Protecting Haiti's Children: Risk factors and outcomes before and since the 2010 earthquake
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Protecting Haiti's Children: Risk factors and outcomes before and since the 2010 earthquake

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Haiti’s 4.25 million children faced a bleak future following the earthquake of January 12, 2010. Not only did the earthquake create new challenges to child protection, it also exacerbated ...

Haiti’s 4.25 million children faced a bleak future following the earthquake of January 12, 2010. Not only did the earthquake create new challenges to child protection, it also exacerbated pre-existing vulnerabilities that limited the fulfillment of children’s rights. More than two years later, Haitian children continue to face myriad challenges to their protection, resilience, and development, despite the dedicated efforts and significant achievements of national and international response and development actors. These actors face formidable obstacles in addressing the protection needs of Haiti’s vulnerable children and adolescents, including those who are orphaned, separated from their families, or at risk of abandonment or violence, abuse, and exploitation. Information is needed on the scope of child protection challenges that Haiti has experienced both before and since the earthquake and on the range of family and community coping responses. Evidence-based decision-making is complicated by a lack of clarity on the level and scope of research and knowledge on the child protection situation in Haiti before the earthquake, and by knowledge gaps in key areas.

To meet this challenge, the FXB Center has undertaken a systematic analysis of Haiti’s child protection situation before and after the 2010 earthquake. The project examines the types of child protection, security, and developmental threats that Haitian children have faced before and after the earthquake and how children and their families respond to these threats. The overall goal of the project is to improve UNICEF’s and child protection actors’ understandings of child protection in Haiti, build a full picture of the child protection risks that Haitian children have historically faced, and the current needs that children and families now experience. It is hoped that the project will bring renewed attention to the protection and promotion of children in Haiti and serve as a foundation for evidence-based policy and programs by Haitian and international organizations advancing the rights and well-being of Haitian children.

The report is the FXB Center’s latest contribution to the protection and promotion of children’s rights in Haiti. It presents a multi-sectoral and multi-dimensional longitudinal analysis of the risks and opportunities affecting the vulnerability and resilience of Haiti’s children, and highlights key areas in need of greater attention and efforts.

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    Protecting Haiti's Children: Risk factors and outcomes before and since the 2010 earthquake Protecting Haiti's Children: Risk factors and outcomes before and since the 2010 earthquake Document Transcript

    • PROTECTING HAITI’S CHILDRENRisk factors and outcomes before and since the 2010 earthquake Nicholas M. Cooper October 2012 © 2012 FXB Center for Health and Human Rights, Harvard University
    • ! !Copyright © 2012by the FXB Center for Health and Human RightsHarvard University651 Huntington Avenue, 7th floorBoston, MA 02115 U.S.A.All rights reserved.Acknowledgments.This!Report!is!intended!as!a!contribution!to!the!Government!of!Haiti,!Haitian!civil!society,!UNICEF,!and!other!organizations!advancing!the!rights!and!wellbeing!of!children!in!Haiti.!!The!views!expressed!in!this!Report!are!those!of!the!author,!and!do!not!necessarily!reflect!those!of!the!faculty,!fellows!or!staff!of!the!FXB!Center!for!Health!and!Human!Rights.!!The!author!would!like!express!his!sincerest!gratitude!to!his!colleagues!and!friends!at!the!FXB!Center!for!Health!and!Human!Rights!and!elsewhere,!whose!input,!insight,!and!assistance!added!immeasurable!value!to!this!Report!and!his!understanding!of!child!protection!in!Haiti.!!Special!thanks!must!go!to!Jennifer!Leaning!and!Arlan!Fuller,!for!their!steadfast!commitment,!vision,!and!leadership;!Megan!McLaughlin!and!Venchele!Saint!Dic,!for!their!instrumental!research!support;!Hannah!Ratcliffe,!for!her!excellent!analysis!of!both!language!and!argument;!Terra!Ziporyn,!Bonnie!Shnayerson,!Elizabeth!Newnham,!Jessica!Moore!Kaplan,!and!Mey!Cooper,!for!their!copyedits;!Elizabeth!Gibbons,!for!her!sage!counsel;!and!members!of!the!faculty!and!staff!of!the!FXB!Center!for!Human!Rights.!Without!your!guidance,!generosity,!and!wealth!of!knowledge,!this!Report!would!never!have!been!realized.!Thank!you.!! ii!
    • ! . . . PROTECTING.HAITI’S.. CHILDREN. . Risk.factors.and.outcomes.before.and. since.the.2010.earthquake. . . Nicholas.M..Cooper. . . October.2012. ! ©!2012!FXB!Center!for!Health!and!Human!Rights,!Harvard!University!! !
    • !Table&of&Contents.List!of!figures!...............................................................................................................................................!vi!Executive!summary!....................................................................................................................................!xii!1.!Introduction!.............................................................................................................................................!1!2.!Methodological!note!................................................................................................................................!4!3.!Demography!.............................................................................................................................................!6! A.!Urbanization!......................................................................................................................................!13! B.!Vital!registration!................................................................................................................................!15! C.!Fertility!...............................................................................................................................................!17! D.!Child!marriage!...................................................................................................................................!32! E.!Mortality!............................................................................................................................................!35! F.!Family!structure!.................................................................................................................................!49!4.!Migration!and!movement!......................................................................................................................!59! A.!Child!migration!..................................................................................................................................!65! B.!Child!trafficking!..................................................................................................................................!67! C.!Adoption!............................................................................................................................................!71!5.!Child!protection!......................................................................................................................................!74! A.!Safety!and!security!............................................................................................................................!75! B.!Violence!.............................................................................................................................................!78! i.!Crime!in!the!camps!..........................................................................................................................!86! C.!Sexual!and!gender`based!violence!....................................................................................................!89! D.!Children!without!parental!care!.......................................................................................................!104! i.!Orphanages!and!other!private!institutions!...................................................................................!114! E.!Children!in!and!of!the!street!............................................................................................................!117!6.!Poverty,!access,!and!empowerment!....................................................................................................!125! A.!Monetary!poverty!............................................................................................................................!125! B.!Food!security!and!nutrition!.............................................................................................................!135! C.!Water,!sanitation,!and!hygiene! .......................................................................................................!149! . D.!Shelter!and!housing!.........................................................................................................................!158! E.!Information!and!communication!technology!..................................................................................!164! F:!Political!and!civic!engagement!.........................................................................................................!167!7.!Health!...................................................................................................................................................!172!iv! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • ! Table&of&Contents& A.!Healthcare!access!............................................................................................................................!172! B.!Physical!health!.................................................................................................................................!179! i.!Communicable!diseases!................................................................................................................!179! ii.!Non`communicable!diseases!and!external!causes!.......................................................................!198! C.!Sexual!and!reproductive!health!.......................................................................................................!201! i.!Reproductive!health!......................................................................................................................!201! ii.!Sexual!health!................................................................................................................................!207! D.!Mental!and!psychological`social!health!..........................................................................................!225! E.!Drug!use!...........................................................................................................................................!229!8.!Education!.............................................................................................................................................!232! A.!Early!childhood!care!and!education!................................................................................................!232! B.!Formal!education!system! ................................................................................................................!236! . C.!Education!engagement!....................................................................................................................!248! i.!Vulnerable!sub`populations!..........................................................................................................!270! D.!Education!quality!.............................................................................................................................!277! E.!Access!to!education!and!barriers!to!enrollment!..............................................................................!288!9.!Labor!and!economic!participation!.......................................................................................................!300! A.!Children!in!domestic!service!and!servitude!.....................................................................................!303! i.!Types!and!definitions!of!child!domestic!service!in!Haiti! ...............................................................!304! . ii.!Prevalence!and!demographic!characteristics!of!children!in!domestic!service!.............................!313! iii.!Factors!motivating!placement!.....................................................................................................!325! iv.!Risk!factors!and!outcomes!of!child!domestic!service!..................................................................!329! B.!Child!labor!migration!to!the!Dominican!Republic!............................................................................!346!References!...............................................................................................................................................!354!!! ©!2012!FXB!Center!for!Health!and!Human!Rights! v!
    • !List&of&figures&Figure!1:!Total!Haiti!domestic!population,!1980`2010!.................................................................................!6!Figure!2:!Population,!household!size!and!gender!ratio,!by!Department,!2003!...........................................!7!Figure!3:!Annual!domestic!population!growth!rate,!1980`2010!..................................................................!7!Figure!4:!Population!under!age!18,!1990`2010!............................................................................................!8!Figure!5:!Proportion!of!total!Haitian!population!under!age!18,!1990`2010!................................................!9!Figure!6:!Age!composition!of!surveyed!households!(hh),!February!2010!..................................................!10!Figure!7:!Haiti!population!pyramid,!2000!..................................................................................................!11!Figure!8:!Haiti!population!pyramid,!2010!..................................................................................................!11!Figure!9:!Percentage!of!population!living!in!urban!and!rural!areas,!1980`2010!........................................!14!Figure!10:!Percentage!of!Haitis!population!in!urban!areas:!National!and!by!Department,!1982!&!2003!.!14!Figure!11:!Percentage!of!young!Haitians!who!had!first!intercourse!before!15!or!before!18,!2006!...........!17!Figure!12:!Sexual!activity!among!Haitian!young!people,!2006! ..................................................................!18! .Figure!13:!Sexual!activity!among!15`19!year!old!females!(percent),!2006!................................................!19!Figure!14:!Total!Fertility!Rate!(TFR),!1980!`!2009!.......................................................................................!20!Figure!15:!Adolescent!Fertility!Rate,!1997!`!2009!......................................................................................!22!Figure!16:!Percent!of!15`19!year!old!females!ever!pregnant!or!had!a!child,!2006!....................................!23!Figure!17:!Age!difference!between!women!age!15!`!24!and!their!current!partners,!2006! .......................!25! .Figure!18:!Contraceptive!prevalence!rate,!1997`2009!...............................................................................!28!Figure!19:!Contraceptive!prevalence!rate:!Total,!modern!methods,!and!condom,!1995`2006!.................!29!Figure!20:!Percentage!of!females!aged!15`24!who!have!ever/never!used!contraception,!2006!..............!30!Figure!21:!Percentage!of!females!aged!15`24!who!used!a!condom!at!last!sex,!2006!................................!31!Figure!22:!Knowledge!of!source!for!condoms!and!condom!use!at!first!sex,!2006!.....................................!32!Figure!23:!Age!at!first!marriage!or!union!for!20`24!year!old!females!(%),!2006!........................................!33!Figure!24:!Percent!of!15`24!year!old!females!who!are!illiterate,!by!marital!status!at!age!15,!2006!.........!34!Figure!25:!Percent!of!15`19!year!old!females!in!school,!by!marital!and!childbearing!status,!2006!...........!35!Figure!26:!Life!expectancy!at!birth:!Total,!female,!and!male,!1980`2009!..................................................!37!Figure!27:!Female!life!expectancy!as!a!percentage!of!male!life!expectancy,!1995`2009!..........................!37!Figure!28:!Probability!of!death!ages!0`19,!by!sex,!1990`2009!...................................................................!38!Figure!29:!Causes!of!neonatal!deaths,!2000!..............................................................................................!39!Figure!30:!Infant!Mortality!Rate!(IMR),!1995`2009!....................................................................................!40!Figure!31:!Progress!towards!MDG!indicator!4.2!(IMR),!1990`2005!...........................................................!41!Figure!32:!Under`5!Mortality!Rate!(U5MR),!1980`2009! ............................................................................!43! .Figure!33:!Progress!towards!MDG!4!(U5MR),!1990`2005!..........................................................................!43!Figure! 34:! Disaggregation! of! U5MR! by! socio`economic! group,! sex,! urban/rural! status,! and! mothers! education,!2000!...................................................................................................................................!44!Figure!35:!Probability!of!death!age!5`9,!by!sex,!1990`2009!.......................................................................!45!Figure!36:!Probability!of!death!age!10`19,!by!sex,!1990`2009!...................................................................!45!Figure!37:!Probability!of!death!age!10`14,!by!sex,!1990`2009!...................................................................!46!Figure!38:!Probability!of!death!age!15`19,!by!sex,!1990`2009!...................................................................!46!Figure!39:!Maternal!Mortality!Ratio!(MMR):!Reported!and!adjusted,!1995`2007!....................................!47!vi! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • ! List&of&Figures&Figure!40:!Progress!towards!MDG!5.A!(MMR),!1990`2005!........................................................................!48!Figure!41:!Average!household!size,!by!income!group!and!Department,!2001!..........................................!50!Figure! 42:! Household! size! in! troubled! neighborhoods! in! Port`au`Prince,! Cap`Haïtien,! Gonaïves,! Saint` Marc!and!Petit`Gôave,!2009!................................................................................................................!51!Figure!43:!Average!household!size!in!World!Vision!operational!areas!in!La!Gonâve,!Plateau!Central,!and! Nord!and!Sud!Departments!following!the!January!2010!earthquake,!March!2010!............................!52!Figure!44:!Net!number!of!immigrants,!1960`2010! ....................................................................................!60! .Figure!45:!Prevalence!of!lifetime!migration,!by!Department,!2001!...........................................................!63!Figure!46:!Reason!for!migrating!(%):!Youth!and!adults,!2001!....................................................................!66!Figure! 47:! Most! at`risk! population! subgroups! after! 2010! earthquake! according! to! household! heads! in! Port`au`Prince!and!World!Vision!operational!areas,!March!2010!.......................................................!78!Figure!48:!Reported!methods!of!punishment!of!children,!by!sex!and!child!domestic!worker!(CDW)!status,! 2002!.....................................................................................................................................................!81!Figure!49:!Percent!of!surveyed!children!punished!in!the!week!before!the!survey,!by!urban/rural!status,! sex,!and!child!domestic!worker!status,!2002!.......................................................................................!81!Figure!50:!Percentage!of!households!affected!by!rape,!murder,!kidnapping!and!gang!involvement,!2006` 2007!.....................................................................................................................................................!84!Figure!51:!Percentage!of!households!with!victims!of!aggression,!by!city,!2006`2007!...............................!85!Figure! 52:! Non`consensual! sex! among! 15`24! year! old! females,! by! Department! and! urban/rural! status,! 2006!.....................................................................................................................................................!92!Figure!53:!Female!attitudes!toward!domestic!violence,!by!condition,!Department!and!urban/rural!status,! 2006!.....................................................................................................................................................!99!Figure!54:!Parental!residence!in!household,!Haiti!and!Port`au`Prince!metropolitan!area,!2000!............!106!Figure!55:!Parental!residence!in!household,!by!region,!urban/rural!status,!and!childs!gender,!2006! ...!108! .Figure!56:!Parental!residence!in!household,!by!urban/rural!status,!and!childs!gender,!2006!................!109!Figure!57:!Parental!survival!among!children!aged!10`14,!by!gender!and!urban/rural!status,!2006!........!110!Figure!58:!Children!in!the!street!(%)!in!troubled!neighborhoods!in!Haiti,!2009!......................................!120!Figure!59:!Gini!indices,!by!Department!and!urban/rural!status,!2001*!...................................................!128!Figure!60:!Income!share!held!by!quintile!and!extreme!deciles,!2001!......................................................!128!Figure!61:!Monthly!income!(%),!2006!and!2008!......................................................................................!129!Figure!62:!Intensity!of!household!economic!activity,!by!city,!2008!.........................................................!130!Figure!63:!GDP!per!capita,!expressed!in!2005!Purchasing!Power!Parity`adjusted!2005!U.S.!dollars,!1991` 2008!...................................................................................................................................................!130!Figure!64:!Median!annual!income!per!capita,!by!Department!and!urban/rural/metropolitan!area!status,! 2001!...................................................................................................................................................!131!Figure! 65:! Household`level! monetary! effects! of! the! earthquake! in! affected! areas,! by! pre`earthquake! income!tercile,!March!2010!...............................................................................................................!135!Figure!66:!Prevalence!of!under`5!malnutrition!and!undernutrition,!1990`2006!.....................................!139!Figure!67:!Post`earthquake!household!priorities,!by!region,!February!2010!..........................................!142!Figure! 68:! Food! consumption! among! displaced! and! non`displaced! earthquake`affected! residents,! February!2010!....................................................................................................................................!142! ©!2012!FXB!Center!for!Health!and!Human!Rights! vii!
    • !Figure! 69:! Prevalence! of! severe! malnutrition! in! most`affected! Departments,! by! surveyed! commune,! January`October!2011!.......................................................................................................................!145!Figure!70:!Prevalence!of!moderate!malnutrition!in!most`affected!Departments,!by!surveyed!commune,! January`October!2011!.......................................................................................................................!145!Figure!71:!Price!of!basic!foodstuffs!in!Port`au`Prince!and!Jacmel,!November!2009`February!2010!.......!146!Figure!72:!Priority!areas!for!nutrition!interventions,!by!commune,!October!2011!.................................!149!Figure!73:!Access!to!improved!water!source,!by!urban/rural!status,!1990`2006!....................................!151!Figure!74:!Access!to!water,!by!income!quintile,!2001! .............................................................................!152! .Figure!75:!Access!to!improved!sanitation!facilities,!by!urban/rural!status,!1990`2006!...........................!155!Figure!76:!Number!of!people!per!latrine!and!shower!in!assessed!camps,!by!Department,!May!2011!...!157!Figure!77:!Current!place!of!residence,!by!status!of!pre`earthquake!residence,!March!2010!..................!162!Figure!78:!Distribution!of!IDP!camps!and!households!by!commune,!June!2010!.....................................!163!Figure!79:!Number!of!IDP!sites,!households,!and!individuals,!July!2010`September!2011!.....................!163!Figure!80:!Access!to!electricity!(%),!by!urban/rural/metropolitan!area!status!and!income!quintile,!2001 !...........................................................................................................................................................!165!Figure!81:!Total!and!mobile!phone!subscribers!(%),!1998`2009!..............................................................!166!Figure!82:!Internet!users!(%),!1998`2009!.................................................................................................!167!Figure!83:!Institutions!where!households!have!filed!complaints,!2009!...................................................!169!Figure! 84:! Geographic! variation! in! cumulative! cases! of,! and! deaths! from,! cholera,! 20! October! 2010`2! February!2011!....................................................................................................................................!185!Figure! 85:! Cumulative! incidence! of! reported! cholera! cases! per! 1,000! population,! by! Department,! 20! October!2010`31!July!2011!(graph)!...................................................................................................!186!Figure! 86:! Cumulative! incidence! of! reported! cholera! cases! per! 1,000! population,! by! Department,! 20! October!2010`31!July!2011!(table)!....................................................................................................!186!Figure!87:!Trends!in!cholera!activity,!by!Department,!April`July!2011!....................................................!188!Figure!88:!Expanded!Program!on!Immunization!coverage!rate!(%),!by!antigen,!2001`2005!...................!197!Figure! 89:! Proportion! of! patients! seen! by! Handicap! International! by! age! group! compared! to! Haitian! population,!19!January!2010.!............................................................................................................!199!Figure! 90:! Percentage! of! births! attended! by! skilled! health! personnel,! by! household! wealth! quintile,! 2003`2006!..........................................................................................................................................!204!Figure! 91:! Percentage! of! women! aged! 15`24! who! received! delivery! assistance! from! various! types! of! service!providers,!by!Department!and!urban/rural!status,!2006!......................................................!205!Figure!92:!Mean!number!of!antenatal!care!visits!among!pregnant!females!aged!15`24,!2006!..............!207!Figure!93:!Percentage!of!young!Haitians!who!had!first!intercourse!before!15!or!before!18,!by!sex,!1995` 2006!...................................................................................................................................................!209!Figure!94:!Percentage!of!females!aged!15`24!who!used!a!condom!at!last!sex,!2006!..............................!210!Figure!95:!Knowledge!of!source!for!condoms!and!condom!use!at!first!sex,!ages!15`19!and!20`24,!by!sex,! 2006!...................................................................................................................................................!211!Figure!96:!Age!difference!between!partners!at!first!sex!among!females!age!15`24,!2006! .....................!212! .Figure!97:!Age!difference!between!current!partners!among!females!age!15`24,!2006!..........................!213!Figure!98:!HIV!testing!among!females!aged!15`24,!by!Department!and!urban/rural!status,!2006!.........!220!Figure!99:!Knowledge!of!HIV!prevention!methods!among!youth,!by!method,!sex!and!age,!2006!..........!221!viii! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • ! List&of&Figures&Figure!100:!Knowledge!of!HIV!prevention!methods!among!women!aged!15`24,!by!method,!urban/rural! status,!and!Department,!2006!...........................................................................................................!222!Figure! 101:! Knowledge! of! mother`to`child! transmission,! by! sex! and! mode! of! transmission,! 2000! and! 2006!...................................................................................................................................................!223!Figure!102:!Prevalence!of!drug!use,!by!substance,!time!period,!and!gender,!2005!................................!231!Figure!103:!Breakdown!of!pre`school!pupils,!by!gender,!section,!and!age,!2006!....................................!235!Figure!104:!Structure!of!the!Haitian!education!system!...........................................................................!237!Figure!105:!Educational!enrollment,!by!public/private!status,!2006!(estimated)! ...................................!242! .Figure!106:!Damage!sustained!by!schools,!Port`au`Prince,!Leogane,!and!Jacmel!(chart),!March!2010!..!244!Figure!107:!Damage!sustained!by!schools,!Port`au`Prince,!Leogane,!and!Jacmel!(table),!March!2010!..!245!Figure! 108:! Planned,! in! construction,! and! completed! semi`permanent! and! permanent! school! reconstruction/rehabilitation,!by!commune,!March!2011!................................................................!247!Figure!109:!School!enrollment!among!10`17!year!olds,!by!age,!sex!and!urban/rural!status,!2006!.........!249!Figure! 110:! School! enrollment! among! 10`14! year! olds,! by! sex,! Department,! urban/rural! status,! and! school!level,!2006!..............................................................................................................................!250!Figure!111:!School!enrollment!among!15`19!year!olds,!by!sex,!urban/rural!status,!and!school!level,!2006! (chart)!................................................................................................................................................!250!Figure! 112:! School! enrollment! among! 15`19! year! olds,! by! sex,! Department,! urban/rural! status,! and! school!level,!2006!(table)!...................................................................................................................!251!Figure!113:!Non`enrollment!among!children!age!6`17,!by!sex!and!Department,!2006!...........................!253!Figure!114:!School!attendance,!by!age!and!metropolitan/urban/rural!status,!2001!..............................!255!Figure!115:!School!enrollment!among!children!living!in!IDP!camps,!by!sex!and!age!group,!July!2011!...!256!Figure!116:!Percentage!of!children!entering!grade!1!at!the!required!age,!by!sex!and!urban/rural!status,! 1997!...................................................................................................................................................!257!Figure!117:!Trends!in!the!evolution!of!basic!education!enrollment,!by!sector,!1980`1997!....................!259!Figure!118:!Basic!education!Net!Enrollment!Rates!(NERs),!by!Department,!2000!..................................!260!Figure!119:!Number!and!percentage!of!over`aged!students!relative!to!total!enrollment,!by!grade,!1998 !...........................................................................................................................................................!263!Figure!120:!Number!and!percent!of!over`age!students!in!basic!education,!1993`1998!..........................!264!Figure!121:!Number!of!over`age!students!in!basic!education,!by!sex!and!sector,!1998!..........................!265!Figure!122:!Distribution!of!students!(%),!by!grade,!1981!and!1997!.........................................................!266!Figure!123:!Student!survival!of!a!synthetic!cohort,!by!grade,!1997!.........................................................!267!Figure!124:!Dropout!rate!in!basic!education,!by!grade,!1997!..................................................................!268!Figure!125:!Highest!education!level!completed,!by!wealth!quintile,!2001!..............................................!271!Figure! 126:! Poverty! headcount! proportion,! by! education! level! and! urban/rural/metropolitan! status,! 2001!...................................................................................................................................................!272!Figure! 127:! Adolescents! not! in! school! and! not! living! with! either! parent,! by! sex,! Department,! and! urban/rural!status,!2006!....................................................................................................................!275!Figure!128:!Girl/boy!ratio!in!primary!and!secondary!education,!1990`2005!...........................................!276!Figure!129:!Adult!illiteracy!in!Haiti,!by!year!and!sex,!1970`2000!.............................................................!286!Figure!130:!Progress!towards!MDG!2.3!(universal!youth!literacy),!1990`2015!.......................................!287!Figure!131:!Illiteracy!among!female!youth,!by!Department,!2006!..........................................................!288! ©!2012!FXB!Center!for!Health!and!Human!Rights! ix!
    • !Figure!132:!School!attendance!of!7`14!year`olds,!by!income!quintile,!2001!...........................................!294!Figure!133:!Co`residents!of!child!domestic!workers,!by!sex!and!urban/rural!status,!2002!.....................!308!Figure!134:!Restavek!kin!ties!to!household!heads!(%),!2008!...................................................................!309!Figure!135:!Matrix!of!categories!and!characteristics!of!child!placement!arrangements!.........................!312!Figure!136:!Percentage!of!children!experiencing!treatment!as!restaveks!in!five!Haitian!cities,!2008!.....!315!Figure!137:!Percentage!of!households!with!one!or!more!child!domestic!workers,!2002!........................!316!Figure!138:!Percentage!of!households!with!restavek!children,!by!survey!site,!2008!..............................!317!Figure!139:!Average!age!of!restaveks!and!restavek`boarders!compared!to!other!children,!2008!..........!318!Figure!140:!Age!distribution!of!child!domestic!workers!and!other!children!(%),!by!sex,!2002!................!318!Figure!141:!Percentage!of!restavek!and!non`restavek!children,!by!gender,!2008!...................................!319!Figure!142:!Distribution!of!child!domestic!workers!(thousands),!by!Department,!gender,!and!urban/rural! status,!2002!.......................................................................................................................................!320!Figure! 143:! Place! of! birth! of! children! aged! 5`17,! by! gender,! child! domestic! worker! status,! and! urban/rural!status,!2002!....................................................................................................................!321!Figure!144:!Economic!status!of!households!placing!their!children!as!restaveks!and!restavek5boarders,!by! socio`economic!status,!2008!.............................................................................................................!323!Figure! 145:! Economic! status! of! households! containing! restaveks! and! restavek`boarders,! by! socio` economic!status,!2008!.......................................................................................................................!323!Figure! 146:! Total! and! per`person! mean! and! median! annual! household! income! (Gourdes),! by! whether! households!have!placed!a!child!in!another!household!for&any&reason,!2002! ...................................!324! .Figure! 147:! Total! and! per`person! mean! and! median! annual! household! income! (Gourdes),! by! whether! households!have!placed!a!child!in!another!household!to&perform&housework,!2002!.......................!324!Figure! 148:! Percentage! of! households! receiving! restaveks! and! restavek5boarders,! by! sending! status,! 2008!...................................................................................................................................................!325!Figure! 149:! Activities! performed! by! child! domestic! workers! and! other! children! during! the! preceding! year,!2002!..........................................................................................................................................!332!Figure!150:!Average!number!of!restavek!and!non`restavek!chores,!by!surveyed!site,!2008! ..................!333! .Figure! 151:! Activities! performed! by! child! domestic! workers! during! the! preceding! week,! by! sex! and! urban/rural!status,!2002!....................................................................................................................!334!Figure!152:!Childrens!weekly!workload,!in!approximate!quintiles!of!hours!worked,!by!age,!2002!........!335!Figure! 153:! Median! number! of! hours! worked! in! the! household! during! the! preceding! week,! by! child! domestic!worker!status,!sex,!age,!and!urban/rural!status,!2002!......................................................!336!Figure! 154:! Percentage! of! children! enrolled! in! school,! by! child! domestic! worker! status,! age,! and! sex,! 2002!...................................................................................................................................................!338!Figure!155:!School!enrollment,!by!residence!with!parents!and!child!domestic!worker!status,!2002! .....!338! .Figure!156:!Average!years!of!schooling!of!restavek!and!non`restavek!children,!by!surveyed!site,!2008!339!Figure!157:!Percentage!of!children!punished!using!various!methods!during!the!preceding!week!(graph),! by!child!domestic!worker!status!and!sex,!2001!.................................................................................!342!Figure!158:!Percentage!of!children!punished!using!various!methods!during!the!preceding!week!(table),! by!child!domestic!worker!status,!urban/rural!status,!and!sex,!2001!.................................................!342!Figure!159:!Child!vulnerability!to!street!life!and!transport!to!the!Dominican!Republic,!by!surveyed!city,! 2008!...................................................................................................................................................!348x! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • !! ! !xi! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • !Executive&summary&!Haiti’s!4.25!million!children!faced!a!bleak!future!following!the!earthquake!of!12!January!2010.!Not!only!did! the! earthquake! create! new! challenges! to! child! protection,! but! also! exacerbated! pre`existing!vulnerabilities! limiting! the! fulfillment! of! children’s! rights.1! Two! and! a! half! years! later,! however,!interventions! by! the! Haitian! Government,! the! international! community,! and! local! organizations! have!made!significant!progress!in!improving!child!protection!risk!factors,!and!outcomes.!Daunting!challenges!remain,!with!critical!unmet!need!in!most!social!and!economic!sectors!at!both!policy!and!programmatic!levels.!Yet!in!some!areas,!such!as!access!to!healthcare,!children!in!Haiti!today!may!have!greater!access!to!services!than!before!the!earthquake.2!While!the!destruction!of!the!earthquake!will!remain!a!tragedy!for! Haiti! and! its! children,! it! has! also! provided! an! opportunity! to! realize! the! vision! of! “building! back!better.”!!!Protecting! Haiti’s! children! requires! a! holistic! assessment! of! risk! factors! that! contribute! to! their!vulnerability!and!resilience.!For!this!reason,!“operational”!definitions!of!child!protection,!which!require!the!categorization!of!those!in!need,!such!as!child!laborers,!separated!and!unaccompanied!children,!and!children! in! contact! with! the! law,3! are! less! useful! to! inter`sectoral! decision`makers! than! information!pertaining! to! current! basic! needs! and! risk! factors.! This! report! recognizes! that! child! protection! is!inextricably!linked!to!familial!and!social!context,!and!that!outcomes!reflect!dynamic!relationships!among!risk! factors.4! Consequently,! the! report! presents! the! current! state! of! child! protection! in! Haiti! from! the!perspective! of! risk! factors,! outcomes,! trends,! and! key! gaps! in! knowledge.! This! perspective! allows!policymakers!and!programmers!to!make!evidence`based!decisions!that!will!help!build!a!better!future!for!Haiti’s!children.!!!Demographics.and.displacement.While!Haiti’s!population!growth!rate!has!fallen!to!1.3%!per!annum,!children!comprise!42.5%!of!the!total!Haitian!population,!contributing!to!a!“youth!bulge”!of!those!aged!5`14.!More!than!half!of!all!Haitians!live!in!urban!areas!and!around!one!quarter!of!the!Haitian!population!lives!in!the!Port`au`Prince!metropolitan!area.5! This! population! concentration! proved! disastrous! when! the! 7.0! Richter! scale! earthquake! struck!just!25km!southwest!of!Port`au`Prince!in!January!2010.6!Over!220,000!people!lost!their!lives,!more!than!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1 !World!Bank,!World&databank&education&statistics&(EdStats).!Available!at!http://data.worldbank.org/data` catalog/ed`stats!2 !L.!Ivers,!A.!Schiff,!D.!Jones,!et!al.,!“Assessment!and!analysis!of!Haitian!HADR!data”!(presentation!to!the!Haiti! Assessments!Working!Group,!April!27!2010).!3 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!4 !UNICEF,!Child&protection:&A&handbook&for&parliamentarians,!Handbook!for!Parliamentarians!No.!7!(2004).! Available!at!http://www.unicef.org/publications/files/Guide_Enfants_OK.pdf!!5 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!6 !U.S.!Geological!Survey,!Magnitude&7.0&–&Haiti&Region:&Details,!Earthquake!Hazards!Program!(2010).!Available!at! http://earthquake.usgs.gov/earthquakes/eqinthenews/2010/us2010rja6/#details!!xii! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&300,000!were!injured,!and!millions!were!directly!affected.7!In!the!month!following!the!earthquake,!an!estimated! 500`600,000! people! (22%! of! the! Port`au`Prince! population)! left! the! Port`au`Prince!metropolitan! area,! although! by! the! end! of! January! 2010! migration! to! the! capital! again! exceeded!migration!from!the!capital.!By!March!2010,!the!Port`au`Prince!population!was!an!estimated!15%!smaller!than!before!the!earthquake.8!The!proportion!of!those!who!left!Port`au`Prince!following!the!earthquake!that! have! since! returned,! as! opposed! to! those! migrating! to! Port`au`Prince! for! the! first! time,! remains!unclear.! By! June! 2010,! 1.6! million! people! were! living! in! more! than! 1,300! Internally! Displaced! Person!(IDP)! camps,! including! approximately! 800,000! children.9! By! September! 2011,! approximately! 550,000!people!remained!in!IDP!camps,!of!whom!209,000!were!estimated!to!be!children.10!!Child.survival..Life! expectancy! at! birth! for! all! people! in! Haiti! increased! from! 1980! (50.6! years)! to! 60.3! years! in! 2009,!increased! probability! of! survival! has! been! greater! for! children! than! for! other! age! groups! during! this!period.11!A!child!born!in!1990!had!an!18.2%!chance!of!dying!before!age!20.!By!2009,!the!WHO!estimated!that! this! probability! had! decreased! by! more! than! one! third,! to! approximately! 11.0! percent.!Improvements!in!survival!rates!were!observed!across!all!child!subgroups,!but!were!most!notable!among!children!under!five!and!those!aged!5`9.12!Despite!remaining!the!highest!in!the!Americas,!Haiti’s!under`five!mortality!rate!(U5MR)!fell!by!52%!between!1990!and!2009,!to!72!deaths!per!1,000!live!births. 13,14!However,! the! U.S.! Census! Bureau! estimated! in! 2010! that! the! direct! and! indirect! effects! of! the!earthquake!raised!Haiti’s!U5MR!to!181!deaths!per!1,000!live!births.15!More!recent!data!are!unavailable.!!!Communicable! diseases! are! the! primary! drivers! of! total! childhood! mortality! in! Haiti,! although! non`communicable! diseases,! including! accidents,! assault,! and! maternal! causes,! are! a! greater! concern! for!those! aged! 10`19! than! for! their! younger! counterparts.16! UNICEF! has! noted! that! following! the! initial!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!7 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!8 !L.!Bengtsson,!X.!Lu,!R.!Garfield,!et!al.,!Internal&population&displacement&in&Haiti:&Preliminary&analyses&of&movement& patterns&of&Digicel&mobile&phones!(May!2010).!9 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!10 !IOM,!Population&in&camps&housing&Haitians&left&homeless&by&the&2010&earthquake&drops&below&600,000,! International!Organization!for!Migration!(August!2011).!Available!at! http://www.iomhaiti.com/ft/page.php?id=53!11 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!12 !WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!13 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!14 !UNESCO,!Data&center:&Custom&tables:&Haiti.!Available!at! http://stats.uis.unesco.org/unesco/TableViewer/document.aspx?ReportId=136&IF_Language=eng&BR_Topic=0!15 !U.S.!Census!Bureau,!International&data&base:&Haiti&demographic&indicators.!Available!at! http://www.census.gov/population/international/data/idb/informationGateway.php!16 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xiii!
    • !destruction!caused!by!the!2010!earthquake,!communicable!diseases!have!once!again!come!to!dominate!Haitian!childhood!mortality.17!.!Child.migration..Child! migration! within! and! from! Haiti! is! dominated! by! the! search! for! economic! opportunity! and!education!for!both!children!themselves!and!for!their!adult!caregivers.18,19!Prior!to!the!2010!earthquake,!it! was! believed! that! every! year! between! 2,000! and! 3,000! children! illegally! crossed! the! border! to! the!Dominican!Republic!in!search!of!work,!before!returning!with!earnings!to!support!their!families.20!A!2001!survey!found!that!36.5%!of!youth!and!adult!respondents!who!had!migrated!within!Haiti!did!so!to!follow!their!family,!while!13%!cited!educational!reasons!as!their!primary!motivation.21!These!proportions!are!likely! to! be! greater! for! children,! who! were! not! surveyed,! than! for! adults,! given! children’s! reliance! on!their!family!for!access!to!basic!needs!and!their!higher!propensity!to!enroll!in!school.!!!Child.trafficking.The!detection!and!eradication!of!child!trafficking!remains!a!pressing!concern!in!Haiti.!In!2009,!UNICEF!estimated! that! 2,000! children! were! trafficked! every! year! to! the! Dominican! Republic.22! Significantly,!UNICEF! and! IOM! had! also! estimated! in! 2002! that! between! 176,000! and! 300,000! children! were! the!victims!of!child!trafficking!within!Haiti.23!The!hidden!nature!of!child!trafficking,!however,!has!prompted!the! International! Labor! Organization! to! suggest! that! these! estimates! be! considered! more! illustrative!than!exact.24!The!2010!earthquake!compounded!children’s!risk!of!trafficking,!with!7%!of!camps!in!Port`au`Prince,! 9%! of! camps! outside! of! Port`au`Prince,! and! 13%! of! non`camp! sites! outside! of! the! capital!reporting! at! least! one! instance! of! suspected! child! trafficking! in! the! first! month! following! the!earthquake.25!No!information!is!available!on!whether!these!cases!were!confirmed!during!follow`up.!The!significant!risks!faced!by!trafficked!children,!including!physical,!psychological,!and!sexual!abuse,!highlight!the!urgency!of!a!comprehensive!response.!The!Haitian!Government!identified!the!need!for!measures!to!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!17 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!18 !H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!!19 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!20 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!21 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!22 !G.!Menezes,!Warning&of&the&dangers&of&child&trafficking&in&Haiti,!UNICEF!(23!March!2011).!Available!at! http://www.unicef.org/infobycountry/haiti_58029.html!23 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm.!!24 !ILO,!Unbearable&to&the&human&heart:&Child&trafficking&and&action&to&eliminate&it,!International!Labour!Office! (2002).!Available!at!http://www.unicef.org/violencestudy/pdf/2002_traff_unbearable_en.pdf!!25 !CDC,!CDC&summary&of&initial&rapid&assessment&conducted&by&UN&OCHA&in&Haiti!(February!2010).!xiv! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&combat! child! trafficking! in! its! Post`Disaster! Needs! Assessment,26! and! international! partners! have!assisted! in! the! design,! implementation,! and! training! of! staff! for! trafficking! prevention! programs.!Between! January! and! July! 2010,! 6,000! cases! of! child! movement! across! the! Dominican! border! and!through! airports! had! been! evaluated,! and! 400! victims! had! been! assisted.27,28! In! March! 2011,! UNICEF!stated!that!of!the!11,774!children!screened!at!the!Port`au`Prince!airport!and!other!border!checkpoints!in! all! of! 2010,! 459! were! identified! as! victims! of! child! trafficking.29! The! relatively! small! increase! in! the!number!of!identified!child!trafficking!victims!may!be!the!result!of!a!true!reduction!in!the!number!of!child!trafficking!attempts,!traffickers’!use!of!other!routes,!or!lower!rates!of!successful!identification,!though!the!impact!of!each!of!these!factors!remains!unknown.!!Child.labor.Child! Labor! is! prevalent! in! Haiti,! despite! legislation! restricting! child! work.! In! 2005,! the! World! Bank!estimated!that!33.4%!of!children!aged!5`14!were!economically!active,!particularly!boys!(37.3%!male!vs.!29.6%! female).30! In! terms! of! employment,! 22%! of! boys! and! 19%! of! girls! in! this! age! group! were!employed,! for! an! aggregate! estimate! of! approximately! 21%.31,32! Among! boys! aged! 15`19,! 51.3%! were!either! employed! or! looking! for! work! in! 2007,! while! the! same! was! true! for! 39.4%! of! girls.! As! such,! the!total!labor!force!participation!rate!for!this!age!group!was!45.4%,!with!girls!80%!as!likely!as!boys!to!be!economically!active.33!!!Of! particular! concern! in! Haiti! are! those! children! working! as! domestic! servants.! These! children! are!referred!to!as!restaveks,!a!pejorative!term.!Household!poverty!compels!many!children!to!leave!families!unable! to! meet! their! basic! needs.34,35! These! children! are! often! “employed”! as! servants! in! another!household.!Restavek!children,!in!general,!compared!to!other!children!in!the!household,!have!less!access!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!26 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!27 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!28 !UN!MINUSTAH,!Haiti:&6&Months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!29 !UNICEF,!OHCHR&Universal&Periodic&Review&–&Haiti!(March!2011).!Available!at! http://lib.ohchr.org/HRBodies/UPR/Documents/session12/HT/UNICEF`eng.pdf!30 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!31 !UNICEF,!State&of&the&world’s&children&199752009!(Oxford:!Oxford!University!Press,!1997`2009).!Available!at! http://www.unicef.org/sowc/!!32 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!33 !UN!DESA,!World&youth&report:&2007!(New!York:!United!Nations,!2007).!Available!at! http://www.un.org/esa/socdev/unyin/wyr07.htm!!34 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!35 !G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xv!
