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IMPLICATIONS OF CHOLERA OUTBREAK AMID GANG VIOLENCE IN HAITI

Jennifer Radlinsky, Breyona Woods, Emergency Management, Health, and Hazards (EMH2) Team, Jan García, Aina Merino Bello, Julia Tsarnas, SOUTHCOM Team

Salomon Montaguth, Justin Maurina, Editor; Hannah Norton, Senior Editor

October 16, 2022



Oral Rehydration Salts sachet used to treat cholera[1]



Geographical Area | The Caribbean

Countries Affected | Haiti


Haiti announced on October 2 seven deaths from cholera, the first cases in three years. Haitian Ministry of Health officials are concerned the outbreak will spread without access to clean water. Haitians are experiencing interruptions in clean water distribution as the Varreux terminal, the main import depot, was blocked by gangs that have cut off fuel-powering water infrastructure. The United Nations has requested the establishment of a safe corridor allowing fuel distribution and clean water to be available to stop cholera’s spread.[2] Insufficient access to fuel to power generators at hospitals will likely lead to fewer people seeking treatment, almost certainly increasing the number of people infected with cholera. The Haitian government will likely need to suppress gang violence to release needed resources to fight the cholera outbreak, likely requiring international assistance.


Security Risk Level:


Areas of High Security Concern: Security deterioration and escalating gang violence will almost certainly decrease access to clean water, fuel, and healthcare. Waterborne disease susceptibility will likely rise without clean water, likely increasing widespread outbreak risks. Healthcare workers will very likely contract cholera from working in unsanitary conditions and direct contact with patients, likely lowering the number of personnel available to stop the disease's spread. The Dominican Republic will likely establish communications with the Haitian Ministry of Health to monitor the development of the cholera outbreak. The Dominican Republic health officials will likely decide to tighten border security between the countries if the outbreak’s severity continues increasing.

Current Claims: Haiti; United Nations (UN); Médecins Sans Frontières (MSF); the Pan American Health Organization (PAHO); Red Cross

Groups Involved in Conflict: Haitian government; Haitian Ministry of Health; Haitian citizens; Chen Mechan gang; 400 Mawozo gang; international armies; UN peacekeeping army; NGOs

Current Conflicts: Ongoing gang violence is threatening Haiti’s security, likely limiting citizens’ access to adequate health services. By controlling the terminal that distributes fuel that powers critical infrastructure such as water and filtration systems, the gangs are almost certainly putting citizens’ lives at risk of illnesses and death from water-borne diseases.

Major Capital Industries: Healthcare; fuel; Haitian law enforcement; Haitian and Dominican Republic border agents

Potential Industry Concerns: Healthcare insecurities in Haiti will likely increase the cholera spread. Emergency personnel’s lives are almost certainly at risk while traveling through gang-populated areas, likely delaying care from reaching ill citizens. Violence in Haiti will likely limit humanitarian supply deliveries, like fuel and clean water, likely leaving cholera victims with no medical assistance, likely causing a higher death toll. Law enforcement will unlikely regain control due to workforce shortages, likely allowing gang violence to escalate.


Areas of Caution:

  • Health: Cholera comes from ingesting contaminated food or water. The infection affects children and adults and is often mild, but severe cases can be life-threatening and kill within hours if untreated. Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities, but oral cholera vaccines can mitigate it. The administration of oral rehydration solution (ORS) dissolved in one liter of clean water is used to treat cholera victims, with severe cases requiring the rapid administration of intravenous fluids and antibiotics.[3] On October 2, after three years without reported cholera cases in Haiti, the authorities reported two confirmed cases of cholera in Port-au-Prince and announced on October 6 that there were a total of 152 suspected cases, 107 hospitalizations, and 4 registered deaths. 55% of the cases are male, and the most affected group is 1 to 4-year-olds.[4] Hospitals and health facilities are closing due to fuel shortages, waste collection is suspended resulting in garbage piling up in the streets, and water distribution has been interrupted.[5]

