While Haiti’s widely despised, US-backed government officially promotes social distancing to suppress Covid-19, the stark reality is that most of the population is likely heading toward herd immunity, where many must get infected in the street rather than die by hunger at home.

By Jeb Sprague and Nazaire St. Fort

Featured image: With N95 respirator masks unavailable, a Haitian woman wears a mask made from a plantain leaf.

Puedes leer este artículo en español aquí.

Haitian President Jovenel Moïse announced on March 19 that two citizens in Haiti had tested positive for Covid-19, known popularly simply as the coronavirus. The government has closed Haiti’s border, ports, and airports to the movement of people but kept supply chains open. Only a small number of tests have been administered, and there are rising fears that a health catastrophe will unfold over the coming weeks and months.

News and commentaries inside the country spread quickly over WhatsApp and local media. Under mounting stress, many know they are wholly unprepared for a pandemic that has also arrived in other Caribbean countries, including the neighboring Dominican Republic.

The latest reports indicate that 859 people have tested positive in the Dominican Republic, with 39 deaths already. One of the country’s main hospitals in the second largest city, Santiago de los Caballeros, reportedly no longer has beds available.

Many families in Haiti have relatives residing in the Dominican Republic and receive updates regularly. The virus appears to have initially been brought to Haiti through Toussaint Louverture International Airport in Port-au-Prince. Since the first two cases, the official number rose to 15 by March 30, although that figure is surely an undercount. Dozens have been placed under quarantine.

Haiti now faces a looming pandemic with an almost non-existent public healthcare system, and with a dysfunctional political system rooted in neocolonial intervention.

The Caribbean region has endured four centuries of slavery and colonialism and a fifth century of economic dependence. Accelerating globalization and technological developments have brought profound change to the region over the past 20 years, including no-cost digital communications, hi-tech remittance networks, low-cost mass travel and tourism, and new banking and financial arrangements. But it has also brought soaring inequality and climate shocks, mainly in the form of hurricanes and rising sea-levels.

Globalization and automation have caused billions of people to be cast into capitalism’s surplus population. Under this system’s relentless logic, vast portions of the world’s people, even entire countries like Haiti, are condemned to rampant crime, unemployment, and inflation, alongside disintegrating infrastructure and government services. It sinks destructively into the social fabric of society.

To preserve social order and the neoliberal conception of “good governance,” Western institutions resort to severe austerity measures and military intervention, further debilitating the neo-colony whose economic life-blood is being sucked out to enrich the transnational bourgeoisie.

This is the recipe that rendered Haiti completely unprepared for the Coronavirus pandemic.

The stark reality of Haiti

Unemployment in Haiti is already sky-high. With 6 million of Haiti’s 11 million citizens living below the poverty line of $2.41 a day, according to the World Bank, most will face a grueling dilemma of how to feed themselves and their families while avoiding virus infection.

Dr. John A. Carroll, who has worked in clinics, hospitals, and orphanages in Haiti since 1995, explained, “There is no treatment in Haiti that will be accessible by the masses. But there is quarantine to stop transmission. But how do we isolate people in the Haitian slum where the population density is so high and people need to have human contact in order to survive?”

“The breadwinners in the house need to score some bread because they all need to eat,” Carroll continued. “And this family’s neighbors next door don’t have the time or abilities to help out because they have equally severe challenges surviving the slum also.“

While the Haitian government is officially promoting confinement and social distancing, the stark reality is that most of the population are likely heading toward collective “herd immunity,” where many must choose to get infected in the street rather than die by hunger at home. Some, like Carroll, think that this steep, as opposed to flattened, infection curve will result in fewer deaths.

Building “herd immunity” is an approach that the UK government actually suggested for its own people weeks ago, but quickly rejected as a result of a fierce public backlash. Instead, the British state has imposed “social distancing” measures and — despite a right-wing government being in office — committed to pay the majority of the payroll costs of businesses whose workers stay home.