    • !to! education,! are! subjected! to! greater! psychological! abuse,! are! often! emotionally! excluded! from! their!host! families,! exhibit! inferior! health! outcomes,! and! have! greater! risk! of! sexual! and! gender`based!violence.36! It! is! estimated! that! there! are! between! 90,000! and! 300,000! restavek! children! in! Haiti,37!although!enumeration!is!difficult!both!because!of!the!hidden!nature!of!the!phenomenon!and!because!there! is! no! categorical! definition! of! restavek.! One! study! estimated! that! approximately! two! thirds! of!restaveks!are!girls,!and!that!in!urban!versus!rural!areas,!a!greater!proportion!of!restaveks!are!also!girls!(72%).38! A! 2009! study! in! the! Port`au`Prince! metropolitan! area! found! that! 30%! of! all! households!contained!at!least!one!restavek.39!However,!this!finding!may!not!be!generalizable!across!Haiti!as!Port`au`Prince!is!the!preferred!destination!for!all!internal!migrants.!Interestingly,!the!survey!found!that!11%!of!household!hosting!a!restavek!had!also!sent!at!least!one!child!to!live!as!a!restavek!elsewhere.40!Similarly,!a!number!of!studies!found!that!households!in!all!income!quintiles!reported!hosting!restaveks,!although!lower!per!capita!household!income!was!a!significant!determinant!of!the!probability!of!sending!a!child!for!placement.41,42,43!!!Exposure.to.violence.Whatever! their! living! situation,! children! in! Haiti! are! also! likely! to! experience! some! form! of! violence.44!Violence! against! children! is! a! multi`faceted! concept! including! physical! and! mental! abuse,! exploitation,!sexual! abuse,! and! negligent! treatment.! While! victimization! from,! and! participation! in,! gangs! is! socially!condemned,!other!forms!of!violence!in!more!“controlled”!environments!including!schools!and!the!home!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!36 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!37 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!38 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!39 !G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!40 !G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!41 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!42 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!43 !G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!44 !Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!xvi! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&are!accepted!as!a!regular!part!of!child`rearing.45!A!2004!study!found!that!60%!of!women!and!85.7%!of!men! in! Haiti! reported! that! they! had! been! mistreated! at! a! moderate! or! severe! level! during! childhood.!Corporal! punishment! in! the! home! is! widely! used! as! a! method! of! discipline,! including! spanking! and!beating.! In! 2005,! the! Government! of! Haiti! stated! that! 40%! of! children! were! hit! or! beaten! when! they!behaved!badly.46!Most!sources!indicate!that!children!who!are!not!biologically!related!to!the!household!head,!such!as!paid!and!unpaid!child!servants,!are!at!greater!risk!of!physical!violence!in!the!home.!A!2009!UN!report!stated!that!70%!of!children!in!domestic!servitude!had!suffered!from!some!form!of!abuse,!and!that! 10%`15%! of! these! abused! children! had! been! sexually! abused.47! In! contrast,! a! 2002! study! by! the!FAFO!found!no!appreciable!difference!in!the!likelihood!of!physical!abuse!between!biological!and!other!children,!but!found!that!non`biological!children!were!subject!to!greater!psychological!abuse,!potentially!resulting!in!greater!harm!from!similar!levels!of!physical!abuse.48!Despite!the!training!of!an!additional!100!Child! Protection! Brigade! officers! within! the! Haitian! National! Police! since! the! earthquake,! social!acceptance! of,! and! legal! ambiguity! regarding,! violence! against! children! in! the! home! has! limited! the!efficacy!of!prevention!and!protection!initiatives.49!Similarly,!despite!its!prohibition,!corporal!punishment!remains!prevalent!in!Haitian!schools,!negatively!affecting!the!physical!and!psychological!wellbeing!and!development!of!children.50!!Despite!a!reduction!of!communal!violence!following!the!cessation!of!political!unrest!in!2006/2007,!the!security! situation! in! Port`au`Prince! deteriorated! markedly! following! the! 2010! earthquake.! Between!January! and! March! 2010,! 14%! of! Cite! Soleil! residents! reported! victimization! or! witnessing! violence!where! they! were! living.! The! leading! forms! of! violence! were! beating! (27%),! fighting! (24%),! rape! (20%),!and! theft! (18%).51! Across! earthquake`affected! areas,! a! greater! proportion! of! people! living! in! camps!reported!threats!to!security!than!those!in!non`camp!zones.!In!fact,!nearly!half!(47%)!of!camp!residents!in! Port`au`Prince! were! victims! of! property! crimes! between! January! and! March! 2010,! while! 21%! had!been! threatened! with! physical! harm.! In! contrast,! the! same! survey! found! that! only! 2%! of! the! general!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!45 !Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on&violence& against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!!46 !Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on&violence& against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!!47 !UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!48 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!49 !Global!Initiative!to!End!All!Corporal!Punishment!of!Children,!Haiti&country&report!(February!2009).!Available!at! http://www.endcorporalpunishment.org/!!50 !Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on&violence& against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!!51 !UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xvii!
    • !non`camp!population!had!been!threatened!with!physical!violence.52!The!physical!arrangement!of!camp!spaces,! including! the! location! of! latrines! and! water! sources,! bathing! facilities,! and! the! presence! of!lighting,!were!highlighted!as!a!key!risk!factor!for!violence!among!camp!residents.53,54,55!As!the!number!of!Haitian! children! living! in! camps! has! decreased! and! service! provision! has! expanded! over! the! past! two!years,! threats! to! security! and! the! risk! of! violence! are! likely! to! have! decreased! in! aggregate,! while!remaining! high! for! those! still! living! in! IDP! camps.! In! November! 2011,! the! UN! Deputy! Special!Representative! of! the! Secretary! General! for! Haiti,! Nigel! Fisher,! stated! that! violence,! in! general,! and!sexual!violence,!in!particular,!continued!in!IDP!camps,!but!with!less!frequency!than!at!the!end!of!2010.56!!Sexual! and! gender`based! violence! (SGBV),! like! physical! violence,! is! prevalent! in! Haiti! as! well,! with!children! in! domestic! servitude,! street! children,! and! child! labor! migrants! at! particularly! high! risk.! The!2010!earthquake!compounded!Haitian!children’s!vulnerability!to!SGBV!by!rendering!pre`existing!safety!nets,!prevention!strategies,!and!survivor!services!inoperable.!In!2003,!the!UN!Committee!on!the!Rights!of! the! Child! noted! that! more! than! one! third! of! Haitian! women! had! been! sexually! abused! before! age!15.57! Notably,! 24.2%! of! all! female! youth! reported! that! their! first! time! having! sex! had! been! forced.58!Female!child!domestic!servants!were!4.5!times!more!likely!to!be!sexually!abused!than!other!girls.59!!There! is! a! widely`held! perception! among! policymakers! and! service! providers! that! the! prevalence! of!sexual!and!gender`based!violence!increased!following!the!earthquake.60,61,62,63,64!While!there!have!been!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!52 !UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&3,!5!April!2010!(April!2010).!Available!at! http://groups.google.com/group/assessmentshaiti/browse_thread/thread/71f3f127213f7a06!!53 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape!(July! 2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!54 !S.!Toupin,!Ensuring&haitian&women’s&participation&and&leadership&in&all&stages&of&national&relief&and& reconstruction:&A&gender&shadow&report&of&the&2010&Haiti&PDNA!(2010).!Available!at! http://reliefweb.int/node/350585!!55 !UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!56 !UN!MINUSTAH,!Press&Conference&by&Deputy&Special&Representative&of&Secretary5General&for&Haiti!(30!November! 2011).!Available!at!http://minustah.org/?p=32936!57 !UN!Committee!on!the!Rights!of!the!Child,!Concluding!observations:!Haiti,!UN!Doc.!CRC/C/15/Add.202!(2003).! Available!at!http://www.unhcr.org/refworld/docid/3f2597274.html!!58 !Government!of!Haiti,!Enquête&mortalité,&morbidité&et&utilisation&des&services&(EMMUS&IV)&200552006!(January! 2007).!Available!at!http://www.measuredhs.com/pubs/pdf/FR192/FR192.pdf!59 !A.!R.!Kolbe!and!R.!A.!Hutson,!“Human!rights!abuse!and!other!criminal!violations!in!Port`au`Prince,!Haiti:!a! random!survey!of!households,”!The&Lancet!368!(2006),!pp.!864`873.!60 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape!(July! 2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!61 !ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!!xviii! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&no!nationally!representative!surveys!allowing!the!quantification!of!this!increase,!available!evidence!and!experience! in! other! post`disaster! contexts! suggests! that! an! increase! is! likely! in! the! post`earthquake!context.!In!addition,!greater!proportions!of!victims!of!sexual!and!gender`based!violence!are!more!likely!to! be! reporting! abuses! now,! due! to! greater! accessibility! of! care! and! support! services.65! A! study!conducted!by!the!Center!for!Human!Rights!and!Global!Justice!at!the!New!York!University!School!of!Law!in!January!2011!highlighted!the!continuing!threat!of!sexual!and!gender`based!violence!in!IDP!camps!one!year!after!the!earthquake,!although!the!authors!noted!that!estimates!may!not!be!generalizable!across!IDP!camps.!The!study!found!that!over!the!one!year!period!following!the!earthquake,!9%!of!respondents!reported! that! a! member! of! their! household! had! been! raped! or! otherwise! forced! to! have! sex,! while! a!further!8%!had!been!the!victims!of!unwanted!touching.!Of!those!respondents!who!reported!the!gender!and! age! of! the! victim,! 12%! reported! the! victim! as! a! girl! and! 5%! as! a! boy.! SGBV! was! found! to! be!associated!with!food!insecurity,!and!some!women!and!girls!turned!to!“transactional!sex”!to!meet!their!basic!needs.66!The!absence!of!reliable!and!comprehensive!estimates!of!the!current!extent!of!risk!factors!and!outcomes!of!SGBV!against!children,!however,!inhibits!efforts!to!effectively!respond!to!the!needs!of!victims!and!evaluate!strategies!implemented!by!state!and!non`state!actors!to!address!post`earthquake!needs.!!!Street.children..Methodological! challenges! also! undermine! attempts! to! determine! the! number! of! children! in! and! of!Haiti’s!streets,!with!estimates!varying!markedly!over!the!past!decade!depending!on!source.!Prior!to!the!earthquake,! in! the! period! 2004`2009,! most! sources! referenced! UNICEF’s! estimate! of! 2,500! street!children!across!Haiti.67,68,69,70!Poverty!has!been!identified!as!a!primary!driver!of!the!prevalence!of!street!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!62 !S.!Toupin,!Ensuring&haitian&women’s&participation&and&leadership&in&all&stages&of&national&relief&and& reconstruction:&A&gender&shadow&report&of&the&2010&Haiti&PDNA!(2010).!Available!at! http://reliefweb.int/node/350585!!63 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!64 !UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!!65 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!66 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!67 !UNICEF!Executive!Board,!Revised&country&programme&document:&Haiti&(200952011)!(2009).!Available!at! http://www.unicef.org/about/execboard/files/Haiti`FRS2009`revised_feb2010`English.pdf!!68 !UNICEF,!UNICEF&humanitarian&action&report&2008!(2008).!Available!at! http://www.unicef.org/har08/index_haiti.php!!69 !Amnesty!International,!Overcoming&poverty&and&abuse:&Protecting&girls&in&domestic&service&in&Haiti!(November! 2009).!Available!at!http://www.amnesty.org/en/library/info/AMR36/004/2009!!70 !UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2005/123!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47! ©!2012!FXB!Center!for!Health!and!Human!Rights! xix!
    • !children,71,72!while!Kovats`Bernat!stated!in!2006!that!some!children!chose!to!live!in!the!street!because!it!provided! them! with! relatively! greater! freedom! and! economic! opportunity.73! Several! studies! have!suggested! that! a! significant! proportion! of! street! children! were! dismissed! or! runaway! indentured!servants! who! had! to! make! a! living!without! the! benefit! of! formal! education.74,75! Prior! to! January! 2010,!most!street!children!were!migrants!from!the!provinces.!!!In! the! wake! of! the! earthquake,! it! is! likely! that! a! significantly! higher! proportion!of! street! children! now!include! urban! residents! whose! pre`existing! support! strategies! are! no! longer! adequate! for! their! needs.!The!2010!earthquake!undoubtedly!resulted!in!an!increase!in!the!number!of!street!children,!due!to!both!economic! necessity! stemming! from! the! loss! of! an! income`generating! family! member! and! the!destruction!of!residences.!However,!estimates!of!the!number!of!children!in!and!of!the!street!following!the!January!2010!earthquake!are!unavailable.!UNICEF!is!supporting!the!establishment!of!residential!care!facilities,!both!“overnight”!and!permanent,!to!provide!street!children!with!an!entry`point!to!services!and!support—although! demand! far! outstrips! supply.76! In! July! 2011,! President! Martelly! also! declared! his!intention! to! create! a! fund! to! support! programs! for! street! children! similar! to! the! National! Fund! for!Education,!though!further!details!have!not!been!released.77! !!Children!without!parental!care!are!always!among!the!most!vulnerable!in!society!due!to!the!absence!of!alternative!coping!strategies!and!social!support!networks!that!provide!an!adequate!substitute!for!family!care.! In! 2006,! the! nationally! representative! Enquête! mortalité,! morbidité! et! utilisation! des! services! IV!(EMMUS! IV)! survey! found! that! 55%! of! Haitian! children! did! not! live! in! a! household! with! both! of! their!parents.! The! proportion! of! children! living! with! both! parents! was! higher! in! rural! areas! (47%)! than! in!urban!areas!(28%).!Countrywide,!roughly!25%!of!Haitian!children!lived!with!neither!parent!in!2006.!The!survey!also!determined!that!11%!of!all!Haitian!children!had!lost!at!least!one!parent,!and!that!1.3%!of!all!Haitian!children!had!no!surviving!parents.78,79,80,81!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!71 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!72 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm!73 !J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!74 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!75 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm!76 !UNICEF,!Residential&care&center&provides&a&refuge&for&street&children&in&Cap5Haitian!(February!2011).!Available!at! http://www.unicef.org/infobycountry/haiti_57670.html!!77 !HaitiLibre,!"Martelly!working!on!a!fund!project!for!street!children,"!HaitiLibre!(July!6,!2011).!Available!at! http://www.haitilibre.com/en/news`3116`haiti`social`martelly`working`on`a`fund`project`for`street` children.html!78 !Government!of!Haiti,!Enquête&mortalité,&morbidité&et&utilisation&des&services&(EMMUS&IV)&200552006!(January! 2007).!Available!at!http://www.measuredhs.com/pubs/pdf/FR192/FR192.pdf!79 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!xx! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&!As! there! have! been! no! nationally! representative! surveys! assessing! children’s! living! situation! since! the!earthquake,! it! has! not! been! possible! to! derive! estimates! that! are! methodologically! comparable! to! the!set!of!EMMUS!surveys.!However,!the!perspective!is!widely!shared!that!the!proportion!of!children!living!in!households!with!only!one!or!neither!parent!has!increased,82!given!the!Haitian!Government’s!estimate!that! the! earthquake`related! death! of! more! than! 220,000! people! resulted! in! one! in! five! families! in!earthquake`affected! areas! experiencing! the! death! of! at! least! one! family! member.83! Additionally,! the!practice!of!placing!children!in!orphanages!as!a!response!to!poverty!rather!than!parental!death!was!likely!to!have!intensified!following!the!earthquake!due!to!the!destruction!of!families’!economic!opportunities!and! livelihood! strategies.! Similarly,! the! practice! of! sending! children! to! work! as! domestic! servants! to!support! their! own! and! their! family’s! needs! would! likely! have! increased.84! In! March! 2010,! the! Haitian!Government! stated! that! 103,000! cases! of! children! without! any! family! protection! had! been! identified!nationwide.85! However,! by! July! 2011,! UNCEF! stated! that! only! 8,212! separated! and! unaccompanied!children! had! been! registered! in! the! Child! Protection! sub`Cluster’s! family! reunification! and! tracking!database.86!It!is!unclear!what!proportions!of!children!in!both!the!Child!Protection!sub`Cluster’s!database!and! the! Haitian! Government’s! estimates! were! considered! separated! and! unaccompanied! minors,!orphans,!children!in!or!of!the!street,!or!living!in!a!single`parent!household,!though!the!exclusion!of!some!of!these!categories!from!the!sub`Cluster’s!database!may!contribute!to!the!apparent!disparity!between!its!coverage!and!the!Government’s!estimate!of!those!in!need.!!Poverty.Widespread! poverty! is! at! the! root! of! many! protection! challenges! facing! Haitian! children.! Despite! its!popularity! as! a! poverty! indicator,! relatively! few! nationally! representative! surveys! that! enumerate!headcount! poverty! proportions! (the! proportion! of! a! population! living! below! a! pre`defined! threshold!definition! of! “poor,”! rather! than! the! depth! of! poverty! experienced)! have! been! conducted! in! Haiti.!International! databases! cite! the! 2001! Haiti! Living! Conditions! Survey! (HLCS)! as! the! most! recent! and!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!80 !M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!81 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!82 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!83 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!84 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!85 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!86 !Haiti!Child!Protection!Sub`Cluster,!Child&protection&sub5cluster&meeting&minutes:&28&July&2011!(July!2011).! Available!at!http://translate.google.com/translate?sl=auto&tl=en&js=n&prev=_t&hl=en&ie=UTF` 8&layout=2&eotf=1&u=http%3A%2F%2Fhaiti.humanitarianresponse.info%2FPortals%2F0%2FChild%2520Protect ion%2FMinutes%2FCPSC_Meeting_Sept22.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxi!
    • !reliable! estimate! of! poverty! nationwide,87,88,89,90! which! showed! that! 54.9%! of! the! Haitian! population!lived! on! less! than! US$1! per! day! in! 2001! (“absolute”! or! “extreme”! poverty;! US$1.25! in! 2005! dollars),!adjusted!for!purchasing!power!parity!(PPP).!It!was!also!estimated!that!72`76%!of!the!Haitian!population!in! 2001! lived! in! “relative”! poverty,! or! below! US$2! per! day.! Poverty! is! strongly! correlated! with! area! of!residence,!with!“absolute”!or!“extreme”!poverty!found!to!be!more!than!twice!as!prevalent!(67%)!in!rural!areas!as!in!the!metropolitan!area!(23%);!other!urban!areas!were!between!these!two!extremes!(57%).!Of!rural! residents,! 88%! were! estimated! to! live! in! relative! poverty,! compared! to! 45%! of! those! in! Port`au`Prince,! and! 76%! in! other! urban! areas.91,92,93,94! Since! then,! (but! prior! to! the! 2010! earthquake)! the!percentage! of! people! living! in! absolute! and! relative! poverty! across! Haiti! was! estimated! to! have!decreased!to!47%!and!68%,!respectively.95!!!Income!inequality!is!also!pervasive!in!Haiti.!In!2010,!the!Haitian!government!stated!that!the!richest!10%!of!the!population!controlled!50%!of!all!revenue.96!Overabundance!of!unskilled!labor,!resulting!in!lower!wages,! high! unemployment,! and! low! intensity! of! economic! activity,! are! cited! as! key! determinants! of!Haiti’s!poverty!profile,!while!low!educational!attainment!is!the!strongest!predictor!of!poverty!status.97!On!the!eve!of!the!January!2010!earthquake,!most!Haitians!were!extremely!vulnerable!to!shocks!to!their!income.!In!this!same!study,!the!Haitian!government!highlighted!that!“most!Haitians!have!no!retirement!provision,!no!social!security!and!no!savings,”!so!that!inability!to!find!work!for!even!a!short!period!of!time!could! be! disastrous! for! the! financial! situation! of! the! household.98! In! March! 2010,! a! rapid! Emergency!Food! Security! Assessment! (EFSA)! conducted! by! the! Government! of! Haiti’s! National! Food! Security!Coordination! Unit! (Coordination& Nationale& de& la& Sécurité& Alimentaire! `! CNSA)! in! earthquake`affected!areas!found!that!48%!of!the!surveyed!population!was!poorer!as!a!result!of!the!earthquake,!with!a!higher!proportion! of! households! in! camps! reporting! being! poorer! after! the! earthquake! in! both! urban! (78%!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!87 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!88 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!89 !UNESCO,!Education&for&all&database:&Haiti.!Available!at! http://www.uis.unesco.org/ev.php?URL_ID=5262&URL_DO=DO_TOPIC&URL_SECTION=201!90 !UNICEF,!State&of&the&world’s&children&database.!Available!at!http://www.unicef.org/statistics/index_step1.php!91 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!92 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!93 !UNESCO,!Education&for&all&database:&Haiti.!Available!at! http://www.uis.unesco.org/ev.php?URL_ID=5262&URL_DO=DO_TOPIC&URL_SECTION=201!94 !UNICEF,!State&of&the&world’s&children&database.!Available!at!http://www.unicef.org/statistics/index_step1.php!95 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!96 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!97 !D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!98 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!xxii! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&were!poorer)!and!rural!areas!(70%!were!poorer)!than!the!average.99!Haitian!families’!ability!to!provide!for! their! children’s! rights! is! heavily! determined! by! their! access! to! financial! and! other! resources.! The!reduction! in! income! of! almost! half! of! households! in! earthquake`affected! areas! has! compounded! pre`existing! endemic! poverty,! preventing! many! families! from! accessing! goods! and! services! necessary! for!their!children’s!safety!and!overall!development.!!Food.security..Prior!to!the!January!2010!earthquake,!Haiti!had!not!realized!its!constitutional!and!human!right!to!food,!with!much!of!its!population!instead!experiencing!chronic!mal`!and!under`nutrition.100!In!2007,!only!one!fifth! of! households! reported! being! able! to! meet! their! food! needs.! Food! consumption! is! highly! elastic!with! changes! in! income.! In! Haiti,! 32%! of! households! declared! that! increasing! their! food! consumption!would! be! their! first! priority! after! an! increase! in! income,! while! most! households! stated! that! reducing!food!consumption!is!their!primary!course!of!action!in!times!of!financial!strife.101!Thus,!unstable!income!sources,!lack!of!domestic!production,!low!purchasing!power,!and!the!absence!of!fallback!food!strategies!directly!contribute!to!the!nutritional!vulnerability!of!Haiti’s!children.!!!Following! the! 2010! earthquake,! surveyed! Haitians! identified! food! as! their! highest! priority.! The! Rapid!Emergency!Food!Security!Assessment!(EFSA)!found!that!31%!of!the!population!of!earthquake`affected!areas! had! poor! or! borderline! food! consumption.! Differences! were! also! observed! between! those!displaced! as! a! result! of! the! earthquake! (43%)! and! those! who! were! not! displaced! (27%).102! Official!estimates! state! that! food! insecurity! in! earthquake`affected! areas! increased! from! 40%! before! the!earthquake!to!52%!by!March!2010.103!In!large!IDP!camps,!this!figure!approximated!69%.104!!!Two!years!after!the!earthquake,!food!insecurity!remained!a!significant!concern.!According!to!a!national!food!security!survey!conducted!by!Food!Cluster!partners!in!the!second!half!of!2011,!4.5!million!Haitians,!or! almost! half! of! the! total! population,! was! food! insecure.105! In! response! to! the! poor! food! security! of!Haitian! children! and! their! high! levels! of! malnutrition,! UNICEF! and! its! partners! established! therapeutic!feeding! programs,! distributed! supplementary! food! and! infant! formula! for! pregnant! and! lactating!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!99 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!100 !Droits!et!Democratie/GRAMIR,!The&human&right&to&food&in&Haiti:&Report&of&an&international&fact5finding&mission! (2008).!Available!at!http://www.dd`rd.ca/site/publications/index.php?id=2316&subsection=catalogue!!101 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!102 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!!103 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!104 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!105 !UN!OCHA,!Humanitarian&bulletin:&19&August&–&20&September&2011!(September!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=Nutrition+Cluster%2f19_Aout_20_Septembre_2011_ Haiti+_Humanitarian_Bulletin+10+English.pdf&tabid=80&mid=1033!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxiii!
    • !women,! and! created! and! scaled! a! school! meal! program! soon! after! the! earthquake.106! In! the! period!between! September! 2010! and! August! 2011,! 14,128! children! had! been! admitted! to! 294! Outpatient!Feeding! Programs! (OTP),! 68,743! children! were! admitted! to! 369! Stabilization! Centers! (SC),! and! 2,061!children! had! been! admitted! to! Therapeutic! Feeding! Centers! (TFC).107! Performance! indicators! of! these!programs! and! centers! highlight! the! success! of! these! initiatives,! with! mortality! rates! below! Sphere!Standard!benchmark!thresholds!for!all!programs.108!!Water.and.sanitation.Access! to! safe! water! and! sanitation! facilities! are! key! risk! factors! for! the! protection! of! children! from!morbidity!and!mortality.!Chronically!low!access!both!before!and!after!the!2010!earthquake!has!placed!Haiti’s! children! at! significant! risk! of! water`borne! illness.! In! 2006,! 58%! of! Haiti’s! population! used!improved! drinking! water! sources,! again! with! significant! differences! between! urban! (70%)! and! rural!(51%)! areas.109,110,111! The! Haitian! Government! reported! that! access! to! clean! water! had! not! changed!appreciably!between!2006!and!January!2010.112!Most!water!in!Haiti!is!provided!by!small`scale!commerce!and!self`collection,!and!families!spend!a!significant!proportion!of!their!income!on!commercially!supplied!water.113!Additionally,!19.2%!of!respondents!in!a!2008!survey!stated!that!the!time!taken!to!collect!water!impacted!their!children’s!ability!to!attend!school.114!Following!the!2010!earthquake,!Water,!Sanitation!and! Hygiene! (WASH)! Cluster! partners! established! a! substantial! water! distribution! system! to! meet! the!needs!of!the!earthquake`affected!population.!By!July!2010,!1.2!million!people!were!receiving!at!least!5!liters! per! day! from! Cluster! partners.115! Recently,! the! WASH! Cluster! has! begun! disengaging! from! water!delivery! activities,! transitioning! to! system! strengthening! initiatives.116! However,! as! only! 39%! of! IDP!camps! had! access! to! chlorinated! water! points! in! May! 2011,! the! provision! of! clean! water! remains! an!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!106 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!107 !Haiti!Nutrition!Cluster,!Nutrition&cluster&update:&Issue&3!(October!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=English+Nutrition+cluster+update+issue+3.pdf&tabid =80&mid=1631!!108 !Sphere!Project,!“3.!Management!of!acute!malnutrition!and!micronutrient!deficiencies,”!in!Sphere!Project,! Humanitarian&charter&and&minimum&standards&in&humanitarian&response!(2011).!Available!at! http://www.spherehandbook.org/en/3`management`of`acute`malnutrition`and`micronutrient`deficiencies/!109 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!110 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!111 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!112 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!113 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!114 !M.!K.!Varma,!M.!L.!Satterthwaite,!A.!M.!Klasing,!et!al.,!“Woch!nan!soley:!The!denial!of!the!right!to!water!in! Haiti,”!Health&and&Human&Rights!10/2!(2008),!pp.!67`89.!115 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!116 !Government!of!Haiti/ACF,!Strategie&de&desengagement:&Water&trucking!(March!29,!2011).!Available!at! http://www.dinepa.gouv.ht/wash_cluster/index.php?option=com_rokdownloads&view=file&task=download&id =1492%3A201103desengagementwt`dinepa`acfstrategievf&Itemid=67!xxiv! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&urgent! need.117! UNICEF! has! prioritized! the! provision! of! clean! water! in! schools,! and! by! January! 2011!reported!reaching!150!schools!with!comprehensive!water,!sanitation,!and!hygiene!packages.118!!Lack! of! access! to! sanitation! also! remains! a! pressing! concern.! In! 2008,! only! 17%! of! Haitians! used!improved! sanitation! facilities,! exhibiting! differences! between! urban! (24`29%)! and! rural! (12%)!areas.119,120,121!Lack!of!access!to!appropriate!sanitation!facilities!in!both!public!and!private!schools!was!also! a! concern,! given! its! potential! to! dissuade! enrollment.122! Expanding! access! to! sanitation! was!identified! as! a! key! priority! following! the! earthquake.! By! July! 2010,! the! WASH! Cluster! had! constructed!11,000! toilets,! resulting! in! an! average! toilet`to`person! ratio! of! approximately! 1! to! 145! and! reaching!roughly!1.6!million!people.123!By!May!2011,!a!survey!by!the!WASH!Cluster!found!that!94%!of!surveyed!IDP!camps!with!more!than!1,500!people!had!a!ratio!of!less!than!1!to!100!per!latrine.124!This!proportion!represents! a! significant! improvement! during! the! first! five! months! of! 2011,! although! significant! gaps!were!identified!among!Communes.!Troublingly,!only!18%!of!surveyed!IDP!camps!had!functioning!hand!washing!stations!in!May/June!2011.125!!Healthcare.Before! the! earthquake,! Haitians! suffered! from! a! chronic! lack! of! access! to! healthcare! services! due! to!prohibitive!cost,!absolute!lack!of!healthcare!infrastructure!and!unequal!distribution!across!the!country,!a!shortage! of! trained! professionals,! and! a! culture! that! places! the! responsibility! for! the! health! of! many!women! in! the! hands! of! their! husbands.! On! the! eve! of! the! earthquake,! the! UN! Office! for! the!Coordination!of!Humanitarian!Affairs!(UN!OCHA)!estimated!that!44%!of!Haitians!lacked!access!to!health!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!117 !UN!OCHA,!Humanitarian&bulletin:&1&July&–&25&July&2011!(July!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=Nutrition+Cluster%2f1_Juillet_25Juillet2011_Haiti_H umanitarian_Bulletin.pdf&tabid=80&mid=1033!!118 !UNICEF,!Children&in&Haiti:&One&year&after&–&the&long&road&from&relief&to&recovery!(January!2011).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/10CF91515919332F49257811001C26F3`Full_Report.pdf!!119 !Millennium!Project,!Countdown&to&2015:&2010&Country&profiles:&Haiti!(2010).!Available!at! http://www.countdown2015mnch.org/documents/2010report/Profile`Haiti.pdf!!120 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!121 !Oxfam!America,!Aid&to&Haiti,&6&months&on:&a&long&way&to&go,!Oxfam!media!briefing!(July!2010).!Available!at! http://www.oxfamamerica.org/publications/aid`to`haiti`6`months`on`a`long`way`to`go/!!122 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!123 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!124 !Haiti!WASH!Cluster,!Enquete&WASH&dans&les&Sites&d’hebergement&temporaire!(May!2011).!Available!at! http://www.dinepa.gouv.ht/wash_cluster/index.php?option=com_rokdownloads&view=file&Itemid=57&id=146 8:110616`enquete`wash`site`hebergement`temporaire!!125 !UN!OCHA,!Humanitarian&bulletin:&1&July&–&25&July&2011!(July!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=Nutrition+Cluster%2f1_Juillet_25Juillet2011_Haiti_H umanitarian_Bulletin.pdf&tabid=80&mid=1033!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxv!
    • !services!as!a!result!of!prohibitive!costs.126!Using!similar!methods,!the!World!Food!Programme!estimated!the!gap!in!access!at!47%!of!the!population.127!!!As! is! occasionally! the! case! in! massive! humanitarian! relief! efforts,! access! to! basic! healthcare! actually!improved!for!many!Haitians!following!the!earthquake,!due!to!the!large!influx!of!medically!oriented!relief!organizations.! A! study! by! the! MIT! Lincoln! Laboratory! and! Harvard! Medical! School! found! that! 80%! of!respondents!in!Port`au`Prince!were!able!to!travel!to!medical!facilities!in!less!than!ten!minutes!in!April!2010,128!while!Schiff!et&al.!found!that!the!majority!of!IDPs!nationwide!could!travel!to!health!services!in!less! than! thirty! minutes.129! There! remains! the! longer`term! need! to! build! local! capacity! to! sustain! this!short`term!improvement!in!access,!since!30!of!the!49!hospitals!operating!in!earthquake`affected!areas!prior!to!the!earthquake!were!either!damaged!or!destroyed,!and!numerous!health!sector!workers!were!killed.130!!Communicable! diseases! drive! childhood! mortality! in! Haiti.! According! to! PAHO,! tuberculosis,! diarrheal!diseases,! malnutrition,! HIV/AIDS,! and! malaria! were! the! five! leading! causes! of! death! in! 2007.131! In!contrast,!the!WHO!Global!Health!Observatory!database!states!that!the!five!leading!causes!of!under`five!death! in! 2008! were! pneumonia! (22%),! diarrhea! (22%),! prematurity! (10%),! birth! asphyxia! (9%),! and!neonatal! sepsis! (5%),! with! “other! causes”! accounting! for! 24%! of! deaths! in! this! age! group.132!Discrepancies!between!these!estimates!may!be!explained!by!the!exclusion!of!neonatal!and!infant!causes!of!death!by!PAHO.!Similar!to!the!under`five!age!group,!PAHO!stated!in!2007!that!tuberculosis,!diarrheal!disease,!malnutrition,!HIV/AIDS,!and!malaria!were!the!leading!causes!of!death!of!children!aged!5`9,!but!that! non`communicable! causes,! such! as! violence! and! accidents,! were! responsible! for! 8%! of! deaths! in!this! age! group.! The! mortality! profile! of! adolescent! Haitians! (10`19)! differs! from! that! of! their! younger!peers,!as!non`communicable!causes!play!an!increasingly!important!role.!In!2007!PAHO!stated!that!the!six! leading! causes! of! death! among! this! age! group! were! HIV/AIDS,! physical! assault,! accidents,!tuberculosis,!typhoid,!and!pregnancy`related!factors!(maternal!mortality).133!!!Low! water,! sanitation,! and! hygiene! coverage! both! before! and! after! the! 2010! earthquake! also! led! to!significant! risks! of! water`borne! diseases.! In! 2006,! the! EMMUS! IV! survey! found! that! 24%! of! under`five!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!126 !UN!OCHA!Haiti,!Haiti&before&January&12th,!Internal!document!(2010).!Available!at! http://ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1165439!!127 !Cited!in!Oxfam!America,!Aid&to&Haiti,&6&months&on:&a&long&way&to&go,!Oxfam!media!briefing!(July!2010).!Available! at!http://www.oxfamamerica.org/publications/aid`to`haiti`6`months`on`a`long`way`to`go/!128 !UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&4&(April!2010).!129 !L.!Ivers,!A.!Schiff,!D.!Jones,!et!al.,!“Assessment!and!analysis!of!Haitian!HADR!data”!(presentation!to!the!Haiti! Assessments!Working!Group,!April!27!2010).!130 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!131! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!132 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!133 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!xxvi! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&Haitian! children! had! diarrhea! in! the! two! weeks! preceding! the! survey,! but! that! only! 47%! of! under`five!children!received!either!a!packet!mixture!or!similarly!prepared!oral!rehydration!therapy!solution!the!last!time! they! had! diarrhea.134! In! 2008,! diarrheal! disease! accounted! for! 22%! of! all! under`five! deaths.135! In!2006,! the! EMMUS! IV! survey! found! that! 40%! of! under`five! children! had! displayed! symptoms! of! acute!respiratory!infection!(ARI)!in!the!two!weeks!preceding!the!survey,136!but!that!few!children!displaying!ARI!symptoms!were!taken!to!a!health!facility!for!assistance.!PAHO!stated!that!in!2006!only!20%!of!under`five!children! displaying! ARI! symptoms! had! been! examined! to! obtain! treatment,137! while! the! WHO! Global!Health!Observatory!and!Measure!DHS!databases!state!that!31.5%!of!under`five!children!displaying!ARI!symptoms! had! been! taken! to! a! health! facility! in! 2006.138! The! source! of! this! discrepancy! is! unclear,! as!these! sources! all! cite! EMMUS! IV! survey! data.! In! 2008,! 22%! of! under`five! deaths! were! attributable! to!pneumonia.139! While! injuries! were! the! primary! health! concern! of! children! immediately! following! the!earthquake,! accounting! for! an! estimated! 56%! of! deaths! among! children! under! five! in! 2010,140! UNICEF!has! noted! that! children’s! risk! profile! had! reverted! to! previous! patterns! after! approximately! three!months.141!!Despite! efforts! to! expand! access! to! clean! water,! sanitation,! and! hygiene! following! the! earthquake,! a!cholera!outbreak!was!identified!in!October!2010!in!Artibonite,!in!central!Haiti.142!By!April!2011,!274,418!cases!and!4,787!deaths!had!been!identified!across!all!Departments.143!In!August!2011,!the!Health!Cluster!reported! that! the! number! of! identified! cholera! cases! had! reached! 419,511! by! 31! July! 2011,! of! which!222,359! had! been! hospitalized! and! 5,968! had! died,! but! that! case! fatality! rates! and! new! cases! were!slowing!in!most!Departments.144!By!1!January!2012,!the!Haitian!Ministry!of!Public!Health!and!Population!(Le&Ministère&de&la&Santé&Publique&et&de&la&Population!–!MSPP)!reported!that!458,216!cholera!cases!had!been! identified! since! the! beginning! of! the! epidemic,! with! a! global! case! fatality! rate! of! approximately!1.4%.145! Analysis! of! MSPP! data! indicates! that! 12.6%! of! all! cholera! cases! identified! by! 1! January! 2012!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!134 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!135 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!136 !PAHO,!Health&situation&in&Haiti&before&the&2010&earthquake,!Presentation!at!Haiti!Health!Cluster!(January!2010).! Available!at!http://ec.europa.eu/echo/files/aid/countries/Haiti_paper_01102010.pdf!!137 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!138 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!139 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!140 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!141 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!142 !D.!Walton,!A.!Suri,!and!P.!Farmer,!“Cholera!in!Haiti:!Fully!integrating!prevention!and!care,”!Annals&of&Internal& Medicine!154/9!(2011),!pp.!635`637.!143 !Haiti!Health!Cluster,!Health&cluster&bulletin&23:&Cholera&and&post5earthquake&response&in&Haiti!(April!2011).! Available!at!http://new.paho.org/disasters/index.php?option=com_docman&task=doc_download&gid=1750!!144 !Haiti!Health!Cluster,!Health&cluster&bulletin&27:&Cholera&and&post5earthquake&response&in&Haiti!(August!2011).! Available!at!http://new.paho.org/disasters/index.php?option=com_docman&task=doc_download&gid=1850!145 !MSPP,!Rapports&journaliers&du&MSPP&sur&lévolution&du&choléra&en&Haiti&(MSPP&daily&reports&on&the&evolution&of& cholera&in&Haiti)!(1!January!2012).!Available!at! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxvii!
    • !were! among! children! under! age! 5—approximately! proportional! to! their! share! of! the! total! Haitian!population—but!that!the!global!case!fatality!rate!for!this!age!group!(0.8)!was!almost!half!of!that!for!all!other!age!groups!combined!(1.4%).146!!Sexual.and.Reproductive.Health.Reproductive! health! risk! factors! and! outcomes! carry! serious! consequences! for! children! and! their!mothers!in!Haiti.!Available!data!indicate!that!programs!and!policies!undertaken!to!improve!reproductive!health!in!Haiti!over!the!past!two!decades!have!seen!positive!results,!although!issues!including!unwanted!pregnancy,! maternal! mortality,! and! low! rates! of! professionally! assisted! delivery! have! persisted.147!Estimates!of!Haiti’s!Maternal!Mortality!Ratio!are!high,!but!different!sources!vary!significantly.!In!2008,!the! Haitian! Government! reported! a! MMR! of! 630,148! while! UNICEF! models! estimated! that! Haiti’s! MMR!was! 300! maternal! deaths! per! 100,000! live! births.149! According! to! the! Population! Reference! Bureau,!women! in! Haiti! had! a! 1! in! 93! probability! of! dying! from! maternity`related! causes! in! 2008.150! The! high!prevalence! of! adolescent! pregnancy! in! Haiti! is! of! particular! concern,! as! adolescent! mothers! younger!than!15!are!five!times!more!likely!to!die!during!childbirth!than!are!women!in!their!twenties.151!Data!for!maternal!mortality!in!the!post`earthquake!period!remain!unavailable.!!Significant!discrepancies!exist!in!estimates!of!adolescent!Haitians’!fertility,!although!all!sources!indicate!a!reduction!over!the!past!decade.!The!World!Bank!estimated!an!adolescent!fertility!rate!of!44.3!births!per!1,000!women!aged!15`19!in!2009,152!while!the!PAHO!estimate!of!69!births!per!1,000!women!aged!15`19!in!2005/2006!suggests!higher!prevalence!of!early!pregnancy.153!High!adolescent!fertility!in!Haiti!is!driven!by!early!onset!of!sexual!activity,!early!marriage,!and!low!contraceptive!use,!with!53%!of!Haitian!girls!reporting!having!had!sex!before!age!18,154!29.9%!of!females!married!before!their!18th!birthday,155!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! http://mspp.gouv.ht/site/download.php?file=downloads/Rapport%20journalier%20MSPP%20du%2001%20janvi er%202012.pdf!&146 !MSPP,!Rapports&journaliers&du&MSPP&sur&lévolution&du&choléra&en&Haiti&(MSPP&daily&reports&on&the&evolution&of& cholera&in&Haiti)!(1!January!2012).!Available!at! http://mspp.gouv.ht/site/download.php?file=downloads/Rapport%20journalier%20MSPP%20du%2001%20janvi er%202012.pdf!147 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!148 !UNICEF,!State&of&the&world’s&children&2007!(Oxford:!Oxford!University!Press,!2007).!Available!at! http://www.unicef.org/sowc/!!149 !UNICEF,!State&of&the&world’s&children&2011!(Oxford:!Oxford!University!Press,!2011).!Available!at! http://www.unicef.org/sowc/!!150 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!151 !UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!152 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!153 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!154 !Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!xxviii! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&and! only! 20%! of! female! youth! age! 15`24! reporting! condom! use! during! the! last! time! they! had! sex! in!2006.156! All! three! outcomes! were! associated! with! poverty,! rural! living! status,! and! lack! of! education.!Unconfirmed! findings! indicate! a! sharp! increase! in! adolescent! pregnancies! in! IDP! camps! following! the!earthquake,157!while!other!sources!highlight!the!use!of!“transactional!sex”!by!Haitian!girls!and!women!to!obtain!basic!goods!and!services,158!further!exacerbating!sexual!and!reproductive!health!risks.!!The!high!rate!of!adolescent!pregnancy!in!Haiti!is!pertinent!because!there!is!significantly!lower!access!to!skilled! delivery! services! for! adolescents! in! rural! areas! compared! to! urban! areas,! and! large! differences!among! Departments.! Overall,! approximately! 33%! of! births! among! girls! age! 15`24! were! assisted! by! a!health!professional!(50%!in!urban!areas!versus!25%!in!rural!areas),!while!a!further!31%!were!assisted!by!a!trained!birth!attendant!(28%!in!urban!areas!versus!33%!in!rural!areas).159!Tong!et&al.&note!that!since!the!January!2010!earthquake,!safe!delivery!services,!as!well!as!antenatal!and!postnatal!care,!have!been!provided! for! free! by! public! and! international! response! health! facilities,! resulting! in! improved! rates! of!medically!supervised!deliveries.160!However,!the!recent!reduction!in!the!number!of!NGOs!operating! in!Haiti,! as! well! as! the! concentration! of! relief! efforts! in! the! Port`au`Prince! metropolitan! area,! raise!concerns!regarding!both!the!sustainability!and!equity!of!this!increase!in!delivery!supervision.!!!Sexual!health!is!of!particular!concern!for!Haitian!adolescents.161!Early!sexual!debut,!multiple!concurrent!partnerships,! and! low! rates! of! condom! use! place! young! Haitians! at! heightened! risk! for! sexually!transmitted! diseases! (STDs).! Many! Haitian! girls! experience! greater! vulnerability! to! STDs! due! to! sexual!violence!and!age!disparities!with!older!partners.162!Haiti!has!the!highest!HIV!prevalence!of!any!country!in!the! Western! Hemisphere,163! and! high! levels! of! knowledge! about! HIV! and! other! STDs! have! failed! to!translate! into! effective! preventative! behavior! for! most! adolescent! Haitians.! HIV! prevalence! among!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!155 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!156 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!157 !K.!Calvin,!Lighting&the&future&for&Haiti’s&women,!UN!Foundation!(January!2011).!Available!at! http://www.unfoundation.org/who`we`are/impact/our`impact/empowering`women`girls/lighting`the` future.html!!158 !IFRC,!Haiti&recovery&assessment:&Volume&1&–&Synthesis&report!(March!2010).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=jNS41RGePVg%3d&tabid=149&mid=1043!!159 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!160 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!161 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!162 !Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!163 !M.!Loudon,!A&study&of&integrated&interventions&for&children&made&vulnerable&by&HIV/AIDS&in&Haiti:&A&case&study& of&La&Maison&l’Arc5en5Ciel,!UNAIDS/UNICEF!(2006).!Available!at!http://www.unicef.org/lac/Haiti_Case_Study` Children_made_Vulnerable_by_AIDS(1).pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxix!
