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A tent where people suffering cholera symptoms are treated at a clinic run by Doctors Without Borders in Port-au-Prince, Haiti, October 7, 2022. © 2022 AP Photo/Odelyn Joseph

(Washington, D.C.) – The international community should help Haiti address a cholera outbreak by urgently delivering fuel, medicines, and safe drinking water, Human Rights Watch said today. Countries should suspend deportations, expulsions, and pushbacks of Haitians due to the worsening humanitarian situation, which is compounded by a severe security, justice, and political crisis.

Since the first case of cholera was confirmed on October 2, 2022, the outbreak has spread rapidly. As of October 16, there were 835 suspected cases, 78 confirmed cases, and at least 36 deaths, Haiti’s Health Ministry reported. Health facilities had conducted only 493 cholera tests. The Pan American Health Organization warned that the real number of cases is “likely much higher,” as gang violence limits access to affected areas.

“Lack of access to clean water and sanitation, pervasive food insecurity, and inadequate health care create perfect conditions for a dangerous cholera outbreak,” said César Muñoz, senior Americas researcher at Human Rights Watch. “The international community should respond urgently to this extremely serious threat to health and life, particularly for young children and other vulnerable people.”

Cholera is an extremely virulent disease caused by ingestion of water or food contaminated with the bacterium Vibrio cholerae, which is present in fecal matter, according to the World Health Organization (WHO). Most people infected do not develop symptoms, but the bacteria in their feces can infect other people. A minority of people develop acute watery diarrhea with severe dehydration and can die within hours if untreated.

More than a quarter of all suspected cases are in children under 9, the Health Ministry’s data show. Young children are particularly vulnerable to the disease and can die very quickly if not treated, Mumuza Muhindo, the chief of the nonprofit Médicins sans Frontières (MSF) in Haiti told Human Rights Watch. MSF operates health facilities across Port-au-Prince, the Sud department, and Artibonite.

Muhindo said that cases are spreading out from central areas of the capital. “Cases are going up every day,” he said.

People in detention are also particularly at risk. Fourteen of the confirmed deaths were in the Port-au-Prince prison, the Health Ministry said. As of June, Haiti’s prisons held almost three times more detainees than they were built for. Many of the more than 11,500 detainees, 83 percent of them awaiting trial, are living in inhumane conditions the United Nations said. The Ombudsman’s Office reported scores of deaths of detainees related to malnutrition, even before the cholera outbreak. Assistance should be directed to the most vulnerable populations, including detainees, Human Rights Watch said.

Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities, the WHO says. In 2020, over a third of the population in Haiti lacked access to clean water and two-thirds had limited or no sanitation service.

In addition, a record 4.7 million people are currently facing acute hunger, according to the World Food Programme. For the first time ever, what is considered a catastrophic level of hunger has been recorded in Haiti, affecting 19,000 people in the capital’s Cité Soleil neighborhood. Nearly 100,000 children under age 5 suffer from severe acute malnutrition, making them especially vulnerable to cholera, UNICEF has said.

In 2010, a cholera outbreak in Haiti, which was traced back to sewage negligently released from a United Nations peacekeepers base into a river near the town of Mirebalais, caused about 9,800 deaths and over 820,000 infections. In 2017, the United Nations acknowledged its role in causing the epidemic and accepted a moral, but not legal, responsibility to address it. It did not pay compensation to victims and underfunded other aid efforts, United Nations independent human rights experts said in 2020.

The international community should respond urgently to prevent such tragic loss of life from happening again by delivering fuel – by plane if necessary – as well as cholera vaccines and medicines to treat those infected, Human Rights Watch said. Fuel is urgently needed to pump, sterilize, and distribute water.

UN agencies, MSF and other local and international organizations have already started distributing medicines and equipment to hospitals. They have established cholera treatment centers, facilitated access to clean water and sanitation, assisted the Health Ministry’s surveillance efforts and case management, and are working to get cholera vaccines into Haiti. However, much more is needed to avert a health disaster, Human Rights Watch said.

Response to the current crisis is particularly difficult because of the compounded crises that afflict Haiti. Gangs have increasingly taken control of strategic areas around Port-au-Prince and other regions of the country. In September, a gang blockaded access to the nation’s main fuel terminal in response to proposed cuts to fuel subsidies, according to the UN. The gangs are preventing the distribution of fuel, crippling businesses, schools, and hospitals, and creating shortages of basic goods and telecommunications, UN agencies said.

Armed people completely control the Brooklyn neighborhood in Cité Soleil, one of the Port-au-Prince areas most affected by the outbreak, Muhindo said. Residents there have not had access to clean water since July 10, as the access road is blocked and is the site of shootouts between armed groups. Several officials told Human Rights Watch that the gangs had links with political and business leaders, and police officers.

A wave of gang violence displaced more than 43,000 people in Port-au-Prince from April through July, the International Organization for Migration (IOM) reported. WHO said that displaced people are particularly vulnerable to cholera because of insecure access to clean water and sanitation.

To address gang violence, which is an impediment for the delivery of aid, the authorities need to ensure that the justice system starts functioning again, Human Rights Watch said. In some jurisdictions, courts have held no hearings on criminal cases for three years, the Office of the United Nations High Commissioner for Human Rights (OHCHR) reported. A main impediment is lack of security. The government should relocate courts, which have been attacked by gangs, to safe areas and protect justice system employees, with international support. Judges should review all cases of detainees and apply alternatives to detention when appropriate.

Political paralysis has worsened the country’s problems. Parliament stopped functioning in January 2020, when former President Jovenel Moïse refused to organize legislative elections. Moïse was assassinated in 2021, and Haiti is currently without an elected or appointed president. Prime Minister Ariel Henry now rules by decree, without any constitutional mandate.

Despite the deteriorating situation, other countries continue to repatriate people to Haiti. From January through September 2022, they expelled or deported and summarily returned more than 21,000 people to Haiti by air or by sea after being interdicted, the IOM reported. The United States is responsible for about 70 percent of the repatriations.

In addition, the Dominican Republic forcibly sent 49,676 Haitians by land between February and September, including people born in the Dominican Republic but considered by Dominican authorities to be Haitian, according to the Support Group for Refugees and Returnees (GARR, in French), a nonprofit organization present at the border.

The rights to water and sanitation are human rights. The right to water entitles everyone, without discrimination, “to have access to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic use.”

The Committee on Economic, Social and Cultural Rights, the UN body responsible for monitoring compliance with the International Covenant on Economic, Social and Cultural Rights, stated that “The water supply for each person must be sufficient and continuous for personal and domestic uses,” including water for hygiene purposes. The Committee also noted that to be safe, it should be, “free from micro-organisms, chemical substances and radiological hazards that constitute a threat to a person’s health.”

The right to sanitation entitles everyone, without discrimination, “to have physical and affordable access to sanitation, in all spheres of life, that is safe, hygienic, secure, and socially and culturally acceptable and that provides privacy and ensures dignity,” the UN General Assembly said in 2015. The United Nations special rapporteur on the rights to water and sanitation has found that states should “ensure that the management of human excreta does not negatively impact on human rights.”

“The cholera outbreak makes it even more urgent for governments to stop sending people to Haiti, where the security, humanitarian, and health crisis endangers everyone´s life and physical integrity,” Muñoz said.

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