On March 29, local medical experts interviewed on Radio Kiskeya, one of the country’s most important radio stations, suggested that up to 800,000 Haitians could perish from the virus. Large-scale foreign investment and monumental local efforts would need to be undertaken to avert such a catastrophe.

The Grayzone spoke with Dr. Ernst Noël, of the Faculty of Medicine and Pharmacy (FMP) in Port-au-Prince, who stated that the number of 800,000 is not an exaggeration. In his view, many people will likely die due to Coronavirus, and in larger numbers than those that perished in the 2010 earthquake.

He added that large-scale foreign investment and monumental local efforts would need to be undertaken to soften the blow of the oncoming disaster.

Teetering on the edge of a meltdown

It would be an understatement to say that Haiti’s health-care system is ill-prepared for the looming catastrophe.

According to Haiti’s National Institute of Statistics, the country has only 911 doctors. A mere 4.4 percent of the national budget is allocated for national health, which translates to ill-equipped hospitals with woefully insufficient staff. State-run hospitals often face labor strikes, and some medical staff appear not to be showing up to work, as they are lacking masks, gloves, and gowns and fear contracting the virus.

According to Haiti’s most read newspaper, Le Nouvelliste, the country has only 130 ICU beds, and most of these are older models.

Dr. Paul Farmer, a co-founder of the Boston-based health care organization Partners in Health, has suggested Haiti may actually have fewer than 30 fully functioning ICU beds.

Meanwhile there are an estimated 64 ventilators inside the country, though some are likely not working.

Dr. Farmer has pointed out how people living in the Global South face significantly more risk due to underdeveloped healthcare infrastructure:

“All these mechanics of a hospital, we [in affluent nations] don’t have to deal with them. The oxygen is piped right into every room. But the dread of responsibility for my coworkers in Haiti is that they have to worry: Where do we get the oxygen, the IV solutions, can we space the beds for intensive or supportive care in a way that doesn’t infect the caregivers? And we’ve exhausted a lot of supplies as health-care workers are more attentive to putting on gloves, changing gloves, gowning up. We’re seeing real supply chain challenges.”

Doctors assigned to the State University of Haiti (HUEH), the country’s biggest medical facility, have reportedly barely escaped from a suspected Covid-19 outbreak. They had not received personal protection equipment, nor did they get the test kits prescribed for testing coronavirus patients. Even running water is lacking in some medical facilities.

#Haiti has less than 130 ICU beds for a population of more than 10 million. A fast moving #Covid-19 and a crumbling medical infrastructure are recipes for disaster. #coronavirus pic.twitter.com/RquC8yNHlb — Etant Dupain (@EtantDupain) March 20, 2020

Dr. Ulysse Samuel serves at an external HUEH clinic receiving outpatients. He explained to The Grayzone that before the Covid-19 pandemic he had “never seen ventilators at the HUEH facility,” and now, as a wave of cases threatens to swamp the hospital, ”I have no idea if there are any.”

After years of foreign intervention and neoliberal structural adjustment, Haiti has been forced into a desperate situation where it has little choice but to rely on international funds during periods of catastrophe.

As of 2013, 64 percent of Haiti’s health budget was derived from international assistance, according to Dr. Georges Dubuche of the country’s Ministry of Public Health and Population. The percentage has remained high.

As Dr. Carroll warns, “Haiti does not have a functional health care system on a good day let alone a system that can effectively fight this virus.”

The Inter-American Development Bank has thus far committed $50 million to the Coronavirus response. The IMF is also apparently considering an unprecedented influx of reserve assets for developing countries.

Haiti is one of 50 desperate countries that will have split between them some part of a recently launched $2 billion UN plan, but that will take time to materialize.

US-blockaded Cuba, whose medical teams have been heavily active in Haiti since 1998, has dispatched a brigade of 348 doctors and other health specialists to help fight the coronavirus.