    • !Haitian! youth! (15`24! years)! was! higher! than! in! children! 0`14,! with! an! estimated! prevalence! of! 0.6%!among! males! and! 1.4%! among! females! in! this! age! group! in! 2007.164! By! 2009,! the! prevalence! of! HIV!among!female!youth!had!dropped!by!a!tenth!of!a!percent!according!to!the!World!Bank,!although!HIV!prevalence! among! male! youth! remained! constant.165! The! disparity! between! male! and! female! HIV!prevalence! in! this! age! group! supports! the! argument! that! large! age! differences! between! partners!negatively!affect!the!younger!females,!as!the!older!partners!of!these!young!women!are!more!likely!to!be!HIV`positive!than!men!of!the!same!or!younger!age!as!their!female!partners.!Estimates!of!HIV!prevalence!among!Haitian!children!vary!by!source.!UNICEF!reported!that!in!2007!there!were!approximately!19,000!children! living! with! HIV,166! in! contrast! to! the! World! Bank’s! estimate! of! 13,000.! The! World! Bank! later!estimated!that!by!2009,!the!number!of!children!under!age!15!living!with!HIV!had!fallen!to!approximately!12,000.167!!.Mental.health.Very! little! data! exist! on! the! prevalence! of! mental! health! difficulties! in! Haiti.! This! report! found! no!quantitative! studies! on! the! mental! and! psychosocial! health! of! children.! However,! as! part! of! their!submission! to! the! Haitian! Government’s! Post`Disaster! Needs! Assessment! following! the! 2010!earthquake,!Plan!International!conducted!a!survey!during!January!and!February!of!2010!that!shed!light!on! the! psychosocial! needs! of! Haiti’s! children! and! youth.! This! analysis! revealed! significant! lingering!psychosocial! health! issues! stemming! from! the! earthquake.! Haitian! children! who! had! witnessed! the!death,! injury,! and/or! disability! of! close! family! members! and! friends,! or! had! been! injured! or! disabled!themselves,! listed! psychological! trauma,! grief,! sleeplessness,! and! fear! as! serious! concerns.168! Other!studies!also!noted!that!the!climate!of!insecurity!after!the!earthquake!had!exacerbated!the!likelihood!of!poor!mental!wellbeing.169!Children!are!inherently!more!at!risk!in!the!short!and!long!term!as!they!are!still!physically,! mentally,! and! emotionally! developing.170! Those! suffering! from! mental! and! psychosocial!concerns!also!have!few!avenues!to!access!support!and!services!in!Haiti.!Before!the!earthquake,!only!two!public! mental! health! facilities! were! available! in! Haiti,! and! both! were! situated! in! Port`au`Prince.!According! to! PAHO,! while! a! number! of! small,! private! centers! have! opened! outside! the! capital,! the!demand!for!mental!and!psychosocial!health!services!far!exceeds!supply.171!To!appropriately!provide!for!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!164 !WHO,!Epidemiological&fact&sheet&on&HIV&and&AIDS:&Haiti!(December!2008).!Available!at! http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_HT.pdf!!165 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!166 !UNICEF,!UNICEF&humanitarian&action&report&2007!(2007).!Available!at! http://www.unicef.org/har07/index_37587.htm!!167 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!168 !E.!Lacroi,!Anticipating&the&future:&Children&and&young&people’s&voices&in&Haiti’s&post5disaster&needs&assessment,! Plan!International!(March!2010).!Available!at!http://plan`international.org/files/global/haiti`pdna`report.pdf!!169 !Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!170 !World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!171 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!xxx! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&Haitian! children’s! long`term! psychosocial! health,! sustainable! systems! of! mental! health! care! are!essential.!!Education.Education!in!Haiti!is!characterized!by!low!quality,!the!existence!of!significant!barriers!to!enrollment,!low!enrollment! rates,! delayed! entry,! high! proportions! of! repeating! and! over`age! students,! and! substantial!early! dropout! rates.! At! age! three,! Haitian! children! are! eligible! for! early! childhood! education! that!officially!last!for!three!years.172!Due!to!competition!for!limited!spaces,!completion!of!pre`school!is!often!used!as!a!screening!tool!for!admittance!to!primary!school.!In!2009,!however,!the!Haitian!Government!stated!that!only!5.5%!of!pre`schools!were!publicly!supported,!thus!serving!only!4.67%!of!Haiti’s!595,000!preschoolers.173! Private! schools! are! generally! located! in! urban! areas,! prohibiting! access! for! the! many!Haitians!living!far!from!these!centers.174!As!such,!many!children!are!disenfranchised!from!the!beginning!of!their!engagement!with!the!education!system.!!!Haitian! children! are! legally! able! to! enter! primary! school! at! age! six.! Primary! education! is! compulsory!(though!unenforced)!and!divided!into!nine!years,!while!non`compulsory!secondary!education!comprises!a!further!four!years.175!UNICEF!reports!that!there!were!approximately!22,000!schools!in!Haiti!prior!to!the!January!2010!earthquake.176!The!increase!in!the!number!of!schools!over!the!past!thirty!years!has!largely!been! attributable! to! the! establishment! of! private! schools! that! operate! outside! of! government!regulation.! Additionally,! these! private! schools! generally! teach! only! the! first! cycle! (years! 1! through! 4),!requiring!students!to!change!schools!in!order!to!continue!their!education.177!On!the!eve!of!the!January!2010!earthquake,!only!8%!(1,241)!of!all!primary!and!secondary!schools!in!Haiti!were!state!schools,!while!the!remaining!92%!(14,027)!were!privately!operated.!As!a!result,!approximately!80%!(1,716,187)!of!all!students!in!Haiti!(2,106,805)!were!educated!in!fee`based!non`public!schools.178,179,180!As!many!as!23%!of!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!172 !Haitian!Ministry!of!Education,!Youth!and!Sports,!The&problem&of&over5age&students&in&the&Haitian&education& system:&An&overview.!UNESCO!Education!for!all!in!the!Carribbean:!Assessment!2000!monograph!series!18!(2000).! Available!at!http://unesdoc.unesco.org/images/0013/001364/136433e.pdf!173 !Government!of!Haiti,!2009&national&policy&framework&for&an&integrated&approach&to&early&childhood& development!(January!2009).!174 !UNESCO,!Haiti:&Early&childhood&care&and&education&(ECCE)&programmes,!UN!Doc.!IBE/2006/EFA/GMR/CP/36! (2006).!Available!at!http://unesdoc.unesco.org/images/0014/001480/148026e.pdf!!175 !Haitian!Ministry!of!Education,!Youth!and!Sports,!The&problem&of&over5age&students&in&the&Haitian&education& system:&An&overview.!UNESCO!Education!for!all!in!the!Carribbean:!Assessment!2000!monograph!series!18!(2000).! Available!at!http://unesdoc.unesco.org/images/0013/001364/136433e.pdf!176 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!177 !B.!Hadjadj,!Education&for&all&in&Haiti&over&the&last&20&years:&Assessment&and&perspectives,!UNESCO!Education!for! all!in!the!caribbean:!Assessment!2000!monograph!series!No.!18!(2000).!Available!at! http://unesdoc.unesco.org/images/0013/001363/136393e.pdf!!178 !Haiti!Education!Cluster,!Education&cluster&bulletin:&18&February&2010!(February!2010).!Available!at! http://oneresponse.info/Disasters/Haiti/Education/Documents/ECU!English.docx!!179 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxxi!
    • !all!schools!in!Haiti!were!damaged!or!destroyed!by!the!earthquake,!including!80`90%!of!all!schools!in!the!earthquake`affected! areas.181,182! Although! they! were! closed! in! the! aftermath! of! the! earthquake,! the!majority!of!structurally!sound!schools!reopened!by!December!2010.183!!While!84%!of!children!age!6`17!were!attending!school!in!2006,!most!of!those!children!were!not!enrolled!in! the! correct! year! for! their! age.184! In! 2007,! the! Haitian! Government! estimated! the! country’s! gross!enrollment! ratio! for! the! first! six! years! of! basic! (primary)! education! at! 136%,& indicating! that! many!students! who! were! not! of! the! official! age! for! these! grades! were! enrolled! in! those! years.! In! stark!contrast,!the!combined!GER!of!Haiti’s!3rd!primary!cycle!(grades!7`9)!and!secondary!education!(grades!10`13)!was!estimated!at!46.2%,!indicating!that!the!total!number!of!students!of!any!age!enrolled!in!these!grades! was! less! than! half! of! the! 12`18! year`old! population.185! According! to! Government! estimates,!Haiti’s! basic! and! secondary! education! net! enrollment! ratios! (NER)! were! 76%! and! 22%,186! respectively,!although!some!sources!place!the!basic!education!NER!as!low!as!50%.187!Discrepancies!between!Haiti’s!gross!and!net!enrollment!ratios!support!the!conclusion!that!the!Haitian!education!system!is!inefficient,!highlighting!the!impact!of!late!entry!and!grade!repetition!on!the!presence!of!over`age!students.188!!!Nationally! representative! data! on! post`earthquake! school! attendance! did! not! exist! at! the! time! of! this!writing,!but!data!collected!as!part!of!the!IDP!Site!Registration!system!indicate!that!children!living!in!IDP!camps!may!now!have!greater!education!utilization!than!a!number!of!pre`earthquake!estimates.!Across!the! 189! camps! registered! as! part! of! the! second! phase! of! the! Haitian! government! and! International!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!180 !H.!D.!Nielsen,!Moving&towards&free&primary&education:&Policy&issues&and&implementation&challenges&5&A&state&of& the&art&review,!UNICEF!social!and!economic!policy!working!paper!(2009).!Available!at! http://www.unicef.org/socialpolicy/index_52077.html!!181 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!182 !UNICEF,!UNICEF&rebuilds&education&in&Haiti&from&the&ruins!(January!2011).!Available!at! http://www.unicef.org/malaysia/media_news11`unicef`rebuilds`education`in`haiti`from`the`ruins.html!!183 !Haiti!Education!Cluster,!Education&cluster&situation&report:&14&December&2010!(December!2010).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Education%20Cluster/reports/Education_Cluster_SitRep_14_1 2_2010.pdf!!184 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!185 !Cited!in!L.!Wolff,!Education&in&Haiti:&The&way&forward,!Partnership!for!Educational!Revitalization!in!the!Americas! (PREAL)!(September!2008).!Available!at! http://www.thedialogue.org/PublicationFiles/Education%20in%20Haiti%20`%20The%20Way%20Forward%20` %20FINAL%20`%209`15`08.pdf!!186 !Cited!in!L.!Wolff,!Education&in&Haiti:&The&way&forward,!Partnership!for!Educational!Revitalization!in!the!Americas! (PREAL)!(September!2008).!Available!at! http://www.thedialogue.org/PublicationFiles/Education%20in%20Haiti%20`%20The%20Way%20Forward%20` %20FINAL%20`%209`15`08.pdf!!187 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!188 !Haitian!Ministry!of!Education,!Youth!and!Sports,!The&problem&of&over5age&students&in&the&Haitian&education& system:&An&overview.!UNESCO!Education!for!all!in!the!Carribbean:!Assessment!2000!monograph!series!18!(2000).! Available!at!http://unesdoc.unesco.org/images/0013/001364/136433e.pdf!xxxii! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & Executive&summary&Organization! for! Migration’s! IDP! registration! process,! 77%! children! aged! 6`14! were! found! to! be!attending!school!(77.1%!of!boys!and!76.9%!of!girls).189!!Despite! their! constitutional! right! to! free! basic! education! (grades! 1`6),! Haitian! children! face! significant!barriers! to! school! enrollment.! Unavailability! of! school! spaces,! the! cost! of! school! fees,! uniforms,! and!learning!materials,!and!children’s!rural!status!prevent!many!from!attending!school,!while!some!families!question! whether! the! low! quality! of! education! warrants! the! significant! financial! investment.190! The!Haitian! Government! has! identified! education! sector! reform! as! a! priority! in! the! post`earthquake!period.191!In!September!2011,!President!Martelly!officially!launched!the!Free!Education!Programme!to!expand!access!to!education.!The!Programme!aims!to!provide!free!education!to!142,000!children!aged!6`12!who!have!not!previously!attended!school.!Additionally,!200,000!children!in!grades!1!through!6!from!poor! neighborhoods! will! receive! a! grant! to! cover! education! expenses.192! The! Programme! is! to! be!supported! by! the! National! Fund! for! Education! (FNE),! established! in! May! 2011,! which! is! funded! by! a!US$0.05! per! minute! surcharge! on! international! calls! and! a! US$1.50! surcharge! on! international! money!transfers.!It!was!estimated!that!the!fund!would!collect!US$8.5!per!month!following!its!implementation!in!June.!However,!after!seven!months!of!operation,!the!Haitian!Senate!Economy!and!Finance!Committee!was! informed! that! the! Fund’s! account! held! only! US$4.8! million! of! the! expected! US$55! million! that!should!have!been!collected!to!that!point,193!while!the!Minister!of!Education!stated!in!November!2011!that! the! FNE! was! not! operational! because! it! lacked! a! legal! framework.194! More! recent! information! on!the! operational! status! of! the! FNE! and! the! Free! Education! Programme! were! unavailable! at! the! time! of!writing.! However,! if! operationalized,! it! is! hoped! that! this! initiative,! in! combination! with! school!construction!and!learning!material!distribution!projects,!will!significantly!improve!young!Haitians’!access!to!education!in!the!future.!...!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!189 !Haiti!Education!Cluster,!Education&cluster&bulletin:&8&August&2011!(August!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Education%20Cluster/reports/Aout%202011/Education_Cluste r_SitRep_080811.pdf!!190 !H.!Lunde,!Youth&and&education&in&Haiti:&Disincentives,&vulnerabilities&and&constraints,!Fafo!paper!2008/26! (2008).!Available!at!http://www.fafo.no/pub/rapp/10070/10070.pdf!!191 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!192 !Haiti!Education!Cluster,!Education&cluster&information&bulletin:&24&September&2011!(September!2011).!Available! at! http://haiti.humanitarianresponse.info/Portals/0/Education%20Cluster/news/Edu_Cluster_info_bulletin_23_sep t_eng.pdf!193 !J.!Juste,!Haiti:&Digicel&CEO&wants&to&know&where&the&education&money,!Defend.ht!(6!January!2012).!Available!at! http://www.defend.ht/money/articles/business/2398`haiti`digicel`ceo`wants`to`know`where`is`the`education` money!194 !Defend.ht,!“National&fund&for&education&is&not&operational”&says&Haiti&Education&Minister,!Defend.ht!(26! November!2011).!Available!at!http://www.defend.ht/politics/articles/executive/2075`qnational`fund`for` education`is`not`operationalq`says`haiti`education`minister! ©!2012!FXB!Center!for!Health!and!Human!Rights! xxxiii!
    • !Conclusion.The!protection!of!Haiti’s!children!depends!on!the!development!of!sustainable!inter`sectoral!strategies!to!restore,!protect,!and!promote!children’s!rights.!Despite!impressive!progress!in!many!areas!following!the!January!2010!earthquake,!key!gaps!remain!in!the!comprehensive!protection!of!Haiti’s!children.!As!the!Government!and!international!responders!transition!to!medium`!and!long`term!rehabilitation!strategies,!maintaining!the!achievements!attained!thus!far!is!imperative!to!ensure!that!programs!and!policies!are!sustainable!and!that!the!best!interests!of!the!child!remain!the!cornerstone!of!evidence`based!decision`making.!! !xxxiv! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 1.&Introduction&1.&Introduction&!The! Haitian! earthquake! of! January! 12,! 2010! struck! a! country! whose! history! has! been! marked! by!hardship.!The!displacement!of!the!native!Taino!population!by!Spanish!colonists!in!1492!was!followed!by!the! importation! of! African! slaves! to! support! sugar! cane! production! and,! in! 1697,! transition! to! French!rule.195!In!1804,!the!first!successful!slave!rebellion!in!the!world!led!Haiti!to!became!the!first!independent!nation!in!Latin!America.!From!then!until!1986,!with!the!fall!of!the!hereditary!Duvalier!dictatorship,!Haiti!was!ruled!by!a!succession!of!repressive!regimes!and!dictators!who!preserved!power!at!the!expense!of!the!people.!The!new!Constitution!of!1987!laid!the!foundation!for!Haiti’s!present!political!system,!which!was!itself!characterized!by!violence!and!bloodshed!until!at!least!2004.196,197!!The!past!decade!has!dramatically!witnessed!Haiti’s!geographic!vulnerability!to!natural!disasters.!In!2004,!floods!in!Fonds`Verrettes!and!Mapou!followed!by!Tropical!Storm!Jeanne!left!more!than!5,000!dead!and!caused!US$250!million!of!damage.198!Four!years!later,!in!2008,!Haiti!was!buffeted!by!Tropical!Storm!Fay!and! Hurricanes! Gustav,! Hanna,! and! Ike! within! one! month,! leaving! 800! dead,! one! million! in! need! of!humanitarian! assistance,! and! damage! worth! 15%! of! Haiti’s! GDP.199! In! 2009,! the! United! Nations!Development!Programme!(UNDP)!ranked!Haiti!as!the!poorest!country!in!the!Western!Hemisphere.200!!The!earthquake!of!January!2010!was!the!largest!natural!disaster!in!Haiti’s!history,!both!in!terms!of!lives!lost!and!economic!cost.!Striking!25!km!west`south`west!of!Port`au`Prince!at!a!depth!of!roughly!13!km!below! the! surface,! the! 7.0! Richter! scale! earthquake! shook! for! 35! seconds.201! According! to! the! Haitian!government!in!March!2010,!over!220,000!people!lost!their!lives,!more!than!300,000!were!injured,!and!more! than! 1.5! million! were! directly! affected.202! Some! sources! believe! the! number! of! deaths! to! be! far!higher,! with! up! to! 316,000! killed,! while! others! suggest! as! few! as! 100,000! casualties,203! though! most!sources! cite! the! official! Haitian! government! estimate! of! 220,000! deaths.! Physical! damage! alone! has!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!195 !J.!Dayan,!“Haiti,!History,!and!the!Gods,”!in!G.!Prakash!(ed.),!After&Colonialism:&Imperial&Histories&and&Precolonial& Displacements!(Princeton:!Princeton!University!Press,!2001).!196 !ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!197 !N.!Caistor,!Haiti’s&history&of&misery,!BBC!News!(13!January!2010).!Available!at! http://news.bbc.co.uk/2/hi/americas/8456728.stm!198 !World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!199 !ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!!200 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!201 !U.S.!Geological!Survey,!Magnitude&7.0&–&Haiti&Region:&Details,!Earthquake!Hazards!Program!(2010).!Available!at! http://earthquake.usgs.gov/earthquakes/eqinthenews/2010/us2010rja6/#details!!202 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!203 !U.S.!Geological!Survey,!Magnitude&7.0&–&Haiti&Region:&Summary,!Earthquake!Hazards!Program!(2010).!Available! at!http://earthquake.usgs.gov/earthquakes/eqinthenews/2010/us2010rja6/#summary!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 1!
    • !been!estimated!at!US$7.8!billion—more!than!Haiti’s!total!GDP!in!2009.!Six!months!after!the!earthquake,!moreover,! UNICEF! estimated! that! 1.6! million! people! were! still! living! in! more! than! 1,300! Internally!Displaced!Person!(IDP)!camps.204!By!the!end!of!September!2011,!more!than!one!and!a!half!years!later,!approximately!550,000!people!remained!in!approximately!800!IDP!camps.205!!As! noted! by! UNICEF,! the! 2010! Haitian! earthquake! was! a! children’s! disaster.206! Overlaid! on! a! bed! of!chronic! poverty! and! insecurity,! the! earthquake! created! new! risks! to! child! protection! and! exacerbated!pre`existing! vulnerabilities.! In! 2010,! Haiti’s! 4.25! million! children! accounted! for! 42.5%! of! the! total!population.207!1.5!million!children!are!reported!to!have!been!affected!by!the!earthquake,!while!800,000!were! believed! to! be! residing! in! IDP! camps! by! July! 2010.208! Furthermore,! 38%! of! registered! IDPs! by!December! 2010! were! children.209! Assuming! this! proportion! has! remained! constant,! approximately!209,000!children!would!be!expected!to!be!living!in!camps!in!September!2011.!!!Children! are! a! vulnerable! group! in! any! emergency,! as! their! means! of! survival! and! development! are!inextricably! mediated! by! other! actors,! be! they! the! family,! the! community,! or! the! state! as! a! whole.!UNICEF!states!that!“the!family!can!be!the!single!most!important!factor!in!determining!whether!or!not!a!child!is!protected.”210!As!a!result,!the!Sphere!Project!has!identified!the!family!as!“a!fundamental!unit!for!the! protection! of! persons,! and! as! a! prime,! motivating! factor! in! the! decision`making! of! the! affected!persons.”211! In! post`disaster! contexts,! such! as! Haiti,! the! protection! of! children! must! therefore! be!situated! in! a! broader! social! context,! encompassing! the! means! and! strategies! available! to! children! as!they!and!their!care`givers!seek!to!overcome!hardship!and!realize!their!rights.!!For!operational!purposes,!UNICEF!uses!the!term!child!protection!“to!refer!to!preventing!and!responding!to! violence,! exploitation! and! abuse! against! children—including! commercial! sexual! exploitation,!trafficking,! child! labor! and! harmful! traditional! practices,! such! as! female! genital! mutilation/cutting! and!child! marriage.”212! Also! targeted! for! child! protection! are! children! at! heightened! risk! of! these! abuses,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!204 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!205 !IOM,!Population&in&camps&housing&Haitians&left&homeless&by&the&2010&earthquake&drops&below&600,000,! International!Organization!for!Migration!(August!2011).!Available!at! http://www.iomhaiti.com/ft/page.php?id=53!!206 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!207 !World!Bank,!World&databank&education&statistics&(EdStats).!Available!at!http://data.worldbank.org/data` catalog/ed`stats!208 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!209 !IOM,!Registration,!International!Organization!for!Migration!(December!2010).!Available!at! http://www.iomhaiti.com/ft/pdf/Brochure.CCCM.Registration.Dec.10.pdf!!210 !UNICEF,!Child&protection:&A&handbook&for&parliamentarians,!Handbook!for!Parliamentarians!No.!7!(2004).! Available!at!http://www.unicef.org/publications/files/Guide_Enfants_OK.pdf!!211 !Sphere!Project,!Sphere&protection&section:&Draft!(June!23,!2011).!Available!at! http://www.crin.org/docs/FileManager/Sphere_Protection_Chapter_23Junedraft1.doc!!212 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!2! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 1.&Introduction&such!as!those!without!parental!care,!in!armed!conflict,!and!those!in!conflict!with!the!law.213!While!useful!for! operational! purposes,! this! “categorization”! of! child! protection! conflates! characteristics! of! risk! and!need,! and! the! assessment! of! need! itself.! In! order! to! assess! child! protection! holistically! in! the! Haitian!context,!a!broader!definition!is!required!that!encompasses!a!wider!range!of!child!protection!risk!factors,!as! well! as! the! outcomes! and! the! dynamic! processes! that! connect! them.! The! Inter`Agency! Standing!Committee—the! principal! international! mechanism! for! the! coordination! of! humanitarian! assistance!between!non`governmental!organizations!and!the!United!Nations—proposed!the!following!definition!of!protection!under!their!1999!framework!for!the!protection!of!internally!displaced!persons:!! The!concept!of!protection!encompasses!all!activities!aimed!at!obtaining!full!respect!for!the!rights! of!the!individual!in!accordance!with!the!letter!and!the!spirit!of!the!relevant!bodies!(human!rights,! 214 humanitarian!law,!and!refugee!law). !!When! applied! to! children,! this! definition! recognizes! that! child! protection! requires! a! multi`tiered!framework,!whereby!the!child’s!experience!is!not!assessed!in!isolation,!but!rather!in!the!context!of!what!is!available!and!can!be!provided!by!the!family,!the!community,!and!the!state!as!a!whole.!Additionally,!it!affirms!the!notion!that!human!security!is!not!merely!the!absence!of!violence,!exploitation!or!abuse,!but!an! enabling! and! fostering! environment! that! expands! the! opportunities! available! to! the! child.215!Facilitating! a! broader! analysis! of! risk! factors,! systems,! and! outcomes,! this! approach! requires! a! more!comprehensive!assessment!of!children’s!lived!experience!in!realizing!their!rights.!!This! report! analyzes! child! protection! risk! factors! and! outcomes! in! Haiti! before! and! after! the! January!2010!earthquake,!highlighting!ways!in!which!children’s!vulnerabilities!and!resilience!are!affected!by!and!translated! into! the! realization! or! violation! of! their! rights.! To! help! guide! and! identify! areas! for! future!research,! the! report! also! highlights! current! gaps! in! the! knowledge! of! child! protection! risk! factors! and!outcomes.! Striving! to! provide! a! holistic! assessment! of! child! protection! in! Haiti,! it! aims! to! empower!policymakers!and!programmers!to!build!a!better!Haiti!for!its!children.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!213 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!214 !ICRC,!Report&of&the&third&workshop&on&protection&for&human&rights&and&humanitarian&organizations:&Doing& something&about&it&and&doing&it&well,!18`20!January!1999!(January!2000).!215 !Sphere!Project,!Humanitarian&charter&and&minimum&standards&in&humanitarian&response!(2011).!Available!at! http://www.sphereproject.org/!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 3!
    • !2.&Methodological&note&!This!Report!directly!examines!the!protection!risk!factors!and!outcomes!experienced!by!children!in!Haiti!before!and!after!the!January!12,!2010!earthquake,!in!addition!to!other!risk!factors!and!outcomes!that,!while! not! directly! associated! with! children,! influence! their! lives.! The! Report! also! aims! to! assess! the!currently! available! body! of! knowledge! of! child! protection! in! Haiti,! and! highlight! areas! where! this!knowledge!should!be!expanded,!deepened,!or!re`oriented.!In!most!cases,!existing!data!are!outdated!in!light! of! the! 2010! earthquake.! The! absence! of! a! large`scale,! nationally! representative! survey! covering!many! of! the! topics! addressed! in! this! Report! necessitates! a! new! comprehensive! assessment,! updating!estimates!of!phenomena!of!interest,!and!facilitating!correlation!analysis.!This!Report!fulfills!the!first!step!of!this!endeavor!by!examining!what!is!known!about!Haitian!children’s!lived!experiences!today,!analyzing!key!aspects!of!the!situation!in!the!recent!past,!and!identifying!areas!that!demand!further!inquiry.!!This!Report!draws!information!from!a!wide!range!of!sources,!including!international!organizations!such!as! the! United! Nations! (UN)! and! its! agencies,! the! International! Monetary! Fund! (IMF),! and! the! World!Bank,! as! well! as! the! offices! of! the! Haitian! government! and! other! states,! the! academic! and! research!community,!and!the!plethora!of!relief!and!development!organizations!operating!within!Haiti!both!before!and!since!the!earthquake.!A!primary!literature!catchment!was!conducted!in!July!and!August!2010!and!then! supplemented! by! further! catchments! in! January! 2011,! June`September! 2011,! and! ongoing!research.! Information! from! international! organizations! was! primarily! collected! through! the! Haiti!oneResponse!website,!manual!and!key`word!searches!on!relevant!organizations’!websites,!and!general!searches! using! Google.! Sources! produced! by! the! Haitian! government! were! obtained! through! online!searches,! the! Haiti! oneResponse! website,! and! hard! copy! collection! by! FXB! Center! team! members! in!Haiti.!Information!collected!from!other!country!governments!was!collected!through!internet!searches.!Academic! sources! were! collected! through! searches! on! Google! and! Google! Scholar,! the! Harvard!University! Hollis! library! catalogue,! PubMed,! the! Harvard! humanitarian! and! human! rights! community,!and!the!Haiti!oneResponse!website.!Information!from!international!relief!and!disaster!organizations!was!sourced! online! through! general! web! searches! using! Google! and! targeted! key`word! and! manual!searching!on!the!websites!of!large!relief!and!development!organizations!registered!with!the!UN!Office!for! the! Coordination! of! Humanitarian! Affairs! (UN! OCHA)! in! Haiti.! In! addition,! “snowball”! research! was!conducted!using!the!reference!lists!of!seminal!and!authoritative!documents.!!For!the!purposes!of!this!Report,!“children”!are!defined!according!to!Article!1!of!the!Convention!on!the!Rights!of!the!Child!as!the!population!that!has!not!yet!reached!their!18th!birthday,!i.e.,!individuals!aged!0!to!17.216!Adolescents!are!defined!according!to!UNICEF!standards!as!individuals!aged!10!to!19.!Similarly,!youth!are!defined!as!those!age!15!to!24.!In!many!cases!throughout!the!Report,!other!age!categories!are!used,!such!as!“children!who!are!under!5!years!of!age,”!or!those!who!are!“school`aged.”!These!cases!are!accordingly!highlighted!in!the!text.!In!some!instances,!lack!of!international!consensus!on!the!definitions!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!216 !Convention!on!the!Rights!of!the!Child,!G.!A.!Res.!44/25!(1989).!Available!at! http://www2.ohchr.org/english/law/crc.htm!!4! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • 2.&Methodological&note&of!“child,”!“adolescent,”!and!“youth”!lead!to!a!lack!of!comparability!among!sources.!In!such!cases,!the!definitional!discrepancy!is!either!highlighted,!or!another!authoritative!source!is!used!when!available.!!Unless!otherwise!noted,!figures!presented!in!this!Report!appear!in!their!original!form.!!Finally,! the! Report! assesses! the! levels! and! trends! of! pertinent! risk! factors! and! outcomes,! and! is!organized! into! a! series! of! sections! each! containing! multiple! topics.! Each! topic! first! examines! Haitian!children’s! experiences! before! the! earthquake! and! highlights! knowledge! gaps! before! discussing! the!impact!of!the!earthquake!on!children!regarding!that!area!of!interest.!In!general,!each!topic!progresses!from!general!to!specific,!discussing!broad!themes!before!going!into!further!detailed!and!focused!inquiry.!Associations! are! drawn! between! topics,! and! cross`references! direct! the! reader! to! other! relevant!information!contained!within!the!Report.!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 5!
    • !3.&Demography&!Since! the! end! of! the! Duvalier! regime! in! 1986,! Haiti’s! population! has! undergone! significant!transformation! in! terms! of! size,! composition,! distribution,! and! rate! of! growth.! The! paucity! of! reliable!historical!data!makes!it!difficult!to!reconcile!estimates!of!Haiti’s!total!population,!which!differ!by!source.!According!to!the!World!Bank,!Haiti’s!total!population!increased!from!approximately!5.7!million!in!1980!to!around!10!million!in!2010!(Figure!1),217!exhibiting!an!average!(crude)!growth!rate!of!2.5%!per!annum.!However,!over!this!same!period,!significant!out`migration!has!tempered!the!domestic!impact!of!Haiti’s!high!prevailing!Total!Fertility!Rate!(TFR),!defined!as!the!number!of!births!the!average!woman!is!likely!to!have! over! the! course! of! her! reproductive! years,! assuming! that! she! is! subject! to! current! age`specific!fertility! rates.! Out`migration! has,! therefore,! simultaneously! provided! the! country! with! significant!opportunities! for! remittance! flows! from! migrants’! destination! countries! and! reduced! the! burden! on!strained!domestic!services.!!Figure.1:.Total.Haiti.domestic.population,.1980T2010. !Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!The!population!has!grown!differentially!across!Haiti’s!ten!administrative!Departments.!A!2008!review!by!Dorte!Verner!highlights!the!diversity!of!experiences!between!regions!in!2003,!when!Haiti!had!only!nine!Departments!(Figure!2).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!217 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!6! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.2:.Population,.household.size.and.gender.ratio,.by.Department,.2003. !Source:!IHSI!(2003),!in!D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first& household&survey&for&Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!!!In! Verner’s! analysis,! population! growth! included! births,! deaths,! and! domestic! and! international!migration.!While!the!impact!of!urbanization!and!migration!will!be!discussed!in!greater!detail!later!in!this!Report,!it!is!worth!noting!here!that!during!the!period!of!1982`2003,!Ouest!Department,!which!includes!the! capital! Port`au`Prince,! demonstrated! both! the! largest! total! population! and! greatest! population!growth.! The! lowest! population! growth! in! this! period! was! in! Grande’Anse! and! Sud`Est! Departments,!which!are!primarily!agricultural!regions.!!Figure.3:.Annual.domestic.population.growth.rate,.1980T2010. !Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2! ©!2012!FXB!Center!for!Health!and!Human!Rights! 7!
    • !!!Since!the!early!1980s,!Haiti!overall!has!experienced!a!declining!annual!population!growth!rate!(Figure!3).!In!2010,!the!World!Bank!estimated!Haiti’s!annual!population!growth!rate!to!be!1.3%!per!annum.218!The!2010! Human! Development! Report! projects! Haiti’s! annual! population! growth! rate! to! remain! low,!averaging!1.5%!per!annum!for!the!2010!–!2015!period.219!This!declining!growth!rate!is!the!result!of!three!factors:! a! reduction! in! fertility! (see! Section! 3C.& Fertility,! below),! limited! changes! in! age`specific! life!expectancies! (see! Section! 3E.& Mortality,! below),! and! continued! out`migration.! However,! despite! a!reduction!in!the!rate!of!population!growth,!Haiti!continues!to!experience!increasing!population!pressure!on!its!natural!resources,!services,!and!institutions.!Haiti!is!the!second!most!densely!populated!country!in!the!Americas,!with!an!average!of!306!people!per!square!kilometer!in!2006.220!!Figure.4:.Population.under.age.18,.1990T2010. !Data!source:!World!Bank,!World&databank&education&statistics&(EdStats).!Available!at! http://data.worldbank.org/data`catalog/ed`stats!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!218 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!219 !UNDP,!Human&development&report&2010:&The&real&wealth&of&nations:&Pathways&to&human&development!(New! York:!Palgrave!Macmillan,!2010).!Available!at!http://hdr.undp.org/en/reports/!!220 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!8! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.5:.Proportion.of.total.Haitian.population.under.age.18,.1990T2010. !Data!source:!World!Bank,!World&databank&education&statistics&(EdStats).!Available!at! http://data.worldbank.org/data`catalog/ed`stats!!!Over!the!period!of!1990`2010,!the!number!of!children!in!Haiti!increased!by!approximately!21.6%!(Figure!4),!from!roughly!3.5!million!in!1990!to!4.25!million!in!2010.221!However,!the!share!of!the!total!population!comprised!of!children!fell!by!6.54%!between!1990!and!2010.!In!1990,!children!accounted!for!49%!of!the!total! Haitian! population,! while! in! 2010,! they! accounted! for! 42.5%.222! Between! 1994`95! and! 2000,! the!median! age! of! the! population! increased! from! 18.5! to! 18.9! years.223! The! World! Bank! attributes! the!decline!in!the!share!of!the!population!under!age!18!to!“the!twin!effects!of!urbanization!(fertility!rates!were!lower!in!urban!areas!than!in!the!countryside)!and!gradually!declining!fertility!rates!overall!(partly!as!a!result!of!increased!educational!attainment).”224,225!!A!World!Vision!rapid!assessment!of!60!camps!and!communities!in!the!Port`au`Prince!metropolitan!area!and!the!organization’s!operational!areas!in!La!Gonâve,!Plateau!Central,!and!Nord!and!Sud!Departments!in! February! 2010! found! average! household! age! composition! to! be! comparable! to! the! pre`earthquake!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!221 !World!Bank,!World&databank&education&statistics&(EdStats).!Available!at!http://data.worldbank.org/data` catalog/ed`stats!222 !World!Bank,!World&databank&education&statistics&(EdStats).!Available!at!http://data.worldbank.org/data` catalog/ed`stats!223 !D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!224 !D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!225 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 9!
    • !situation! (Figure! 6).226! Though! the! survey! was! not! random! and! had! a! limited! sample! size,! the! findings!suggest!that!earthquake!mortality!did!not!disproportionately!affect!any!specific!age!group,!and!that!pre`earthquake!household!age!composition!ratios!remain!valid.!!Figure.6:.Age.composition.of.surveyed.households.(hh),.February.2010. !Source:!World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!!!The! changing! age! composition! of! Haiti’s! population! can! be! seen! in! its! population! pyramid,! which!graphically!displays!the!proportion!of!the!population!in!each!five`year!age!group!(Figure!7!and!Figure!8).!In!2000,!Haiti’s!population!pyramid!conformed!to!the!typical!shape!of!a!developing!country,!where!the!share!of!the!population!in!each!ascending!age!group!is!smaller!than!that!of!the!preceding!age!group.!In!2010,!however,!the!population!pyramid!shows!that!the!proportion!of!Haiti’s!population!in!the!0`4!age!group! was! smaller! than! that! in! the! 5`9! age! group.! If! sustained,! this! effect! is! called! the! demographic!transition.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!226 !World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!10! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.7:.Haiti.population.pyramid,.2000. !Data!source:!U.S.!Census!Bureau,!International&data&base:&Haiti&demographic&indicators.!Available!at! http://www.census.gov/population/international/data/idb/informationGateway.php!!!Figure.8:.Haiti.population.pyramid,.2010. !Data!source:!U.S.!Census!Bureau,!International&data&base:&Haiti&demographic&indicators.!Available!at! http://www.census.gov/population/international/data/idb/informationGateway.php! ©!2012!FXB!Center!for!Health!and!Human!Rights! 11!
    • !!!While! Haiti’s! population! is! still! growing,! the! proportion! of! its! population! in! the! youngest! age! groups!(ages! 0`19)! is! falling,! due! to! lower! fertility! rates! among! women! in! their! reproductive! years,! ceteris&paribus.! As! noted! previously,! the! proportion! of! the! population! under! age! 18! has! fallen! since! 1993,!reflecting!the!relative!stability!of!age`specific!life!expectancies!and!decreases!in!fertility!over!that!period.!!The!population!proportions!illustrated!in!Figure!8!for!age!groups!0`4,!5`9,!10`14,!and!15`19!also!indicate!a!“youth!bulge”!moving!through!Haiti’s!population!structure.!Youth!bulges!present!both!challenges!and!opportunities.! These! opportunities,! collectively! referred! to! as! the! “demographic! window! of!opportunity,”!derive!from!the!potential!of!a!low!“dependency!ratio”!to!stimulate!economic!growth!and!development,!leading!to!a!“demographic!dividend.”227!The!dependency!ratio!is!the!ratio!of!the!segment!of!the!population!in!the!working!age!range!(15`64)!to!the!combined!population!segment!younger!than!age!15!and!aged!65!and!over.!As!such,!the!dependency!ratio!can!be!conceived!of!as!the!average!number!of!dependents!for!each!person!in!the!working`age!population.!Lower!dependency!ratios!are,!therefore,!preferable! to! large! dependency! ratios,! as! each! person! of! working! age! is! responsible! for! fewer!dependents,! thereby! enjoying! a! higher! share! of! his! or! her! total! earnings.! Bloom,! Canning,! and! Sevilla!propose!that!the!movement!of!a!youth!bulge!through!the!population!structure!was!one!of!the!primary!reasons!that!many!East!Asian!economies!were!able!to!elicit!impressive!economic!growth!over!the!past!20! years.228! As! the! youth! bulge! moves! up! into! the! older! age! groups,! a! greater! proportion! of! the!population!will!be!in!the!working`age!segment!of!the!population.!If!gainful!employment!is!available!to!the!population,!the!movement!of!this!group!through!the!working!ages!will!fuel!economic!growth,!as!the!lower!dependency!ratio!will!allow!them!to!save!and/or!invest!more!of!their!earnings.!!!While!the!observed!youth!bulge!provides!Haiti!with!many!opportunities,!lack!of!options!for!children!and!young! people! expose! many! concomitant! challenges.! As! will! be! discussed! in! Chapters! 8! and! 9! of! this!Report,!children!in!Haiti!do!not!enjoy!the!human!capital!and!positive!employment!options!required!to!capitalize! on! the! demographic! window! of! opportunity.! Education! quality! is! poor,! depriving! children! of!the!knowledge!and!skills!necessary!to!realize!potential!gains!of!the!demographic!transition.!A!shortage!of! employment! and! sustainable! livelihood! opportunities! thus! stymie! chances! for! rapid! growth.! The!potential! effects! of! the! youth! bulge! therefore! stand! in! stark! contrast! to! each! other.! If! Haiti! is! able! to!rebuild! from! the! January! 2010! earthquake! in! a! manner! that! promotes! the! holistic! protection! and!development!of!its!children,!promoting!a!safe!and!enabling!environment!for!their!physical!and!mental!development!while!bolstering!the!availability!of!gainful!employment!opportunities,!the!youth!bulge!may!be! an! engine! for! growth! and! poverty! reduction.! If,! on! the! other! hand,! children! are! not! protected,!necessary! investments! in! human! security! and! development! are! not! made,! children! are! not! equipped!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!227 !D.!E.!Bloom,!D.!Canning,!and!J.!Sevilla,!The&demographic&dividend:&A&new&perspective&on&the&economic& consequences&of&population&change,!RAND!population!matters!monograph!No.!MR`1274!(2003).!Available!at! http://www.rand.org/pubs/monograph_reports/2007/MR1274.pdf!228 !D.!E.!Bloom,!D.!Canning,!and!J.!Sevilla,!The&demographic&dividend:&A&new&perspective&on&the&economic& consequences&of&population&change,!RAND!population!matters!monograph!No.!MR`1274!(2003).!Available!at! http://www.rand.org/pubs/monograph_reports/2007/MR1274.pdf!12! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&with!the!skills!and!capacities!necessary!to!prosper!through!their!working!years,!and!Haiti!continues!on!its!pre`earthquake!trajectory,!the!youth!bulge!will!result!in!higher!unemployment!and!the!consolidation!and! deepening! of! poverty,! increasing! the! attractiveness! of! maladaptive! survival! strategies! and!undermining! social! welfare.! Investing! in! child! protection! is,! therefore,! of! critical! importance! to! Haiti’s!future.!!!A.&Urbanization&!Haiti’s!population!has!continued!to!urbanize!over!the!past!30!years!(Figure!9).!Between!1980!and!2010,!the!proportion!of!the!population!living!in!urban!areas!grew!from!20.5%!to!49.6%—!an!increase!of!142%,!or!a!simple!average!urbanization!rate!of!4.7%!per!annum.229,230!In!the!period!of!1986!to!2006,!the!Port`au`Prince!metropolitan!area!received!an!average!of!75,000!internal!migrants!per!annum,!in!addition!to!its! natural! annual! growth! rate! of! 40,000! people,! together! accounting! for! growth! in! the! metropolitan!area! of! 115,000! people! per! year.231! Between! 1982! and! 2003,! every! Department! in! Haiti! registered! an!increase! in! urban! population! share! (Figure! 10),232! while! the! proportion! of! the! total! urban! population!residing! in! the! capital! fell! from! 60.09%! in! 1980! to! 55.56%! in! 2009.! By! July! 2010,! six! months! after! the!earthquake,! the! World! Bank! estimated! that! this! proportion! had! fallen! further,! to! 43.24%,! due! to!earthquake`related! migration! out! of! the! capital.233! It! is! unclear! whether! this! reduced! proportion! has!remained!constant,!or!whether!the!proportion!of!the!total!urban!population!living!in!Port`au`Prince!has!returned!to!pre`earthquake!levels.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!229 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!230 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!231 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!232 !D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!233 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2! ©!2012!FXB!Center!for!Health!and!Human!Rights! 13!
