haiti’s warring political class to do the same, the likelihood remains dim. Even in her remarks, La Lime acknowledged that after a relatively calm political climate, amid the outbreak of the coronavirus in Haiti following the 18 months of mobilization against Moïse, the landscape had once more evolved into public acrimony. A growing number of opposition figures are today contesting the length of Moïse’s presidential term and calling for a transitional administration to take over. “The vicious cycle of mistrust, recrimination, and ultimately violence is once again starting to define the dynamics of Haitian politics, at a time when the entire society should be unified in its response to the pandemic, and striving to lay more virtuous and lasting foundations on which to build its future,” La Lime said.

In its latest report to the Security Council ahead of Friday’s virtual meeting, La Lime’s U.N. Integrated Office in Haiti highlighted some of the ongoing challenges and lack of progress in Haiti, where police recruitment has been put on hold because of a lack of a budget and 470 cases of human rights abuses and violations have been documented by the office between Jan. 1 and May 31. In 93 of the cases, the Haiti National Police are believed to be responsible, the report said.

Still, the report paints Moïse in a much more favorable light, as it indirectly blames the opposition for the breakdown in talks to reach a political consensus earlier this year, which led to Moïse appointing his own prime minister. Despite the mission having to rely on virtual platforms to communicate with the government due to the pandemic, the presidency, it said, “remains actively engaged in advancing work that can be accomplished in the current context.” “In seven speeches to the nation, the President called for national unity and urged the population to follow directives issued by the Ministry of Public Health and Population,” the report said. “He cautioned against the stigmatization of infected persons and promised to address the crisis efficiently and transparently while also responding to socioeconomic urgencies.”

Among issues that failed to make the report were a strike by judges over the recently published budget and ongoing criticism by human rights activists and local mayors over the centralization of the response to the COVID-19 epidemic.

Some of those concerns, however, were raised by the president of the Haitian Bar Federation, Jacques Letang. He told the council that impunity and insecurity reigned in Haiti, where “the state is less and less in control of the territory,” a judgment in the La Saline massacre is blocked at the supreme court, and “massive human rights violations are on the rise.” “The public services are virtually failing. The most basic rights are not guaranteed, while the depreciation of the gourdes and the hurricane season directly jeopardize the lives of millions of Haitians who are already food insecure,” Letang said, speaking from Port-au-Prince. “The rapid spread of the virus is particularly worrying in prisons, where conditions continue to deteriorate. The contingency and debottlenecking plans announced by the authorities have so far not been implemented.”

On the issue of the constitution, Letang said, given the institutional vacuum that exists in Haiti, where there is no Parliament and local mayors will have their mandates come to an end in July, “How can one support a contested government in carrying out a constitutional reform?”

With the exception of the U.S., which noted it had donated $16 million toward Haiti’s COVID-19 response, the other council members joined U.N. Secretary-General António Guterres in his call for more financial, political and technical support to Haiti. Of a $253 million humanitarian appeal issued by the United Nations on behalf of the country, only $29.9 million has been received “as of the 8th of June,” José Singer, Special Envoy of the Dominican Republic to the U.N. Security Council, told his colleagues during the virtual meeting.

On Friday, Haiti reported 4,916 confirmed cases of COVID-19 and 84 deaths. While the Dominican Republic has registered 25,068 cases and 647 deaths, it has tested far more people, more than 117,000, in comparison to Haiti’s 9,800, according to both countries’ ministries of health statistics.

“We are confronted with a situation where we are already faced with a number of challenges for the country and to these challenges now is added COVID-19,” said Germany’s U.N. Ambassador, Christopher Heusgen. “Haiti cannot cope with this by itself; it needs international support.” Estonia’s representative said it was distressful that developments in the political process have been marginal.

“During the reporting period the number of human rights violations and abuses have increased,” said Ambassador Sven Jürgenson of Estonia. “Efforts to combat impunity are required. No progress has been made on any cases ... including La Saline or Bel-Air; 75 percent of the detainees are still waiting for their trial due to length and complicated proceedings.”

Jürgenson then brought up the issue that has been frustrating the country’s local mayors as the central government struggles with credibility problems in trying to convince Haitians to take the pandemic seriously. “Estonia is concerned about the impact of the coronavirus in Haiti, where the humanitarian situation is already serious,” he said. “We welcome measures taken by the government of Haiti to combat the pandemic. ... However, more action has to be taken and a coordinated national response to the pandemic is needed.”

Jacqueline Charles has reported on Haiti and the English-speaking Caribbean for the Miami Herald for over a decade. A Pulitzer Prize finalist for her coverage of the 2010 Haiti earthquake, she was awarded a 2018 Maria Moors Cabot Prize — the most prestigious award for coverage of the Americas.

28 June 2020

Reuters

By Andre Paultre, Sarah Marsh

Berthony Clermont shares a two-room flat without running water with 10 relatives in the Haitian capital's Cite Soleil slum, so when he fell ill with the novel coronavirus, they all did. "I tried staying at home at the beginning but it was difficult to isolate myself as the house is too small," said the 45-year old. Mistrustful of the dilapidated public healthcare in Haiti - the poorest country in the Americas - Clermont and his family treated themselves at home with herbal teas.