Haiti's government has steadily reduced national health spending in recent years. In the last approved budget, more funds were allocated to parliament than toward the health sector. https://t.co/pYrHrdhsUs pic.twitter.com/nQwUS1VLop — Jake Johnston (@JakobJohnston) March 27, 2020

Some important private and donor-backed medical clinics do exist, such as the Partners in Health-run hospital in Mirebalais. It is apparently one of the first major medical institutions that has been proactively testing for Covid-19. A variety of NGOs and smaller health-oriented groups have scrambled to prepare and educate people about the pandemic.

At UniFA, the University of the Aristide Foundation, in a Port-au-Prince suburb called Tabarre, the medical school has just begun to graduate students who are required to practice inside the country. In March, the university graduated its first 138 students. Among its faculty have been teachers from Cuba.

As its website explains, the “medical school graduates are currently fulfilling their one-year government mandated social service residency in health care centers across the country. In many instances, these young professionals are the only health care providers for the entire community.”

#Haiti's health system is ill-prepared for COVID-19 outbreak due to corruption of current US-backed govt. The doctors & nurses of UNIFA stand ready to fill the gap and serve the Haitian people. https://t.co/3iPI4IghGF pic.twitter.com/IWK9k76gKw — HaitiInfoProj (@HaitiInfoProj) March 21, 2020

A medical brigade from Cuba consisting of 348 doctors and nurses arrived in #Haiti today, as the number of #coronavirus cases jumps to 8. Cuban medical solidarity is GREAT……But the government's neglect of national health care is a crime that should not be ignored. pic.twitter.com/isqoDz1Cvy — Madame Boukman – Justice 4 Haiti 🇭🇹 (@madanboukman) March 25, 2020

Factories in Port-au-Prince were closed on March 20th. Most were assembling clothes and electronics for export. A few factories may soon be overhauled to produce things like surgical masks. For common people seeking to take precautions, one surgical mask costs approximately 50 Gourdes (about $0.53) but these are very hard to find.

Some business groups active in Haiti are beginning to prepare, including an association of Chinese enterprises.

2nd Shipment of the medical supplies (including 138000 masks) hv departed from China,donated by Association of Chinese Enterprises in Haiti. pic.twitter.com/lUTjmzkBCI — 陳文(Chen Wen) (@ChenWen007) March 30, 2020

To compound the problem, under the corruption-stained Moïse government, the country’s National Office of Old Age Insurance (OFNAC) has been grievously mismanaged. Funds for the elderly have been delayed or cut, further endangering those most at risk from the coronavirus.

Responding to the calamity ahead

Will the quarantine ordered by the Moïse government be ultimately seen as a hollow act of grand-standing? It is in large part not being enforced, and it’s not clear if it even can be, given people’s day-to-day struggle for survival.

Haiti’s government has put forward a preparation and response plan with an estimated $37.2 million budget, but it’s unclear how effective it can be. Local and international organizations have been meeting to coordinate a response.

#Haiti's govt has forsaken its responsibility to its people. This just yesterday in downtown Port au Prince. Does this look like social distancing? If #COVID19 takes hold there is NO medical infrastructure to contain it. pic.twitter.com/VKZaTEbp3h — HaitiInfoProj (@HaitiInfoProj) March 29, 2020

One street vendor woman (known as a “Ti Marchan”) said in an interview with Haiti’s Island TV that the present confinement is intolerable. Needing to earn money to feed up to eight family members, she exclaimed that she would rather be infected with the virus than not work, since her sole daily livelihood was now being taken away.

Many are asking if Haiti’s government will be able to secure basic food staples to feed the majority of the population, as large parts of the population live on just a few dollars a day or less and are now being pressured to isolate themselves and not work.

The Haitian government has announced food distribution measures for some districts, and this comes as the prices of some basic food staples has increased in recent months and the currency has rapidly depreciated.