    • !Figure.9:.Percentage.of.population.living.in.urban.and.rural.areas,.1980T2010. !Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!Figure.10:.Percentage.of.Haitis.population.in.urban.areas:.National.and.by.Department,.1982.&.2003. !Source:!D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey& for&Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!!!Both! the! absolute! number! and! percentage! of! the! urban! population! living! in! slums! increased! between!1990!and!2001,!from!1.7!million!(84.9%!of!total!urban!population)!in!1990,!to!2.6!million!(85.7%!of!urban!population)!in!2001.!However,!both!the!absolute!number!and!percentage!living!in!slums!in!urban!areas!then!decreased!between!2001!and!2005,!to!2.3!million!(70.1%!of!urban!population).234!Therefore,!while!the! absolute! number! of! people! living! in! slums! in! urban! areas! increased! by! approximately! 590,000!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!234 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!14! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&between!1990!and!2005,!the!proportion!of!urban!residents!living!in!slums!decreased!by!17.4%!from!the!1990!level—an!absolute!reduction!in!the!proportion!of!the!urban!population!living!in!slums!of!14.8%.!!There! is! a! higher! proportion! of! female! than! male! adolescents! living! in! urban! areas.! In! 2006,! 40.3%! of!girls!aged!10`14!and!47.2%!aged!15`19!lived!in!urban!areas,!compared!to!32.0%!of!boys!aged!10`14!and!39.4%!aged!15`19.235!As!such,!girls!aged!10`14!were!25.9%!more!likely!to!reside!in!urban!areas!than!boys!of! the! same! age,! while! girls! aged! 15`19! were! 19.8%! more! likely! to! live! in! urban! areas! than! their! male!counterparts.! This! lack! of! parity! is! attributed! to! discrepancies! in! the! types! of! labor! sought! by! each!gender;!women!generally!migrate!to!urban!areas!in!search!of!employment!in!export!processing!zones!or!as! domestic! servants,! while! men’s! traditionally! agricultural! work! profile! has! led! them! to! seek! more!opportunities!in!rural!areas.236!For!this!reason,!it!is!believed!that!twice!as!many!women!as!men!migrate!from!rural!to!urban!areas.237!!!B.&Vital&registration&!Vital!registration!is!the!official!government!recording!of!major!life!events!of!its!population,!such!as!births!and! deaths.238! As! noted! by! UNICEF,! birth! registration! “is! fundamental! to! the! realization! of! children’s!rights!and!practical!needs,”!contributing!to!their!right!to!an!identity!and!opening!the!way!for!civic!and!economic!engagement.239!Birth!registration!may!assist!individuals!to!obtain!credit,!apply!for!a!passport,!vote,! and! entitle! them! to! immunizations! and! school! access.! It! is! also! critical! for! child! protection,! as!registered! children! are! better! able! to! access! legal! protections,! are! more! visible! in! child! trafficking!investigations! and! anti`child! marriage! policies,! and! are! more! easily! reunited! with! family! members!following!domestic!or!international!repatriation.!Finally,!birth! registration! allows! for! more! appropriate!budgetary!procedures!as!population!estimates!are!more!reliable.!It!therefore!has!two!major!purposes:!legal!and!statistical.240!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!235 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!236 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!237 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!238 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!239 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!240 !UNICEF,!The&‘rights’&start&to&life:&A&statistical&analysis&of&birth&registration!(February!2005).!Available!at! http://www.unicef.org/publications/index_25248.html!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 15!
    • !Prior!to!the!2010!earthquake,!Haiti!had!made!progress!towards!universal!birth!registration,!increasing!prevalence! from! 70%! at! the! turn! of! the! century! to! 81%! by! 2006.241! While! negligible! gender! bias! is!observed!in!registration!rates,!differences!are!observable!between!urban!(87%)!and!rural!(78%)!areas,242!mother’s! education! (64.4%! for! those! with! no! education! versus! 96.7%! for! those! with! a! tertiary!education),! and! socio`economic! status! (60.2%! for! lowest! quintile! versus! 83.6%! for! highest! quintile).243!UNICEF! noted! with! interest! that! in! 2000,! Haitian! children! who! attended! early! childhood! education!programs!were!less!likely!(76%)!to!be!registered!than!those!who!did!not!(84%);!in!other!contexts,!birth!registration!is!usually!positively&associated!with!early!childhood!education!attendance.244!!Several! barriers! to! birth! registration! exist! in! Haiti.! First,! the! distribution! of! civil! registry! offices!disenfranchises!rural!children,!as!there!are!few!offices!outside!of!the!capital!and!none!in!rural!areas.245!UNICEF!has!also!noted!that!the!costs!of!registering!a!child,!both!financially!in!terms!of!official!costs!and!informally!in!terms!of!lost!time,!may!not!be!deemed!worthwhile.!Lack!of!knowledge!of!where!to!register!a!birth!may!be!another!barrier,!along!with!a!lack!of!understanding!of!the!importance!of!the!registration!process.246! Conflict! situations,! such! as! periods! of! civic! unrest,! have! also! been! found! to! lower! the!likelihood!of!birth!registration.247!!The!Haitian!government!has!attempted!to!address!sub`optimal!birth!registration.!In!1995,!a!Presidential!Decree! created! an! opportunity! for! those! whose! birth! had! not! been! registered! to! bypass! the! late!registration! process.! Additionally,! the! country! instituted! a! new! process! in! which! a! child! may! be!registered! by! parish! administrative! services! at! a! child’s! baptism—a! rite! of! passage! highly! regarded! in!Haitian! culture.248! It! is! unclear! whether! the! rise! in! birth! registration! between! 2000! and! 2008! can! be!attributed! to! this! collaboration! between! church! and! state,! or! whether! increasing! levels! of! female!education!are!a!more!important!factor.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!241 !UNICEF,!State&of&the&world’s&children&200452009!(Oxford:!Oxford!University!Press,!2004`2009).!Available!at! http://www.unicef.org/sowc/!!242 !UNICEF,!State&of&the&world’s&children&2009!(Oxford:!Oxford!University!Press,!2009).!Available!at! http://www.unicef.org/sowc/!!243 !UNICEF,!The&‘rights’&start&to&life:&A&statistical&analysis&of&birth&registration!(February!2005).!Available!at! http://www.unicef.org/publications/index_25248.html!!244 !UNICEF,!The&‘rights’&start&to&life:&A&statistical&analysis&of&birth&registration!(February!2005).!Available!at! http://www.unicef.org/publications/index_25248.html!!245 !UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!246 !UNICEF,!The&‘rights’&start&to&life:&A&statistical&analysis&of&birth&registration!(February!2005).!Available!at! http://www.unicef.org/publications/index_25248.html!!247 !UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!!248 !UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!16! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Haiti!maintains!a!critically!low!rate!of!death!certification.!In!1997,!death!certificates!were!completed!for!only! 6.3%! of! deaths,! and! coverage! had! increased! to! only! 10%! by! 2003.! Subsequently,! a! large! drop! in!coverage!occurred!in!2004!and!2005!at!roughly!the!same!time!as!civil!unrest!spread!nationwide.!Despite!lower! coverage,! the! quality! of! the! certification! process! improved,! with! the! proportion! of! ill`defined!causes!falling!from!48%!in!1999!to!26%!in!2002.249!!!C.&Fertility&!Haiti!displays!a!young!age!of!sexual!debut,!though!prevalence!varies!by!data!source.!According!to!the!!2009! Children! and! AIDS! report,! 42%! of! men! and! 15%! of! women! had! sex! before! age! 15! in! 2008,250!compared!to!worldwide!rates!of!20%!of!men!and!8%!of!women!in!1994!as!cited!in!the!2007!World!Youth!Report.251! Following! a! nationwide! survey! in! 2005`06,! the! Institut! Haitien! de! l’Enfance! found! that! the!percentage!of!young!people!of!both!genders!having!sex!before!age!15!was!increasing!over!time!(Figure!11),!as!was!the!proportion!having!sex!before!age!18.252!!Figure.11:.Percentage.of.young.Haitians.who.had.first.intercourse.before.15.or.before.18,.2006. !Source:!Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!249 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!250 !UNAIDS,!Children&and&AIDS:&Fourth&stocktaking&report,&2009!(December!2009).!Available!at! http://www.unicef.org/publications/index_51902.html!!251 !UN!DESA,!World&youth&report:&2007!(New!York:!United!Nations,!2007).!Available!at! http://www.un.org/esa/socdev/unyin/wyr07.htm!!252 !Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home! ©!2012!FXB!Center!for!Health!and!Human!Rights! 17!
    • !Among!those!aged!15`19!who!had!ever!had!sex,!the!majority,!both!male!and!female,!had!sex!in!the!12!months!preceding!the!survey.253!As!Figure!12!illustrates,!males!in!all!age!categories!were!more!likely!to!report!having!had!sex!than!were!females!in!the!same!category.!!Figure.12:.Sexual.activity.among.Haitian.young.people,.2006. !Source:!Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!!!Prevalence! of! sexual! activity! among! young! people! is! not! uniform! across! Haiti,! varying! by! location! and!marital!status!(Figure!13).!Young!women!aged!15`19!in!the!Port`au`Prince!metropolitan!area!were!most!likely!to!be!sexually!active!(21.6%)!and!to!report!having!ever!had!sex!(47.2%),!while!those!in!Nord`Est!(10.0%)!and!Sud!Departments!(10.1%)!were!least!likely!to!be!sexually!active.!Child!marriage!was!a!key!determinant! of! young! people’s! sexual! activity,! with! those! who! were! married! displaying! significantly!higher!rates!of!sexual!activity.!!!The!highest!rates!of!sexual!activity!among!females!aged!15`19!who!had!never!been!married!were!in!Sud`Est! Department! and! the! Port`au`Prince! metropolitan! area! (10.6%! and! 10.1%,! respectively).! Ouest!Department! had! the! highest! prevalence! of! females! aged! 15`19! who! reported! ever! having! had! sex!(32.5%)! among! those! who! had! never! been! married.! Across! all! marital! categories,! females! aged! 15`19!living! in! urban! areas! reported! higher! rates! of! sexual! activity! and! ever! having! sex! than! their! rural!counterparts.254!Education!also!plays!a!vital!role:!according!to!the!Population!Council!and!UNFPA,!“girls!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!253 !Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!254 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!18! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&who! are! in! school! during! adolescence! (even! if! they! are! not! in! the! expected! grade! for! their! age)! have!lower!rates!of!reported!sexual!activity!than!their!out`of`school!peers.”255!!Figure.13:.Sexual.activity.among.15T19.year.old.females.(percent),.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!Since!1980,!Haiti!has!witnessed!a!marked!reduction!in!the!Total!Fertility!Rate!(TFR)!(Figure!14).!Over!this!time!period,!Haiti’s!TFR!peaked!in!1982,!with!an!average!of!6.15!births!per!woman.!Since!1982,!the!TFR!has! consistently! fallen,! resulting! in! a! TFR! of! 3.4! in! 2009.256! Accordingly,! Haiti’s! crude! birth! rate! fell! on!average!during!this!period,!from!41.9!births!per!1,000!total!population!in!1980,!to!27.0!births!per!1,000!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!255 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!256 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2! ©!2012!FXB!Center!for!Health!and!Human!Rights! 19!
    • !total!population!in!2009.257!However,!28.9%!of!currently!married!women!are!still!expected!to!have!five!or!more!children!over!the!course!of!their!reproductive!years.258!!Figure.14:.Total.Fertility.Rate.(TFR),.1980.T.2009. !Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!Significant! fertility! differentials! exist! based! on! area! of! residence,! education,! and! economic! status.! The!1995! EMMUS! II! survey! found! that! “women! in! rural! areas! (5.9! children)…! give! birth! to! nearly! twice! as!many! children! (as)! in! the! Metropolitan! Area! (3.0! children).”259! The! same! study! revealed! that! women!with! no! education! gave! birth! to! more! than! twice! as! many! children! (6.1! children)! as! those! with! a!secondary!education!(2.5!children),260!supporting!the!World!Bank’s!assertion!that!women’s!fertility!falls!as!educational!attainment!increases.261!Similarly,!economic!status!greatly!affects!women’s!fertility.!The!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!257 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!258 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!259 !M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!260 !M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!261 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!20! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&TFR! of! women! in! the! poorest! income! quintile! is! 2.5! times! that! of! women! in! the! richest! income!quintile.262!!Little!data!exist!on!adolescent!fertility!before!1992,!and!different!sources!provide!varying!estimates.!In!1992,!the!UN!Statistics!Division!estimated!that!there!were!79!births!per!1,000!women!aged!15`19.!This!rate! increased! slightly! to! 80! births! per! 1,000! women! aged! 15`19! in! 1998,! before! falling! to! 68.6! in!2003.263!The!Pan`American!Health!Organization!has!estimated!that!the!15`19!year`old!fertility!rate!was!80! per! 1,000! girls! in! 2000264! and! 69! per! 1,000! girls! in! 2005/2006.265! These! estimates! are! higher! than!those!of!the!World!Bank,!which!estimated!fertility!among!Haitian!women!aged!15`19!to!be!61.8!births!per! 1,000! women! in! 1997,! 51.3! births! per! 1,000! women! in! 2003,! and! 44.3! births! per! 1,000! women! in!2009! (Figure! 15).266! In! 2006,! 14.6%! of! women! aged! 15`19! had! either! given! birth! or! were! pregnant,267!indicating! a! negligible! reduction! since! 1995! (Figure! 16).268! In! 2002,! it! was! estimated! that! fertility!between! ages! 15`19! accounted! for! 8%! of! all! births! in! Haiti.269! The! significant! risks! associated! with!adolescent!childbirth!will!be!reviewed!in!Section!7C.&Sexual&and&reproductive&health.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!262 !D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!263 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!264 !PAHO,!Health&situation&and&trends&summary:&Haiti!(2007).!Available!at! http://www.paho.org/English/DD/AIS/cp_332.htm!!265 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!266 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!267 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!268 !M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!269 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 21!
    • !Figure.15:.Adolescent.Fertility.Rate,.1997.T.2009. !Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!22! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.16:.Percent.of.15T19.year.old.females.ever.pregnant.or.had.a.child,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!.Figure! 16! illustrates! the! stark! contrast! in! adolescent! fertility! between! urban! and! rural! areas,! and!between!women!who!have!been!married!and!those!who!have!never!married.!Adolescent!girls!in!rural!areas! are! approximately! 1.5! times! more! likely! to! have! been! pregnant! than! those! in! urban! areas! —! a!difference! of! 6%! likelihood! of! ever! being! pregnant! during! ages! 15`19.! The! adolescent! fertility! rate! in!rural!areas!(86!per!1,000!girls)!was!far!greater!than!that!in!the!Port`au`Prince!metropolitan!area!(46!per!1,000!girls)270!and!urban!areas!in!general!(69!per!1,000!girls).271!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!270 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!271 !PAHO,!Health&situation&in&Haiti&before&the&2010&earthquake,!Presentation!at!Haiti!Health!Cluster!(January!2010).! Available!at!http://ec.europa.eu/echo/files/aid/countries/Haiti_paper_01102010.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 23!
    • !One!factor!contributing!to!high!rates!of!adolescent!fertility!in!Haiti!is!the!prevalence!of!child!marriage,!discussed! further! below.! Most! significantly,! as! shown! in! Figure! 16,! adolescent! girls! who! have! ever!married! are! 28.5! times! more! likely! to! have! been! pregnant! than! those! who! have! never! married.! Child!marriage! increases! the! probability! of! adolescent! pregnancy,! especially! when! the! girl! is! significantly!younger!than!her!husband,!which!will!be!further!discussed!in!Section!3D.&Child&marriage.!Child!marriage!is!quite!typical!in!Haiti.!In!2006,!only!7.5%!of!married!or!cohabiting!female!youth!in!Haiti!were!the!same!age!or!older!than!their!husband!or!cohabiting!partner!(Figure!17).!In!74.5%!of!couples!involving!female!youth,! the! husband! or! partner! was! less! than! ten! years! older! than! the! female,! while! in! 18.1%,! the!husband! or! partner! was! more! than! ten! years! older.! While! these! proportions! were! roughly! equivalent!between!urban!and!rural!areas,!there!were!small!differences!between!Departments.272!As!noted!by!the!Population!Council,!“The!age!difference!between!partners!—!whether!married!or!not!—!has!implications!for! the! woman’s! ability! to! negotiate! voluntary,! safe,! and! protected! sexual! relations.”273! Young! girls!married!to!considerably!older!men!do!not!have!the!same!ability!to!negotiate!for!contraceptive!use!and!are! more! likely! to! be! sexually! active,! thereby! increasing! their! risk! of! adolescent! pregnancy.274!Furthermore,!when!adolescent!girls!marry,!they!are!also!less!likely!to!continue!with!schooling,!which!is!associated!with!significantly!higher!adolescent!and!lifetime!fertility.275!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!272 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!273 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!274 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!275 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!24! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.17:.Age.difference.between.women.age.15.T.24.and.their.current.partners,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!UNICEF!has!noted!that,!in!general,!high!adolescent!fertility!rates!are!associated!with!poverty!and!lack!of!education,!as!individuals!in!these!groups!“often!have!the!least!ability!and!incentive!to!avoid!unplanned!pregnancy.”276! Findings! from! Haiti,! where! poverty! is! widespread! in! rural! areas! and! additional! children!are!perceived!as!necessary!for!their!utility!in!farm!labor,!support!this!proposition.277!As!further!described!in!Section!8E.&Access&to&education&and&barriers&to&enrollment,!educational!opportunities!are!also!closely!related! to! poverty! in! Haiti,! while! inadequate! access! to! education! in! rural! areas! also! prevents! many!adolescents! from! attending! school.! The! inter`related! impacts! of! poverty,! education,! and! access! on!adolescent! fertility! are! highlighted! in! the! 1994`95! Survey! on! Mortality,! Morbidity! and! Utilization! of!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!276 !UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!277 !T.!T.!Schwartz,!Fewer&men,&more&babies:&Sex,&family&and&fertility&in&Haiti!(Lanham:!Lexington!Books,!2009).! ©!2012!FXB!Center!for!Health!and!Human!Rights! 25!
    • !Services! (EMMUS! II),! which! found! that! early! childbearing! is! 3.25! times! more! likely! among! female!teenagers!with!no!education!(26%)!than!among!those!with!secondary!education!(8%).278!!In!a!July!2010!assessment,!Plan!International!noted!anecdotal!reports!provided!by!the!Ministry!of!Health!and!local!service!providers!of!a!dramatic!rise!in!adolescent!pregnancies.!While!Plan!did!not!observe!such!an!increase!in!their!field!visits!to!IDP!camps,!they!concluded!that!the!consistency!of!reports!suggested!that!such!an!increase!was!likely,!but!that!pregnant!adolescents!refrained!from!activities!in!visible!camp!spaces,! further! deepening! their! vulnerability.279! A! January! 30,! 2011! article! by! the! CEO! of! the! UN!Foundation! noted! with! concern! that! fertility! across! Haiti! may! have! tripled! since! the! earthquake,! and!that! there! had! been! a! sharp! increase! in! the! number! of! adolescent! pregnancies! in! IDP! camps.280! If!confirmed,!these!findings!indicate!a!significant!increase!in!risk!for!those!already!chronically!vulnerable,!requiring!the!immediate!attention!of!the!response!community.!!Haitian! women’s! desired! fertility! is! lower! than! their! observed! fertility.281,282! The! 1994`95! EMMUS! II!survey! indicated! that! women! ideally! desired! 3.3! children,! while! men! desired! 3.4.! In! 1995,! then,! the!survey! concluded! that! 34%! of! births! within! the! preceding! five! years! were! not! wanted.283! Similarly,! in!2000,! the! Population! Reference! Bureau! found! that! 29.8%! of! pregnancies! were! not! wanted.284! Desired!fertility!was!found!to!increase!with!age.!Those!aged!20`24!wanted!to!have!2.7!children,!while!those!aged!30`34!wanted!3.1!children.285!In!2006,!the!World!Bank!estimated!desired!fertility!to!be!even!lower,!at!2.4!births!per!woman—far!lower!than!its!estimate!of!the!Total!Fertility!Rate!in!that!year,!at!3.66.286!A!2007!study!by!the!Institute!for!Reproductive!Health!found!that!55%!of!women!did!not!want!to!have!any!more!children.287!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!278 !M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!279 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!280 !K.!Calvin,!Lighting&the&future&for&Haiti’s&women,!UN!Foundation!(January!2011).!Available!at! http://www.unfoundation.org/who`we`are/impact/our`impact/empowering`women`girls/lighting`the` future.html!!281 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!282 !D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!283 !M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!284 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!285 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!286 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!287 !Institute!for!Reproductive!Health,!Awareness&project:&Haiti&country&report,&200552007,!Georgetown!University! (January!2008).!Available!at!http://www.k4health.org/system/files/Haiti%20Country%20Report%202005` 2007.pdf!!26! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&!Unwanted! pregnancies! carry! greater! risks! for! both! the! mother! and! child,! both! because! women! with!unwanted! pregnancies! are! less! likely! to! give! birth! in! the! presence! of! a! skilled! attendant,! and! also!because!they!are!less!likely!to!seek!antenatal!care.!UNICEF!has!estimated!that!the!effective!promotion!of!family! planning! could! reduce! maternal! deaths! by! one! third! in! countries! with! high! birth! rates! and!significantly!reduce!maternity`related!morbidity.288!!While!adolescent`specific!estimates!are!not!available,!comparisons!of!desired!and!actual!lifetime!fertility!suggest!that!a!large!portion!of!the!need!for!family!planning!in!Haiti!remains!unmet.289!Again,!however,!estimates! of! the! extent! of! unmet! need! for! family! planning! vary! by! source.! The! World! Bank! estimated!that! in! 1995,! 44.5%! of! married! women! who! did! not! want! any! more! children! were! not! using!contraception.!In!2000,!this!unmet!demand!had!fallen!to!39.6%,!and!by!2005!had!reached!37.5%.290!In!comparison,! the! UN! Statistics! Division! estimated! that! unmet! need! for! family! planning! was! 47.8%! in!1995,! 39.8%! in! 2000,! and! 37.5%! in! 2006.291,292! A! review! of! data! by! the! Population! Reference! Bureau!found!that!unmet!need!for!family!planning!was!slightly!greater!in!rural!areas!(39%)!than!in!urban!areas!(35%).293!!Demand!for!family!planning!can!be!disaggregated!by!its!purpose,!i.e.,!either!to!limit!fertility!or!to!space!births.!UNICEF!notes!that!spacing!births!by!at!least!two!years!increases!the!chance!of!child!survival.294!According!to!the!UN!Statistics!Division,!17.7%!of!married!women!had!an!unmet!need!for!family!planning!to! space! their! pregnancies! in! 1995.! This! percentage! has! remained! relatively! constant! over! time,!decreasing!to!16%!in!2000,!and!rising!again!to!17%!by!2006.!In!contrast,!unmet!need!for!family!planning!to! limit! total! fertility! has! continued! to! decline! over! the! past! 15! years,! falling! from! 30.1%! in! 1995,! to!23.8%! in! 2000,! to! 20.4%! in! 2006.295! The! literature! does! not! provide! hypotheses! to! explain! the!differential!movement!of!unmet!need!for!limiting!and!spacing!fertility.!!Haiti’s!contraceptive!prevalence!rate!has!increased!from!18%!in!1997!to!32%!in!2009!(Figure!18).296!This!estimate! includes! all! family! planning! methods,! including! “traditional”! methods,! and! coincides! with! a!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!288 !UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!289 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!290 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!291 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!292 !Millennium!Project,!Countdown&to&2015:&2010&Country&profiles:&Haiti!(2010).!Available!at! http://www.countdown2015mnch.org/documents/2010report/Profile`Haiti.pdf!!293 !Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!294 !UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!295 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!296 !UNICEF,!State&of&the&world’s&children&199752009!(Oxford:!Oxford!University!Press,!1997`2009).!Available!at! http://www.unicef.org/sowc/!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 27!
    • !reduction!in!Haiti’s!TFR!over!the!same!period.!The!UN!Statistical!Division!notes!that!among!those!using!any!form!of!contraception,!73.4%!used!a!modern!method!in!2006,!a!minor!increase!from!73.3%!in!1995,!but!a!reduction!from!a!high!of!79.4%!in!2000.297!Only!a!small!percentage!of!those!who!reported!using!contraception! used! condoms.! In! 1995,! condoms! accounted! for! 14.4%! of! all! contraceptives! used,!declining!to!10.3%!in!2000,!before!increasing!to!16.6%!by!2006!(Figure!19).298!!Figure.18:.Contraceptive.prevalence.rate,.1997T2009. !Data!source:!UNICEF,!State&of&the&world’s&children&199752009!(Oxford:!Oxford!University!Press,!1997`2009).! Available!at!http://www.unicef.org/sowc/!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!297 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!298 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!28! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.19:.Contraceptive.prevalence.rate:.Total,.modern.methods,.and.condom,.1995T2006. !Data!source:!DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!!!In! 2006,! use! of! contraception! by! adolescents! was! higher! than! the! national! average.299! However,!contraception! use! varied! by! location! and! marital! status! (Figure! 20).! Those! in! urban! areas! were!approximately! 35%! more! likely! to! use! a! modern! contraceptive! method! than! those! in! rural! areas.!Interestingly,! female! youth! who! were! married! were! 18%! more! likely! to! use! a! modern! contraceptive!method!than!their!never`married!peers.300!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!299 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!300 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 29!
    • !Figure.20:.Percentage.of.females.aged.15T24.who.have.ever/never.used.contraception,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!Similar! to! contraceptive! prevalence! overall,! youth! in! Haiti! reported! higher! use! of! condoms! than! the!national!average!in!2006.301!Overall,!20%!of!female!Haitian!youth!reported!using!a!condom!the!last!time!they!had!sex!(Figure!21).!Condom!use!was!higher!among!those!who!had!never!been!married!than!their!ever`married! peers.! Of! never`married! female! youth,! 36.9%! reported! using! a! condom! at! last! sex,!compared!to!20.3%!of!female!youth!currently!in!union!but!without!a!child,!and!7.2%!in!union!and!with!a!child.!Condom!use!by!female!youth!was!strikingly!higher!in!urban!areas!than!rural!areas,!where!female!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!301! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!30! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&youth!were!less!than!half!as!likely!as!their!urban!peers!to!have!used!a!condom!the!last!time!they!had!sex.!This!was!true!for!all!marital!categories.302!!Figure.21:.Percentage.of.females.aged.15T24.who.used.a.condom.at.last.sex,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!Availability!of!condoms!and!other!contraceptive!methods!in!Haiti!has!failed!to!translate!into!high!usage!rates.!The!EMMUS!IV!survey!found!that!the!vast!majority!of!adolescent!men!and!women!knew!where!to!obtain!condoms!but!that!relatively!few!used!one!at!first!sex!(Figure!22).303!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!302! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!303! Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of&services& survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home! ©!2012!FXB!Center!for!Health!and!Human!Rights! 31!
    • !!Figure.22:.Knowledge.of.source.for.condoms.and.condom.use.at.first.sex,.2006. !Source:!Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of& services&survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!!!D.&Child&marriage&!Child!marriage!carries!significant!risks,!and!is!a!violation!of!the!rights!of!the!child.304!Young!married!girls!are!more!at!risk!of!sexual!and!gender`based!violence!than!their!unmarried!peers.!2006!EMMUS!IV!data!reveal! that! 25.4%! of! married! girls! age! 15`19! had! experienced! spousal! violence! in! the! 12! months!preceding!the!survey,!with!women!who!married!earlier!facing!higher!risk.305!As!mentioned!above,!child!marriage! may! also! lead! to! adolescent! pregnancy,! which! carries! significantly! higher! risks! for! both! the!woman!and!the!child!than!pregnancies!of!women!in!their!20s.306!Girls!who!marry!may!lack!opportunities!for!social!engagement,!and!face!additional!sexual!and!reproductive!health!risks,307!described!further!in!Sections!3C.&Fertility,!3E.&Mortality,!and!7C.&Sexual&and&reproductive&health.!Married!girls!also!typically!have! limited! control! over! resources,! highly! restricted! mobility,! and! little! or! no! power! in! their! new!households.308!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!304 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!305 !P.!S.!Pinheiro,!World!report!on!violence!against!children,!United!Nations!secretary`general’s!study!on!violence! against!children,!UN!Doc.!A/61/299!(2006).!Available!at! http://www.unicef.org/violencestudy/reports/SG_violencestudy_en.pdf!!306! UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!307! UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!308 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!32! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&The!prevalence!of!child!marriage!in!Haiti!has!increased!over!the!past!ten!years.!In!2000,!it!was!estimated!that! 24%! of! young! women! were! married! by! their! 18th! birthday.309! By! 2006,! this! percentage! had!increased! to! 29.9%,! with! rural! areas! reporting! higher! rates! of! married! girls! (32.6%)! than! urban! areas!(27.4%)!(Figure!23).310!Of!greatest!concern!is!the!finding!that!in!2006,!5.6%!of!girls!were!married!before!age!15.!!Figure.23:.Age.at.first.marriage.or.union.for.20T24.year.old.females.(%),.2006.Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!Rates!of!illiteracy!are!also!higher!among!those!girls!married!by!age!15!(31.9%)!than!in!their!unmarried!peers!(14.2%)!(Figure!24).!In!both!urban!and!rural!areas,!women!married!before!age!15!were!more!than!twice! as! likely! to! be! illiterate! (19.7%! and! 42.8%,! respectively)! than! their! unmarried! peers! (8.4%! and!20.3%,!respectively).!A!lower!rate!of!school!enrollment!for!married!women!explains!this!finding.!In!2006,!only! 16.4%! of! married! girls! aged! 15`19! and! with! a! child! were! in! school,! while! 59.4%! of! married! girls!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!309 !UNICEF,!State&of&the&world’s&children&200452009!(Oxford:!Oxford!University!Press,!2004`2009).!Available!at! http://www.unicef.org/sowc/!!310! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 33!
    • !without!a!child!were!in!school,!compared!to!a!rate!of!83.6%!for!those!girls!who!had!never!been!married!and!did!not!have!a!child!(Figure!25).311!In!addition,!age!discrepancies!between!partners,!also!discussed!in!Sections! 3C.& Fertility! and! 3D.& Child& marriage,! play! a! key! role! in! determining! the! educational!opportunities!available!to!married!adolescent!girls.!These!findings!underscore!the!critical!intersection!of!child! marriage,! adolescent! fertility,! education! and! illiteracy,! highlighting! the! necessity! for! holistic! child!protection!responses!aimed!at!reducing!child!marriage.312!!Figure.24:.Percent.of.15T24.year.old.females.who.are.illiterate,.by.marital.status.at.age.15,.2006.Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!311! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!312! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!34! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.25:.Percent.of.15T19.year.old.females.in.school,.by.marital.and.childbearing.status,.2006.Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!E.&Mortality&!Haiti! is! periodically! struck! with! large`scale! natural! disasters,! complicating! efforts! both! to! measure! and!respond! to! factors! impacting! mortality.! In! September! 2004,! Hurricane! Jeanne! caused! the! death! of!approximately! 5,000! people! in! the! north! and! north`east! of! Haiti,! affected! more! than! 300,000! people,!and! caused! property! damage! estimated! at! $250! million.313,314! In! 2008,! a! series! of! four! hurricanes! and!one! tropical! storm! seriously! hit! eight! of! Haiti’s! ten! Departments,! killing! 800! people,! affecting! 800,000!people,!and!destroying!property!and!infrastructure!worth!12%!of!Haiti’s!GDP.315,316!The!12!January!2010!earthquake! had! by! far! the! largest! human! and! infrastructure! impact! of! all! Haiti’s! disasters! in! recent!history:!by!March!2010,!the!Haitian!Government!reported!that!over!220,000!people!had!died!and!over!300,000! were! injured,317! with! an! estimated! 3,000! people! handicapped318! and! 1.5! million! directly!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!313 !Oxfam,!Haitians&talk&about&rebuilding&the&country&after&the&January&12,&2010&earthquake!(March!2010).! Available!at!http://www.reliefweb.int/node/351160!!314 !ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!!315! Oxfam,!Haitians&talk&about&rebuilding&the&country&after&the&January&12,&2010&earthquake!(March!2010).! Available!at!http://www.reliefweb.int/node/351160!!316! ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!317! Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!318! Oxfam,!Haitians&talk&about&rebuilding&the&country&after&the&January&12,&2010&earthquake!(March!2010).! Available!at!http://www.reliefweb.int/node/351160!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 35!
    • !affected.319! Additionally,! critical! health! infrastructure,! programs! and! social! support! networks! were!destroyed! or! interrupted.! The! damage! wrought! by! the! earthquake! therefore! not! only! heightened! the!underlying!mortality!rates!of!the!Haitian!population,!but!also!undermined!the!ability!to!measure!levels,!trends,! and! recovery! efforts.! Relatively! little! disaggregated! mortality! data! has! emerged! since! the!earthquake,!stymieing!timely!efforts!to!assess!Haiti’s!mortality!profile.!Therefore,!the!previous!estimates!cited!below!should!be!used!more!as!a!guide!to!pre`existing!areas!of!need!and!a!baseline!against!which!the! impact! of! the! earthquake! can! be! measured,! rather! than! an! indication! of! the! current! level! of!institutional!and!human!capacity.!!!Life! expectancy! at! birth! in! Haiti! has! significantly! improved! since! 1980,! with! children! born! in! 2009!expected! to! live! roughly! ten! years! longer! than! those! born! in! 1980! (Figure! 26)—although,! again,! these!estimates! do! not! incorporate! the! effects! of! the! 2008! hurricane! season! nor! the! 2010! earthquake. 320!Haitian! life! expectancy! has! continued! to! increase,! on! average,! since! 1960,! when! combined! male! and!female!life!expectancy!at!birth!was!43!years.321!According!to!the!World!Bank,!if!subjected!to!the!current!age`specific! mortality! rates! over! the! course! of! a! lifetime,! a! male! child! born! in! 2009! would! live! for! an!average! of! 60.3! years,! while! a! female! child’s! life! expectancy! would! be! 62.6! years—a! female`to`male!ratio!of!1.04.322!UNICEF!estimates!the!female`to`male!life!expectancy!ratio!to!be!slightly!higher,!at!1.06.!The!ratio!of!female!to!male!life!expectancy!has!changed!relatively!little!since!1995,!though!according!to!UNICEF,!the!period!1998`2001!witnessed!a!wider!differentiation!between!the!genders’!life!expectancies!(Figure! 27).323! This! differentiation! is! not! reflected! in! World! Bank! estimates,! which! predict! that! the!percentage! of! females! expected! to! survive! to! age! 65! increased! from! 46.3%! for! those! born! in! 2000! to!57.5%!for!those!born!in!2008,!while!the!probability!for!males!born!in!those!years!increased!from!34.2%!to! 50.8%.324! However,! the! World! Bank! estimates! that! only! a! weighted! average! of! 90%! of! total! life!expectancy!for!either!of!these!cohorts!would!be!spent!with!the!equivalent!of!full!health. 325!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!319! Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!320! World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!321 !UNICEF,!State&of&the&world’s&children&1997!(Oxford:!Oxford!University!Press,!1997).!Available!at! http://www.unicef.org/sowc/!!322! World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!323 !UNICEF,!State&of&the&world’s&children&199752009!(Oxford:!Oxford!University!Press,!1997`2009).!Available!at! http://www.unicef.org/sowc/!!324 !UNDP,!Human&development&report!(New!York:!Palgrave!Macmillan,!2001`2007/08).!Available!at! http://hdr.undp.org/en/reports/!!325 !UNDP,!Human&development&report&2007/08:&Fighting&climate&change!(New!York:!Palgrave!Macmillan,!2008).! Available!at!http://hdr.undp.org/en/reports/!!36! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.26:.Life.expectancy.at.birth:.Total,.female,.and.male,.1980T2009. !Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!Figure.27:.Female.life.expectancy.as.a.percentage.of.male.life.expectancy,.1995T2009. !Data!source:!UNICEF,!State&of&the&world’s&children&199752011!(Oxford:!Oxford!University!Press,!1997`2011).! Available!at!http://www.unicef.org/sowc/!!!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 37!
    • !The! probability! of! children! dying! between! birth! and! age! 20! declined! significantly! between! 1990! and!2009!(Figure!28).326!Overall,!the!probability!of!a!child!dying!before!their!20th!birthday!fell!in!those!years!by! approximately! 40%,! from! 18.17%! to! 11.04%.! This! reduction! was! 3.11%! greater! for! boys,! whose!probability! of! death! before! age! 20! fell! by! 44.66%,! compared! with! the! reduction! in! girl’s! mortality! of!41.55%.! However,! the! observation! that! the! probability! of! death! for! males! and! females! combined! was!lower!than!sex`specific!probabilities!in!2009!raises!concerns!of!data!reliability.!!Figure.28:.Probability.of.death.ages.0T19,.by.sex,.1990T2009. Probability of Probability of Probability of Ratio of female- death age 0-19, death age 0-19, death age 0-19, to-male total male female reduction 1990 18.17% 18.22% 18.09% 2000 13.17% 13.48% 12.84% 2009 11.04% 10.08% 10.57% % reduction 39.23% 44.66% 41.55% 93.04%Data!source:!WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!!!Haiti’s! neonatal! mortality! rate! (deaths! in! the! first! four! weeks! after! birth! per! 1,000! live! births)! has!significantly! improved! over! the! past! ten! years.! The! State! of! the! World’s! Children! report! states! that!neonatal!mortality!in!Haiti!was!34!deaths!per!1,000!live!births!in!2000,!but!that!this!rate!fell!to!27!deaths!per! 1,000! live! births! by! 2009.327! This! change! represents! a! 20.6%! reduction! between! 2000! and! 2009.!More!recent!estimates!are!not!available.!Analysis!of!mortality!data!from!the!Hôpital!Albert!Schweitzer!(HAS)!in!Artibonite!Department!found!that!35%!of!deaths!in!children!under!five!years!of!age!occurred!during! the! first! month! of! life.! Additionally,! Perry,! Ross,! and! Ferdinand! found! that! among! neonatal!deaths! at! the! HAS,! 27%! occurred! in! the! first! day! after! birth,! and! 80%! in! the! first! ten! days! following!delivery.328!!The!WHO!estimated!that!78%!of!neonatal!deaths!in!Haiti!are!the!result!of!three!causes:!preterm!birth!(29%),!severe!infection!(25%),!and!birth!asphyxia!(24%)!(Figure!29).329!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!326 !WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!327 !UNICEF,!State&of&the&world’s&children&200752011!(Oxford:!Oxford!University!Press,!2007`2011).!Available!at! http://www.unicef.org/sowc/!!328 !H.!Perry,!A.!Ross,!and!F.!Ferdinand,!"Cause!of!under`five!mortality!in!rural!Haiti:!Findings!from!the!Hopital!Albert! Schweitzer!service!area,"!Revista&Panamericana&de&Salud&Pública!18!(2005),!pp.!178`186.!329! WHO,!Mortality&country&fact&sheet&2006:&Haiti!(2007).!38! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.29:.Causes.of.neonatal.deaths,.2000. !Source:!WHO,!Mortality&country&fact&sheet&2006:&Haiti!(2007).!!!Haiti’s!Infant!Mortality!Rate!(IMR)!(deaths!before!the!first!birthday,!per!1,000!live! births)!has!declined!significantly! over! the! past! 20! years,! but! remains! the! highest! in! the! Americas.330! The! World! Bank!attributes! this! high! IMR! to! women’s! low! education! levels,331! while! the! Pan`American! Health!Organization!highlights!the!effects!of!poverty,!deficiencies!in!the!health!care!system,!and!the!impact!of!HIV/AIDS.!UNICEF!estimated!Haiti’s!IMR!to!be!64!per!1,000!live!births!in!2009,!a!reduction!of!9.9%!from!1995! (71! deaths! per! 1,000! live! births),332! 39.0%! from! 1990! (105! deaths! per! 1,000! live! births),333! and!56.8%!from!1970!(148!deaths!per!1,000!live!births)!(Figure!30).334!Haiti’s!IMR!decreased!to!a!low!of!54!deaths! per! 1,000! live! births! in! 2008,! but! increased! in! 2009,! possibly! due! to! the! effects! of! the! 2008!hurricane!season.!Gains!in!IMR!prior!to!2009!were!not!uniform!across!location!or!socio`economic!group:!infant! mortality! was! 73.3%! higher! among! the! poorest! quintile! of! the! population! (78! deaths! per! 1,000!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!330! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!331! World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!332! UNICEF,!State&of&the&world’s&children&2011!(Oxford:!Oxford!University!Press,!2011).!Available!at! http://www.unicef.org/sowc/!!333! DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!334 !UNDP,!Human&development&report&2000:&Human&rights&and&human&development!(New!York:!Palgrave! Macmillan,!2000).!Available!at!http://hdr.undp.org/en/reports/!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 39!