  • Emergency Management: The Haitian government established a health protocol and recommended the population take appropriate hygiene measures.[6] The government requested international assistance to address the blockade and the outbreak.[7] Several organizations, such as MSF and PAHO, joined Haitian health authorities to support the cholera outbreak response, donating medical supplies to treat patients and materials for case management and disinfection to prevent cholera spread.[8] Since 2019, PAHO and the Haitian Ministry of Health have implemented the Labo Moto project, enabling field nurses to transport samples to laboratories on motorcycles, and increasing the testing of suspected cholera cases.[9]

  • Political: Increased gang violence broke out in Haiti after former Haitian president Jovenel Moise’s assassination in July 2021 when Ariel Henry became acting president.[10] Gang violence is worsening efforts to recover from the 7.2 magnitude earthquake in August 2021, which resulted in a political crisis where the government is unable to call for elections due to insecurity.[11] A lack of authority and understaffed and underfunded police departments have decreased national security significantly since gang violence began.[12] On October 8, the Haitian government agreed to the request for international military aid to help combat gang violence in the country. It is unknown if the request reactivated the UN peacekeeping troops stationed in the country since 2017.[13]

  • Social: Food insecurity continues to be the most pressing challenge in the Haitian southwest peninsula, leaving 4.5 million Haitians in acute food insecurity, and 1.3 million at risk of severe hunger. Between January and June 2022, confrontations between Haitian gangs such as the Chen Mechan and the 400 Mawozo killed 934 people, injured 684, and kidnapped 680 in Port-au-Prince, forcing citizens to flee their homes for safety. Over the past year, the exponential growth of gangs has increased food and fuel insecurity in Port-au-Prince, with gangs controlling highways and areas close to the capital’s port, such as the Cité Soleil. Young people ​suffering from the economic crisis resulting from the 2021 earthquake are forced to join gangs to cover basic needs such as food and sanitary water.[14]


Predictive Analysis:

  • Who: The Haitian government will unlikely respond properly to the cholera outbreak due to increased gang violence and the economic crisis generated after the 2021 earthquake. Citizens without sufficient access to clean water, fuel, and food are almost certainly at risk of cholera and will likely struggle to recover. The UN will likely continue to advocate for establishing a safe corridor to distribute goods and fuel to the Haitian people, likely resulting in the intervention of international armies such as the UN peacekeeping troops, and NGOs such as the Red Cross. Criminal gangs will almost certainly continue blocking the entrance of primary goods and fuel in Port-au-Prince, almost certainly endangering the security of its citizens.

  • What: Destruction of sanitation and water infrastructures, along with increased pollution due to abandoned street litter has very likely contributed to the spread of cholera in Haiti. The Haitian government will likely focus on eradicating cholera, likely without success, and leave other issues such as gang violence and the earthquake recovery untreated, very likely worsening overall security. The gang blocking necessary goods such as fuel will likely increase hospital closures and overwhelm the healthcare system as hospitalizations continue increasing, very likely making cholera eradication difficult.

  • Why: The political crisis in Haiti will very likely allow a major spread of cholera among the citizens likely due to the inadequate first response to the outbreak. The untreated destruction from the 2021 earthquake and the gang presence in the country will very likely worsen the outbreak, almost certainly causing a major spread of the bacteria and difficulty treating infected citizens. Poverty and famine in Port-au-Prince will very likely increase the cholera death rate in Haiti, as citizens will unlikely have the resources and physical well-being to combat the disease. Haitian gangs will very likely continue blocking essential imports such as fuel and water to influence citizens and the government. Their increased influence in the country will allow gangs to traffic easily as the government will unlikely persecute their illegal activities.

  • When: Increased cholera incidence within Haiti will very likely persist without establishing a “humanitarian corridor.” Gangs will very likely attempt to block the humanitarian corridor to continue influencing the country. The population will unlikely gain access to essential goods in the next few weeks, very likely causing international armies and NGOs to intervene and assume the responsibility to provide those necessary goods.