Clermont's plight is shared by many in Haiti and, more broadly, across the Caribbean and Latin America. Home to 654 million people, it is the most unequal region in the world, according to the United Nations. As governments in Europe and some parts of Asia have managed to stem the spread of coronavirus, Latin America and the Caribbean have emerged as one of the epicenters of the pandemic. With confirmed cases globally hitting the 10 million mark on Sunday, the region accounts for around a quarter of those.

From Argentina to Mexico, nearly one in five of Latin America's urban population lives in crowded slums, like Cite de Soleil. In such poor, densely-packed neighborhoods - with little or no access to running water, sanitation and health facilities - residents struggle to follow even the basic hygiene guidelines that experts recommend to prevent contagion with the highly infectious virus.

And, given a large informal labor sector and insufficient government welfare, many people cannot afford to quarantine - even when they are ill. Sauveur Desroches, 55, said that even after he started feeling sick with the virus, he kept working for four days at a construction site in Port au Prince. "But then my body just gave way and I had to stay in bed," said Desroches, receiving treatment at an emergency COVID-19 facility set up in Cite Soleil by medical charity Doctors Without Borders (MSF).

The situation is deteriorating fast. The number of cases in Latin America and the Caribbean has more than tripled from 690,000 one month ago to around 2.5 million. In Brazil and Mexico, which make up more than half the region's population, populist governments went against scientific opinion and downplayed the threat of the virus, continuing to hold political rallies and resisting lockdowns.

While some smaller countries - such as Costa Rica, Cuba, Uruguay and Paraguay - appear to have tamed their outbreaks by reacting more swiftly and comprehensively, these two regional heavyweights are hitting record numbers of daily cases. Their epidemic curves stand to rise even more sharply as both are planning to ease quarantine restrictions on their struggling economies, defying the cautionary tale of Chile, where a partial re-opening appears to have led to an explosion in cases.

Carlos del Rio, a Mexican-born infectious disease expert with Emory University, said that - given very low levels of testing across the region - the most worrying aspect was not the number of confirmed cases but the levels of mortality. "Latin America has just 8% of the world's population but it currently accounts for 45% of daily deaths," he told Reuters. "What has lacked in many countries is leadership and a clear strategy. Europe had a much more energetic response."

In a worst-case scenario, if restrictions are relaxed further, the COVID-19 death toll could climb to 340,476 people in Brazil and 151,433 people in Mexico by October, researchers from the University of Washington's Institute for Health Metrics and Evaluation (IHME) warned this week.

Experts say the true scale of the virus' spread in the region is likely much worse than reported as many countries have failed to implement rigorous testing programs for practical or ideological reasons. In Haiti, which has a population of around 11 million, the spread has outpaced its testing capacity so much that its coronavirus task force declared that symptoms were enough to diagnose COVID-19, the illness caused by virus.

Many Haitians do not want to be tested because of the stigma attached to coronavirus and their distrust of authorities. Some believe the government is lying about the virus to garner aid funds and fear negligent treatment should they be hospitalized. While official data puts confirmed cases in Cite Soleil at 73, Clermont, who also works as a local community activist, reckons a majority of its around 250,000 inhabitants has contracted the virus.

So far, Haiti has confirmed just 5,722 cases nationwide. "There is a certain denial," said Erneau Mondesir, a doctor at the MSF facility. People were consequently failing to take precautions and arriving at hospital too late, when they were already critically ill, he said.

Haiti is reliant on initiatives by foreign aid organizations given its shambolic healthcare system. While the situation there is extreme, healthcare coverage throughout much of Latin America and the Caribbean is patchy. Many are counting instead on natural remedies - often distributed in Haiti by priests of the Afro Caribbean Voodoo religion who are also treating patients in their temples. "Without traditional medicine, those who live beyond the metropolitan areas would have serious problems," said Euvonie Georges Auguste, deputy leader of Haiti's Voodoo confederation.

Given the reluctance of many Haitians to go for treatment, many believe the toll from COVID 19 is far higher than the 100 deaths officially registered to date. A funeral homes company director in Port-au-Prince, who asked not to be named, said deaths had doubled since mid-May, though only some of the excess had death certificates confirming the cause as coronavirus.

However, Haiti and the broader region has one strong suit - a younger population compared to some other parts of the world. Older people appear to be more vulnerable to the serious effects of COVID-19. Less than 9% of the population of Latin America and the Caribbean - and just 4.5 % in Haiti - is aged 65 and above. That compares with 20% in the European Union and 16% in North America.

This may help explain why Haiti has so far defied early predictions of a devastating death toll, according to Ronald Laroche, a doctor who set up and runs a network of low-cost health centers and hospitals in Haiti. Poor living conditions have likely also helped people build resilience while the hot and humid tropical climate may have reduced the virus' virulence. "We think the virus, which has caused so much damage in other countries, is not behaving the same way here," said Patrick Dely, director of epidemiology at the National Laboratory. "The question now is why?"

Some warn the situation in Haiti could quickly deteriorate if the country goes ahead with its plans to reopen international airports at the end of this month. Haitians flying back from New York and Miami risk bringing with them more virulent versions of the virus. "It could be a massacre," said Laroche.

(Reporting by Andre Paultre and Sarah Marsh; Editing by Daniel Flynn and Daniel Wallis)

 

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