    • !live!births)!than!among!the!richest!(45!deaths!per!1,000!live!births),335!and!the!IMR!in!Haiti’s!rural!areas!was! 1.4! times! that! in! urban! areas! in! 2007.336! Overall,! Haiti’s! progress! in! reducing! infant! mortality! by!2005!meant!that!it!was!on!track!to!meet!Millennium!Development!Goal!indicator!4.2:!reducing!the!IMR!by!two!thirds!of!the!1990!level!by!2015!(Figure!31).337!However,!the!effects!of!the!2008!hurricane!season!and!the!2010!earthquake!may!have!hindered!Haiti’s!ability!to!meet!this!indicator.338!!Figure.30:.Infant.Mortality.Rate.(IMR),.1995T2009. !Data!source:!UNICEF,!State&of&the&world’s&children&199752011!(Oxford:!Oxford!University!Press,!1997`2011).! Available!at!http://www.unicef.org/sowc/!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!335 !UNDP,!Human&development&report&2007/08:&Fighting&climate&change!(New!York:!Palgrave!Macmillan,!2008).! Available!at!http://hdr.undp.org/en/reports/!!336! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!337! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!338! U.S.!Census!Bureau,!International&data&base:&Haiti&demographic&indicators.!Available!at! http://www.census.gov/population/international/data/idb/informationGateway.php!40! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.31:.Progress.towards.MDG.indicator.4.2.(IMR),.1990T2005. !Source:!IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!!The!under`five!mortality!rate!(U5MR)!fell!significantly!prior!to!the!2010!earthquake.!Partly!as!a!result!of!the!falling!infant!mortality!rate,!Haiti’s!U5MR!more!than!halved!between!1990!and!2009,!from!a!rate!of!151.2!deaths!per!1,000!live!births!in!1990339,340!to!72!deaths!per!live!births!in!2009341,342—a!reduction!of!52.4%!over!19!years,!and!a!reduction!of!64%!since!1980!(Figure!32).343!While!the!UN!Committee!on!the!Rights!of!the!Child!noted!Haiti’s!performance!in!reducing!its!U5MR,!the!Committee!also!noted!that!60%!of!children!who!survive!until!their!fifth!birthday!do!not!grow!or!develop!normally!after!that!point.344!!Though!Haiti’s!U5MR!reduction!is!impressive,!the!Pan`American!Health!Organization!(PAHO)!observed!in!2007!that!the!achieved!mortality!rate!still!meant!that!one!in!every!12!children!would!die!before!reaching!age!five.345!As!such,!Haiti!still!recorded!the!highest!U5MR!in!the!Latin!America!and!Caribbean!region!in!2006,! leading! Guyana! and! Bolivia! which! had! rates! of! 62! and! 61! deaths! per! 1,000! live! births,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!339 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!340! World!Bank,!World&databank&education&statistics&(EdStats).!Available!at!http://data.worldbank.org/data` catalog/ed`stats!341 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!342 !UNESCO,!Data&center:&Custom&tables:&Haiti.!Available!at! http://stats.uis.unesco.org/unesco/TableViewer/document.aspx?ReportId=136&IF_Language=eng&BR_Topic=0!343! UNICEF,!State&of&the&world’s&children&1998!(Oxford:!Oxford!University!Press,!1998).!Available!at! http://www.unicef.org/sowc/!!344! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!345! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 41!
    • !respectively.346!Despite!its!progress,!Haiti!was!not!on!track!to!meet!MDG!4:!reducing!the!U5MR!by!two`thirds!by!2015!(Figure!33).347!Additionally,!the!U.S.!Census!Bureau!estimates!that!the!2010!earthquake!increased!the!incidence!of!under`five!mortality,!raising!its!estimate!to!181!deaths!per!1,000!live!births.348!In!the!wake!of!the!earthquake,!the!WHO!reported!that!!! (N)one!of!the!mortality!indicators!found!in!CE`DAT!exceed!the!WHO!emergency!threshold!levels! of!1!death!per!10,000!persons!per!day!(CMR)!and!2!deaths!per!10,000!persons!per!day!(U5MR).! However,! the! Sphere! guidelines! place! regional! emergency! thresholds! at! 0.3! (CMR)! and! 0.4! (U5MR)! deaths! per! 10,000! persons! per! day,! which! are! approximately! double! the! regional! baselines!for!CMR!and!U5MR!in!Latin!America!and!the!Caribbean.!!Under`five!mortality!differentially!affects!sub`populations,!especially!those!of!different!socio`economic!groups,!urban/rural!location,!and!mother’s!education!quintile!(Figure!34).!Children!in!the!lowest!income!quintile! were! 50.5%! more! likely! to! die! before! age! five! than! those! in! the! top! income! quintile! in! 2000.!Children!under!five!in!rural!areas!were!33.0%!more!likely!to!die!than!their!urban!peers.!Underscoring!the!impact! of! women’s! education! on! reducing! under`five! mortality,! children! whose! mothers! were! in! the!lowest!education!quintile!were!twice!as!likely!to!die!before!their!fifth!birthday!as!those!whose!mothers!were!in!the!highest!education!quintile.349!!According!to!PAHO,!tuberculosis,!diarrheal!diseases,!malnutrition,!HIV/AIDS,!and!malaria!were!the!five!leading!causes!of!death!in!2007.350!In!contrast,!the!WHO!Global!Health!Observatory!database!states!that!the!five!leading!causes!of!under`five!death!in!2008!were!pneumonia!(22%),!diarrhea!(22%),!prematurity!(10%),!birth!asphyxia!(9%),!and!neonatal!sepsis!(5%),!with!“other!causes”!accounting!for!24%!of!deaths!in! this! age! group.351! Discrepancies! between! these! estimates! may! be! explained! by! the! exclusion! of!neonatal!and!infant!causes!of!death!by!PAHO.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!346! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!347! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!348! U.S.!Census!Bureau,!International&data&base:&Haiti&demographic&indicators.!Available!at! http://www.census.gov/population/international/data/idb/informationGateway.php!349! WHO,!Mortality&country&fact&sheet&2006:&Haiti!(2007).!350! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!351 !WHO,!Global&health&observatory&database:&Haiti.!Available!at!http://www.who.int/gho/en/!42! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.32:.UnderT5.Mortality.Rate.(U5MR),.1980T2009. !Data!sources:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!and!WHO,!Global&health&observatory& database:&Haiti.!Available!at!http://www.who.int/gho/en/!!!Figure.33:.Progress.towards.MDG.4.(U5MR),.1990T2005. !Source:!IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 43!
    • !Figure.34:.Disaggregation.of.U5MR.by.socioTeconomic.group,.sex,.urban/rural.status,.and.mothers.education,.2000. !Source:!WHO,!Mortality&country&fact&sheet&2006:&Haiti!(2007).!!!!According!to!the!WHO,!mortality!among!children!age!5`9!has!almost!halved!during!the!past!20!years.!In!1990,! children! surviving! to! their! fifth! birthday! experienced! a! 1.56%! likelihood! of! mortality! before!reaching! age! ten! (Figure! 35).! The! probability! of! mortality! in! these! ages! was! greater! for! young! girls!(1.64%)!than!young!boys!(1.49%).!By!2009,!the!probability!of!death!in!the!5`9!age!group!had!fallen!by!44.86%!to!0.86%!overall.!Young!girls!continued!to!face!a!greater!risk!of!death!during!these!years!(0.81%)!than! young! boys! (0.76%).! However,! young! girls’! probability! of! mortality! in! this! age! group! fell!proportionally!more!(50.31%)!than!that!for!young!boys!(48.66%)!over!the!period!1990`2009.352!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!352! WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!44! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.35:.Probability.of.death.age.5T9,.by.sex,.1990T2009. Probability of Probability of Probability of Ratio of female- death age 5-9, death age 5-9, death age 5-9, to-male total male female reduction 1990 1.56% 1.49% 1.64% 2000 1.04% 1.04% 1.04% 2009 0.86% 0.76% 0.81%% reduction 44.86% 48.66% 50.31% 103.39%Data!source:!WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!!!In! 2007,! the! WHO! reported! that! 27%! of! recorded! deaths! in! the! 5`9! age! group! were! attributable! to!infectious! and! parasitic! diseases.! Tuberculosis,! diarrheal! disease,! malnutrition,! HIV/AIDS,! and! malaria!were! the! leading! causes! of! death,! similar! to! the! 0`4! age! group.! Significantly,! 8%! of! deaths! among! 5`9!year`olds!were!from!external!causes:!data!from!2000!revealed!that!boys!were!more!likely!to!be!victims!of!traffic!accidents!and!girls!more!often!victims!of!accidents!in!the!home.!!In! 2009,! Haitian! adolescents! (age! 10`19)! had! a! 1.41%! chance! of! dying! between! their! 10th! and! 20th!birthdays! (Figure! 36).! The! probability! was! higher! for! adolescent! girls! (1.28%)! than! adolescent! boys!(1.15%).!These!statistics!are!consistent!with!the!situation!in!1990,!when!adolescent!girls!were!found!to!have!a!higher!(2.56%)!chance!of!dying!than!adolescent!boys!(1.56%).!While!adolescent!boys’!probability!of! death! moderately! declined! between! 1990! and! 2009! (26.06%! reduction),! the! risk! of! death! for!adolescent!girls!fell!by!almost!half!(49.89%).353!!Figure.36:.Probability.of.death.age.10T19,.by.sex,.1990T2009. Probability of Probability of Probability of Ratio of female- death age 10-19, death age 10-19, death age 10-19, to-male total male female reduction 1990 2.06% 1.56% 2.56% 2000 1.52% 1.43% 1.61% 2009 1.41% 1.15% 1.28%% reduction 31.60% 26.06% 49.89% 191.42%Data!source:!WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!!!The! reduction! in! the! probability! of! death! for! adolescent! girls! was! greater! in! the! 15`19! age! group!(55.33%)! than! the! 10`14! age! group! (41.91%)! over! the! period! 1990`2009! (Figure! 37! and! Figure! 38).! In!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!353! WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/! ©!2012!FXB!Center!for!Health!and!Human!Rights! 45!
    • !contrast,! adolescent! boys’! probability! of! death! experienced! a! greater! decline! in! the! 10`14! age! group!(30.38%)!than!the!15`19!age!group!(21.91%).354!!Figure.37:.Probability.of.death.age.10T14,.by.sex,.1990T2009. Probability of Probability of Probability of Ratio of female- death age 10-14, death age 10-14, death age 10-14, to-male total male female reduction 1990 0.90% 0.78% 1.01% 2000 0.63% 0.62% 0.65% 2009 0.63% 0.54% 0.59% % reduction 29.50% 30.38% 41.91% 137.95%Data!source:!WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!!!Figure.38:.Probability.of.death.age.15T19,.by.sex,.1990T2009. Probability of Probability of Probability of Ratio of female- death age 15- death age 15-19, death age 15-19, to-male 19, total male female reduction 1990 1.17% 0.78% 1.56% 2000 0.89% 0.82% 0.97% 2009 0.78% 0.61% 0.70% % reduction 33.40% 21.91% 55.33% 252.56%Data!source:!WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!!!The! mortality! profile! of! adolescent! Haitians! differs! significantly! from! their! younger! peers,! as! non`communicable!factors!play!an!increasingly!important!role!in!the!older!group.!In!2007!PAHO!stated!that!the! six! leading! causes! of! death! among! this! age! group! were! HIV/AIDS,! physical! assault,! accidents,!tuberculosis,!typhoid,!and!pregnancy`related!factors!(maternal!mortality).355!In!2003,!6%!of!all!deaths!in!the!15`19!age!group!were!connected!with!assaults,356!while!5.8%!were!attributed!to!HIV/AIDS.357!!!Maternal!mortality!remains!a!major!concern!in!Haiti,!both!because!adolescent!fertility!carries!a!greater!risk! of! death,! and! because! maternal! death! has! a! negative! impact! on! child! survival! and! development.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!354! WHO,!Life&tables&for&WHO&member&states:&Haiti.!Available!at! http://www.who.int/healthinfo/statistics/mortality_life_tables/en/!355 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!356! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!357! UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!46! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Women! in! Haiti! have! a! 1! in! 44! (2.3%)! probability! of! dying! from! maternity`related! causes! over! their!lifetime.358! Haiti’s! reported! Maternal! Mortality! Ratio! (number! of! maternal! deaths! per! 100,000! live!births)! is! consistently! below! estimates! by! non`governmental! and! inter`governmental! organizations,!although!these!estimates!recently!converged!following!the!2005`2006!EMMUS!IV!survey!(Figure!39).!In!2007,! UNICEF! estimated! that! Haiti’s! MMR! was! 670! maternal! deaths! per! 100,000! live! births,! while! the!Haitian!Government!reports!a!MMR!of!630.359!These!estimates!are!considerably!higher!that!the!results!of! EMMUS! surveys! II! and! III,! which! reported! MMRs! of! 523! and! 457! maternal! deaths! per! 100,000! live!births,! respectively.360! By! International! Monetary! Fund! (IMF)! estimates,! Haiti! will! fall! far! short! of!meeting!its!MDG!target!of!114!maternal!deaths!per!100,000!live!births!by!2015!(Figure!40).!!Figure.39:.Maternal.Mortality.Ratio.(MMR):.Reported.and.adjusted,.1995T2007. !Data!source:!UNICEF,!State&of&the&world’s&children&200352008!(Oxford:!Oxford!University!Press,!2003`2008).! Available!at!http://www.unicef.org/sowc/!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!358! Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!359 !UNICEF,!State&of&the&world’s&children&2007!(Oxford:!Oxford!University!Press,!2007).!Available!at! http://www.unicef.org/sowc/!!360! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 47!
    • !Figure.40:.Progress.towards.MDG.5.A.(MMR),.1990T2005. !Source:!IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!!Analysis! of! maternal! mortality! causes! by! PAHO! in! 2003! indicate! that! childbirth! complications,! such! as!hemorrhage,! are! the! leading! causes! of! maternal! death! (29%),! with! hypertension! and! eclampsia!accounting!for!26%!of!these!deaths.!PAHO!notes!with!concern!that!abortion!was!implicated!in!13%!of!maternal!deaths.361!!High!adolescent!birth!rates!are!also!a!cause!for!concern!among!Haitian!adolescent!girls,!and!contribute!significantly!to!the!Maternal!Mortality!Ratio.!Adolescent!childbirth!carries!additional!risks,!as!these!girls!may!be!less!likely!to!give!birth!in!the!presence!of!a!skilled!attendant,!lack!necessary!reproductive!health!information,!and!may!not!be!physiologically!mature.!Adolescent!mothers!younger!than!15!are!five!times!more!likely!to!die!during!childbirth!than!women!in!their!twenties.362!!Access! to! modern! contraceptive! methods,! health! services,! and! women’s! education! are! key! protective!factors! against! maternal! mortality.! Prevalence! of! medically! assisted! childbirth! has! remained! steady! at!24%! over! the! past! decade.363! Increasing! coverage! should! reduce! the! Maternal! Mortality! Ratio.!Additionally,! increasing! contraceptive! prevalence! (discussed! in! Section! 3C.& Fertility,! above)! should!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!361! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!362! UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!363! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!48! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&contribute! to! a! decline! in! maternal! mortality,! especially! those! occurring! as! a! result! of! unsafe!abortions.364!Women’s!education!is!also!a!key!factor!in!reducing!maternal!mortality.!UNICEF!states!that!“for! each! additional! year! of! education! achieved! by! 1,000! women,! two! maternal! deaths! will! be!prevented.”365!Women’s!education!also!increases!negotiating!power!with!partners,!including!the!ability!to!make!decisions!affecting!their!health.366!!In!addition,!maternal!mortality!is!negatively!associated!with!ensuring!the!protection!and!development!of!the!child.!Anderson!et&al.!found!that!families!experiencing!a!maternal!death!have!55.0%!greater!odds!of!losing!a!child!under!12,!whereas!the!death!of!other!family!members!does!not!increase!these!odds.367!Children!without!parental!care!also!face!increased!risk!of!other!negative!protection!outcomes,!discussed!in! Section! 5D.& Children& without& parental& care,! highlighting! the! primacy! of! reducing! maternal! mortality!for!the!protection!of!Haiti’s!children.!!!F.&Family&structure&!This!section!will!discuss!household!size!and!composition!in!Haiti!before!and!after!the!January!12,!2010!earthquake,! the! broad! range! of! unions! (marriage! and! informal)! among! the! Haitian! population,! and!gender!and!age!roles!within!households.!An!examination!of!orphans,!foster!children,!and!the!effects!of!a!lack!of!parental!care!in!Haiti!is!presented!in!Section!5D.&Children&without&parental&care.!!In! 2001,! Haiti! had! an! average! household! size! of! approximately! 4.6! people,! with! significant! differences!among! Departments! and! socio`economic! groups! (Figure! 41).! Those! in! the! non`poor! socio`economic!category!exhibited!significantly!fewer!household!members368!(3.6!per!household)!than!in!poor!(4.9!per!household)!and!indigent!(5.1!per!household)!households.!The!EMMUS!IV!(2005`2006)!survey!indicated!an! increase! in! average! household! size,! to! 4.9! members,! with! persistent! differences! among! different!Departments!and!socio`economic!groups.369!However,!this!density!is!similar!to!the!EMMUS!II!estimate!from! 1994`1995! of! five! members! per! household,! indicating! that! the! decrease! in! household! size!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!364! UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!365! UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!366! UNICEF,!Progress&for&children&number&7:&A&report&card&on&maternal&mortality!(September!2008).!Available!at! http://www.unicef.org/progressforchildren/files/Progress_for_Children`No._7_Lo`Res_082008.pdf!!367! F.!W.!Anderson,!S.!U.!Morton,!S.!Naik,!and!B.!Gebrian,!“Maternal!mortality!and!consequences!on!infant!and! child!survival!in!rural!Haiti,”!Journal&of&Maternal&and&Child&Health!11/4!(2007),!pp.!395`401.!368! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!369! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 49!
    • !exhibited!in!2001!may!be!the!result!of!sample!error!rather!than!a!true!reduction!(standard!deviations!reported!in!parentheses!for!estimates!in!Figure!41).370!!Figure.41:.Average.household.size,.by.income.group.and.Department,.2001. !Source:!D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey& for&Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!!A!2009!assessment!by!the!Pan`American!Development!Foundation!(PADF)!found!a!significant!difference!between! the! national! average! household! size! and! those! in! troubled! urban! neighborhoods! in! Port`au`Prince,!Cap`Haïtien,!Gonaïves,!Saint`Marc,!and!Petit`Gôave.!In!these!areas,!average!household!size!was!6.3! members,! compared! to! the! 2005`2006! EMMUS! IV! national! estimate! of! 4.9! (Figure! 42).371! This!difference!is!consistent!with!the!assertion!that!household!size!is!associated!with!socio`economic!status,!as! the! surveyed! troubled! neighborhoods! are! generally! of! lower! socio`economic! status! (although! the!PADF!estimates!remain!higher!than!any!point!estimates!from!2001).!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!370! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!371! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!50! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&Figure.42:.Household.size.in.troubled.neighborhoods.in.PortTauTPrince,.CapTHaïtien,.Gonaïves,.SaintTMarc.and.PetitTGôave,.2009. CITY. Average. N. PortTauTPrince. 6.2! 777! CapTHaitian. 6.2! 267! Gonaïves. 6.9! 166! SaintTMarc. 6.5! 123! PetitTGoâve. 5.9! 120! Total. 6.3! 1453!Source:!G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,& restavèks,&&&victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project! (November!2009).!Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!!The! destruction! caused! by! the! January! 2010! earthquake! forced! many! individuals! and! families! to!relocate.!This!was!due!both!to!the!damage!caused!by!the!earthquake!to!previous!living!quarters,!and!to!fear! of! living! in! permanent! structures! given! the! possibility! of! aftershocks.! As! many! households!effectively!doubled!in!size,!their!short`,!medium`!and!long`term!needs!remain!a!cause!for!concern,!even!as!those!displaced!return!to!their!pre`earthquake!residences.372!!A! rapid! assessment! of! programming! areas! in! La! Gonâve,! Plateau! Central,! and! Nord! and! Sud!Departments!by!World!Vision!showed!significant!growth!in!household!size!as!a!result!of!IDP!movement!(Figure! 43).! In! Sud! Department,! household! size! more! than! doubled! 2001! estimates,! from! 4.7! per!household!to!9.8!per!household,!placing!a!significant!strain!on!households.!Increased!size!was!reported!by! 48%! of! households! in! La! Gonâve! and! 36%! of! households! in! Plateau! Central.! Nord! Department!exhibited! the! smallest! percentage! (27%)! of! households! reporting! an! increase! in! size! following! the!earthquake.! According! to! World! Vision,! almost! 100%! of! household! growth! in! rural! areas! was!attributable! to! IDPs! from! the! Port`au`Prince! metropolitan! area,! motivated! by! either! the! collapse! of!houses! or! the! lack! of! available! employment! opportunities! in! former! areas! of! residence.373! In! contrast,!Catholic!Relief!Services!states!that!78%!of!respondents!in!Sud!Department!reported!hosting!an!average!of! 5.6! IDPs! in! their! household! –! a! figure! far! greater! than! estimates! compiled! by! World! Vision.374! This!discrepancy! may! be! explained! by! the! different! survey! periods,! as! World! Vision! conducted! their!assessment!from!3`6!February,!whereas!Catholic!Relief!Services!assessed!the!time!period!12!February`1!March,! when! more! people! may! have! had! the! opportunity! to! reestablish! connections! with! extended!family!and!migrate!to!other!Departments.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!372 !IFRC,!Haiti&recovery&assessment:&Volume&1&–&Synthesis&report!(March!2010).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=jNS41RGePVg%3d&tabid=149&mid=1043!!373! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!374! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&2,!29!March!2010!(March!2010).!Available!at! http://groups.google.com/group/assessmentshaiti/browse_thread/thread/71f3f127213f7a06!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 51!
    • !Figure.43:.Average.household.size.in.World.Vision.operational.areas.in.La.Gonâve,.Plateau.Central,.and.Nord.and.Sud.Departments.following.the.January.2010.earthquake,.March.2010. !Source:!World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!!Studies! indicate! that! children! under! age! 15! accounted! for! a! greater! share! of! household! population! in!rural! than! in! urban! areas! and! in! poor! versus! non`poor! households! before! the! 2010! earthquake.375!Accordingly,! households! in! rural! areas! and! in! low! socio`economic! groups! demonstrate! a! larger!dependency!ratio,!reducing!their!potential!ability!to!provide!for!their!children’s!needs!and!complicating!poverty! reduction! strategies.! Schwartz! believes! that! children’s! labor! utility! explains! why! fertility! rates!have!not!declined!as!significantly!in!rural!areas!as!they!have!in!urban!areas.!In!addition!to!their!utility!in!agricultural! work,! children! often! conduct! small,! time`consuming! tasks! that! free! adults! to! engage! in!gardening!and!commerce.!As!such,!households!in!rural!areas!may!desire,!or,!at!least,!can!justify,!a!larger!percentage!of!children!per!household.376!!The!World!Bank!estimates!that!urban!and!rural!extremely!poor!households!have!more!family!members!under!age!15!than!do!non`poor!households.!In!2007,!rural,!“extremely!poor”!households!had!an!average!of! 2.2! children! under! age! 15,! while! urban! extremely! poor! households! had! an! average! of! 1.7.! In!comparison,!during!approximately!the!same!time!period,!rural!and!urban!non`poor!households!had!an!average!of!0.9!and!1.2!children!under!age!15,!indicating!a!strong!association!between!poverty!and!the!child!share!of!households.377,378!It!is!unclear!whether!this!association!is!directly!causative!or!not—poor!households! may! have! more! children! due! to! attitudes! or! conditions! that! happen! to! be! more! common!among!less!affluent!populations!such!as!a!lack!of!access!to!contraception!or!poor!female!empowerment,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!375! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!376! T.!T.!Schwartz,!Fewer&men,&more&babies:&Sex,&family&and&fertility&in&Haiti!(Lanham:!Lexington!Books,!2009).!377! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!378! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!52! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&or!they!may!desire!more!children!due!to!perceptions!that!children’s!labor!has!utility!and!that!children!represent!an!investment!in!parents’!retirement.!It!is!also!unclear!what!effect!the!earthquake!has!had!on!household! composition,! especially! given! widespread! internal! migration! and! recourse! to! fosterage! and!the!“restavek”!phenomenon!(see!Section!9A.&Children&in&domestic&service&and&servitude).!!Destruction! of! residential! facilities! during! the! January! 2010! earthquake! has! led! to! an! unsustainable!situation! of! multiple! families! residing! in! the! same! shelter.! Very! little! data! exist! on! the! prevalence! of!multiple`family! households! prior! to! the! earthquake,! although! some! observers! have! noted! that! this!phenomenon!is!more!prevalent!in!major!cities.379!The!most!common!reasons!given!for!multiple`family!households!before!the!earthquake!were!economic!concerns,!which!led!to!the!migration!of!one!or!more!family! members,! or! the! death! of! a! child’s! parents! leading! to! their! placement! in! another! household.380!Post`earthquake,!the!most!common!explanation!has!been!the!destruction!of!previous!residences,!which!led! to! a! significant! prevalence! of! multiple`family! households,! either! within! or! outside! IDP! camps.! An!assessment!by!the!Massachusetts!Institute!of!Technology!Lincoln!Laboratory!and!Partners!in!Health!in!April! 2010! found! that! almost! 75%! of! shelters! in! Gonaïves,! 50%! of! shelters! in! Jeremie,! and! 70%! of!shelters!in!Port`au`Prince!contained!six!or!more!families.!The!vast!majority!of!shelters!in!surveyed!areas!housed!three!or!more!families,!while!a!very!small!percentage!contained!only!one!or!two.381!As!IDPs!have!relocated! to! temporary! and! permanent! shelters! constructed! during! the! earthquake! response,! and!others!have!found!alternative!housing,!it!is!likely!that!the!proportion!of!households!containing!multiple!families!has!decreased.!However,!no!national!study!has!been!undertaken!to!test!this!hypothesis.!!Two! additional! features! of! Haitian! households! merit! mention:! the! importance! of! both! the! extended!family!and!the!lakou!system,!especially!in!rural!Haiti.!Extended!family!networks!are!extremely!important!in! Haiti,! whether! to! access! a! job,! share! household! risk,! or! respond! in! times! of! crisis.! When! parents!migrate,! they! often! entrust! their! children! to! extended! family! before! those! outside! the! family.382! As!Justensen!and!Verner!note,!the!nuclear!family!is!not!a!common!phenomenon!in!Haiti,!where!households!will! typically! be! comprised! of! three! or! more! generations.383,384! Moreover,! in! rural! Haiti! especially,! the!role! of! the! lakou! system! has! significant! importance! to! child! protection! and! development.! A! lakou! is!typically! a! small! peasant! village! of! 4! to! 100! households! constituted! by! a! large! extended! family! that! is!generally! conjugally! or! ancestrally! related! to! the! descendants! of! the! first! owner! of! farmland.385,386! The!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!379! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!380! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!381! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&4&(April!2010).!382! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!383! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!384! S.!C.!Wortham,!“The!young!child!and!social!relationships!in!developing!countries,”!in!M.!R.!Jalongo!(ed),! Enduring&bonds:&the&significance&of&interpersonal&relationships&in&young&children’s&lives!(Indiana:!Springer,!2007).!385! J.!M.!Dash,!Culture&and&customs&of&Haiti!(Westport,!CT:!Greenwood!Press,!2001).!386 !S.!Larose,!“The!Haitian!lakou:!Land,!family!and!ritual,”!in!A.!F.!Marks!and!R.!A.!Romer!(eds),!Family&and&kinship&in& middle&America&and&the&Caribbean!(Leiden:!University!of!the!Netherlands!Antilles,!1976).! ©!2012!FXB!Center!for!Health!and!Human!Rights! 53!
    • !lakou!system!is!central!to!the!organization!of!collective!labor!(the!coumbite)!at!harvest!time387!and!has!evolved!in!response!to!traditional!inheritance!practices!whereby!descendants!each!receive!a!portion!of!the!land!owned!by!their!parents!upon!their!parents’!death388—resulting!in!decreased!per!capita!holdings!with!each!successive!generation.389!Edmond,!Randolph!and!Richard!state!that!the!lakou!system!provides!“financial!and!emotional!support!that!sometimes!reduces!family!hardship!and!provides!a!buffer!for!daily!stressors—but!the!ability!to!provide!support!is!compromised!by!poverty.”390!In!the!lakou!system,!several!women! cooperatively! care! for! and! supervise! children,! in! contrast! to! the! nuclear! model! common! in!Western!countries.!A!2007!survey!of!a!small!rural!community!in!Leogane!found!that!most!mothers!(81%)!had!resided!for!more!than!ten!years!in!their!lakou,!and!nearly!two`thirds!(65%)!had!both!kin!and!blood!relatives! who! resided! in! the! same! lakou.! While! the! lakou! system! has! been! progressively! replaced! by!household`centric! child`rearing! strategies! in! recent! years,! it! remains! an! important! consideration! in!Haiti’s!rural!child!protection!and!development!strategies.391!!Partnership! unions! in! Haiti! vary! considerably! in! terms! of! legal! status! and! stability,! with! significant!impacts! on! the! children! of! such! unions.392! There! are! five! general! levels! of! unions,! though! some! may!overlap.! In! decreasing! level! of! stability,! these! are:! 1)! Marye! (legal! marriage),! 2)! plase! (“setting! up! a!household”),!3)!vivavek!and!menaj!(“living!with!someone”!and!“living!as!a!pair,”!respectively),!4)!reman!and! fyanse! (“lover”! and! “engaged,”! respectively),! and! 5)! antente,! flirte! and! wik’en! (“getting! along,”!“flirt,”!and!“weekend,”!respectively).393!!Marye!and!plase!are!the!most!popular!unions!in!Haiti.!Legal!marriage!(marye)&is!the!most!coveted!type!of! union! but! the! second`most! common! due! to! the! cost! of! festivities.394,395! Plase! is! the! second! most!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!387! J.!M.!Dash,!Culture&and&customs&of&Haiti!(Westport,!CT:!Greenwood!Press,!2001).!388 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!389! S.!Larose,!“The!Haitian!lakou:!Land,!family!and!ritual,”!in!A.!F.!Marks!and!R.!A.!Romer!(eds),!Family&and&kinship&in& middle&America&and&the&Caribbean!(Leiden:!University!of!the!Netherlands!Antilles,!1976).!390! Y.!M.!Edmond,!S.!M.!Randolph,!and!G.!L.!Richard,!“The!lakou!system:!A!cultural,!ecological!analysis!of!mothering! in!rural!Haiti,”!Journal&of&Pan&African&Studies!2/1!(2007),!pp.!19`32.!391! Y.!M.!Edmond,!S.!M.!Randolph,!and!G.!L.!Richard,!“The!lakou!system:!A!cultural,!ecological!analysis!of!mothering! in!rural!Haiti,”!Journal&of&Pan&African&Studies!2/1!(2007),!pp.!19`32.!392 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!393 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!394 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!395! M.!J.!N’Zengou`Tayo,!“Fanm!se!potomitan:!Haitian!woman!is!the!pillar!of!society,”!Feminist&Review!59!(1998),! pp.!118`142.!!54! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&preferred!type!of!union!and!the!most!commonly!practiced,!especially!in!the!countryside396,397!(estimated!at! 51.3%! of! women! attending! antenatal! services! at! Hospital! Albert! Schweitzer,! Artibonite! in! 2000).398!Plasage& generally! involves! cohabitation,! and! may! be! as! stable! as! legal! marriage,! although! it! does! not!carry!the!same!legal!weight!as!marriage.399!Under!a!plase!relationship,!a!man!may!have!more!than!one!common`law!wife!but!is!expected!to!financially!provide!for!each!wife!and!any!children!borne!of!those!unions.400! In! 2007,! Justensen! and! Verner! stated! that! approximately! 8%! of! “married”! men! have! more!than! one! wife.401! Marye& and! plase! unions! are! generally! characterized! by! a! more! steady! income! than!other! types! of! unions.402! The! World! Bank! also! hypothesizes! that! another! reason! for! the! popularity! of!plase!unions!may!be!men’s!reluctance!to!disinherit!prospective!children!born!with!other!women!outside!of!a!legal!marriage!(marye).403!Attributing!paternity!is!a!critical!social!and!filial!factor!in!Haitian!society,!and!by!law!and!custom,!a!married!(marye)!man’s!children!with!other!women!may!not!be!his!heirs.!As!such,!children!born!of!unions!other!than!legal!marriage!may!not!have!many!of!the!same!rights!as!those!born! from! marye! unions,! including! the! right! to! inheritance! and,! in! some! cases,! the! right! to! know! the!identity!of!their!father.404!!Vivavek! and! menaj! unions! are! less! stable! than! marye! and! plase! and! may! or! may! not! involve!cohabitation;! however,! they! are! more! stable! than! visiting! sexual! relationships.405! Vivavek! and! menaj!unions!are!two!of!the!three!most!widespread!unions!in!rural!areas,!with!remen!unions!also!prevalent,406!while!vivavek!unions!are!the!third!most!common!form!of!union!nationally.407!As!they!are!less!stable!than!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!396 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!397! J.!M.!Dash,!Culture&and&customs&of&Haiti!(Westport,!CT:!Greenwood!Press,!2001).!398! D.!W.!Fitzgerald,!F.!Behets,!A.!Caliendo!A,!et!al.,!“Economic!hardship!and!sexually!transmitted!diseases!in!Haiti’s! rural!Artibonite!Valley,”!American&Journal&of&Tropical&Medicine&and&Hygiene!62/4!(2000),!pp.!496`501.!399 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!400! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!401! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!402 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!403! World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!404! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!405! G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!406! G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!407! World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` ©!2012!FXB!Center!for!Health!and!Human!Rights! 55!
    • !marye!and!plase!unions,!issues!arise!when!a!father!refuses!to!provide!financially!for!the!children!borne!of!the!union.408!!Remen! and! fyanse! relationships! are! sexual! relationships! that! are! most! prevalent! among! young! people!and! generally! do! not! involve! cohabitation.! Fyanse! relationships! are! more! common! in! urban! areas! and!are!generally!practiced!by!wealthier!individuals.!They!may!or!may!not!lead!to!plase!unions.409!!!Antente,!flirte,!and!wik’en!are!the!most!casual!sexual!relationships!and!are!generally!unstable.410!!The!1994`1995!EMMUS!II!survey!indicated!that!32%!of!women!and!43%!of!men!aged!15`49!were!single.!In! this! age! group! 46%! of! women! and! 44%! of! men! reported! being! in! a! relationship! with! cohabitation,!while!12%!and!7%!of!women!and!men,!respectively,!reported!being!in!unions!without!cohabitation.411!!Gender!roles!play!an!important!part!in!social!and!familial!organization!in!Haiti.!The!Cultural!consultation!service!recently!noted!that!“women!are!responsible!for!market!transactions,!management!of!the!family!budget,! food! preparation,! and! care! of! the! children.”412,413! In! addition,! rural! women! fetch! water! and!assist! in! agricultural! activities! at! harvest! time.414! In! contrast,! men! are! generally! responsible! for!agriculture,!repair!and!maintenance!of!the!home,!and!providing!for!the!family.415!These!responsibilities!have!shifted!in!the!course!of!the!past!century,!however.!In!1938,!60%!of!women!reported!agriculture!as!their! primary! activity.! By! 1980,! the! majority! of! women! identified! marketing! as! their! primary!occupation.416!However,!care!should!be!taken!interpreting!this!statement!as!respondents!may!not!have!perceived!household`related!tasks!as!a!“primary!activity”!category.!Devin!and!Erickson!have!noted!that!most! women! in! their! survey! were! away! from! the! house! for! an! average! of! 4.6! days! per! week,! which!meant! that! substitute! child! caregivers! were! required! during! these! periods.! The! survey! reported! that!men!were!perceived!as!the!“caregiver!of!last!resort”!when!grandmothers!or!older!daughters!were!not!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!408! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!409 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!410 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!411! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!412! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!413! M.!J.!N’Zengou`Tayo,!“Fanm!se!potomitan:!Haitian!woman!is!the!pillar!of!society,”!Feminist&Review!59!(1998),! pp.!118`142.!!414 !T.!T.!Schwartz,!Fewer&men,&more&babies:&Sex,&family&and&fertility&in&Haiti!(Lanham:!Lexington!Books,!2009).!415! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!416! M.!J.!N’Zengou`Tayo,!“Fanm!se!potomitan:!Haitian!woman!is!the!pillar!of!society,”!Feminist&Review!59!(1998),! pp.!118`142.!56! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 3.&Demography&available.! Aware! that! child! outcomes! are! worse! when! the! father! is! the! primary! caregiver,! Devin! and!Erickson! concluded! that! children! in! households! without! mature! female! family! members! were! at! a!disadvantage.417!!The!1994`1995!EMMUS!II!survey!found!that!39%!of!households!in!Haiti!were!headed!by!women.418!By!2008,! the! World! Bank! estimated! that! this! proportion! had! increased! to! 43.7%,419! while! Justensen!estimated!that!53%!of!households!were!headed!by!women!in!2007,!because!the!husband!had!migrated,!died,! or! never! taken! part! in! household! decisions.420! A! 2007! estimate! by! Lunde! is! closer! to! the! World!Bank! estimate,! at! 42%,! and! indicated! that! in! 1/3! of! these! cases,! the! women! is! the! head! of! household!even!though!the!husband!is!living!at!home.421!The!2005`2006!EMMUS!IV!survey!stated!that!even!though!93%! of! women! believed! that! men! should! help! with! housework! when! the! woman! works! outside! the!home,!and!79%!believed!that!the!woman!had!the!right!to!express!her!opinion!if!she!disagreed!with!her!husband,! only! 49%! of! women! in! 2006! disagreed! with! the! statement! that! important! household! level!decisions!should!be!made!by!men.422!Female!empowerment,!especially!in!terms!of!control!over!what!is!socially!considered!as!the!“woman’s!realm,”!remains!a!cause!for!concern!in!Haiti,!especially!as!it!relates!to!decisions!that!affect!the!security,!welfare,!and!development!of!the!household’s!children.!!In! addition! to! witnessing! clearly! defined! gender! roles,! children! in! Haiti! also! grow! up! in! defined! age!hierarchies.! Elderly! parents! typically! rely! on! their! children! for! their! retirement,! and! are! highly!respected.423!As!the!Cultural!Consultation!Service!observed,!“if!three!or!more!generations!are!living!in!the! house,! power! and! authority! are! generally! assumed! in! the! following! order:! grandparents,! father,!mother,!the!eldest!child!and!so!on.!Most!Haitians!have!no!old!age!pensions,!savings!or!social!security.!Their!children!are!their!source!of!social!security.”424!!The! low! position! of! children! in! the! family! hierarchy! is! manifest! in! their! household! responsibilities.! As!noted!above,!children!generally!perform!time`consuming!tasks!that!allow!adults!to!spend!their!time!on!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!417! R.!B.!Devin!and!P.!I!Erickson,!“The!influence!of!male!care!givers!on!child!health!in!rural!Haiti,”!Social&Science&&& Medicine!43/4!(1996),!pp.!479`488.!418! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!419! World!Bank,!Genderstats&database:&Latin&America&and&the&Caribbean.!Available!at! http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTGENDER/EXTANATOOLS/EXTSTATINDDATA/EXTGEND ERSTATS/0,,contentMDK:21442622~menuPK:4851685~pagePK:64168445~piPK:64168309~theSitePK:3237336,00 .html!420! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!421! H.!Lunde,!Haiti&youth&survey&2009&5&Volume&I:&Tabulation&report,!Fafo!report!2009/53!(2009).!Available!at! http://www.fafo.no/pub/rapp/20143/20143.pdf!!422! Government!of!Haiti,!Enquête&mortalité,&morbidité&et&utilisation&des&services&(EMMUS&IV)&200552006!(January! 2007).!Available!at!http://www.measuredhs.com/pubs/pdf/FR192/FR192.pdf!423! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!424! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 57!
