While Haiti, the poorest country in the Americas, has long had one of the world's highest levels of food insecurity, drought has ravaged harvests for the last few years, worsening food shortages and raising prices. The northwest, one of the Caribbean nation's most remote and impoverished regions, has suffered the most. The impoverished slums of the capital are, together with the Northwest, the areas worst affected by hunger. Humanitarian workers - and Haitians - beg the world not to turn a blind eye to the immediate suffering.
One in three Haitians - around 3.7 million people - needs urgent food assistance, up from 2.6 million people at the end of 2018, the United Nations said in December. Haiti now ranks 111 out of 117 countries on the Global Hunger Index, in the company mostly of the poorest sub-Saharan African countries. If immediate action is not taken, by next month 1.2 million people will only be able to eat one meal every other day in the Caribbean nation, the United Nations has warned.
The real impact of the crisis will show in six months or so as malnutrition sets in, experts like Cédric Piriou, Haiti Country Director of Action Against Hunger, say.
Infant mortality already appears to be rising.
"If we had four children suffering malnutrition die before, now these last few months it has been six to eight," said Dr Margareth Narcisse, at St Damien Pediatric's Hospital in Port-au-Prince, the capital city.
A collapse in the gourde currency has put imported food - which supplies more than half the country's needs - out of reach for many Haitians. By further stoking inflation and squeezing incomes, the peyi lock, as the standstill was known in Creole, has tipped Haiti into a new hunger crisis.
"No one has eaten yet today but if I feed my kids too early in the day they are hungry by night and cannot sleep," said Frena Remorin, 30. "I don't have enough money now for two meals a day," she said.
It wasn't always like this.
Haiti was largely food self-sufficient until the 1980s, when at the encouragement of the United States the country started loosening restrictions on crop imports and lowered tariffs, then imported surplus U.S. crops, a decision that put Haitian farmers out of business and contributed to investment tailing off.
Add to this the effects of climate change: Haiti regularly tops the ranks of most vulnerable nations. This is because it is part of an island in the Caribbean, where hurricanes are getting stronger, but also because it has little infrastructure or resilience. In the past, at least they could rely on the mango and breadfruit trees if they could not afford to buy food. But due to the drought, these trees are no longer producing.
In the malnutrition ward, three-year-old Dorvil Chiloveson lies on his side in a cot. He is suffering from severe protein malnutrition, known as kwashiorkor: his tiny body is swollen with edema, with patches of skin discolored and showing raw flesh.
"We couldn't go sell our harvest during peyi lock so we lost it," said his grandmother Marise Rose Dor, 41, who lives on the outskirts of Port-au-Prince. After they ate their crop, all they could afford was rice with bananas from the garden. Instead of buying drinking water, they used a local spring they know is likely to be contaminated due to the absence of a sewage system in Haiti. Many families can no longer afford purification tablets to clean the water or charcoal to boil it.
The U.N. World Food Programme (WFP), which alongside other international organizations assists Haiti's most needy, has scaled up operations in response to the crisis, distributing more food, and cash. The WFP estimated in November it needed $72 million to fund this emergency assistance to 700,000 Haitians for eight months. On Wednesday it said it had raised only $19 million so far.
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