Haiti: Crisis Info 1 - Hurricane Matthew, October 2016

Many communities along the coast in southern Haiti as well as inland have been very badly affected by the hurricane that hit the country on 4 October. The regions most affected are Grand Anse, Nippes and Sud. Sud was hit hardest, but Grand Anse and Nippes sustained severe damage and destruction.

According to evaluation by national authorities, 175,000 people have been displaced, over two million people are affected, and 1.4 million people are in need of aid. 546 people are reported dead, but the real number is very likely higher. Medical structures, already under-funded and under-resourced, were not spared: the World Health Organization reports that 23 health centres have been damaged or partially destroyed.

Access to care was already scarce before the hurricane, as health centres were often under-resourced and healthcare costs were high, but the situation is now critical. In addition to damage to health centres, their stocks of supplies are dwindling because access by road is blocked. In Nord and Sud, infected wounds and fractures (including complicated fractures) are the most common conditions linked to the hurricane, though diseases like gastritis and upper respiratory infection are common. Without skilled and repeated care, infected wounds can lead to sepsis and death, while broken bones can lead to disabilities.

Isolated villages in the mountains must be prioritised. As they are difficult to reach, they have the least access to healthcare, clean water, food or reconstruction material. Some are reachable by car, but MSF uses various transport means to reach the villages, including specially hired helicopters and even donkeys. In many villages, our teams have been the only aid teams to access the population and the needs are vast. The rainy season adds to the emergency, because the weather is unpredictable, and helicopters can only fly during clear weather. When the teams arrive, they have sometimes only two or three hours to set up and consult as many people as possible.

Food, clean water, shelter and medical care are the most immediate needs. In addition to the destruction of stock, the damage to crops and difficulty transporting goods mean that prices have risen significantly. 800,000 people face an extreme level of food insecurity according to OCHA, and we are very concerned about the impact this will have on health, particularly for children. People are using what material they can find to build shelters or makeshift homes – but these offer no protection against Haitian storms and also form ideal conditions for infections such as Dengue, malaria and pneumonia.

Water and sanitation activities are a major component of MSF’s response. We are focusing on access to clean water – distributing chlorine tablets, cleaning or repairing water sources, installing water bladders, cleaning and disinfecting areas, and assessing water quality. Ten water and sanitation specialists are working on the projects. In Sud, MSF has already distributed over 500,000 chlorine tablets to disinfect water, and will also soon begin distributing them in Nippes and Grand Anse.

Cholera infections, which always peak during the rainy season (from October to December/January), have risen in affected areas. If clean water and shelter are not provided soon, cases are likely to rise further. Surveillance data and notification are still an issue in affected regions. Expansion of the outbreak towards other regions is a concern, and vaccination in these areas at risk should be prioritised, as the peak of infection may well have passed in the most affected areas once vaccinations begin. Moreover, with destroyed homes and torrential rains, there is growing concern about other epidemics such as Dengue, malaria and pneumonia.

According to Pan American Health Organization epidemiological surveillance in the week up to 18 October, there were 167 suspect cases of cholera reported in Grand Anse, 464 in Sud, 73 in Artibonite (north of Port au Prince) and one in Nippes. We use these numbers with caution given that the surveillance and notification system was affected in the aftermath of the hurricane. However, we must certainly remain vigilant about new cases flaring up. Cholera prevalence is higher in regions most affected by the hurricane, and controlling transmission in these areas should be prioritised. MSF believes that cholera vaccination provides an opportunity to curb transmission in areas less affected by the hurricane.

MSF has been present in Haiti for over 19 years, providing free healthcare for the thousands of people who cannot afford the limited healthcare available. We currently runs six projects in the Port-au-Prince metropolitan area, including the Drouillard hospital for severe burns, the Tabarre traumatology hospital, the Martissant emergency centre, the Centre de Référence des Urgences en Obstétrique (CRUO), and the Pran Men’m clinic for survivors of sexual and gender-based violence. MSF also supports the Diquini centre for cholera patients.