    • !income`generating! activities.425! Smucker! and! Murray! state! that! parents’! expectations! of! their! children!change!at!around!age!six,!after!which!point!the!children!are!expected!to!serve!in!the!household!as!adults!and!engage!in!income`generating!activities,!predominantly!agriculture!and!marketing.426,427!Children!in!slum! areas,! especially,! are! introduced! to! street! trading! and! menial! work! that! does! not! require!supervision.428!Child!labor,!whether!performed!within!or!outside!the!house,!bears!the!risk!of!exploitation!and! interfering! with! the! child’s! education! and! development,! violating! the! rights! of! the! child.! These!topics! are! reviewed! in! Chapter! 9.& Labor& and& economic& participation.! Family! expectations,! economic!necessity,! and! children’s! traditionally! low! status! within! the! family! may! therefore! contribute! to! their!exploitation!and!ongoing!risks!to!their!protection!and!development.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!425! T.!T.!Schwartz,!Fewer&men,&more&babies:&Sex,&family&and&fertility&in&Haiti!(Lanham:!Lexington!Books,!2009).!426! G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!427! S.!C.!Wortham,!“The!young!child!and!social!relationships!in!developing!countries,”!in:!M.!R.!Jalongo!(ed),! Enduring&bonds:&the&significance&of&interpersonal&relationships&in&young&children’s&lives!(Indiana:!Springer,!2007).!428 !G.!Maynard`Tucker,!“Haiti:!Unions,!fertility!and!the!quest!for!survival,”!Social&Science&&&Medicine!43/9!(1996),! pp.!1379`1387.!58! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement&4.&Migration&and&movement&!Since!the!1960’s,!Haiti!has!experienced!net!international!emigration,!with!more!individuals!exiting!than! 429entering! the! country! (Figure! 44). ! In! 2005,! approximately! 170,000! Haitians! emigrated,! while! roughly! 430,431!30,000! individuals! immigrated,! resulting! in! the! “net! migration”! of! 140,000! people. In! the! period! 4322000`2005,!the!country!saw!an!emigration!rate!of!2.3!per!1,000!people,!or!0.23%. !This!rate!was!lower!than!those!observed!during!the!periods!1985`1990!(2.8!per!1,000),!1990`1995!(3.4!per!1,000),!and!1995` 433,4342000!(2.6!per!1,000). !However,!the!2000`2005!rate!still!suggested!the!continuing!desire!of!many!Haitians! to! leave! their! own! country! in! search! of! a! better! life! elsewhere,! despite! the! significant! cost!associated!with!migration.! Net!migration!from!Haiti!increased!sharply!in!2010,!when!it!was!estimated! 435that! approximately! 240,000! people! left! the! country. ! This! increase! reflects! the! impact! of! the!earthquake,!as!many!left!Haiti!in!the!wake!of!the!disaster.!To!this!day,!it!is!uncertain!what!proportion!of!these!international!migrants!were!children.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!429 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!430 !UNDP,!Human&development&report&2009:&Overcoming&barriers:&Human&mobility&and&development!(New!York:! Palgrave!Macmillan,!2009).!Available!at!http://hdr.undp.org/en/reports/!!431 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!432 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!433 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!434! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!!435 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2! ©!2012!FXB!Center!for!Health!and!Human!Rights! 59!
    • !Figure.44:.Net.number.of.immigrants,.1960T2010.Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!Of! the! estimated! 170,000! Haitians! who! emigrated! in! 2005,! 13,542! were! classified! refugees,! though!again,! it! is! unclear! what! proportion! of! these! refugees! were! children.436! By! 2008,! the! total! number! of!refugees!fleeing!Haiti!had!increased!to!approximately!23,000.!This!increase!was!potentially!the!result!of!both!civil!unrest!and!post`hurricane!season!flight,!as!the!2008!season!caused!a!particularly!large!degree! 437of! damage! to! Haiti’s! infrastructure. ! In! 2010,! this! number! again! increased—this! time! to! 25,892— 438primarily!as!a!result!of!the!January!2010!earthquake. !However,!despite!sharing!a!land!border!with!the!Dominican! Republic,! UNICEF! noted! that! there! was! not! a! particularly! high! rate! of! emigration! to! the! 439neighboring!country!during!this!period. !!!The! International! Crisis! Group! estimated! that! in! 2007,! there! were! around! 3! million! Haitians! living!abroad.! These! émigrés! consisted! predominantly! of! wealthy,! middle! class,! and! educated! individuals,!some! of! whom! are! in! political! exile,! while! a! smaller! portion! of! the! more! recent! émigrés! consisted! 440primarily! of! members! of! Haiti’s! working! class. ! In! contrast,! the! Haitian! Ministry! for! Haitians! Living!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!436 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!437 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!438 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!439 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!440 !Cited!in:!ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!60! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement&Abroad! estimated! that! there! were! only! approximately! 1.5! million! Haitians! living! in! other! countries! in! 4412007. !!According! to! the! UNDP,! an! estimated! 64.3%! of! Haitian! migrants! in! 2000`2003! relocated! to! North! 442America. !Estimates!of!the!number!of!Haitians!in!North!America!vary!by!source,!ranging!from!500,000! 443 444 445 446(Caribbean! Country! Management! Unit)! to! 2! million! (World! Bank). , , , ! The! proportion! of! these!individuals! residing! in! the! United! States,! specifically,! is! unclear,! with! estimates! varying! from! 500,000! 447,448(Cultural! Consultation! Service)! to! 2! million! (World! Bank). ! It! is! estimated! that! approximately! 449,450100,000!Haitian!emigrants!reside!in!Canada. !!In!addition!to!those!in!North!America,!between!500,000!and!550,000!Haitians!and!Dominicans!of!Haitian!descent!are!believed!to!live!in!the!Dominican!Republic.!These!migrants!mostly!work!on!plantations,!in! 451,452,453the!construction!industry,!and!as!domestic!servants. !Up!to110,000!Haitians!are!also!believed!to! 454,455have!migrated!to!the!Bahamas!and!neighboring!French!islands!prior!to!the!2010!earthquake. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!441 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!442! UNDP,!Human&development&report&2009:&Overcoming&barriers:&Human&mobility&and&development!(New!York:! Palgrave!Macmillan,!2009).!Available!at!http://hdr.undp.org/en/reports/!!443 !Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!444 !PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!445! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!446 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!447! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!448! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!449! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!450! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!451! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!452! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!453! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!454! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 61!
    • !!The! World! Bank! noted! that! 30%! of! all! Haitian! households! and! 44%! of! metropolitan! households! have!“close! relatives”! living! abroad.! Of! those! living! abroad,! 72%! were! reported! to! live! in! high`income! 456countries,!such!as!the!United!States!and!Canada. !While!high!levels!of!migration!among!the!educated!elite!present!Haiti!with!a!potential!“brain!drain”!effect,!the!Haitian!diaspora!does!play!a!significant!part!in! supporting! the! economic! livelihoods! of! those! relatives! remaining! in! Haiti:! émigrés! send! “home”! an! 457,458estimated!$800!million!every!year. !!! 459Migration!within!Haiti!occurs!predominantly!from!rural!to!urban!areas. !In!2001,!it!was!estimated!that! 46020.4%! of! Haitians! had! migrated! from! their! Department! of! birth! to! another! Department! (Figure! 45). !The! Port`au`Prince! metropolitan! area,! where! 51%! of! current! residents! were! born! elsewhere,! is! the! 461primary! destination! for! most! internal! migrants. ! As! a! result,! the! Ouest! Department,! containing! the!Port`au`Prince! metropolitan! area,! had! the! highest! proportion! of! residents! who! had! been! born! in! a!different! Department—approximately! 36.7%! had! been! born! elsewhere.! Despite! poor! job! prospects,! 462Port`au`Prince!draws!approximately!100,000!individuals!from!rural!areas!every!year, !and!the!search! 463for! economic! opportunity! remains! the! primary! motivation! for! internal! migration. ! The! World! Bank!reports! that! “nearly! 17%! of! all! Haitians! over! the! age! of! 18! have! migrated! at! some! point! to! Port`au` 464Prince.” !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!455! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!456! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!457! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!458! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!459! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!460! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!461! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!462! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!463! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!464! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!62! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement&!Participation! in! internal! migration! has! been! linked! to! significantly! reduced! chances! of! living! in! 465 466poverty. , ! A! 2006! World! Bank! report! found! that! those! who! migrated! from! one! Department! to!another! demonstrated! a! 24%! reduction! in! the! probability! of! living! on! less! than! $2! per! day! when!compared! to! peers! who! had! never! migrated,! at! 30%! and! 54%,! respectively.! However,! this! report!revealed!little!difference!between!those!who!migrated!from!one!rural!area!to!another!and!those!who!never!migrated!from!their!original!rural!home.!Individuals!who!migrated!to!Port`au`Prince!exhibited!an!8%! lower! probability! of! living! below! $1! per! day! than! those! who! had! not! migrated,! with! no! difference! 467between!those!migrating!from!rural!and!other!urban!areas. !Justesen!and!Verner!have!proposed!that!these! effects! may! be! primarily! due! to! the! higher! average! educational! attainment! of! those! who! 468migrate. ! Internal! migrants! possess! an! average! of! three! more! years! of! education! than! do! non` 469migrants. !!Figure.45:.Prevalence.of.lifetime.migration,.by.Department,.2001. !Source:!World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!!!The!January!2010!earthquake!had!an!immediate!impact!on!internal!migration.!According!to!Bengtsson!et&al.,!who!used!cell!phone!movement!to!determine!internal!migration!from!earthquake`affected!areas,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!465! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!466 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!467 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!468! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!469 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 63!
    • !approximately! 570,000! people! (22%)! left! Port`au`Prince! between! January! 12! and! 31.! The! majority! of!those!displaced!from!Port`au`Prince!moved!to!the!Sud,!Ouest,!and!Artibonite!Departments!(outside!of!the! Port`au`Prince! metropolitan! area),! causing! significant! increases! in! these! Departments’!populations.! Sud! and! Nippes! Departments! witnessed! the! largest! increase! from! pre`earthquake!population! levels,! at! 19%! and! 18%! respectively,! followed! by! Grande‘Anse! and! Sud`Est! Departments,! 470which!witnessed!increases!of!10%!each. !!Despite! a! period! of! intense! migration! from! Port`au`Prince! in! the! two! weeks! following! the! 2010!earthquake,! migration! to! the! capital! was! soon! reestablished! and! once! more! surpassed! migration! to!other! Departments.! Bengtsson! et& al.! estimated! that! 68%! of! those! who! entered! the! Port`au`Prince! 471metropolitan!area!between!February!1!and!March!11!were!residents!prior!to!the!earthquake. !While!reasons! for! a! net! return! to! the! capital! can! be! hypothesized,! no! research! has! been! conducted! to!determine!individual!motivations.!By!March!11,!the!Port`au`Prince!population!was!estimated!to!be!15%!smaller! than! before! the! earthquake,! indicating! that!not!all! former! residents!were!willing!or!able! to! 472return! to! the! capital. ! Two! years! later,! it! remains! unclear! what! percentage! of! Port`au`Prince’s! pre`earthquake!residents!have!returned.!!By! March! 2010,! an! estimated! 1.1! million! Haitian! people! had! been! displaced! by! the! earthquake,!according! to! the! International! Organization! for! Migration! (IOM).! Of! this! 1.1! million,! 692,000! were!believed! to! be! living! in! 591! identified! IDP! camps! within! Port`au`Prince,! while! the! others! had! left! the!capital.!During!the!same!period,!the!Haitian!Government!estimated!that!511,495!people!had!migrated! 473from!Port`au`Prince. !In!June!2010,!the!Camp!Coordination!and!Camp!Management!Cluster!reported! 474that!1.6!million!people!had!been!displaced!across!1,272!sites!Haiti`wide. !These!larger!figures!may!be!the!result!of! a! more!comprehensive!assessment.!As!of!September!2011,!the!IOM!estimated!that!there!were! 550,000! Haitians,! or! 135,961! households,! living! in! 802! camps! in! earthquake`affected! areas—a! 475reduction!of!64%!since!July!2010. !!Of! significant! concern! to! child! protection! are! recent! efforts! to! close! camps,! often! forcibly,! on! both!private! and! public! land.! Upon! assuming! office,! President! Martelly! resolved! to! close! six! large! camps! in!the! metropolitan! area.! With! support! from! the! World! Bank,! those! living! in! the! camps! were! to! be!relocated! to! 16! redeveloped! neighborhoods.! Relocated! families! were! to! receive! US$125! in!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!470! L.!Bengtsson,!X.!Lu,!R.!Garfield,!et!al.,!Internal&population&displacement&in&Haiti:&Preliminary&analyses&of& movement&patterns&of&Digicel&mobile&phones!(May!2010).!471! L.!Bengtsson,!X.!Lu,!R.!Garfield,!et!al.,!Internal&population&displacement&in&Haiti:&Preliminary&analyses&of& movement&patterns&of&Digicel&mobile&phones!(May!2010).!472! L.!Bengtsson,!X.!Lu,!R.!Garfield,!et!al.,!Internal&population&displacement&in&Haiti:&Preliminary&analyses&of& movement&patterns&of&Digicel&mobile&phones!(May!2010).!473 !World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!474 !IOM,!Displacement&tracking&matrix:&Summary&of&IDP&situation,!Haiti!CCCM!Cluster!(June!2010).!475! IOM,!Displacement&tracking&matrix:&V2.0&update,!Haiti!CCCM!Cluster!(September!2011).!Available!at! http://www.cccmhaiti.info/pdf/DTM_V2_Report_September_English.pdf!!64! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement&assistance.476! This! initiative! indicates! a! desire! on! the! part! of! the! Haitian! government! and! response!community! to! provide! for! the! needs! of! those! still! displaced! by! the! earthquake,! as! 94%! of! camp!inhabitants! said! that! they! would! like! to! relocate! if! alternate! housing! was! available.! However,!most!camp!inhabitants!also!said!that!they! would!not!be!able!to!pay!rent!or!other!expenses!if!they!had! to! relocate! immediately.! This! finding! calls! into! question! both! the! feasibility! and! equity! of! the! 477relocation!strategy. !!According! to! Haiti’s! Institute! for! Justice! and! Democracy,! many! camps! within! the! Port`au`Prince!metropolitan! area! have! been! forcibly! cleared,! most! notably! the! Sylvio! Cator! stadium.! Reportedly,!municipal! officials! and! the! Haitian! national! police! used! the! threat! and! implementation! of! violence! to!clear!the!stadium.!Additionally,!the!Institute!highlighted!that!the!US$125!relocation!payment!to!families!was!not!enough!to!secure!adequate!housing,!and!that!these!payments!appeared!to!be!allocated!based!upon!lists!of!households!in!camps!scheduled!to!close.!Unfortunately,!large!numbers!of!households!were!excluded!from!camp!lists,!leaving!many!families!without!compensation!or!a!means!of!reestablishment! 478following!camp!closures. !!!A.&Child&migration&!Prior!to!the!January!2010!earthquake,!child!migration!within!Haiti!was!generally!a!result!of!the!search!for! economic! opportunities,! both! for! the! children! themselves,! and! for! their! adult! caregivers.! As! noted!earlier,!scant!information!is!available!about!the!proportion!of!international!migrants!who!are!children,!save! estimates! of! the! number! of! children! migrating! to! the! Dominican! Republic,! specifically! (discussed!further!in!Section!9B.&Child&labor&migration&to&the&Dominican&Republic).!In!2007,!UNICEF!stated!that!between!2,000!and!3,000!children!were!estimated!to!have!crossed!to!the!Dominican!Republic!to!work!in!agriculture,!construction,!and!domestic!service!each!year.!Most!of!these!children!eventually!returned!to!Haiti!to!support!their!family!with!their!earnings.479!!!Several!factors!have!commonly!been!thought!to!contribute!to!youth!migration!in!Haiti.!One!such!factor!is! economic! security,! which! rural! youth! generally! seek! through! agriculture.! However,! inheritance!practices!and!environmental!degradation!create!a!situation!in!which!each!subsequent!generation!must!cultivate!smaller!plots!of!land!and!make!do!with!lower!agricultural!output!per!acre.!The!lower!prices!of!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!476! T.!Daniel,!"Haiti!mayor!says!he!plans!to!clear!huge!quake!camp,"!New&York&Times!(July!10,!2011).!Available!at! http://ijdh.org/archives/20587!477! T.!Daniel,!"Haiti!mayor!says!he!plans!to!clear!huge!quake!camp,"!New&York&Times!(July!10,!2011).!Available!at! http://ijdh.org/archives/20587!478! Institute!for!Justice!and!Democracy!in!Haiti,!Sylvio&Cator&stadium&and&Camp&Django&–&the&Government&of&Haiti’s& continuing&campaign&to&close&IDP&camps&without&respecting&the&human&rights&of&displaced&communities!(August! 9,!2011).!Available!at!http://ijdh.org/archives/20551!!479! UNICEF,!UNICEF&humanitarian&action&report&2007!(2007).!Available!at! http://www.unicef.org/har07/index_37587.htm!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 65!
    • !subsidized!competing!imports!then!result!in!scanty!returns!for!those!relying!on!agriculture.!The!problem!is!even!greater!for!rural!youth!who!lack!land!rights!due!to!low!ownership`rent!rates!and!diminishing!plot!sizes!(see!Section!3F.&Family&structure).!As!a!result,!many!rural!youth!are!forced!to!search!for!livelihoods! 480and!education!in!urban!areas. !!In!contrast,!a!2006!report!released!by!the!World!Bank,!using!2001!survey!data,!estimated!that!at!least!61.2%!of!internal!migration!undertaken!by!youth!and!adults!was!undertaken!for!reasons!other!than!the!migrant’s!search!for!economic!opportunity!(when!considering!each!migrant!individually,!rather!than!as!part! of! a! household! unit)! (Figure! 46).481! Approximately! 36.5%! of! those! who! reported! a! past! migration!stated! that! their! primary! motivation! was! to! follow! family! members,! while! 13%! cited! educational!reasons.482! Although! the! search! for! economic! security! may! have! been! indirectly! associated! with! the!choice!to!follow!a!migrating!family!member,!it!did!not!constitute!the!primary!motivation!to!migrate.483!When!considering!children,!the!proportion!of!those!who!migrate!in!order!to!follow!family!members!is!likely!to!be!greater!than! for!older!youth!and!adults,!and!it!is!reasonable!to!conclude!that!children!are!even!less!likely!than!older!individuals!to!migrate!for!reasons!having!to!do!with!economic!security.!!Figure.46:.Reason.for.migrating.(%):.Youth.and.adults,.2001. !Source:!World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!!!Succeeding!as!a!young!migrant!in!urban!areas,!especially!in!Port`au`Prince,!requires!having!a!high!level!of!education,!as!well!as!an!established!network!of!contacts!who!can!assist!upon!arrival.!Lunde!notes!that!“for!uneducated!youth!without!existing!networks,!the!relocation!costs!related!to!migration!to!the!capital!become!so!high,!and!the!chances!of!succeeding!so!slim,!that!rural!youth!choose!rather!to!engage!in!high!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!480! H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!!481 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!482 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!483 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!66! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement& 484risk!illegal!migration!to!the!Dominican!Republic.” !Despite!these!challenges,!the!World!Bank!concluded!that!youth!who!migrate!are,!ceteris&paribus,!more!successful!in!acquiring!gainful!employment!than!those! 485who!do!not!migrate. !!The!January!2010!earthquake!may!be!viewed!as!having!both!a!catalyzing!and!an!inhibitive!effect!on!child!migration,! though! quantitative! indicators! are! few.! On! one! hand,! the! destruction! caused! by! the!earthquake! severely! affected! economic! capacity! in! the! Port`au`Prince! metropolitan! and! surrounding!urban!areas,!thus!decreasing!the!relative!attractiveness!(the!“pull”!factors)!of!migration!from!rural!areas!to!those!urban!centers.!It!also!restricted!the!overall!movement!of!children!in!search!of!work!and!made!adult!accompaniment!difficult.!Conversely,!youth!and!children!living!in!earthquake`affected!areas!were!forced! to! migrate! as! a! result! of! the! destruction! of! their! former! residences! and! livelihoods.! Thus,! they!were!compelled!to!move!to!IDP!camps!and!unaffected!areas!for!the!same!reasons!given!by!those!who!had! traditionally! moved! to! the! Port`au`Prince! area—economic! and! educational! opportunities,! and! the!accompaniment!of!family.!UNICEF!estimated!that!330,000!of!the!661,000!people!still!displaced!outside!of! Port`au`Prince! six! months! after! the! earthquake! were! children,! though! more! recent! estimates! were! 486unavailable!at!the!time!of!this!writing. !In!addition,!World!Vision!stated!that!most!children!who!were! 487displaced!after!the!earthquake!were!then!widely!dispersed!among!families!and!others!across!Haiti. !!The!impact!of!the!earthquake!on!the!movement!and!migration!of!children!may!be!greater!than!that!for!other!segments!of!the!population.!The!earthquake!not!only!compelled!young!people!who!would!have!traditionally! migrated! to! the! capital! in! search! of! work! to! remain! in! agricultural! areas! and! displaced!others! from! damaged! urban! areas,! but! it! may! also! have! influenced! children’s! perceptions! of!vulnerability! and! risks! informing! their! decisions! of! whether! or! not! to! migrate,! due! to! the! death! of!parents!and!caregivers!(a!topic!discussed!further!in!Section!5D.&Children&without&parental&care).!!!B.&Child&trafficking&!Before!an!analysis!of!child!trafficking!in!Haiti!is!possible,!it!is!necessary!to!define!the!term!“trafficking.”!The! most! comprehensive! definition! is! presented! by! the! UN! Protocol! to! Prevent,! Suppress! and! Punish!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!484! H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!!485! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!486 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!487! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 67!
    • !Trafficking!in!Persons,!Especially!Women!and!Children,!adopted!in!December!2000!and!to!which!Haiti!is! 488a!signatory!but!has!not!yet!ratified. !The!Protocol!defines!trafficking!as:!! …! the! recruitment,! transportation,! transfer,! harbouring! or! receipt! of! persons,! by! means! of! the! threat! or! use! of! force! or! other! forms! of! coercion,! of! abduction,! of! fraud,! of! deception,! of! the! abuse! of! power! or! of! position! of! vulnerability! or! of! the! giving! or! receiving! of! payments! or! benefits!to!achieve!the!consent!of!a!person!having!control!over!another!person,!for!the!purpose! 489 of!exploitation. !&Furthermore,!the!Protocol!specifies!that:!! ...! recruitment,! transportation,! transfer,! harbouring! or! receipt! of! a! child! for! the! purpose! of! exploitation! shall! be! considered! ‘trafficking! in! persons’! even! if! this! does! not! involve! any! of! the! 490 means!set!forth!in!the!definition. !!Accordingly,!UNICEF!and!the!International!Labour!Organization!note!that!the!use!of!violence!or!fraud!is! 491not!necessary!for!the!practice!to!be!considered!trafficking!in!the!case!of!children. !!The! Convention! on! the! Rights! of! the! Child! contains! a! number! of! Articles! that! are! typically! applied! to!determine!whether!a!situation!is!exploitative,!including:!Article!32!regarding!economic!exploitation!and!work! that! would! be! harmful! to! the! child’s! health,! safety,! and! development;! Article! 34! on! sexual!exploitation! and! abuse;! and! Article! 35! on! the! protection! of! children! from! treatment! as! chattel.!Additionally,! the! ILO! considers! child! trafficking! a! practice! similar! to! slavery! and! places! it! in! the! same! 492category!as!child!labor. !!In!2002,!a!study!by!UNICEF!and!the!International!Organization!for!Migration!estimated!that!more!than! 493,494,495,496!2,000! Haitian! children! are! trafficked! to! and! through! the! Dominican! Republic! every! year,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!488 !UN!ODC,!Signatories&to&the&CTOC&trafficking&protocol!(2011).!Available!at! http://www.unodc.org/unodc/en/treaties/CTOC/countrylist`traffickingprotocol.html!!489! ILO,!Unbearable&to&the&human&heart:&Child&trafficking&and&action&to&eliminate&it,!International!Labour!Office! (2002).!Available!at!http://www.unicef.org/violencestudy/pdf/2002_traff_unbearable_en.pdf!!490! ILO,!Unbearable&to&the&human&heart:&Child&trafficking&and&action&to&eliminate&it,!International!Labour!Office! (2002).!Available!at!http://www.unicef.org/violencestudy/pdf/2002_traff_unbearable_en.pdf!!491! UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!492 !ILO,!Unbearable&to&the&human&heart:&Child&trafficking&and&action&to&eliminate&it,!International!Labour!Office! (2002).!Available!at!http://www.unicef.org/violencestudy/pdf/2002_traff_unbearable_en.pdf!!493 !UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!!494 !UN!OCHA!Haiti,!Haiti&before&January&12th,!Internal!document!(2010).!Available!at! http://ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1165439!!495 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm!496! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!68! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement& 497with!an!additional!176,000!to!300,000!trafficked!domestically!within!Haiti. !Due!to!its!proximity!and!relatively! porous! border! with! Haiti,! the! Dominican! Republic! is! the! largest! destination! country! for!trafficked!Haitian!children.!However,!trafficked!children!also!appear!in!the!Bahamas,!the!United!States,! 498Canada,!Europe,!and!Jamaica. !While!there!are!no!publically!available!estimates,!the!U.S.!Department!of!State!asserted!that!NGOs!observed!an!increase!in!the!trafficking!of!Haitian!children!to!the!Dominican! 499Republic! and! the! Bahamas! in! 2008. ! Whether! or! not! this! increase! indicates! a! sustained! trend! over!time,!it!highlights!the!continuing!nature!of!the!phenomenon!and!the!need!for!further!action.!The!ILO!has!noted! that! the! trafficking! of! children,! especially! for! labor! and! sexual! exploitation,! is! a! hidden!phenomenon!that!complicates!rigorous!data!collection,!and!opined!that!statistics!should!be!considered! 500illustrative!of!such!underlying!issues,!rather!than!as!perfect!indicators. !!The!type!of!work!in!which!trafficked!children!generally!must!engage!poses!disproportionate!risks!to!their!health,! safety,! and! future! opportunities.! Trafficked! children! are! often! employed! in! street! professions,!such!as!begging,!shoe!shining,!and!petty!sales,!or!in!hazardous!work!including!prostitution!(particularly! 501 502for! girls),! farming,! and! construction. , ! They! are! deprived! of! education! and! a! supportive! family!environment,! and! are! often! forced! to! work! in! unsafe! environments! for! little! or! no! pay.! Young! girls!forced! into! prostitution! face! the! additional! risks! of! sexually! transmitted! diseases,! unwanted! 503 504pregnancies,!and!physical!violence!and!abuse. , !!!Comprehensive!strategies!to!alleviate!child!trafficking!impact!both!the!demand!and!supply!sides!of!the! 505phenomenon,! and! require! international,! regional,! and! national! cooperation. ! Prior! to! the! 2010!earthquake,!Haiti’s!strategy!for!suppressing!child!trafficking!centered!on!containment!at!airports!and!the!Dominican! border.! During! that! time,! MINUSTAH! representatives! were! stationed! with! immigration!officials!to!help!identify!children!being!trafficked!across!the!border!or!through!the!airport—a!“first!and!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!497 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm!498 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!499 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!500 !ILO,!Unbearable&to&the&human&heart:&Child&trafficking&and&action&to&eliminate&it,!International!Labour!Office! (2002).!Available!at!http://www.unicef.org/violencestudy/pdf/2002_traff_unbearable_en.pdf!!501! OMCT,!Rights&of&the&child&in&Haiti!(October!2002).!Available!at! http://www.omct.org/files/2001/11/1155/haitichildren2002.pdf!502 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!503 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!504 !ILO,!Unbearable&to&the&human&heart:&Child&trafficking&and&action&to&eliminate&it,!International!Labour!Office! (2002).!Available!at!http://www.unicef.org/violencestudy/pdf/2002_traff_unbearable_en.pdf!!505 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 69!
    • ! 506last!line!of!defense”!strategy!that,!alone,!was!insufficient!to!prevent!the!illicit!movement!of!children. !If! trafficked! children! were! instead! intercepted! in! another! country,! the! National! Office! of! Migration! 507attended!to!their!supervision!and!reintegration!upon!repatriation. !!Haiti’s! January! 2010! earthquake! significantly! compounded! children’s! risk! of! trafficking.! In! the! months!following! the! earthquake,! reports! of! child! trafficking! and! illegal! adoption! dominated! the! international! 508press. !UN!OCHA’s!Initial!Rapid!Assessment!revealed!that!7%!of!camps!in!Port`au`Prince,!9%!of!camps!outside! of! Port`au`Prince,! and! 13%! of! non`camp! sites! outside! of! the! capital! reported! at! least! one! 509instance!of!suspected!child!trafficking. !!Cognizant! of! the! increased! risk! of! child! trafficking! in! the! relief! and! recovery! phase! of! post`earthquake!operations,! the! Haitian! Government! stated! that! the! establishment! of! “measures! for! combating! 510trafficking! and! dealing! in! Haitian! children”! was! a! priority! in! the! Post`Disaster! Needs! Assessment. ! In!association! with! UNICEF! and! MINUSTAH,! over! 100! staff! from! the! Brigade! de! Protection! des! Mineurs!(BPM)!of!the!Haitian!National!Police,!the!Institut!du!Bien!Être!Social!et!de!Recherches!(IBESR),!and!the!Ministère! des! Affaires! Sociales! et! du! Travail! (MAST)! were! trained! in! the! prevention! of! child! trafficking!and! other! forms! of! violence,! including! sessions! on! case! management! when! trafficking! situations! are!identified.!Between!January!and!July!2010,!6,000!cases!of!child!movement!across!the!Dominican!border!and!through!airports!had!been!assessed,!and!400!victims!had!been!assisted.511,512!In!March!2011,!UNICEF!stated!that!of!the!11,774!children!screened!at!the!Port`au`Prince!airport!and!other!border!checkpoints!in!all!of!2010,!459!were!identified!as!victims!of!child!trafficking.513!However,!it!is!not!clear!what!degree!of! impact! this! initiative! has! had! upon! the! overall! rate! of! child! trafficking,! since! the! post`earthquake! 514 515baseline!rate!and!number!of!successful!interventions!are!unknown. , !The!relatively!small!increase!in!the!number!of!identified!child!trafficking!victims!may!be!the!result!of!a!true!reduction!in!the!number!of!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!506 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!507 !UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!508 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!509 !CDC,!CDC&summary&of&initial&rapid&assessment&conducted&by&UN&OCHA&in&Haiti!(February!2010).!510 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!511 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!512 !UN!MINUSTAH,!Haiti:&6&Months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!513 !UNICEF,!OHCHR&Universal&Periodic&Review&–&Haiti!(March!2011).!Available!at! http://lib.ohchr.org/HRBodies/UPR/Documents/session12/HT/UNICEF`eng.pdf!514 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!515! UN!MINUSTAH,!Haiti:&6&Months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!70! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement&child! trafficking! attempts,! traffickers’! use! of! other! routes,! or! lower! rates! of! successful! identification,!though!the!impact!of!each!of!these!factors!remains!unknown.!!With! US$1.6! million! provided! by! the! U.S.! Government! and! UNICEF,! the! International! Organization! for!Migration!initiated!a!program!to!assist!1,000!victims!of!domestic!child!trafficking.!From!January!to!June!2011,!IOM!reported!that!they!had!assisted!400!domestic!trafficking!victims!who!had!been!living!in!IDP! 516camps,!with!additional!cases!identified!in!other!areas!of!Port`au`Prince!and!surrounding!provinces. !!!C.&Adoption&!Haiti! has! a! history! of! both! domestic! and! international! child! adoption,! although! international! adoption!predominates.! Haiti’s! current! domestic! and! international! adoption! framework! was! created! by! the!decree! of! April! 4,! 1974.! In! general,! domestic! adoption! predominates!for! the! 10`15!year! age! group,!while! international! adoption! predominates! within! the! 1`3! year! age! group.! Adoption! is! authorized! 517when!it!is!perceived!that!“real!and!definite!advantages”!are!available!to!the!child!through!adoption. !The! decree! of! 1974! outlines! age! requirements! for! those! seeking! to! adopt! a! Haitian! child,! both!domestically!and!internationally,!whereby!the!age!difference!between!the!child!and!the!adopter!must!be!at!least!19!years,!and!the!adopter!must!be!at!least!35!years!of!age.!However,!in!eligible!cases,!these!stipulations!may!be!waived!by!Haiti’s!President.!!!In! the! period! 1994`1999,! the! Institut! du! Bien! Être! Social! et! de! Recherches! (IBESR)! documented! 2,097!cases!of!international!adoption,!compared!to!only!338!cases!of!domestic!adoption.!The!UN!Committee!on! the! Rights! of! the! Child! stated! that! this! number! of! international! adoptions! represented! an! increase!over!previous!periods,!suggesting!that!the!number!of!cases!for!the!decade!2000`2009!was!likely!to!be! 518even!higher,!although!they!provided!no!specific!estimates. !!Prior!to!the!January!12,!2010!earthquake,!many!pending!cases!of!adoption!of!abandoned!children!had!become! stalled! due! to! the! requirement! that! an! appeal! by! IBESR! for! the! child’s! parents! or! former!caregivers!to!come!forward!be!fulfilled,!to!which!there!was!never!a!response.519!Haiti!is!not!a!party!to!the! Hague! Convention! on! the! Protection! of! Children! and! Co`Operation! in! Respect! of! Inter`Country!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!516! UN!OCHA,!Humanitarian&bulletin:&3&May&–&6&June&2011!(2011).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_1060.pdf!!517! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!518! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!519! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 71!
    • !Adoption,! which! seeks! to! protect! children! from! the! risk! of! improper! and! illegal! adoption,! nor! does! 520 521domestic!Haitian!legislation!provide!a!comparable!degree!of!protection. , !Children!in!Haiti!thus!face!heightened! risks! to! their! protection—a! situation! both! highlighted! and! exacerbated! by! the! 2010!earthquake.!!Following!the!2010!earthquake,!the!issue!of!international!adoption!of!Haitian!children!soon!dominated!the! international! media.! Several! factors! converged! to! override! the! few! safeguards! that! existed! with!respect! to! international! adoption! of! Haitian! children.! The! proximity! of! the! crisis! to! the! United! States!meant!that!many!crisis`specific!organizations!converged!on!Haiti,!without!training!in,!or!awareness!of,!Haitian! and! international! regulations! governing! inter`country! adoption.! The! influx! of! U.S.! Christian!organizations,! which! have! increasingly! embraced! orphan! care! as! a! tenant! of! faith,! both! directly!responded!and!placed!political!pressure!on!their!government!to!ease!restrictions!and!requirements!for!the! adoption! of! Haitian! children.! The! U.S.! government,! under! the! seldom`used! “humanitarian! parole”!procedure,! relaxed! visa! restrictions! and! pre`screening! requirements! of! both! prospective! adoptive!parents! and! Haitian! children.! It! also! overlooked! pre`existing! documentation! requirements! intended! to!prevent! fraud! and! trafficking.! Under! the! strain! of! the! crisis,! the! Haitian! government,! which! had! lost!significant! human! and! physical! resources! during! the! earthquake,! was! unable! to! insist! upon! and!implement!domestic!procedures!for!the!protection!of!children,!including!the!appeal!for!family!members! 522to! come! forward! and! claim! children! placed! in! orphanages. ! The! result,! as! Ginger! Thompson! of! the! 523New!York!Times!put!it,!“evolved!into!a!baby!lift!unlike!anything!since!the!Vietnam!War.” !!In!the!months!following!the!earthquake,!more!than!1,150!children!were!fostered!to!U.S.!families!who!had!applied!for!adoption!prior!to!the!earthquake.!Thompson!noted!that!this!was!a!figure!higher!than!the!total!number!of!children!adopted!by!American!families!during!the!previous!three!years.!Despite!calls!to!limit!international!adoptions!following!the!earthquake!from!UN!agencies,!NGOs,!and!other!groups,!many!Haitian! orphanages,! including! some! that! had! not! been! affected! by! the! earthquake,! were! “nearly!emptied.”! These! actions! were! driven! by! the! perceived! priority! of! the! international! community! and! 524governments!to!remove!children!from!harm’s!way. !Child!protection!remains!a!concern!for!those!who!were! evacuated! from! Haiti,! as! well! as! for! those! who! remained! following! the! 2010! earthquake.! Haiti!currently! seeks! to! revise! and! implement! adoption! regulations,! and! the! status! of! post`earthquake!international! adoptions! requires! monitoring.! Though! the! U.S.! government! closed! the! “humanitarian!parole”!process,!the!practice!of!placing!children!in!orphanages!as!a!result!of!the!socio`economic!position!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!520 !Hague!Conference!on!Private!International!Law,!Status:&Convention&of&29&May&1993&on&protection&of&children& and&co5operation&in&respect&of&intercountry&adoption!(2011).!Available!at! http://www.hcch.net/index_en.php?act=conventions.status&cid=69!!521 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!522! G.!Thompson,!“After!Haiti!quake,!the!chaos!of!U.S.!adoptions,”!New&York&Times!(August!3,!2011).!Available!at! http://www.nytimes.com/2010/08/04/world/americas/04adoption.html?pagewanted=all!523! G.!Thompson,!“After!Haiti!quake,!the!chaos!of!U.S.!adoptions,”!New&York&Times!(August!3,!2011).!Available!at! http://www.nytimes.com/2010/08/04/world/americas/04adoption.html?pagewanted=all!524! G.!Thompson,!“After!Haiti!quake,!the!chaos!of!U.S.!adoptions,”!New&York&Times!(August!3,!2011).!Available!at! http://www.nytimes.com/2010/08/04/world/americas/04adoption.html?pagewanted=all!72! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 4.&Migration&and&movement&of!their!families,!rather!than!the!death!of!their!parents,!is!a!factor!that!must!be!considered!with!regard!to!inter`country!adoption!following!the!earthquake.! ©!2012!FXB!Center!for!Health!and!Human!Rights! 73!
    • !5.&Child&protection&!Since!the!January!2010!earthquake!in!Haiti,!children!have!faced!a!myriad!of!protection!challenges.!More!than!1.5!million!children!were!directly!affected!by!the!earthquake,!many!more!were!indirectly!affected,!and! 500,000! were! left! extremely! vulnerable,! prompting! UNICEF! to! label! the! disaster! a! “children’s!emergency.”525,526!Because!threats!arising!from!the!earthquake!compounded!pre`existing!deficiencies!in!child!protection!systems!and!structures,!and!further!marginalized!children!and!youth!in!Haitian!society,!fulfilling! children’s! rights! will! require! a! paradigm! shift! from! pre`earthquake! “business`as`usual”! to!“building!back!better.”!!Narrow!definitions!of!“child!protection”!have!hampered!the!comprehensive!assessment!required!for!an!adequate!response!to!Haiti’s!fragile!child!protection!situation.!In!2006,!UNICEF!stated!that!it!used!“child!protection”! to! refer! to! “preventing! and! responding! to! violence,! exploitation! and! abuse! against!children—including! commercial! sexual! exploitation,! trafficking,! child! labor! and! harmful! traditional!practices,! such! as! female! genital! mutilation/cutting! and! child! marriage.”527! However,! this! constricted!definition!conflates!categories!and!characteristics!of!risk!and!need,!and!undermines!the!assessment!of!need!itself.!While!arguably!useful!for!targeting!offenders,!this!definition!excludes!some!of!the!genuine!threats!faced!by!Haiti’s!children.!!!These! UNICEF! categories! and! characteristics! alone! are! not! optimal! tools! for! defining! child! protection!needs.! Instead,! a! more! holistic! definition! of! child! protection! that! encompasses! a! wider! range! of! child!protection!risk!factors!and!outcomes,!as!well!as!the!dynamic!processes!that!connect!them,!is!required.!Indeed,! UNICEF! notes! that! one! of! the! challenges! confronting! the! assessment! and! promotion! of! child!protection!is!the!lack!of!an!appropriate!and!uniform!definition!of!the!term.528!!In! contrast! to! limited! categorical! definitions! of! child! protection,! the! Inter`Agency! Standing! Committee!proposed! the! following! definition! of! protection! under! their! 1999! framework! for! the! protection! of!internally!displaced!persons:!! The!concept!of!protection!encompasses!all!activities!aimed!at!obtaining!full!respect!for!the!rights! of!the!individual!in!accordance!with!the!letter!and!the!spirit!of!the!relevant!bodies!(human!rights,! 529 humanitarian!law,![and]!refugee!law). !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!525 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!526 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!527 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!528 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!529 !ICRC,!Report&of&the&third&workshop&on&protection&for&human&rights&and&humanitarian&organizations:&Doing& something&about&it&and&doing&it&well,!18`20!January!1999!(January!2000).!74! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&Protection!as!a!set!of!activities!directed!towards!the!realization!of!human!rights!is!a!marked!departure!from!categorical!definitions!and!facilitates!a!broader!assessment!of!risk!factors,!systems,!and!outcomes!than! do! issue`specific! conceptualizations.! Moreover,! it! affirms! a! “positive”! approach! to! protection! by!suggesting!that!human!security!depends!not!only!the!absence!of!violence,!exploitation,!and!abuse,!but!also! on! the! existence! of! an! environment! that! reduces! vulnerability! and! promotes! access! to!opportunities.530! Child! protection! in! this! sense! is! a! multi`tiered! framework! in! which! the! child’s!experience!is!not!assessed!in!isolation,!but!rather!with!respect!to!families,!communities,!and!the!country!as!a!whole.531!!Because! the! development! of! indicators! requires! conceptual! clarity,! the! lack! of! unanimity! surrounding!the! definition! of! child! protection! has! led! to! significant! challenges! in! assessment,! monitoring,! and!evaluation.! UNICEF! notes! that! the! introduction! of! the! Demographic! and! Health! Surveys! (DHS),! the!Multiple! Indicator! Cluster! Surveys,! and! their! Haitian! corollaries,! the! EMMUS! surveys,! have! filled! some!critical! gaps! in! what! is! known! about! child! protection! in! Haiti.532! Nonetheless,! many! areas! continue! to!suffer!from!a!lack!of!rigorous!indicators!and!data,!either!because!appropriate!indicators!do!not!exist,!or!because! household! surveys! are! an! ineffective! method! to! quantify! certain! phenomena.! In! this! sense,!building! state! capacity! is! not! only! necessary! for! the! implementation! of! policies! and! programs! that!promote! child! protection,! but! also! for! the! collection! and! dissemination! of! data! for! planning,!implementation,!monitoring,!and!evaluation!purposes.533!!!A.&Safety&and&security&!In! addition! to! observable! outcomes,! human! protection! is! inextricably! linked! to! individual! perceptions!about! self! and! community.! High! levels! of! social! cohesion! and! trust! in! the! community! reduce! young!people’s! feelings! of! insecurity,! contributing! to! environments! that! enable! and! foster! children’s! rights.!Strong! social! cohesion! also! facilitates! children’s! access! to! otherwise! unavailable! community`based!psychosocial!supports,!further!enhancing!coping!and!resilience.534,535!Prior!to!the!2010!earthquake,!58%!of!residents!in!Port`au`Prince!reported!feeling!unsafe!“often!or!most!of!the!time”!at!home,!compared!to!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!530! Sphere!Project,!Sphere&protection&section:&Draft!(June!23,!2011).!Available!at! http://www.crin.org/docs/FileManager/Sphere_Protection_Chapter_23Junedraft1.doc!!531! Sphere!Project,!Sphere&protection&section:&Draft!(June!23,!2011).!Available!at! http://www.crin.org/docs/FileManager/Sphere_Protection_Chapter_23Junedraft1.doc!!532! UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!533! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!534 !U.!Bronfenbrenner,!The&Ecology&of&Human&Development:&Experiments&by&Nature&and&Design!(Cambridge,!MA:! Harvard!University!Press,!1979).!535 !T.!S.!Betancourt,!R.!T.!Brennan,!J.!Rubin`Smith,!et!al.,!“Sierra!Leone’s!former!child!soldiers:!A!longitudinal!study! of!risk,!protective!factors,!and!mental!health,”!Journal&of&the&American&Academy&of&Child&and&Adolescent& Psychiatry!49/6!(2010),!pp.!606`615.!Available!at!http://www.hsph.harvard.edu/mch`cyf` concentration/files/betancourt_et_al._2010_jaacap.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 75!