By comparison, in the nearby Dominican Republic, state officials have announced on national television that the nation’s poorest sectors will receive financial aid for food purchases through the government’s “solidarity debit cards.” They will start receiving an increase of 5,000 Pesos (about US$92) monthly, starting on April 1 and running through the end of May. The Dominican Republic has become one of the largest locations for Foreign Direct Investment (FDI) in the Caribbean and is among the region’s top tourist hotspots, so the government has many more resources to deal with such a crisis.

The first cases of Covid-19 in the Dominican Republic were officially acknowledged by its Health Ministry in late February. The Dominican government, meanwhile, has begun to take drastic measures such as a suspension of flights from Europe, a 5 PM to 6 AM curfew which may turn into a draconian 24-hour lockdown with exceptions for grocery shopping, buying prescriptions, and other necessary excursions.

Haiti is the Dominican Republic’s number two export market after the US, and is heavily dependent upon Dominican exports for basic food staples such as rice, as well as manufactured consumer items. Thus, anything that impacts the Dominican Republic eventually affects life in Haiti.

A number of Haitian migrant workers appear to have fled back to the country to be with family. Others, whose economic survival depends on daily migrant labor, have no choice but to find illicit ways to cross back and forth across the border.

A large part of the Haitian population is clearly aware of the real dangers posed by the coronavirus, but at the same time many confess they have no choice but to gain their daily livelihoods through the usual improvised and informal activities in the small scale economy. The overwhelming majority of these workers are forced to take very crowded public transportation to their workplaces.

As the virus hits countries worldwide, it is unlikely foreign governments will be able to marshal the Herculean support that Haiti needs. Haiti spends just $13 per capita on healthcare, compared to $180 by the Dominican Republic, and $781 in Cuba.

Confusion reigns. Some Haitians have criticized recent moves by the government to push thousands of people to line up for national IDs, after officials declared the cards will be required to receive aid during the pandemic.

Desperate times, desperate measures. After #Haiti closed the border with the Dominican Republic, people crossed the river to buy and sell. In the era of neoliberal globalization, Haitians are forced to pick their poison: #coronavirus or mass starvation. pic.twitter.com/lM0IxCJ5AP — Madame Boukman – Justice 4 Haiti 🇭🇹 (@madanboukman) March 17, 2020

Meanwhile a kidnapping wave has traumatized people in Haiti, even affecting the transportation sector bringing in goods from the Dominican Republic.

A protest movement pauses and hospital director is kidnapped

The situation is made more difficult by the ongoing political crisis. Moïse now governs without parliament after failing to hold elections, and had been facing a mass uprising threatening to chase him from office. Strong diplomatic support from the US has been the linchpin allowing his tenuous political survival.

The coronavirus though has put a pause on the giant anti-government protests that occurred throughout late 2019 and into early 2020. Yet these will undoubtedly return given how sharply the inhuman essence of neoliberal capitalism in Haiti and elsewhere has been exposed by the current crisis.

As massive protests against the US-backed Moïse rocked Haiti throughout 2019, and his government struck back by hiring violent paramilitaries to crack down, the Bernard Mevs Hospital went into debt treating hundreds of wounded demonstrators for free.

This March, while Covid-19 bore down on Haiti, the hospital’s director, Dr. Jerry Bitar, was kidnapped. Hospital staff refused to take in new patients until Bitar was freed, leading to his release on March 27.

Hospital workers protest the kidnapping of Dr. Jerry Bitar who was kidnapped today while on the way to work. "We will not continue to work without the release of Dr. Bitar." "This is a hospital that accepts everyone, whether they can afford it or not." https://t.co/6k0VIeyN1o pic.twitter.com/5SNrdFRKon — Madame Boukman – Justice 4 Haiti 🇭🇹 (@madanboukman) March 27, 2020

In the 21st century, Haitians have experienced one ordeal after another. Estimates of deaths from the January 12, 2010 earthquake range from 46,000 to 160,000 people, while many more were wounded and up to a million were displaced. The country has yet to recover from these tragedies, with many survivors still trapped tent cities.

