Sandra Lamarque is the head of mission for Doctors Without Borders in Haiti. (Caroline Frechard/Doctors Without Borders)

Aid workers in Haiti are bracing for a COVID-19 outbreak that may prove nearly impossible to contain.

The Caribbean country has officially reported fewer than 20 deaths from the coronavirus disease, but with many cases going unreported, the real number may be much higher.

What’s more, health-care workers fear a COVID-19 peak could be on the horizon, and it’s likely to coincide with hurricane season, which begins next month.

That’s because more than 17,000 Haitian migrants have returned home from the Dominican Republic over the last couple weeks after losing their jobs due to the coronavirus lockdown. That country, which shares a long and porous border with Haiti, had 13,223 confirmed cases and 441 deaths as of Tuesday, according to government figures.

Sandra Lamarque is the head of mission for Doctors Without Borders in Haiti, which just opened a hospital dedicated to COVID-19 patients in Port-au-Prince. Here is part of her conversation with As It Happens host Carol Off.

Can you give us an idea of how many Haitians have actually now returned from the Dominican Republic since the outbreak?

Movements are happening every week between the Dominican Republic and Haiti.

In those movements, you have Haitian workers that have returned to Haiti because they lost employment opportunities in Dominican Republic. But you also have daily movements of Haitians crossing the border to Dominican Republic for business, trade or casual work opportunities.

Is there any testing, any way of knowing how many there may be carrying coronavirus?

Unfortunately, no. So the border, as you may know, is 360 kilometres long between the two countries. It’s quite a long border and you have over 100 informal crossing points and only a small number of official crossing points.

At these informal crossing points, there is no screening or testing ongoing. And even at the formal crossing points, being able to set up proper screening and isolation or quarantine took a long time. It was not done right from the beginning of the outbreak in DR or in Haiti.

Sandra Lamarque is the head of mission for Doctors Without Borders in Haiti. (Caroline Frechard/Doctors Without Borders)

Given the size of the outbreak … in DR, which is the largest one in the region … what are your greatest fears for what might happen to Haiti?

We were definitely worried that some COVID cases have been and will continue being imported with these returns. And what we observe at the moment in Haiti is actually that the local transmission has increased a lot.

In the past 24 hours, we’ve had almost 100 new cases, which is unprecedented for the outbreak in Haiti. So it’s now increasing really fast. We have huge local transmission.

And how well is Haiti equipped to deal with a major outbreak of this disease?

It is not equipped to deal with such an outbreak. At the moment, we estimate that there are 250 beds available especially to treat people that are infected with COVID-19. This is not enough. And there are only 100 ventilators.

So setting up an intensive care unit for severe patients of COVID-19 in Haiti will be extremely challenging, to say the least.

We know that the health system in Haiti was already weak before it got hit with that earthquake in 2010. And large parts of it have never really recovered. So where do people go if they are feeling the symptoms or suspect they have it? Where can they get help?

This is the main concern is that people do not necessarily seek health care or did not seek health care on time.

Just to give you an example, we opened a COVID hospital last Saturday … and on the first day of opening, we received a patient who unfortunately died five minutes after being admitted in our emergency ward.

Unfortunately, he delayed the time to seek health care in an institution. And the first hospital that he presented himself to denied access to health care for this man. They refused to admit him, and they did not facilitate the referral with ambulance up to our hospital.

So this is extremely worrying. People are afraid of getting tested, they’re afraid of seeking health care and they’re afraid of being stigmatized or even attacked.

There have been cases in the recent past of [people with] suspected cases of COVID-19 being harassed by neighbours or being threatened.

Residents gather outside a hotel designated as a quarantine facility for COVID-19 n Port-au-Prince on May 12. (Andres Martinez Casares/Reuters)

So people are afraid of getting it. They’re afraid of neighbours getting it. But it sounds like the hospitals and any place they might go for treatment, they’re afraid of taking in those cases. Why is that?

A lot of the public hospitals are not equipped with personal protection equipment for their staff. So the staff is afraid of getting infected, understandably.

This is a perfect storm in so many ways, isn’t it? Because you have these people coming back into Haiti by the … tens of thousands. Any number of them could be carrying it. You have a hospital system already not able to cope with normal health care. And now you have the possibility of a major outbreak of COVID-19.

Absolutely. Not to mention the hurricane season coming up. So we’re hoping that we will not have all these factors coinciding into an even bigger problem.

Workers walk in a safe distance between each other during a break at a Port-au-Prince clothing manufacturer after it switched part of its production from clothing exports to making protective masks. (Jeanty Junior Augustin/Reuters)

After the earthquake in 2010, there followed a major outbreak of cholera and … people just felt that they couldn’t trust the system. … Is it bringing back memories, do you think, for people of the cholera outbreak?

Absolutely.

Haitians have long been distrustful of their institutions, and this has been even aggravated in the past two years with a very profound political crisis.

What we saw 2010 is that people … at the initial phase of the outbreak, there were a lot of cholera treatment centres that were attacked or burned down, or there were protests from the neighbours against the installation of these facilities because people were worried that the facility itself would would be the vector of the disease in their community.

This is something that we observe again today in relation to COVID-19, where even [on Sunday] in a town called Jacmel in the southern part of a country, a facility that had been identified for the isolation of suspected COVID cases was burned down.

And we’ve seen recently in Port-au-Prince that an institution was willing to set up a COVID facility, but the neighbouring community protested against that and maybe made some threats. And so the institution had to put their plan on standby.

If Doctors Without Borders has opened a hospital dedicated to COVID-19 patients, what are your concerns for the safety of that centre?

I think what was maybe an aggravating factor for the problems I mentioned is the lack of information and the lack of communication about the disease.

So before setting up our hospital, we worked for about a month and a half just on communication, especially communication with the community surrounding the hospital, and trying to explain all the precautions that we are taking in terms of patient flow, in terms of protection equipment, in terms of waste management, to reassure the community.

Before the hospital opened, we [invited] community leaders to visit the hospital. We also made a movie. In this movie, we showed the patient flow and the precautions that we are taking and we broadcast this movie in the community in order to reassure people.

So I think that if you take the necessary precautions and, of course, you need to go a bit slowly, you may overcome most of the risks and most of the fear.

At the same time, you know better than I, you have many areas of Haiti and in the capital that are very poor. Ability to have proper hygiene is extremely difficult and the physical distancing is almost impossible. So how bad could the situation get in Haiti?

On top of this, we should also say that the barrier measures, as we call them, that worked in other contexts, such as having people stay at home or avoid the gatherings, these measures are not being implemented in Haiti.

People cannot afford to stay home. They need to go out for their daily income. And this is the socioeconomic reality here. So a lot of these measures are not and will not be put in place.

Otherwise, you may have very, very severe food security crises on top of the crisis. And so it’s true that it makes things even more challenging.


Written by Sheena Goodyear with files from Reuters. Interview produced by Jeanne Armstrong. Q&A has been edited for length and clarity.