    • !15%!of!those!in!rural!areas.536!In!2009,!only!18%!of!urban!young!people!aged!10`24!reported!feeling!that!most! people! could! be! trusted.! Trust! among! young! people! in! rural! areas! was! almost! double! this!percentage,! at! 35%.537! Though! remarkably! low,! these! proportions! are! a! notable! increase! over! the!proportion! of! young! people! who! believed! that! they! could! trust! others! in! their! community! at! the!conclusion!of!civil!unrest!only!two!years!earlier;!in!2007,!only!one!out!of!every!10!youth!felt!they!could!generally!trust!others!in!their!community.538,539!Discrepancies!between! urban!and!rural!areas!highlight!the! impact! of! social! cohesion! and! community! bonds! on! an! individual’s! sense! of! security.540! These!differences! stem! from! a! multitude! of! factors,! including! higher! crime! rates! in! cities,! political! violence!concentrated! in! urban! areas,! and! the! prominence! of! reciprocal! collective! labor! groups,! such! as! the!coumbite,!the!eskwad,!and!the!societé&de&travail,!in!rural!regions.541!!The! January! 2010! earthquake! devastated! the! sense! of! security! of! those! in! affected! areas.! A! Joint!Security! Assessment! by! MINUSTAH! and! intergovernmental,! governmental,! and! non`governmental!partners!in!March!2010!found!“a!near!unanimous!perception!of!insecurity!among!IDPs!in!camps.”542!One!month!later,!this!sense!of!insecurity!had!fallen,!with!45%!of!internally!displaced!persons!(IDPs)!reporting!that! they! felt! insecure.! Notably,! heightened! feelings! of! insecurity! were! not! limited! to! IDPs! in! Port`au`Prince,! with! more! than! 50%! of! IDPs! in! camps! in! Port`de`Paix! (Nord! Department)! and! Les! Cayes! (Sud!Department)!also!reporting!insecurity.543!!The! causes! of! heightened! insecurity! among! IDPs! can! be! categorized! as! human`,! system`,! and!environment`centric.! Human`centric! causes! are! directly! related! to! trust! and! social! cohesion.! In! March!2010,!MINUSTAH!reported!that!IDPs!linked!insecurity!to!heightened!risk!of!rape,!other!violence,!theft,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!536 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!537 !H.!Lunde,!Haiti&youth&survey&2009&5&Volume&I:&Tabulation&report,!Fafo!report!2009/53!(2009).!Available!at! http://www.fafo.no/pub/rapp/20143/20143.pdf!538 !M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!539! Sphere!Project,!Sphere&protection&section:&Draft!(June!23,!2011).!Available!at! http://www.crin.org/docs/FileManager/Sphere_Protection_Chapter_23Junedraft1.doc!!540 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!541 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!542! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!543 !L.!Ivers,!A.!Schiff,!D.!Jones,!et!al.,!“Assessment!and!analysis!of!Haitian!HADR!data”!(presentation!to!the!Haiti! Assessments!Working!Group,!April!27!2010).!76! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&and!the!presence!of!escaped!prisoners!and!gangs.544!The!University!of!Michigan!and!Small!Arms!Survey!of!April!2010!found!that!3.4%!of!respondents!in!the!Port`au`Prince!metropolitan!area!had!been!victims!of! property! crimes! since! the! earthquake.! Theft! of! water! and! food! were! the! most! common! crimes,!especially!in!the!neighborhoods!of!Delmas,!Martissant/Gran!Ravine,!Bel!Air,!Cite!Solei,!Petionville,!and!Carrefour.545! Respondents! to! MINUSTAH’s! Joint! Security! Assessment! also! reported! high! levels! of!insecurity! due! to! system`related! factors,! including! lack! of! support! networks! and! state! capacity,! high!unemployment! rates,! inadequate! food! distribution,! and! lack! of! access! to! healthcare,! education,! and!other! basic! services.546! Destruction! caused! by! the! earthquake! exacerbated! these! concerns! by! creating!continued!distress!about!physical!environments,!including!the! possibility! of! aftershocks,! the! upcoming!rainy! season,! the! vulnerability! of! shelters,! poor! living! conditions,! and! uncertainty! about! future!opportunities.547!Each!cause!of!insecurity!has!impacted!child!protection!in!Haiti,!due!to!both!the!threat!itself,! and! its! impact! on! families’! and! communities’! sense! of! insecurity.! The! creation! of! an! enabling!environment!for!child!protection!in!Haiti!must,!therefore,!seek!not!only!to!alleviate!threats!to!children’s!security,!reduce!vulnerability,!and!promote!the!resilience!of!IDPs!and!their!children,!but!also!to!address!the!enduring!sense!of!insecurity!caused!by!the!earthquake!and!its!aftermath.!!A!population!survey!by!World!Vision!from!February!4`6,!2010!found!that!respondents!in!Port`au`Prince!and! World! Vision! operational! areas! overwhelmingly! identified! children! as! the! most! vulnerable!population! sub`group! following! the! earthquake! (Figure! 47).548! According! to! this! survey,! children’s!vulnerabilities! stemmed! from! both! physical! and! mental! factors.! The! eight! most! common! components!identified!by!respondents!were:!1)!infections!and!sickness!with!no!available!treatment;!2)!lack!of!shelter;!3)!inability!to!take!care!of!themselves;!4)!lack!of!protection!and!security;!5)!inability!to!run!from!danger;!6)! fear! of! “evil! forces”;! 7)! separation! from! parents;! and! 8)! having! “lost! their! dreams.”549! These!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!544! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!545! A.!R.!Kolbe,!R.!Muggah,!R.!A.!Hutson,!et!al.,!Assessing&needs&after&the&quake:&Preliminary&findings&from&a& randomized&survey&of&Port5au5Prince&households,!University!of!Michigan/Small!Arms!Survey!(April!2010).! Available!at! http://www.comunidadesegura.org/files/Results%20of%20a%20Random%20Survey%20of%20Haitian%20House holds.doc!!546! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!547! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!548! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!549! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 77!
    • !challenges! are! in! addition! to! those! confronting! the! population! as! a! whole,! including! lack! of! access! to!food,!clothing,!and!family!residences!in!exposed!camps.550!!!Figure.47:.Most.atTrisk.population.subgroups.after.2010.earthquake.according.to.household.heads.in.PortTauTPrince.and.World.Vision.operational.areas,.March.2010. !Source:!World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!!!B.&Violence&!Violence! against! children! is! a! multi`faceted! concept! including! physical! and! mental! abuse,! exploitation,!sexual!abuse,!and!negligent!treatment.!Violence!carries!the!risk!of!many!long`term!effects!and!can!occur!across!a!range!of!settings,!including!the!home,!the!street,!the!school,!and!the!workplace,!as!well!as!in!justice! institutions! and! alternative! care! facilities.551! Physical! and! psychological! violence! may! result! in!temporary!or!permanent!disability;!undermine!adult!development;!compromise!the!ability!to!socialize,!learn,!and!engage!with!the!community;!and!perpetuate!inter`generational!normalization!of!violence.!In!the!worst!cases!of!physical!and!mental!abuse,!death!may!result!from!either!physical!injury!or!suicide.552!In!2003,!for!example,!it!was!estimated!that!6%!of!all!deaths!among!Haitians!in!the!15`19!year!age!group!were!connected!with!assaults.553!!!The! 2001! Haitian! law! prohibiting! corporal! punishment! in! a! range! of! settings! defines! inhumane!treatment,!which!constitutes!corporal!punishment,!in!Article!2:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!550 !World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!551! UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!552 !UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!553! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!78! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&! Inhuman[e]!treatment!is!defined!by!any!action!that!causes!a!bodily!or!emotional!shock!to!a!child,! such!as!hitting!or!pushing,!or!inflicting!any!punishment!that!causes!damage!to!the!child,!using!or! 554 without!the!intermediary!of!an!object,!weapon!or!abusive!physical!force. ! !In! Haiti,! violence! against! children! does! not! only! occur! in! the! context! of! corporal! punishment.! Instead,!violence!is!a!regular!part!of!children’s!lives!and!is!normalized!to!some!degree!across!society.555!Though!some!forms!of!violence!against!children,!such!as!their!participation!in,!and!victimization!by,!gangs!and!other!armed!groups,!are!socially!condemned,!other!forms!in!more!“controlled”!environments!including!schools!and!the!home!are!accepted!as!a!regular!part!of!child`rearing.556!A!2004!study!found!that!60%!of!women!and!85.7%!of!men!reported!that!they!had!been!mistreated!at!a!moderate!or!severe!level!during!childhood.557!!Violence!against!children!in!Haitian!households!occupies!a!legal!grey`area.!While!Article!1!of!the!2001!law! prohibiting! corporal! punishment! states! that! “(t)he! inhuman! treatment! of! any& nature! comprising!corporal!punishment!of!a!child!is!forbidden”!(emphasis!added),!the!other!major!contextual!provisions!of!the!legislation!deal!exclusively!with!organizations,!schools!and!other!institutions,!without!specifying!the!home! as! an! environment! under! the! auspices! of! the! law.! Without! any! known! public! education! or!awareness`raising! campaigns! regarding! the! law,! NGOs! are! uncertain! whether! corporal! punishment! is!prohibited,!either!de&facto&or!de&jour.558!!Corporal! punishment! in! the! home,! including! spanking! and! beating,! is! widely! used! as! a! method! of!discipline.559!Harsh!treatment!of!children!is!driven!by!parents’!fear!that!failing!to!reprimand!a!child!will!lead! to! children! “getting! out! of! hand,”! thus! necessitating! early! assertion! of! parental! control.! As! such,!children’s! appeals! to! their! rights! may! make! the! situation! worse,! since! parents! may! interpret! these!appeals!as!a!sign!that!the!situation!has!already!escaped!their!control.560!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!554 !Unofficial!translation!provided!by!Global!Initiative!to!End!All!Corporal!Punishment!of!Children,!Haiti&country& report!(February!2009).!Available!at!http://www.endcorporalpunishment.org/!!555 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!556! UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2005/123!(2005).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!557! Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on& violence&against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!558 !Global!Initiative!to!End!All!Corporal!Punishment!of!Children,!Haiti&country&report!(February!2009).!Available!at! http://www.endcorporalpunishment.org/!!559! Cultural!Consultation!Service,!Mental&health&in&Haiti:&A&literature&review!(February!2010).!Available!at! http://www.state.nj.us/humanservices/dmhs/disaster/MH_in_Haiti%20_Literature_Review.pdf!560 !T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 79!
    • !In! 2005,! the! government! of! Haiti! reported! to! the! UN! Study! on! Violence! against! Children! that! 40%! of!children! were! hit! or! beaten! when! they! behaved! badly,! and! that! 14%! of! children! in! UNICEF’s! Voice! of!Children! survey! had! reported! living! in! a! family! where! there! were! scenes! of! aggression! and! violence,!primarily! between! the! adults! and! then! directed! at! the! child.! The! government! also! asserted! that! the!proportion! of! children! who! were! hit! or! beaten! when! they! behaved! badly! was! higher! among! rural!children! than! for! urban! children.561! Supporting! the! notion! that! corporal! punishment! in! the! home! is!normalized! in! Haiti,! the! government! further! noted! that! only! a! very! small! proportion! of! those! children!who! experienced! violence! in! the! household! included! this! criterion! in! their! evaluation! of! the! quality! of!their!relationships!with!their!parents.!!!Researchers! often! differentiate! between! the! biological! children! of! heads! of! household! and! child!domestic! workers,! which! include! paid! child! servants! and! those! referred! to! as! “restaveks.”! Numerous!reports! highlight! the! particularly! high! risks! of! physical! violence! experienced! by! restaveks,! (discussed!further!in!Section!9A.&Children&in&domestic&service&and&servitude).!Restavek!children!are!often!subjected!to! physical,! psychological! and! sexual! abuse! by! household! heads! and! their! biological! children.562,563!Among! the! many! causes! and! consequences! of! the! “restavek”& situation,! the! UN! “Report! of! the! Special!Rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and!consequences”!stated!that70%!of!restavek&children!in!domestic!servitude!in!2009!had!suffered!from!some!form!of!abuse.!Among!these!children,!about!10%`15%!had!been!sexually!abused!in!the!home.564!The!most!comprehensive!analysis!of!corporal! punishment! in! Haitian! households! was! conducted! by! FAFO! in! 2002.! This! analysis! found! that,!contrary! to! prior! assumptions,! child! domestic! workers! did! not! experience! significantly! higher! rates! of!corporal! punishment! in! the! home! than! biological! children.! However,! the! use! of! corporal! punishment!was!shown!to!be!very!high!overall!(Figure!48!and!Figure!49).565!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!561! Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on& violence&against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!562! UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!563 !U.S.!Department!of!Labor,!Haiti,!Bureau!of!International!Labor!Affairs!(2011).!Available!at! http://www.dol.gov/ilab/media/reports/iclp/Advancing1/html/haiti.htm!!564! UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!565! T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!80! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&Figure.48:.Reported.methods.of.punishment.of.children,.by.sex.and.child.domestic.worker.(CDW).status,.2002. !Source:!T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s& residence,&relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!!!Figure.49:.Percent.of.surveyed.children.punished.in.the.week.before.the.survey,.by.urban/rural.status,.sex,.and.child.domestic.worker.status,.2002. !Source:!T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s& residence,&relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!!!Despite!finding!that!the!prevalence!of!corporal!punishment!is!relatively!equal!between!child!domestic!workers! and! other! children! in! the! household,! FAFO! noted! that! psychological! violence! appeared! to! be!more!prevalent!in!child!domestic!workers.!These!children!do!not!benefit!from!the!same!level!of!inclusion! ©!2012!FXB!Center!for!Health!and!Human!Rights! 81!
    • !in! the! emotional! community! of! the! family! as! other! children.566! This! sense! of! being! an! “outsider”! may!both! increase! the! level! of! psychological! anguish! experienced! when! the! child! is! physically! or! verbally!reprimanded,!and!lower!their!ability!to!cope.!The!UN!Special!Rapporteur!on!Slavery!noted!that!“many!restaveks&suffer!from!serious!trauma!induced!by!mistreatment:!inferiority!complex,!fear!of!men,!fear!of!adults! and! incontinence! among! other! things.”567! Thus,! while! many! child! domestic! workers! experience!similar!rates!of!violence!in!the!home!as!biological!children,!the!psychological!effects!of!such!treatment!may!be!greater,!supporting!their!identification!as!a!vulnerable!group.!!In! cases! where! child! abuse! in! the! home! is! reported,! the! Haitian! National! Police’s! Brigade! for! the!Protection!des!Mineurs!(BPM)!intervenes!by!extracting!children!from!these!environments.!Due!to!lack!of!resources,! these! child! victims! are! often! held! in! the! same! room! with! children! in! conflict! with! the! law!before!being!transferred!to!the!protection!of!the!Institute!for!Social!Welfare!and!Research!(Institut&du&Bien5Être& Social& et& de& la& Recherche& or! IBESR),! raising! concerns! regarding! their! physical! and! mental!wellbeing.! Since! the! earthquake,! an! additional! 100! BPM! officers! have! been! trained! to! prevent! and!respond! to! cases! of! child! abuse! and! child! trafficking,568! though! it! is! unclear! whether! alternative! care!arrangements!are!now!made!for!victims!of!child!abuse.!In!addition!to!intervening!in!cases!of!child!abuse,!the! BPM! also! carries! out! community! sensitization! activities,! and! their! officers! are! trained! social!workers.569!!Despite!its!prohibition!in!2001,570!corporal!punishment!remains!prevalent!in!schools.!The!use!or!threat!of! violence! is! used! to! maintain! classroom! discipline,! with! the! presence! of! a! whip! or! large! ruler.! These!tools!often!serve!as!a!constant!threat!by!teachers!and!disciplinary!monitors!to!maintain!discipline,!even!if!they!are!never!used.!A!2008!report!by!Amnesty!International!asserted!that!children!in!Haiti’s!schools!remained! subject! to! beatings! and! food! deprivation,! as! well! as! insults! and! other! psychological! abuse.!Additionally,! young! girls!were!subject!to!sexual!abuse!by!teachers!and!administrative!staff.!They!were!often!then!forced!to!change!schools!due!to!the!stigma!that!follows!such!acts!of!violence.571!Despite!the!fact! that! children! rarely! question! the! use! of! violence! in! schools,! physical! and! psychological! abuse!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!566! T.!Sommerfelt,!Child&domestic&labour&in&Haiti:&Characteristics,&contexts&and&organisation&of&children’s&residence,& relocation&and&work,!FAFO!(May!2002).!Available!at! http://www.fafo.no/ais/other/haiti/childlabour/EEDH_Report_draft_english.pdf!!567! UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!568! UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!569! UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!570 !Global!Initiative!to!End!All!Corporal!Punishment!of!Children,!Haiti&country&report!(February!2009).!Available!at! http://www.endcorporalpunishment.org/!!571 !Amnesty!International,!Safe&schools:&Every&girl’s&right!(March!2008).!Available!at! http://www.amnesty.org/en/library/info/ACT77/001/2008!!82! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&negatively! affect! children’s! wellbeing.! Beyond! the! physical! ramifications,! such! abuse! also! curtails! self`esteem!and!expressive!abilities,!and!reinforces!feelings!of!failure.572!!Little! is! known! about! the! risks! of! violence! Haitian! children! face! in! detention! and! alternative! care.!Corporal!punishment!of!children!is!illegal!in!both!settings!under!the!law!of!September!2001.!However,!as! of! 2005! neither! codes! of! conduct! nor! disciplinary! commissions! to! monitor! and! prosecute! non`compliance!had!been!created.573!While!corporal!punishment!is!prohibited!both!as!a!sentence!for!a!crime!and! as! a! disciplinary! measure! in! prisons! and! alternative! care! facilities,! as! of! 2009! there! were! no!publically!available!estimates!of!the!prevalence!of!violence!against!children!in!either!penal!institutions!or!alternative!care!facilities.574!!Children!can!be!both!the!perpetrators!and!victims!of!violence!in!their!communities.!Communal!violence!in!Haiti!and!its!effects!on!children!are!intimately!related!to!political!conflict.!In!2006,!Haiti!experienced!an! unprecedented! increase! in! kidnappings! linked! to! political! groups! in! Cite! Soleil! and! other! hotspot!neighborhoods!that!had!previously!served!as!traditional!bases!for!one!of!Haiti’s!major!political!parties.575!During! this! period,! it! was! estimated! that! 600! children! were! members! of! armed! groups.! Meanwhile!political! violence! in! Cite! Soleil! resulted! in! the! deaths! of! at! least! 40! children! between! September! and!November!2005.576!Despite!sustained!efforts!to!disperse!gangs!and!restore!order!by!MINUSTAH!and!the!Haitian!National!Police!(HNP)!in!2007,577!disarmament!efforts!failed!to!block!the!easy!availability!of!small!arms.!In!2006,!the!World!Bank!estimated!that!there!were!around!200,000!weapons!in!civilian!hands.578!High!levels!of!gun!ownership!have!contributed!to!Haiti’s!high!rate!of!homicides;!in!2006,!there!were!an!estimated! 34! homicides! for! every! 100,000! citizens,! 48%! higher! than! the! regional! average! of! 22.9! per!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!572! Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on& violence&against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!573! Haitian!Ministry!of!Social!Affairs!and!Labor,!Response&to&the&United&Nations&Secretary5General’s&study&on& violence&against&children&questionnaire&to&governments!(March!9,!2005).!Available!at! http://www2.ohchr.org/english/bodies/CRC/docs/study/responses/Haiti.pdf!!574! Global!Initiative!to!End!All!Corporal!Punishment!of!Children,!Haiti&country&report!(February!2009).!Available!at! http://www.endcorporalpunishment.org/!!575! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!576! UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!577! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!578! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 83!
    • !100,000! people.579! Availability! of! small! arms! remains! a! significant! contributor! to! persistent! endemic!violence.!!A! 2009! Pan`American! Development! Foundation! study! of! households! in! troubled! urban! neighborhoods!of! Port`au`Prince,! Cap`Haïtien,! Gonaïves,! Saint`Marc,! and! Petit`Gôave! found! that! 6.7%! of! households!had!been!victimized!by!rape,!murder!and/or!kidnapping!in!the!18`month!period!May!2006!–!December!2007! in! troubled! urban! neighborhoods! of! Port`au`Prince,! Cap`Haïtien,! Gonaïves,! Saint`Marc! and! Petit`Gôave.!Political!conflict!was!centered!in!these!neighborhoods!during!that!period!(Figure!50).580!Survey!respondents!identified!armed!authorities!and!political!groups!as!the!main!perpetrators!of!the!majority!of!violence!in!Haiti.!It!is!worth!noting!that!1.2%!of!households!stated!that!one!or!more!members!of!their!households! had! been! involved! with! an! armed! group.! Higher! proportions! (15.62%)! of! households!victimized! by! aggression! were! found! in! Port`au`Prince! than! in! any! other! urban! area.! Saint`Marc!experienced!the!lowest!proportion!of!households!experiencing!violence!(4.03%)!(Figure!51).581!Though!Haiti!maintained!an!undercurrent!of!communal!violence!in!the!lead`up!to!the!January!2010!earthquake,!Oxfam! noted! that! the! 10! months! before! the! earthquake! were! marked! by! rising! incomes,! as! well! as!declines!in!kidnappings!and!unemployment.582!!Figure.50:.Percentage.of.households.affected.by.rape,.murder,.kidnapping.and.gang.involvement,.2006T2007. Households.victimized. Households.victimized. Number.of.valid. Types.of.violations. by.violence. by.violence. responses. %. #. N. Rape! 1.8 26! 1,456! Murder! 3.3 49! 1,456! Kidnapping! 1.4 20! 1,456! Involvement!with!gangs! 1.2 18! 1,456! At!least!one!case!of!these! 6.7 98! 1,456! violations!Source:!G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,& restavèks,&&&victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project! (November!2009).!Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!579! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!580! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!581! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!582 !Oxfam!America,!Haiti:&A&once5in5a5century&chance&for&change,!Oxfam!Briefing!Paper!136!(March!2010).!Available! at!http://www.oxfamamerica.org/publications/haiti`a`once`in`a`century`chance`for`change!!84! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&!!Figure.51:.Percentage.of.households.with.victims.of.aggression,.by.city,.2006T2007. !Source:!G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,& restavèks,&&&victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project! (November!2009).!Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!!!Young! people! crossing! the! border! to! the! Dominican! Republic! also! experience! high! risks! of! violence.!Fieldwork!by!FAFO!in!2009!revealed!that!young!Haitian!labor!migrants!are!exposed!to!a!range!of!threats!to! their! physical! safety! at! the! hands! of! their! employers,! Dominican! authorities,! and! border! guards,! in!addition! to! the! natural! hazards! involved! in! crossing! the! mountainous! border! with! the! Dominican!Republic.! In! the! Dominican! Republic,! young! Haitian! labor! migrants! have! reported! harassment! and!physical!abuse!by!employers,!as!well!as!robbery!during!their!crossing!and!stay.!Some!criminals!specialize!in! attacking! labor! migrants! during! their! return! to! Haiti,! when! they! are! carrying! their! earnings! back! to!their!households.!At!the!hands!of!their!new!employers,!these!migrants!risk!abuse!without!recourse!to!the! authorities! as! a! result! of! their! illegal! status! in! the! Dominican! Republic.583! Reports! of! abuse! by!Dominican! authorities,! including! by! border! officers! who! patrol! with! dogs,! are! well! known! to! young!Haitian! labor! migrants.! Those! detained! by! the! authorities! also! have! experienced! poor! conditions! of!detention!before!deportation,!including!confiscation!of!earnings.!Despite!the!risks!to!their!physical!and!mental! wellbeing,! however,! young! Haitians! continue! to! subject! themselves! to! these! risks! because!emigrating!appears!better!than!the!alternatives!of!poverty!and!stagnant!social!mobility!in!Haiti.584!This!topic!is!discussed!further!in!Section!9B.&Child&labor&migration&to&the&Dominican&Republic.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!583! H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!!584! H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 85!
    • !!Unfortunately,! lack! of! knowledge! and! a! subservient! position! in! Haitian! households! and! society! places!children!at!particularly!high!risk!of!violence.!They!are!both!less!likely!to!know!that!assistance!services!are!available! to! them! and! less! likely! to! use! these! services! because! of! established! family! and! community!pressures!and!norms.!A!2009!survey!found!that!a!very!low!proportion!of!adults!knew!where!they!could!find! services! for! victims! of! violence.! Only! 15%! of! the! 1,431! respondents! indicated! that! they! knew! of!available!services.585!Although!no!data!exists!on!the!issue,!it!is!likely!that!this!proportion!is!even!lower!for!children,!in!part!because!they!are!less!likely!than!adults!to!have!heard!about!these!organizations,!but!also!because!their!parents!are!often!the!perpetrators!of!the!violence!against!them.!!!i..Crime.in.the.camps.!The! security! situation! in! Port`au`Prince! deteriorated! markedly! following! the! 2010! earthquake.! In! Cite!Soleil,! 14%! of! residents! reported! having! been! victimized! by! or! having! witnessed! violence! where! they!were! living! between! January! and! March! 2010.! The! leading! forms! of! violence! were:! beating! (27%),!fighting! (24%),! rape! (20%),! and! theft! (18%).586! Risks! of! violence! following! the! earthquake! were!compounded!by!many!factors,!including!the!availability!of!small!arms,!the!disarray!of!security!forces,!the!escape!of!over!4,000!inmates!from!the!prison!in!Port`au`Prince,!and!the!desperate!need!of!households!in!earthquake`affected!areas.587,588!!Insecurity!in!camps!is!greater!than!in!non`camp!zones!in!earthquake`affected!areas.!In!March!2010,!the!University!of!Michigan!and!Small!Arms!Survey!found!that!47%!of!camp!residents!in!Port`au`Prince!had!been! victims! of! property! crimes! since! the! earthquake,! while! 21%! had! been! threatened! with! physical!harm.! In! contrast,! the! survey! found! that! only! 2%! of! the! general! non`camp! population! had! been!threatened!with!physical!violence!over!the!same!period.589!!The! increased! sense! of! insecurity! among! camp! residents! appears! related! to! two! primary! factors:!occurrences!of!violence!and!property!crimes,!and!the!physical!arrangement!of!camp!spaces!that!expose!individuals,! particularly! children,! to! greater! risk.! Adequate! lighting! in! camp! spaces,! the! availability! of!latrines! within! camps,! and! the! lack! of! private! bathing! facilities! were! listed! as! the! primary! factors!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!585! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!586! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!!587! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!!588! IFRC,!Haiti&earthquake:&Operations&update&No.&1!(January!2010).!Available!at! http://www.ifrc.org/docs/appeals/10/MDRHT00801.pdf!!589! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&3,!5!April!2010!(April!2010).!Available!at! http://groups.google.com/group/assessmentshaiti/browse_thread/thread/71f3f127213f7a06!!86! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&affecting! perceptions! of! insecurity,! especially! for! women! and! girls.! As! a! result,! women! and! girls! often!restricted!their!movements!at!night.!Many!parents!expressed!fear!for!their!children’s!safety,!and!many!kept!their!children!within!the!shelter!at!all!times!unless!accompanied!by!an!adult.590!For!this!reason,!the!provision!of!adequate!lighting!in!camps!has!been!a!priority!for!camp!management!organizations.!!Threats!to!camp!security,!as!identified!by!residents,!included!rape!and!other!sexual!and!gender`based!violence,! physical! violence,! violence! against! children,! fighting,! and! theft.! Respondents! also! mentioned!concerns! surrounding! arguments! between! IDPs! and! the! owners! of! land! occupied! by! IDP! camps! (see!Section!6D.&Shelter&and&housing).!They!further!cited!concerns!regarding!drug!and!alcohol!abuse!and!the!presence! of! prisoners! who! had! escaped! as! a! result! of! the! earthquake.591! In! March! 2010,! the! Haitian!government!noted!that!the!camp!security!situation!was!deteriorating,!with!increasing!rates!of!property!crimes! and! gender`based! violence! (discussed! further! in! Section! 5C.& Sexual& and& gender5based&violence).592!!The! response! to! insecurity! in! camps! has! been! both! exogenous! and! endogenous.! In! many! instances,!camp!committees!and!security!brigades!formed!to!deal!with!security!issues,!and!have!been!credited!as!key! actors! in! reducing! insecurity! and! increasing! camp! stability.! In! addition,! they! provided! a! valuable!avenue! for! relief! workers! to! both! assess! camp! needs! and! deliver! a! timely! response.! However,! some!groups! also! have! been! accused! of! corruption,! abuse,! enflaming! camp! tensions,! and! misrepresenting!camp! information! for! personal! gain.! Nevertheless,! camp! committees! and! security! brigades! were!generally!perceived!to!have!a!positive,!stabilizing!influence.593!!In! March! 2010,! many! residents! noted! that! they! rarely! saw! MINUSTAH! or! the! HNP! within! the! camps.!Those!concerns!led!them!to!request!a!fixed!police!post!in!camps!and!foot!patrols!at!night.594!In!contrast,!the! HNP! stated! that! dozens! of! police! patrols! were! present! in! camps! every! day,! leading! MINUSTAH! to!conclude! that! the! disparities! between! the! reports! from! the! HNP! and! the! camp! residents! meant! that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!590! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!591! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!592 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!!593! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!594! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 87!
    • !police! patrols! were! not! visible! even! when! present.! These! uncertainties! have! heightened! the! sense! of!insecurity!among!camp!residents!and!compromised!the!deterrence!of!crimes.595!The!Haitian!government!conceded! that! the! presence! of! police! authorities! in! camps! was! insufficient,! but! also! noted! that! the!police!force!was!significantly!restricted!by!human!and!material!losses!stemming!from!the!earthquake.596!Many! recruits,! even! when! deployed,! did! not! have! the! necessary! equipment! (such! as! weapons! or!flashlights)!to!fulfill!the!daunting!challenge!of!ensuring!the!rule!of!law!in!post`earthquake!Haiti.597!!!Threats! to! security! were! also! associated! with! the! distribution! of! humanitarian! aid.! The! impact! of! this!factor! is! likely! to! be! less! on! children! than! adults! because! children! are! rarely! responsible! for! collecting!distribution! packages.! However,! it! is! important! to! consider! the! ability! of! children! to! access! food!distributions!without!parental!care.!A!survey!by!World!Vision!in!March!2010!found!that!one!quarter!of!respondents! identified! risks! to! safety! and! security! as! a! result! of! food! distributions.! The! three! primary!concerns! were! fighting! when! distributions! were! insufficient! for! the! needs! of! all! families,! violence! at!distribution! points! attributable! to! the! lack! of! police! security! presence,! and! fighting! when! non`camp!residents! entered! camps! to! receive! distributions! intended! for! camp! residents.598! The! International!Federation!of!Red!Cross!and!Red!Crescent!Societies!(IFRC)!noted!an!increase!in!violence!and!looting!in!the! first! days! of! the! disaster! due! to! the! desperation! of! vulnerable! groups! to! meet! basic! needs.599!However,!a!July!2010!UN!report!stated!that!claims!of!looting!and!violence!following!the!disaster!were!largely! overblown! by! the! international! media! and! that! rates! were! far! lower! than! reported.600! In! the!months! following! the! earthquake,! food! distribution! became! more! organized! as! a! result! of! better!information! and! the! consolidation! of! logistic! supply! chains.! Accordingly,! reports! of! violence! quickly!subsided,! and! security! concerns! related! to! aid! distribution! appeared! to! become! a! peripheral! security!issue.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!595! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!596 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!597! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!598! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&2,!29!March!2010!(March!2010).!Available!at! http://groups.google.com/group/assessmentshaiti/browse_thread/thread/71f3f127213f7a06!!599 !IFRC,!Haiti&earthquake:&Operations&update&No.&1!(January!2010).!Available!at! http://www.ifrc.org/docs/appeals/10/MDRHT00801.pdf!!600 !Cited!in!ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!!88! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&C.&Sexual&and&genderLbased&violence&!High! levels! of! sexual! and! gender`based! violence! (SGBV)! are! endemic! in! Haiti.! The! January! 2010!earthquake!has!further!intensified!the!risk!of!abuse,!as!pre`existing!safety!nets!and!prevention!strategies!were!rendered!inoperable.!Specific!sub`groups!with!elevated!risk!can!be!identified,!including!children!in!domestic!servitude,!street!children,!child!commercial!sex!workers,!and!labor!migrants!to!the!Dominican!Republic.!Victims!of!SGBV!overwhelmingly!lack!access!to!legal!recourse!and!medical!services,!deepening!their!vulnerability!to!adverse!outcomes!and!reinforcing!the!perception!of!perpetrator!impunity.!!!Following! the! fall! of! the! Duvalier! era,! rape! and! other! forms! of! sexual! violence! were! used! as! tools! of!repression! against! women! and! girls! in! the! military! regime.! The! Ministry! of! Women’s! Affairs! and!Women’s!Rights!recorded!1,500!cases!of!sexual!abuse!and!aggression!against!girls!aged!6`15!between!1994! and! 1999.601,602! However,! a! 1996! UNICEF`funded! household! study! suggests! that! this! figure!significantly!underestimates!the!scale!of!victimization.!The!study!found!that!46%!of!young!girls!had!been!sexually! abused! during! their! lifetime,! and! that! 33%! of! those! abuses! had! been! committed! against! girls!aged! 5`9! while! 43%! were! committed! against! girls! aged! 10`14.! The! survey! also! revealed! that! an!overwhelming! 70%! of! Haiti’s! female! population! had! experienced! some! form! of! violence! over! their!lifetime.!Of!these,!approximately!37%!involved!sexual!violence!and!48%!involved!physical!violence.!The!study! further! noted! that! half! of! all! cases! of! physical! violence! against! Haitian! women! occurred! at! the!hands!of!an!intimate!partner.603!!!While!consistent!and!reliable!estimates!of!violence!against!Haitian!women!do!not!exist,!it!is!possible!to!discern! potential! trends! over! time.! Taken! together,! studies! show! that! the! prevalence! of! SGBV! has!changed! very! little! over! the! past! two! decades.! In! 2000,! the! study! of! a! non`representative! sample! of!sexually! active! youths! aged! 15`24! in! Haiti! showed! that! 22%! of! females! and! 15%! of! males! had! ever!experienced! sexual! violence! over! their! lifetimes.604! The! nationally! representative! EMMUS! III! survey! of!the!same!year!indicates!a!higher!occurrence!of!SGBV!against!women,!reporting!that!35%!of!women!over!the! age! of! 15! had! experienced! physical! violence! in! the! year! preceding! the! survey,! with! greater!prevalence! in! rural! areas! (41%)! than! in! urban! areas! (34%).605! Another! survey! in! 1999! found! that!domestic! violence! was! the! most! common! form! of! violence! against! women,! and! that! 29%! of! Haitian!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!601 !Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf.!602 !OMCT,!Rights&of&the&child&in&Haiti!(October!2002).!Available!at! http://www.omct.org/files/2001/11/1155/haitichildren2002.pdf!!603 !Cited!in!World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866` LAC!(2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!604 !A.!M.!Gomez,!I.!S.!Speizer,!and!H.!Beauvais,!“Sexual!violence!and!reproductive!health!among!youth!in!Port`au` Prince,!Haiti,”!Journal&of&Adolescent&Health!44!(2000),!pp.!508`510.!605! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 89!
    • !women!had!experienced!domestic!violence!in!the!preceding!year,!while!13%!of!women!were!found!to!have! experienced! two! or! more! forms! of! violence! over! the! same! period.606,607! Asserting! the! continued!risk!of!SGBV!faced!by!young!girls,!the!Committee!on!the!Rights!of!the!Child!reported!in!2003!that!more!than!one!third!of!Haitian!women!had!been!sexually!abused!before!age!15.608,609!!!One! of! the! more! troubling! pieces! of! data! to! arise! during! this! period! was! UNICEF’s! 2000! finding! that!there!existed!a!significant!association!between!early!marriage!and!intimate!partner!violence.!At!the!time!of!the!report,!they!noted!that!25%!of!married!girls!aged!15`19!had!experienced!some!form!of!intimate!partner!violence,!and!that!“younger!women!and!women!who!married!at!the!earliest!ages!reported!the!most! intimate! partner! violence.”610! This! conclusion! is! of! particular! concern! as! the! prevalence! of! child!marriage!in!Haiti!has!continued!to!increase!over!the!past!decade,!surpassing!30%!in!2006!(See!Section!3D.&Child&marriage).611!!!Political! violence! surrounding! the! exile! of! President! Aristide! in! 2004! led! to! a! surge! in! sexual! violence,!particularly!in!urban!areas.612!During!this!period,!the!prevalence!of!gang!rapes!also!increased,!with!NGOs!estimating!that!33%!of!all!rapes!were!perpetrated!by!two!or!more!assailants.613!!Armed!groups!used!rape!as!a!weapon!to!terrorize!the!population.614!The!2005`2006!EMMUS!IV!survey!provided!a!nationally!representative!snapshot!of!gender`based!violence!at!the!height!of!this!civil!unrest.!The!survey!found!that!27%!of!women!over!age!15!had!experienced!physical!violence!over!their!lifetime,!and!that!16%!of!these!cases!had!occurred!in!the!preceding!12!months.!In!64%!of!cases,!husbands!and!other!partners!were!cited!as!the!perpetrators.!Regrettably,!the!prevalence!of!domestic!violence!did!not!improve! significantly! from! the! 2000! EMMUS! III! survey,! with! roughly! a! quarter! of! married! women!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!606 !World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!607! A.!J.!Gage,!“Women’s!experience!of!intimate!partner!violence!in!Haiti,”!Social&Science&&&Medicine!61/2!(2005),! pp.!343`364.!608! UN!Committee!on!the!Rights!of!the!Child,!Concluding!observations:!Haiti,!UN!Doc.!CRC/C/15/Add.202!(2003).! Available!at!http://www.unhcr.org/refworld/docid/3f2597274.html!!609! OMCT,!Rights&of&the&child&in&Haiti!(October!2002).!Available!at! http://www.omct.org/files/2001/11/1155/haitichildren2002.pdf!610! P.!S.!Pinheiro,!World!report!on!violence!against!children,!United!Nations!secretary`general’s!study!on!violence! against!children,!UN!Doc.!A/61/299!(2006).!Available!at! http://www.unicef.org/violencestudy/reports/SG_violencestudy_en.pdf!!611 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!612! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!613! UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!614 !Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!90! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&reporting! domestic! abuse.! Six! percent! of! women! reported! having! experienced! physical! violence! while!pregnant.615!!!Based! on! the! available! data,! it! is! evident! that! far! more! women! and! girls! experience! gender`based!violence!than!report!it.!UNICEF!observed!that!only!4,000!cases!of!gender`based!violence!were!recorded!in! Sud`Est,! Ouest,! Artibonite,! and! Grande‘Anse! Departments! between! January! 2006! and! June! 2007.616!Though! high! in! absolute! terms,! these! values! are! far! lower! than! would! be! expected! if! prevalence!estimates! derived! from! the! EMMUS! IV! survey! were! applied! to! the! populations! in! each! of! these!Departments.!!Other! studies! conducted! in! 2006! also! revealed! high! rates! of! sexual! violence! towards! girls.! In! the! 22`month! period! between! February! 29,! 2004! and! December! 2005! following! the! departure! of! President!Aristide,!a!Lancet!study!estimated!that!approximately!3.1%!of!all!females!in!the!greater!Port`au`Prince!area! were! sexually! assaulted! (35,000! girls! and! women),! including! almost! one! in! every! 20! girls! (4.6%)!younger! than! 18! years.617! The! authors! estimated! that! 1! in! 40! girls! in! Port`au`Prince! were! sexually!assaulted! each! year! and! that! girls! under! age! 18! accounted! for! more! than! half! (53.1%)! of! all! sexual!assault!victims!in!the!capital.!Of!the!victims!surveyed!in!this!study,!32%!were!aged!11`17,!and!16%!were!aged!10!or!younger,!suggesting!that!approximately!13,000!girls!aged!10`17!and!5,600!girls!aged!less!than!10! were! sexually! assaulted! in! the! 22! months! following! President! Aristide’s! departure.618! This! age!breakdown! of! Haitian! sexual! assault! victims! is! roughly! equivalent! to! that! found! by! service! provision!organizations.!Kay!Fanm!reported!that!55%!of!those!who!sought!care!at!their!facilities!were!aged!18!or!younger,! and! Haitian! Women’s! Solidarity! (Solidarité! Fanm! Ayisien,! SOFA)! reported! that! girls! under! 18!accounted!for!50%!of!those!seeking!service.619,620!UNICEF!found!a!similar!age!pattern!in!2006,!with!47%!of!all!sexual!assault!victims!being!girls!under!the!age!of!18.621!!Analysis!of!2006!EMMUS!IV!data!also!found!a!high!prevalence!of!sexual!abuse!across!all!Departments,!with! Port`au`Prince! witnessing! the! lowest! prevalence! of! forced! first! sex! (18.5%),! and! the! Ouest!Department!exhibiting!the!lowest!prevalence!of!spousal!forced!sex!(3.7%)!(Figure!52).!At!the!time!of!the!survey,! 10.8%! of! female! youth! aged! 15`24! reported! having! been! forced! to! participate! in! a! sexual! act!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!615 !Government!of!Haiti,!Enquête&mortalité,&morbidité&et&utilisation&des&services&(EMMUS&IV)&200552006!(January! 2007).!Available!at!http://www.measuredhs.com/pubs/pdf/FR192/FR192.pdf!616 !UNICEF!Executive!Board,!Revised&country&programme&document:&Haiti&(200952011)!(2009).!Available!at! http://www.unicef.org/about/execboard/files/Haiti`FRS2009`revised_feb2010`English.pdf!617! A.!R.!Kolbe!and!R.!A.!Hutson,!“Human!rights!abuse!and!other!criminal!violations!in!Port`au`Prince,!Haiti:!a! random!survey!of!households,”!The&Lancet!368!(2006),!pp.!864`873.!618! A.!R.!Kolbe!and!R.!A.!Hutson,!“Human!rights!abuse!and!other!criminal!violations!in!Port`au`Prince,!Haiti:!a! random!survey!of!households,”!The&Lancet!368!(2006),!pp.!864`873.!619! Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!620! UN!GA,!Situation!of!human!rights!in!Haiti,!UN!Doc.!A/HRC/4/3!(2007).!Available!at! http://www.unhcr.org/refworld/docid/461f2e552.html!!621! UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47! ©!2012!FXB!Center!for!Health!and!Human!Rights! 91!