Haiti has also survived a cholera outbreak which killed close to 10,000 and sickened over 800,000. UN occupation troops were found to have caused the epidemic through their negligence, and a campaign demanding reparations from the UN continues.

The country has also suffered several devastating hurricanes, including Hurricane Matthew in 2016, which extensively ravaged Haiti’s southern peninsula, wiping out crops and coastal towns.

US-imposed right-wing governments set the stage for another disaster

Haiti’s population faces the coronavirus pandemic after a series of man-made crises that set the backdrop for the coming crisis.

First, there were the 1991 and 2004 coup d’états, both US-backed schemes that sought to roll-back popular gains made after historic turnouts at the polls by Jean Bertrand Aristide’s leftist Lavalas movement.

In the 2010-2011 elections, Washington intervened through the Organization of American States (OAS) to effectively change the electoral results and install the right-wing pop singer Michel “Sweet Micky” Martelly, ushering in a decade of US puppet regimes.

Martelly’s successor, Moïse, appears to have pocketed millions of dollars stolen from funds meant to help build up the country through Venezuela’s PetroCaribe program. Funds from PetroCaribe have been used by many Caribbean states to plug budget shortfalls and invest in important infrastructure.

Moïse is officially mentioned 69 times in the recent corruption report produced by the State Administrative Court and is considered one of the principal beneficiaries, both politically and financially, of the Petrocaribe funds corruption scheme.

In response to protests, the Haitian government and its allies have also turned to violent repression against popular neighborhoods where anti-government sentiments run high.

US-backed Haitian government agents accused of conducting massacre By @JebSpraguehttps://t.co/mCCl3jCvKA — The Canary US (@TheCanaryUS) December 20, 2018

Instead of investing in healthcare, the government has increasingly sought to strengthen its repressive capabilities.

With the support of planners at the Inter-American Defense Board, the Moïse government has begun rebuilding the military, which was disbanded in 1995. Historically, the Haitian military has symbolized repression of the popular will, presiding over numerous coups, massacres, and counter-insurgency campaigns to guarantee the Washington consensus.

As Jake Johnson of the Center for Economic and Policy Research (CEPR) has written, “The Inter-American Defense Board, a body of the OAS, developed a ‘white paper’ in July [of 2015] focused on reinstating a Haitian defense force with the support of the UN.”

By 2018, Haiti’s new army had six personnel being trained at the US military’s School of the Americas (SOA), which was renamed the Western Hemisphere Institute for Security Cooperation (WHINSEC).

In March, the Haitian government disseminated a snappily produced public relations video on Whatsapp that portrayed soldiers distributing bags of rice to the doors of people’s ramshackle homes.

In February 2020, however, the newly reconstituted military engaged in a deadly clash with police officers in Port-au-Prince who had been locked in a labor dispute with the government. The conflict illustrated the fundamental purpose of the country’s military, which has always been loyal to the country’s political right-wing, and whose existence was sustained for the purpose of internal repression.

Battered by years of man-made and natural disasters, Haiti faces another historical ordeal with few resources to shoulder it. Sidelined and repressed by a US-imposed political apparatus, the poor majority will bear the brunt of the coronavirus.

Jeb Sprague is a Research Associate at the University of California, Riverside and previously taught at UVA and UCSB. He is the author of “Globalizing the Caribbean: Political economy, social change, and the transnational capitalist class” (Temple University Press, 2019), “Paramilitarism and the assault on democracy in Haiti” (Monthly Review Press, 2012), and is the editor of “Globalization and transnational capitalism in Asia and Oceania” (Routledge, 2016). He is a co-founder of the Network for the Critical Studies of Global Capitalism. Visit his blog at: http://jebsprague.blogspot.com