by DeVaughn Jones*
“We have no protections whatsoever. We’re in God’s hands.” – A Haitian woman[1]
Americans have admirably mobilized to protect our most vulnerable people from the shocking spread of COVID-19. As we increase those efforts over these next few weeks, we must remember to include the most vulnerable geographic neighbors[2] we have:
Haitians.
Around 11.5 million people live in Haiti,[3] and most of them live in extreme poverty; around 4.5 million Haitians were at risk of dying of starvation before Coronavirus was an issue.[4] Almost all Haitians are also “highly vulnerable” to natural disaster.[5] They are prematurely aged by their environment. Malnutrition, poor hygiene, and unreliable shelter make Haitians physiologically older than non-Haitians who have lived the same number of years.[6] There are approximately 300,000 HIV/AIDS positive Haitians, many of whom are incarcerated in prisons so overcrowded that they are described as “inhumane.”[7] This uniquely hostile environment renders the Haitian people less disease-resistant and dramatically increases their odds of dying from sicknesses that are non-fatal everywhere else.[8]
The Haitian public health system is not equipped to address such dramatic health issues. Recent surveys counted only 124 ICU beds in Haiti; less than seventy of these beds supported patient ventilation, and outside the ICUs, that number dropped to less than ten.[9] Further, there is a severe shortage of health workers, including doctors and nurses, and there are gaps in services across all levels of the Haitian healthcare system.[10] It is hard to imagine a more inviting environment for an infectious disease to unforgivingly spread. [11]
Now that COVID-19 is already in Haiti,[12] its effects will be compounded by Haitians’ physiological vulnerability. Haitians’ social response is also problematic; most Haitians are either unaware of COVID-19 or do not trust foreign reports about it.[13] Unchecked, this global crisis will have uniquely tragic effects in Haiti. At minimum, the world must be aware of that. Moving forward, the United States should immediately and aggressively provide COVID-19 prevention and treatment.
The United States is a leading party in the global commitment to “prevent, protect against, [and] provide a public health response to the international spread of disease.”[14] USAID’s $62 million commitment to combat third-world COVID-19 outbreaks is a good start.[15] In the interest of speed and efficiency, we may consider temporarily relaxing or suspending existing restrictions on sending aid funds to Haiti.[16] Afterward, we can continue to support our ongoing agreements to modernize global public health infrastructure on a global scale.[17]
In the meantime, COVID-19 should be fought in communities where it will hurt the worst. Scientifically, legally, and morally – this is the right thing for a global leader to do. There is no time to waste.[18]
*DeVaughn Jones is a second year law student at Washington College of Law at American University. He is a staff member of the American University International Law Review.
[1] LeMaire et al., infra note 13.
[2] Compare Recommended Travel Mode from Washington, DC to Miami, Google Maps, https://www.google.com/maps/dir/Washington+D.C.,+DC/Miami,+FL/@32.0134525,-88.3682513,5z/data=!3m1!4b1!4m13!4m12!1m5!1m1!1s0x89b7c6de5af6e45b:0xc2524522d4885d2a!2m2!1d-77.0368707!2d38.9071923!1m5!1m1!1s0x88d9b0a20ec8c111:0xff96f271ddad4f65!2m2!1d-80.1917902!2d25.7616798 (1053 miles), with Recommended Travel Mode from Haiti to Miami, Google Maps, https://www.google.com/maps/dir/Haiti/Miami,+FL/@22.304344,-80.7351579,6z/data=!3m1!4b1!4m13!4m12!1m5!1m1!1s0x8eb6c6f37fcbbb11:0xb51438b24c54f6d3!2m2!1d-72.285215!2d18.971187!1m5!1m1!1s0x88d9b0a20ec8c111:0xff96f271ddad4f65!2m2!1d-80.1917902!2d25.7616798 (Haiti is about 400 miles closer to Miami than Washington, DC).
[3] Haiti Population 2020, World Population Review, https://worldpopulationreview.com/countries/haiti-population/ (last visited Mar. 22, 2020).
[4] See The World Bank Group, infra note 5 (more than half of Haitians live on less than $2.41 USD per day, and more than one-fifth live on less than $1.23 per day); seealso John Carroll, Haiti and Coronavirus – Can You Imagine?, Dispatches From Haiti (Feb. 27, 2020), https://blogs.pjstar.com/haiti/2020/02/27/haiti-and-coronavirus-can-you-imagine/ (stating that 4.5 million Haitians are “predicted to be on the verge of starvation”).
[5] The World Bank Group, Overview, The World Bank in Haiti,https://www.worldbank.org/en/country/haiti/overview#1 (last visited Mar. 22, 2020) (“More than 96% of the population is exposed to . . . natural hazards.”).
