Learning the hard way: Lessons from the Haiti earthquake

Today marks five years since the massive earthquake that devastated Haiti, with some 220,000 people lost their lives and more than 1.5 million made homeless. Still very much in the recovery phase, the country currently risks slipping into freefall following the recent resignation of Laurent Lamothe as prime minister.

Even before the disaster, Haiti was considered a fragile and impoverished state with serious public health issues. The Haitian government’s resourcing of its HIV response for example has always been very limited and virtually all funding comes from the U.S. President’s Emergency Plan for AIDS Relief and Global Fund to Fight AIDS, Tuberculosis and Malaria. As a result of the earthquake, many health facilities, including the capital’s main hospital, were destroyed.    

Shortly after the quake, the Ministry of Public Health and Population and UNAIDS estimated that fewer than 40 percent of people living with HIV had access to antiretroviral therapy sites. In many instances, HIV services were being provided in the yards of health centers or hospitals.  There were shortages of drugs. The logistical management and distribution of drugs used for prophylactic treatment was poor. In a lot of institutions, hygiene and medical waste management were problematic.

In the emergency response that followed, our national partner Promoteurs Objectif Zerosida worked in the camps for internally displaced people to reach groups most at risk of HIV infection and to advocate on behalf of victims of sexual assaults. Formal and informal sex work increased as women resorted to transactional sex to survive.

The huge number of people moving into the camps or from Port-au-Prince to provincial towns in the aftermath meant that palliative care and antiretroviral therapy adherence were difficult to manage for people living with HIV. With death and destruction on such a massive scale, immediate rescue and short-term survival had to take priority over other needs, but POZ and other partners working on HIV were nonetheless determined to learn lessons from the catastrophe to help inform emergency planning and reduce HIV vulnerability in the future.

Although the United Nations set up clusters around specific themes such as nutrition and water, sanitation and hygiene, no group was established for HIV, leading to an interruption in service delivery. Efforts to engage with local civil society organizations were limited, language barriers not taken into account, and many of the humanitarian NGOs that arrived after the earthquake didn’t have the expertise that local organizations had, particularly when it came to working with vulnerable and marginalized populations. One key lesson is that during an emergency response, the international community needs to place more emphasis on funding programs that are locally owned and led which would also help address the kind of sustainability issues that Haiti is currently experiencing due to international organizations withdrawing.

Emergency planning needs to take account of the fact that people most at risk of HIV infection often become more vulnerable in terms of emergency due to a lack of prioritization of their needs and stigma. With more than half of the people living with HIV living in fragile states, we need to do more to link local organizations and networks, including networks of people living with HIV, to national and local disaster preparedness training and systems so that they are fully equipped to respond to the needs of communities at times of conflict and natural disasters. Developing sustainable community models for delivering access to HIV testing and treatment at times of crisis will only serve to improve overall health outcomes in fragile states.

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