  • How: Without proper management to contain the outbreak, cholera will likely spread to the Dominican Republic, likely causing an outbreak there. The Dominican Republic will very likely continue with border closures to avoid cholera’s spread into the country, likely also restricting the movement of gang members between both countries. The political crisis and mismanagement will likely allow criminal gangs to gain increased influence over the citizens during the cholera outbreak, very likely by controlling access to essential goods for recovering from the bacteria, such as food and sanitary water.


The Emergency Management, Health, and Hazards (EMH2) and SOUTHCOM Teams recommend that the United Nations “safe corridor” plan be implemented immediately. This plan should include secure passage for healthcare workers deployed into communities to identify and treat cholera patients. Humanitarian aid organizations should organize critical needs assessments as the patients are treated to ensure proper funds allocation. A public health campaign should be conducted by healthcare workers from humanitarian organizations, like MSF, in the communities to educate citizens about effective hygiene practices and mitigation strategies. The Counterterrorism Group (CTG) works to detect, defeat, and deter terrorism and will continue to monitor this event for the cause and future developments. CTG’s Worldwide Analysis of Threats, Crimes, and Hazards (W.A.T.C.H) Officers will continue to monitor Haiti and the Caribbean for similar disease outbreaks following this hazard.

 

[1] “Ors sachet” by Shubjt licensed under CC BY-SA 4.0

[2] UN warns cholera cases in Haiti could skyrocket, Medical Xpress, October 2022, https://medicalxpress.com/news/2022-10-cholera-cases-haiti-skyrocket.html

[3] Cholera, World Health Organization, March 2022, https://www.who.int/news-room/fact-sheets/detail/cholera

[4] Epidemiological Update - Resurgence of cholera in Haiti - 7 October 2022, Pan American Health Organization, October 2022, https://www.paho.org/en/documents/epidemiological-update-resurgence-cholera-haiti-7-october-2022

[5] UN warns cholera cases in Haiti could skyrocket, Medical Xpress, October 2022, https://medicalxpress.com/news/2022-10-cholera-cases-haiti-skyrocket.html

[6] Choléra Communiqué # 1, Ministère de la Communication, October 2022, https://www.communication.gouv.ht/2022/10/cholera-communique-1/

[7] US Reviewing Haiti's Request for International Security Assistance, VOA, October 2022, https://www.voanews.com/a/us-reviewing-haiti-request-for-international-security-assistance/6781723.html

[8] PAHO supports health authorities in Haiti in the response to the reemergence of cholera, Pan American Health Organization, October 2022, https://www.paho.org/en/news/6-10-2022-paho-supports-health-authorities-haiti-response-reemergence-cholera

[9] Cholera Haiti - Risk assessment, Pan American Health Organization, October 2022 https://www.paho.org/en/documents/cholera-haiti-risk-assessment

[10] In worsening gang fighting in Haiti, 20 dead, thousands displaced, Al Jazeera, April 2022, https://www.aljazeera.com/news/2022/4/28/in-worsening-gang-fighting-in-haiti-20-dead-thousands-displaced

[11] In worsening gang fighting in Haiti, 20 dead, thousands displaced, Al Jazeera, April 2022, https://www.aljazeera.com/news/2022/4/28/in-worsening-gang-fighting-in-haiti-20-dead-thousands-displaced

[12] Haitians struggle to find food, shelter amid new gang battle, ABC News, April 2022, https://abcnews.go.com/International/wireStory/20-dead-thousands-flee-homes-gangs-battle-haiti-84362135

[13] Haiti’s leader requests foreign armed forces to quell chaos, AP News, October 2022, https://apnews.com/article/caribbean-united-nations-port-au-prince-haiti-antony-blinken-057bf6462ca2b00fe667e93b5289d319

[14] Haiti’s Spiraling Gang Violence Threatens to Cut Off Capital and Hamper Earthquake Recovery Efforts, Relief Web, August 2022, https://reliefweb.int/report/haiti/haitis-spiraling-gang-violence-threatens-cut-capital-and-hamper-earthquake-recovery-efforts

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