[6] SeePhysiological Age, Medical Dictionary,https://medical-dictionary.thefreedictionary.com/physiological+age (“The relative age of a person, especially when comparing that individual’s physical status with those of other persons of the same chronological age.”).
[7] See U.S. Dep’t of State, Office of the U.S. Glob. AIDS Coordinator and Health Diplomacy, Haiti Country Operational Plan (COP) 2019 Strategic Direction Summary 6 (Jun. 11, 2019) [hereinafter, 2019 Haiti COP] (“Haiti has a national HIV/AIDS prevalence of 2.7%, with higher prevalence in major cities and among men who have sex with men . . . female sex workers . . . and prison populations.”); Teresa Bo, Haiti Prisons: Overcrowding a Major Problem, Al Jazeera (Jan. 5, 2018), https://www.aljazeera.com/news/2018/01/haiti-prisons-overcrowding-major-problem-180105130018827.html (“Haiti has some of the most overcrowded prisons in the world…around 11,000 inmates live in inhumane conditions.”); Dep’t of Justice, Exec. Office for Immigration Review, Haiti 2018 Human Rights Report 4 (2018) (“Most [inmates] died from starvation, anemia brought on by malnutrition, tuberculosis, or other communicable diseases.”).
[8] Arachu Castro et al., Infectious Disease in Haiti, 4 EMBO Rep. (2003), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1326436/pdf/4-embor844.pdf (discussing how systemic poverty in Haiti “predisposes [Haitians] to pathogenic vulnerability by shaping the risk of infection and subsequent disease reactivation”).
[9] Lia Losonczy et al., Critical Care Capacity in Haiti: A Nationwide Cross-Sectional Survey, 14 PLOS One 2 (2019).
[10] 2019 Haiti COP, supra note 7, at 6.
[11] See Castro et al., supra note 8 (explaining how “[t]he social contexts in which…patients bec[o]me infected,” are integral to determining how bad an infection will be); see also Kavita Vinekar et al., Hospitalizations and Deaths Because of Respiratory and Diarrheal Diseases Among Haitian Children Under Five Years of Age, 2011–2013, Pediatric Infectious Disease J. (Oct. 1, 2016) (“Respiratory and diarrheal diseases contributed to more than half of hospitalizations and almost a third of deaths in children younger than 5 years in Haiti.”). Compare, e.g., Harvard Medical School, Coronavirus Resource Center, As Coronavirus Spreads, Many Questions and Some Answers (last updated Mar. 20, 2020),https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center (stating that Coronavirus hosts with underlying conditions such as AIDS have a higher chance of developing deadly pneumonia), with 2019 Haiti COP, supra note 7, at 6 (Haitian HIV/AIDs prevalence is around 3% of the total population).
[12] Jovenel Moise, President of Haiti, Adresse a la Nation du President Jovenel Moise / Coronavirus [President Jovenel Moise’s Address to the Nation / Coronavirus], YouTube (Mar. 19, 2020), https://www.youtube.com/watch?v=DX2oATBSeyY (confirming two Coronavirus cases in Haiti).
[13] Sandra Lemaire et al., Conspiracy Theories, Misinformation Abound as Haitians Brace for Coronavirus, VOA News (Mar. 13, 2020),https://www.voanews.com/science-health/coronavirus-outbreak/conspiracy-theories-misinformation-abound-haitians-brace (describing Haitians as “woefully uninformed” about Coronavirus).
[14] World Health Org., International Health Regulations (2005) 10 (2nd ed. 2008);Revision of the International Health Regulations, Rep. of the World Health Assembly on Its Fifty-Eighth Session, 14, U.N. Doc. No. WHA58/2005/REC/1 (2005).
[15] Press Release, Mark Green, USAID Adm’r, Statement on a Second Funding Tranche of $62 Million in Assistance to Respond to the Pandemic of COVID-19 (Mar. 18, 2020),https://www.usaid.gov/news-information/press-releases/mar-18-2020-statement-administrator-green-second-funding-tranche-62.
[16] See generally USAID, FAQ on USAID Funding in Haiti,https://www.usaid.gov/faq-usaid-funding-haiti, (last visited Mar. 22, 2020) (providing background on the existing, and stringent, regulatory framework that controls aid funding sent from USAID to Haiti).
[17] See USAID, USAID/HAITI Strategic Framework 2018-2020 3 (2018) (“All of USAID/Haiti’s programs will reflect our Administrator’s organizing principle that the purpose of foreign assistance should be ending its need to exist.”); see also International Health Regulations, supra note 14.
[18] Bill Gates, How to Respond to COVID-19, GatesNotes (Feb. 28, 2020), https://www.gatesnotes.com/Health/How-to-respond-to-COVID-19.