    • !with!their!spouse,!with!greater!prevalence!in!urban!areas!(12.7%)!than!in!rural!areas!(8.8%).!Critically,!24.2%! of! all! female! youth! reported! that! their! first! sexual! encounter! had! been! forced,! with! the!prevalence!of!forced!first!sex!slightly!higher!in!rural!areas!(25.9%)!than!in!urban!areas!(22.5%).622!!Figure.52:.NonTconsensual.sex.among.15T24.year.old.females,.by.Department.and.urban/rural.status,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!Assessments! of! SGBV! after! 2006! have! not! been! nationally! representative,! further! complicating! trend!analyses.!A!2009!study!found!that!rape!was!no!longer!employed!as!a!political!tool!to!the!same!extent!as!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!622! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!92! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&earlier!in!the!decade.623!This!decline!also!may!have!affected!the!observed!decline!in!the!proportion!of!rapes! committed! by! more! than! one! perpetrator.! However,! following! the! 2008! hurricane! season,!occurrences!of!rape!and!other!forms!of!sexual!violence!were!thought!to!have!increased,!as!is!often!the!case!following!disasters.624,625!A!survey!conducted!in!2008!found!that!44%!of!pregnant!women!seeking!prenatal!care!at!community!health!centers!in!Artibonite!reported!that!they!had!experienced!violence!in!the! preceding! six! months.! In! 77.8%! of! these! cases,! the! violence! was! perpetrated! by! an! intimate!partner.626!These!findings!suggest!that,!while!the!elevated!rates!of!SGBV!attributable!to!civil!unrest!and!political!conflict!had!fallen!before!the!January!2010!earthquake,!Haitian!women!and!girls!continued!to!face!significant!risks!at!the!hands!of!strangers!and!intimate!partners.!!There! is! a! widely`held! perception! among! policy`makers! and! service! providers! that! the! prevalence! of!SGBV! increased! following! the! 2010! earthquake.627,628,629,630,631,632,633,634! While! there! have! been! no!nationally! representative! surveys! to! enable! the! quantification! of! this! increase,! available! evidence! and!experience! in! other! post`disaster! contexts! do! suggest! that! it! has! occurred.! In! addition,! it! is! likely! that!greater!proportions!of!victims!are!now!reporting!abuses!due!to!greater!accessibility!of!care!and!support!services.635!A!randomized!survey!of!households!in!Port`au`Prince!in!February!and!March!of!2010!found!that!3%!of!all!people!in!Port`au`Prince!had!been!victimized!by!sexual!assault!in!the!1`2!months!following!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!623! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!624! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!625 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!626 !M.!J.!Small,!J.!Gupta,!R.!Frederic,!et!al.,!“Intimate!partner!and!nonpartner!violence!against!pregnant!women!in! rural!Haiti,”!International&Journal&of&Gynecology&and&Obstetrics!102!(2008),!pp.!226`231.!627! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!!628 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!629! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!630! S.!Toupin,!Ensuring&haitian&women’s&participation&and&leadership&in&all&stages&of&national&relief&and& reconstruction:&A&gender&shadow&report&of&the&2010&Haiti&PDNA!(2010).!Available!at! http://reliefweb.int/node/350585!!631! ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!632 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!633 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!634 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape! (July!2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!635 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).! ©!2012!FXB!Center!for!Health!and!Human!Rights! 93!
    • !the!earthquake,!and!that!all!but!one!respondent!was!female.!Half!of!those!who!reported!sexual!abuse!in!this! survey! were! under! the! age! of! 18.! Victims! identified! perpetrators! as! “criminals,”! rather! than! as!neighbors,!friends!or!spouses.636!This!finding!was!supported!by!another!survey!in!July!2010,!which!found!that!most!rapes!were!undertaken!by!people!unknown!to!the!victim,!and!were!usually!attributed!to!two!or! more! armed! individuals! who! were! members! of! neighborhood! gangs! or! escaped! prisoners.637!According! to! UN! OCHA! in! March! 2010,! rape! constituted! 20%! of! all! violence! in! Cite! Soleil,! and! was!attributed!in!large!part!to!the!absence!and!ineffectiveness!of!security!forces.638!!A!study!conducted!by!the!Center!for!Human!Rights!and!Global!Justice!at!the!New!York!University!School!of! Law! in! January! 2011! highlighted! the! continuing! threat! of! SGBV! in! IDP! camps! one! year! after! the!earthquake.!As!the!authors!noted,!prevalence!estimates!may!not!be!generalizable!to!all!IDP!camps,!as!the! survey! was! conducted! in! only! four! camps! within! Port`au`Prince,! but! they! may! offer! valuable!guidance!in!terms!of!patterns!and!trends.!The!study!found!that!over!the!one`year!period!following!the!earthquake,!14%!of!respondents!reported!either!the!rape,!unwanted!touching,!or!both,!of!one!or!more!household!members;!9%!of!respondents!reported!that!a!member!of!their!household!had!been!raped!or!otherwise!forced!to!have!sex,!8%!had!been!the!victims!of!unwanted!touching,!and!3%!had!experienced!both!unwanted!touching!and!rape.!Of!those!respondents!who!provided!the!gender!of!the!victim,!74%!reported!the!victim!to!be!a!woman!in!their!household,!12%!reported!the!victim!as!a!girl!under!age!18!(combined! girls! and! women! constituted! 86%! of! victims! with! reported! gender),! 9%! of! victims! were!reported! to! be! men,! and! 5%! of! victims! were! reported! to! be! boys.! The! study! authors! note! that! these!proportions! are! likely! to! be! underestimates! due! to! shame! and! stigma! associated! with! SGBV!victimization,! in! addition! to! lack! of! knowledge! of! victimization! of! other! household! members! and! a!reluctance!to!report!SGBV!committed!by!members!within!the!household.639!!Fear! of! sexual! and! gender`based! violence! remained! prevalent! one! year! after! the! earthquake! among!households!in!the!four!surveyed!IDP!camps.!Approximately!60%!of!respondents!reported!being!afraid!of!sexual! or! gender`based! violence! for! themselves! or! for! others! in! their! household,! with! little! difference!between!male!and!female!respondents.!Approximately!70%!of!respondents!stated!that!they!were!more!worried! about! SGBV! than! they! had! been! before! the! earthquake,! with! differences! observed! between!female! (72%)! and! male! (61%)! respondents.! Seven! percent! of! female! respondents! and! 13%! of! male!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!636! A.!R.!Kolbe,!R.!Muggah,!R.!A.!Hutson,!et!al.,!Assessing&needs&after&the&quake:&Preliminary&findings&from&a& randomized&survey&of&Port5au5Prince&households,!University!of!Michigan/Small!Arms!Survey!(April!2010).! Available!at! http://www.comunidadesegura.org/files/Results%20of%20a%20Random%20Survey%20of%20Haitian%20House holds.doc!!637 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape! (July!2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!638! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!!639 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!94! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&respondents!reported!comparable!concerns!of!SGBV!victimization!compared!to!before!the!earthquake,!while!20%!of!females!and!26%!of!males!reported!feeling!less!worried.640!!Camp! security! and! organization! were! universally! cited! as! factors! impacting! the! prevalence! of! SGBV! in!camps!following!the!earthquake.!As!noted!previously,!adequate!lighting!in!common!camp!spaces,!such!as!around!latrines!and!bathing!facilities,!was!consistently!identified!by!stakeholders!and!respondents!as!a!key!determinant!of!SGBV!risk,641,642,643,644,645!and!many!young!women!said!that!they!felt!vulnerable!and!restricted! their! movement! to! these! unlit! areas! at! night! for! fear! of! being! attacked.646! The! absence! of!security!personnel!patrolling!camps!also!increased!the!vulnerability!of!female!camp!residents,!and!many!women!organized!their!own!security!brigades!to!escort!girls!and!women!to!the!bathroom!at!night!and!groups! of! men! to! patrol! camp! areas.! The! loss! of! male! family! members! in! the! earthquake,! who! would!traditionally!have!protected!girls!and!women!in!the!family,!has!also!increased!the!sense!of!insecurity!in!camps.647!The!majority!of!sexual!violence!in!camps!has!occurred!between!9!pm!and!3!am!in!the!streets,!in! tents,! or! in! public! spaces.648,649,650! Thus,! the! protection! of! children! and! women! from! SGBV! in! camps!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!640 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!641! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!642! S.!Toupin,!Ensuring&haitian&women’s&participation&and&leadership&in&all&stages&of&national&relief&and& reconstruction:&A&gender&shadow&report&of&the&2010&Haiti&PDNA!(2010).!Available!at! http://reliefweb.int/node/350585!!643! Oxfam!America,!Haiti:&A&once5in5a5century&chance&for&change,!Oxfam!Briefing!Paper!136!(March!2010).!Available! at!http://www.oxfamamerica.org/publications/haiti`a`once`in`a`century`chance`for`change!!644 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape! (July!2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!645! Amnesty!International,!Haiti:&After&the&quake,!Initial!Mission!Findings!(March!2010).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2010/en/d12e3cdc`2103`40b8`af57` 1412dcf3d413/amr360042010en.pdf!646! UN!MINUSTAH,!IDP&camp&joint&security&assessment&report,!MINUSTAH!Human!Rights!Section!(March!2010).! Available!at! http://oneresponse.info/Disasters/Haiti/Protection/publicdocuments/Joint%20Security%20Assessment%20repor t%20`%20Final.doc!!647! Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape!(July! 2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!648! A.!R.!Kolbe,!R.!Muggah,!R.!A.!Hutson,!et!al.,!Assessing&needs&after&the&quake:&Preliminary&findings&from&a& randomized&survey&of&Port5au5Prince&households,!University!of!Michigan/Small!Arms!Survey!(April!2010).! Available!at! http://www.comunidadesegura.org/files/Results%20of%20a%20Random%20Survey%20of%20Haitian%20House holds.doc!!649 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape! (July!2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 95!
    • !will!require!a!multi`faceted!approach,!including!aspects!of!camp!organization!and!management,!greater!visible!presence!of!security!personnel,!and!support!for!organically!created!initiatives!by!camp!residents.!!The!Center!for!Human!Rights!and!Global!Justice!survey!also!found!correlations!between!SGBV!and!food!insecurity!and!camp!management!status.!Those!reporting!household!SGBV!victimization!were!less!likely!than! other! households! to! report! having! eaten! every! day! during! the! week! preceding! the! survey.! The!results! of! the! study! also! supported! the! assertion! that! SGBV! was! more! prevalent! in! unmanaged! IDP!camps!than!in!those!with!an!official!camp!management!agency.!Though!the!limited!survey!sample!size!hampers! generalizability,! the! finding! that! 18%! of! households! in! one! surveyed! unmanaged! camp! had!experienced! SGBV! while! 10%! of! those! in! a! managed! camp! had! similar! experiences! may! highlight! the!importance! of! camp! management! agencies! in! preventing! SGBV,! especially! given! that! 50%! of! camps!remained!unmanaged!in!January!2011.651!In!addition,!some!sources!have!highlighted!the!impact!of!cash`for`work!interventions!designed!to!provide!income!assistance!for!IDPs!on!SGBV!prevalence.!In!cash`for`work!interventions,!money!is!typically!placed!in!men’s!hands,!thus!leaving!female!IDPs!in!a!vulnerable!state,!and!contributing!to!“survival!sex”!and!prostitution.652!!Lack!of!access!to!basic!needs!(including!work,!food,!etc.)!following!the!earthquake,!has!raised!concerns!among!many!non`governmental!organizations!(NGOs)!that!survivors,!especially!women!and!girls,!were!resorting! to! negative! coping! strategies,! such! as! transactional! sex,! to! fulfill! their! needs.653! The! Haitian!Government’s! Post`Disaster! Needs! Assessment! (PDNA)! shows! these! concerns! to! be! well`founded.654!Though! prevalence! estimates! are! not! available,! many! young! women! have! reportedly! been! forced! to!negotiate! sexual! favors! in! order! to! access! food! and! shelter,! and! have! increasingly! used!“transactional/survival!sex”!since!the!earthquake.655,656,657!The!use!of!transactional!sex!was!reported!in!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!650 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!651 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!652 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!653 !IFRC,!Haiti&recovery&assessment:&Volume&1&–&Synthesis&report!(March!2010).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=jNS41RGePVg%3d&tabid=149&mid=1043!!654 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!655! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&1,!22!March!2010!(March!2010).!Available!at! http://haiti.cridlac.org/XML/eng/doc90885/doc90885`contenido.pdf!!656 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!96! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&all!15!focus!groups!conducted!during!UNHCR’s!January`March!2011!study!of!Port`au`Prince!IDP!camps.!Women!were!found!to!have!engaged!in!transactional!sex!to!meet!their!own!needs,!as!well!as!those!of!their!children!and!household,!especially!in!cases!of!food!scarcity.!Of!the!women!who!reported!engaging!in!transactional!sex!in!2011,!none!reported!using!this!coping!strategy!prior!to!the!2010!earthquake,!and!all! expressed! distaste! for! what! they! were! doing.! The! UNHCR! noted! the! “harrowing”! context! of!transactional!sex!in!IDP!camps,!observing!that!“the!women!assessed!their!daily!needs!at!a!meager!10`25!Haitian! gourdes! (US$0.25! `! US$0.60)! per! day! —! a! far! cry! from! the! legal! minimum! daily! wage! of! 200!Haitian! gourdes! (US$5.000).”658! The! study! also! highlighted! the! failure! of! response! organizations! to!follow!best!practices!in!food!distribution!and!interventions!intended!to!broaden!access!—!and!how!this!failure! contributed! to! the! perpetuation! and! exacerbation! of! women! engaging! in! high`risk! practices! to!meet!their!basic!needs.659!!Within! the! female! population,! a! number! of! subgroups! can! be! identified! who! are! at! elevated! risk! of!SGBV.! These! include! female! child! domestic! servants,! street! children,! young! labor! migrants,! and!commercial! sex! workers.! Female! child! domestic! servants,! often! referred! to! by! the! pejorative! term,!“restavek,”! are! at! a! greater! risk! of! sexual! abuse! than! male! child! domestic! servants! and! the! general!female!population.!A!2006!Lancet!study!found!that!female!child!domestic!servants!were!4.5!times!more!likely!to!be!sexually!abused!than!other!girls.!They!further!deduced!that!1!in!every!19!female!restaveks!was!sexually!assaulted!each!year.!Ultimately,!female!child!domestic!servants!represented!“36.2%!of!all!sexual! assault! victims! and! 68.0%! of! child! victims! of! sexual! assault.”660! In! 2009,! the! UN! Special!Rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and!consequences,!found!that!of!the!70%!of!girl!domestic!servants!who!reported!some!form!of!abuse,!10`15%!reported!being!sexually!abused!by!the!head!of!household!or!other!children!in!the!family.661!The!U.S.!Labor!Department!has!also!noted!that!if!a!domestic!servant!becomes!pregnant,!she!is!typically!expelled!from!the!household.662!!There!is!a!widespread!perception!that!females!who!migrate!to!the!Dominican!Republic!in!search!of!work!will!become!prostitutes,!making!labor!migration!a!less!attractive!option!for!girls!than!boys!(See!Section!9B.&Child&labor&migration&to&the&Dominican&Republic).!While!only!a!small!proportion!of!girls!who!migrate!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!657 !UNHCR,!Driven&by&desperation:&Transactional&sex&as&a&survival&strategy&in&Port5au5Prince&IDP&camps!(May!2011).! Available!at!http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=w`7_7C8C` 2o%3d&tabid=81&mid=1413!!658 !UNHCR,!Driven&by&desperation:&Transactional&sex&as&a&survival&strategy&in&Port5au5Prince&IDP&camps!(May!2011).! Available!at!http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=w`7_7C8C` 2o%3d&tabid=81&mid=1413!!659 !UNHCR,!Driven&by&desperation:&Transactional&sex&as&a&survival&strategy&in&Port5au5Prince&IDP&camps!(May!2011).! Available!at!http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=w`7_7C8C` 2o%3d&tabid=81&mid=1413!!660 !A.!R.!Kolbe!and!R.!A.!Hutson,!“Human!rights!abuse!and!other!criminal!violations!in!Port`au`Prince,!Haiti:!a! random!survey!of!households,”!The&Lancet!368!(2006),!pp.!864`873.!661! UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!662 !U.S.!Department!of!Labor,!Haiti,!Bureau!of!International!Labor!Affairs!(2011).!Available!at! http://www.dol.gov/ilab/media/reports/iclp/Advancing1/html/haiti.htm!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 97!
    • !to!the!Dominican!Republic!work!as!prostitutes,!a!number!of!factors!aggregate!to!increase!their!risk!of!SGBV.!First,!young!female!labor!migrants!generally!work!“hidden”!as!servants!in!Dominican!households,!making! them! more! vulnerable! than! male! migrants! who! work! in! construction,! on! plantations,! and! in!other!more!visible!contexts.!Second,!many!migrant!girls!are!forced!to!perform!sexual!acts!in!exchange!for!“favors”!that!allow!them!to!find!work.!Finally,!when!crossing!the!frontier!to!the!Dominican!Republic,!Haitian!girls!risk!sexual!violence!from!armed!authorities!and!bandits.663!While!no!reliable!estimates!exist!on!the!extent!of!prostitution!and!sexual!violence!against!young!female!Haitian!labor!migrants,!the!threat!of! abuse! and! the! social! stigma! associated! with! female! migration! mean! that! far! fewer! girls! than! boys!migrate!to!the!Dominican!Republic.664!!No!estimates!exist!on!the!number!of!child!commercial!sex!workers!in!Haiti!before!or!after!the!January!2010!earthquake.!Commercial!child!sexual!exploitation!is!one!of!the!most!heinous!forms!of!child!labor,!and!is!defined!as!the!sexual!abuse!of!a!child!by!an!adult!in!exchange!for!pay!or!access!to!services.665!A!2003!study!by!ILO`IPEC!found!that!most!Haitian!child!commercial!sex!workers!were!between!ages!13`17,!with!some!as!young!as!9!or!10!years!old.666!The!rise!in!transactional!sex!in!exchange!for!food,!shelter,!and!other!basic!amenities!is!of!particular!concern!in!the!attempt!to!guarantee!child!protection!following!the!earthquake.667,668!!As! with! other! population! sub`groups,! there! is! very! little! information! on! the! extent! of! sexual! abuse!against!street!children.!Due!to!the!methodological!challenges!and!the!hidden!nature!of!this!population,!those! estimates! that! do! exist! may! be! unreliable.! However,! a! 2003! survey! by! the! Center! for! Popular!Education! uncovered! a! dire! situation! for! Haiti’s! female! street! children,! with! 70%! reporting! sexual!violence! over! their! lifetimes.669! Unfortunately,! the! impact! of! the! January! 2010! earthquake! on! this!population’s!vulnerability!remains!unknown.!!!SGBV! in! Haiti! occurs! against! a! backdrop! of! widespread! tolerance! for! and! justification! of! such! abuse.!According!to!the!EMMUS!IV!survey!of!2005`06,!35.8%!of!female!youth!(ages!15`24)!believed!that!wife!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!663! H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!!664! H.!Lunde,!Young&Haitian&labour&migrants:&Risks&and&opportunities&in&Haiti&and&the&Dominican&Republic,!Fafo! Report!2010:!24!(2010).!Available!at!http://www.fafo.no/pub/rapp/20168/20168.pdf!!665! UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!666 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm!667 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!668 !Center!for!Human!Rights!and!Global!Justice,!Sexual&violence&in&Haiti’s&IDP&camps:&Results&of&a&household&study,! New!York!University!School!of!Law!(March!2011).!Available!at! http://haiti.humanitarianresponse.info/Portals/0/Child%20Protection/studies%20reseaches%20evaluation%20b ooks/Haiti%20Sexual%20Violence%20March%202011.pdf!!669! OMCT,!Rights&of&the&child&in&Haiti!(October!2002).!Available!at! http://www.omct.org/files/2001/11/1155/haitichildren2002.pdf!98! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&beating!was!justified!under!at!least!one!condition!(Figure!53).670!The!two!most!common!reasons!used!to!justify!violence!against!a!spouse,!according!to!surveyed!female!youths,!were!“if!wife!goes!out!without!husband”!(25.2%)!and!“if!wife!neglects!kids”!(25.8%).!Rural!respondents!were!more!likely!to!report!that!wife! beating! was! justified! across! all! conditions,! although! there! were! significant! differences! between!Departments.671!A!2004!survey!by!the!Haitian!Government!revealed!a!similarly!troubling!situation,!with!80%! of! men! believing! that! violence! against! a! woman! is! purely! a! family! matter,! with! a! significant!proportion!believing!that!domestic!violence!was!justified!in!some!cases.672!!Figure.53:.Female.attitudes.toward.domestic.violence,.by.condition,.Department.and.urban/rural.status,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!670! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!671! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!672! K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).! ©!2012!FXB!Center!for!Health!and!Human!Rights! 99!
    • !!!A!number!of!pre`!and!post`earthquake!factors!have!been!found!to!increase!the!risk!of!SGBV!for!Haitian!children.! Analyses! conducted! prior! to! the! 2010! earthquake! found! that! age! discrepancies! between!partners! placed! young! girls! at! higher! risk! of! sexual! and! domestic! violence,! decreasing! their! ability! to!negotiate! safe,! protected,! voluntary! sexual! relations.673! Internalization! of! gender! relations! has! also!meant! that! children! who! have! witnessed! sexual! and/or! gender`based! violence! in! their! household! are!more!likely!to!accept!or!practice!violence!within!their!own!relationships.!This!phenomenon!results!in!the!inter`generational! perpetuation! of! abuse674,675! and! is! particularly! concerning! given! that! 20%! of!households!with!a!child!in!primary!school!reported!that!the!wife!had!been!beaten!in!front!of!the!child.676!Pre`earthquake!risk!factors!also!included!neighborhood`level!poverty!and!male!unemployment,!number!of! children,! female! acceptance! of! gender`based! violence,677! length! of! time! in! the! relationship,678! and!sense! of! security! at! home.679! Women’s! economic! independence! and! self`reported! relationship! quality!were!identified!as!two!protective!factors!for!SGBV.680!!Sexual! and! gender`based! violence! entails! a! multitude! of! adverse! outcomes,! especially! for! children.!Principally,! children! who! experience! sexual! violence! in! Haiti! are! more! likely! to! become! pregnant! or! to!contract! sexually! transmitted! diseases,! and! are! at! greater! risk! of! these! outcomes! than! the! adult!population.681,682,683,684,685!Furthermore,!sexually!abused!children!are!more!likely!to!drop!out!of!school!or!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!673 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!674! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!675! A.!J.!Gage,!“Women’s!experience!of!intimate!partner!violence!in!Haiti,”!Social&Science&&&Medicine!61/2!(2005),! pp.!343`364.!676 !M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!677! A.!J.!Gage,!“Women’s!experience!of!intimate!partner!violence!in!Haiti,”!Social&Science&&&Medicine!61/2!(2005),! pp.!343`364.!678! M.!C.!Smith!Fawzi,!W.!Lambert,!J.!M.!Singler,!et!al.,!"Factors!associated!with!forced!sex!among!women!accessing! health!services!in!rural!Haiti:!Implications!for!the!prevention!of!HIV!infection!and!other!sexually!transmitted! diseases,"!Social&Science&&&Medicine!60/4!(2005),!pp.!679`689.!679 !M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!680! A.!J.!Gage,!“Women’s!experience!of!intimate!partner!violence!in!Haiti,”!Social&Science&&&Medicine!61/2!(2005),! pp.!343`364.!681 !A.!M.!Gomez,!I.!S.!Speizer,!and!H.!Beauvais,!“Sexual!violence!and!reproductive!health!among!youth!in!Port`au` Prince,!Haiti,”!Journal&of&Adolescent&Health!44!(2000),!pp.!508`510.!682! OMCT,!Rights&of&the&child&in&Haiti!(October!2002).!Available!at! http://www.omct.org/files/2001/11/1155/haitichildren2002.pdf!683! UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!684! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!100! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&endure!physical!injury.686,687!SGBV!can!also!have!a!serious!impact!on!children’s!mental!and!psychosocial!development! and! functioning.! Many! withdraw! from! daily! activities,! become! less! able! to! deal! with!stressful!situations,!and!exhibit!self`destructive!behavior.688,689!Effective!interventions!to!alleviate!abuse!risk! factors! and! mitigate! negative! outcomes! should! therefore! be! a! priority! for! child! protection! actors!and!a!key!component!of!inter`sectoral!planning.!!Victims! of! sexual! and! gender`based! violence! require! timely! access! to! justice,! legal,! medical! and!psychosocial! services.! Even! prior! to! the! earthquake,! however,! the! Haitian! Government! lacked! the!capacity! to! effectively! prevent! and! respond! to! SGBV.! Thus,! victims! have! historically! lacked! access! to!medical!and!psychosocial!services!and!have!been!unable!to!receive!necessary!interventions.690!Access!is!also! limited! by! social! stigma! surrounding! SGBV! victims,! even! though! a! large! proportion! of! the! female!population!has!experienced!abuse.691!Responding!to!SGBV!requires!a!continuum!of!care.!Even!following!the! rapid! post`earthquake! influx! of! medical! response! organizations,! which! were! capable! of! providing!services!for!the!clinical!management!of!cases,!few!post`clinical!referral!options!were!available.!After!the!earthquake,!moreover,!there!were!few!mental!and!psychosocial!support!operations,!and!the!shortage!of!legal!support!further!limited!victims’!access!to!justice!mechanisms.!Organizations!such!as!Kay!Fanm!and!SOFA!that!were!providing!services!to!victims!before!the!earthquake!have!been!overwhelmed,!and!lack!of! funding! and! capacity! constraints! limit! their! ability! to! respond! to! the! magnitude! of! the! post`earthquake!need.692!!In! addition,! access! to! and! utilization! of! existing! services! remains! extremely! low! in! Haiti.! In! 2002,! the!World!Bank!found!that!66%!of!SGBV!victims!never!reported!their!attacks!to!the!authorities,!even!though!79%! of! victims! could! identify! the! perpetrator.693! This! finding! was! concordant! with! a! range! of! studies!showing! that! the! vast! majority! of! cases! are! not! reported,! thus! complicating! efforts! to! combat!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!685 !M.!J.!Small,!J.!Gupta,!R.!Frederic,!et!al.,!“Intimate!partner!and!nonpartner!violence!against!pregnant!women!in! rural!Haiti,”!International&Journal&of&Gynecology&and&Obstetrics!102!(2008),!pp.!226`231.!686! UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!687! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!688 !M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!689! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!690! UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!691! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!692! K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!693 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 101!
    • !perpetrator! impunity,! deliver! justice,! and! gain! restitution.694,695! As! noted! earlier,! available! evidence!suggests! that! the! incidence! of! sexual! and! gender`based! violence! has! increased! since! the! 2010!earthquake.!Some!sources!suggest!that!this!may!be!due,!in!part,!to!increased!reporting!of!SGBV!cases,!given! the! improved! availability! of! reporting! systems! and! a! rise! in! public! education! campaigns! urging!victims!to!come!forward.696!However,!despite!the!influx!of!medical!services!to!Haiti!in!2010,!most!victims!did!not!seek!out!care!because!they!were!unaware!that!services!were!free,!they!were!unable!to!pay!for!transportation! to! treatment! centers,! and/or! because! they! feared! retaliation.697! Many! victims! have!remained!unwilling!or!unable!to!report!crimes!because!perpetrators!live!in!the!same!camp!or!in!nearby!areas.!Victims!regard!reporting!violations!to!police!and!other!authorities!as!futile,!due!to!lack!of!police!follow`up!and!the!de&facto!requirement!that!victims!identify!the!perpetrator.698,699!!In!the!past!seven!years,!two!landmark!reforms!were!adopted!in!response!to!international!concern!over!the! inadequacy! of! sexual! violence! legislation.700,701! A! Presidential! Decree! was! issued! in! 2005! that!reclassified!rape!as!a!criminal,!rather!than!a!moral,!offense.702,703!As!a!result,!the!maximum!punishment!for!rape!increased!from!two!years!to!15!years!of!forced!labor,!with!the!possibility!of!life!if!the!victim!is!younger!than!16.704!Further,!Haiti!ratified!ILO!Convention!182!on!the!worst!forms!of!child!labor,!and!in!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!694! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!695 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!696 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!697 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape! (July!2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!698 !Institute!for!Justice!&!Democracy!in!Haiti,!Our&bodies&are&still&trembling:&Haitian&women’s&fight&against&rape! (July!2010).!Available!at!http://ijdh.org/wordpress/wp`content/uploads/2010/07/Haiti`GBV`Report`Final` Compressed.pdf!!699! Amnesty!International,!Haiti:&After&the&quake,!Initial!Mission!Findings!(March!2010).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2010/en/d12e3cdc`2103`40b8`af57` 1412dcf3d413/amr360042010en.pdf!700! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!701! UN!Committee!on!the!Rights!of!the!Child,!Concluding!observations:!Haiti,!UN!Doc.!CRC/C/15/Add.202!(2003).! Available!at!http://www.unhcr.org/refworld/docid/3f2597274.html!!702! Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!703! K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!704! Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!102! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&2007! the! Ministry! of! Social! Affairs! introduced! the! National! Plan! for! the! Protection! of! Vulnerable!Children.705!!Child! protection! advocates! assert! that! the! full! implementation! of! the! National! Plan! and! provisions! of!Convention!182!would!significantly!contribute!to!addressing!SGBV!in!Haiti.!However,!State!institutions!charged! with! the! implementation! of! these! reforms,! including! those! in! the! justice! sector,! were,! and!remain,! insufficiently! supported! to! meet! policy! objectives.706,707! As! of! March! 2010,! operational! police!stations!lacked!facilities!allowing!victims!to!report!abuses!safely!and!confidentially.708!Despite!the!2005!Presidential!Decree,!which!reclassified!rape!as!a!criminal!offence,!very!few!trials!for!rape!offenders!had!taken!place!as!of!2008,!and!prosecution!rates!for!sexual!violence!remained!extremely!low,!reinforcing!women’s!reticence!to!report!violations.709!In!its!2010!Post`Disaster!Action!Plan,!the!Haitian!Government!recognized!the!importance!of!implementing!measures!to!prevent,!support!the!victims!of,!and!punish!the!perpetrators! of! SGBV,710! although! it! remains! unclear! whether! this! commitment! will! be! backed! by!requisite!investment!and!implementation.!!The!absence!of!reliable!and!comprehensive!estimates!regarding!the!current!extent!of!SGBV!risk!factors!and!outcomes!amongst!Haiti’s!children!inhibits!efforts!to!respond!effectively!to!the!needs!of!victims!and!stymies! the! success! of! post`earthquake! recovery! strategies! implemented! by! state! and! non`state!actors.711,712,713,714,715,716! In! 2008,! Amnesty! International! noted! that! no! unified! mechanism! existed! for!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!705! Amnesty!International,!Overcoming&poverty&and&abuse:&Protecting&girls&in&domestic&service&in&Haiti!(November! 2009).!Available!at!http://www.amnesty.org/en/library/info/AMR36/004/2009!!706! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!707! Amnesty!International,!Haiti:&After&the&quake,!Initial!Mission!Findings!(March!2010).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2010/en/d12e3cdc`2103`40b8`af57` 1412dcf3d413/amr360042010en.pdf!708! Amnesty!International,!Haiti:&After&the&quake,!Initial!Mission!Findings!(March!2010).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2010/en/d12e3cdc`2103`40b8`af57` 1412dcf3d413/amr360042010en.pdf!709 !Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!710 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!711 !Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!712! UN!Committee!on!the!Rights!of!the!Child,!Concluding!observations:!Haiti,!UN!Doc.!CRC/C/15/Add.202!(2003).! Available!at!http://www.unhcr.org/refworld/docid/3f2597274.html!!713! OMCT,!Rights&of&the&child&in&Haiti!(October!2002).!Available!at! http://www.omct.org/files/2001/11/1155/haitichildren2002.pdf!!714! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 103!
    • !collecting!and!analyzing!information!on!SGBV!in!Haiti.!As!a!result,!analyses!are!generally!conducted!on!the! basis! of! ad& hoc! reports! by! NGO! service! providers.717! In! light! of! this! shortcoming! and! with! a! view!towards!creating!better!SGBV!policy!and!programming!in!Haiti,!the!UN!Committee!on!the!Rights!of!the!Child! recommended! that! the! Haitian! government! establish! mechanisms! for! the! comprehensive!collection!and!analysis!of!information!relating!to!SGBV.718!At!the!time!of!writing,!the!continuing!absence!of! these! mechanisms! hampers! the! ability! of! the! Haitian! Government! and! other! responders! to!implement!evidence`based!strategies!to!prevent,!respond!to,!and!punish!perpetrators!of!SGBV.!!!D.&Children&without&parental&care&!This! section! and! the! one! that! follows! will! consider! the! situation! of! children! who! are! separated,!unaccompanied,! orphaned,! and/or! living! in! single`parent! households,! as! well! as! the! risks! faced! and!coping!strategies!employed!by!these!children!both!before!and!after!the!January!2010!earthquake.!The!response! activities! implemented! by! domestic! and! international! actors! also! will! be! examined! in! this!section.!!!Children! without! parental! care! are! among! the! most! vulnerable! in! society! due! to! the! absence! of!alternative! coping! strategies! and! social! support! networks! that! provide! an! adequate! substitute! for!familial!care.!Article!29(a)!of!UN!General!Assembly!Resolution!64/142!(February!2010)!defines!children!without! parental! care! as! “all! children! not! in! the! overnight! care! of! at! least! one! of! their! parents,! for!whatever! reason! and! under! whatever! circumstances,”719! which! is! intended! to! exclude! those! children!living!with!one!parent.!However,!this!Report!will!use!the!term!as!it!is!often!operationally!interpreted!by!UNICEF!and!others!as!children!not!living!with!both!parents,!as!can!be!the!case!with!orphans,!rather!than!those!not!living!with!either!parent.720!!!Several!subcategories!of!children!without!parental!care!can!be!differentiated:!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!715 !K.!Tong!and!F.!Gaillardin,!Adolescent&sexual&and&reproductive&health&assessment&mission&to&PLAN,&Haiti!(July! 2010).!716 !Amnesty!International,!Overcoming&poverty&and&abuse:&Protecting&girls&in&domestic&service&in&Haiti!(November! 2009).!Available!at!http://www.amnesty.org/en/library/info/AMR36/004/2009!!717! Amnesty!International,!Don’t&turn&your&back&on&girls:&Sexual&violence&against&girls&in&Haiti!(2008).!Available!at! http://www.amnesty.org/en/library/asset/AMR36/004/2008/en/f8487127`b1a5`11dd`86b0` 2b2f60629879/amr360042008eng.pdf!718! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!719! Guidelines!for!the!Alternative!Care!of!Children,!G.!A.!Res.!64/142!(2010).!Available!at! http://www.unicef.org/protection/alternative_care_Guidelines`English.pdf!!720 !UNICEF,!Child&Protection&Information&Sheet:&Children&without&parental&care!(May!2006).!Available!at! http://www.unicef.org/chinese/protection/files/Parental_Care.pdf!104! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection& • Children&in&single5parent&households:&children!in!a!household!in!which!one!legal!parent!cares!for! them!without!the!assistance!of!another!legal!parent.! • Orphan&children:&children!for!whom!at!least!one!parent!is!known!to!be!deceased.721! • Separated& children:! children! separated! from! both! parents,! or! from! their! previous! legal! or! customary! primary! caregiver,! but! not! necessarily! from! other! relatives.! These! may,! therefore,! include!children!accompanied!by!other!adult!family!members.722! • Unaccompanied& children:& children! who! have! been! separated! from! both! parents! and! other! relatives!and!are!not!being!cared!for!by!an!adult!who,!by!law!or!custom,!is!responsible!for!doing! so.723!!UNICEF! categorizes! children! of! each! group! as! “vulnerable! children”.724,725! It! is! important! to! note! that!these! categories! are! not! mutually! exclusive,! as! orphan! children! may! be! living! in! a! single`parent!household,! or! may! be! separated! or! unaccompanied.! Additionally,! all! unaccompanied! children! are,! by!definition,!separated!children.!!The!EMMUS!II,!III,!and!IV!surveys,!conducted!in!1994/95,!2000,!and!2005/06,!respectively,!provide!the!most!comprehensive!estimates!of!orphans!and!resident!parents!in!households!that!include!children.!In!the!1994/95!EMMUS!II!study,!it!was!estimated!that!11%!of!children!under!age!15!were!orphans,!having!lost!one!or!both!parents.726!In!1995,!the!U.S.!Census!Bureau!estimated!a!higher!proportion,!stating!that!15.5%! of! all! Haitian! children! under! age! 15! had! lost! at! least! one! parent,! with! 9.3%! lacking! a! surviving!father,! and! 6.2%! having! lost! either! their! mother! only! or! both! parents.727! However,! only! half! of! all!children!under!age!15!were!living!in!a!household!with!both!biological!parents!at!the!time!of!the!EMMUS!II!survey.!This!indicated!that!a!significant!proportion!of!those!whose!mothers!and!fathers!were!still!alive!were! also! living! in! a! household! with! only! one! or! neither! of! their! parents.728! Of! children! living! with!neither! or! only! one! parent,! the! EMMUS! II! survey! found! that! 82%! had! two! surviving! parents.729! As! a!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!721 !UNICEF,!Orphans!(February!2009).!Available!at!http://www.unicef.org/media/media_45279.html!!722! ICRC,!Inter5agency&guiding&principles&on&unaccompanied&and&separated&children!(January!2004).!Available!at! http://www.ecdgroup.com/docs/lib_004784237.pdf!!723! ICRC,!Inter5agency&guiding&principles&on&unaccompanied&and&separated&children!(January!2004).!Available!at! http://www.ecdgroup.com/docs/lib_004784237.pdf!!724! Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of&services& survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!725! ICRC,!Inter5agency&guiding&principles&on&unaccompanied&and&separated&children!(January!2004).!Available!at! http://www.ecdgroup.com/docs/lib_004784237.pdf!!726! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!727! Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!728! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!729! Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 105!
    • !result,!it!can!be!inferred!that,!a!significant!proportion!of!children!who!were!not!orphans!were!separated!and!unaccompanied.!!The!EMMUS!III!survey!in!2000!found!a!similar!proportion!of!children!living!without!both!parents!in!the!household.! Haiti`wide,! it! was! found! that! 51%! of! children! under!age! 15! did! not! live! with! both! parents,!and!that!17%!lived!with!neither!parent,!with!the!remaining!32%!living!in!a!single`parent!household.!The!proportion!of!children!not!living!with!both!parents!was!higher!in!Port`au`Prince,!where!61%!of!children!were! living! with! only! one! or! neither! parent.! Of! children! in! the! metropolitan! area,! approximately! 35%!lived!only!with!their!mother,!8%!only!with!their!father,!and!17%!with!neither!parent!(Figure!54).730!The!U.S.! Census! Bureau! estimated! that,! countrywide,! 13.2%! of! all! children! had! lost! one! or! both! parents,!7.3%!having!lost!their!father,!and!5.9%!having!lost!either!their!mother!only!or!both!parents.731!It!should!be! noted! that! this! proportion! is! lower! than! estimates! for! 1995,! perhaps! due! to! the! aging! of! the! 1995!child!cohort!coupled!with!a!decrease!in!civic!violence!and!a!concomitant!decrease!in!parental!death!for!the!2000!child!cohort!in.!!Figure.54:.Parental.residence.in.household,.Haiti.and.PortTauTPrince.metropolitan.area,.2000. Living.with.one.or. Living.with. Living.with. Living.with.neither. neither.parent. mother. father. parent. Metropolitan. Metropolitan. Metropolitan. Metropolitan. Haiti. Haiti. area. area. area. area. 51%! 61%! 35%! 8%! 17%! 17%!Data!source:!World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!!!!By! 2006,! the! proportion! of! children! living! with! both! parents! had! fallen! again.! The! EMMUS! IV! survey!found! that! 60%! of! Haitian! children! aged! 10`14! did! not! live! in! a! household! with! both! parents,732,733!although! this! proportion! was! slightly! lower! (55%)! for! all! children! under! age! 18.734! The! proportion! of!children! living! with! both! parents! was! higher! in! rural! areas! (47%)! than! in! urban! areas! (28%).!Approximately!27%!of!all!Haitian!children!lived!only!with!their!mother!in!2006,!with!a!slight!difference!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!730! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!731! Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!732 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!733! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!734! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!106! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&between!urban!(31%)!and!rural!(25%)!areas.!Conversely,!7%!of!all!children!in!Haiti!lived!with!only!their!father,!with!a!slightly!higher!proportion!in!rural!areas!(7.5%)!compared!to!urban!areas!(6.8%).!Country`wide,! roughly! 25%! of! Haitian! children! lived! with! neither! parent! in! 2006,! with! children! in! urban! areas!experiencing! a! higher! likelihood! of! living! with! neither! parent! (34%)! than! their! rural! counterparts!(20%).735,736!!In! addition! to! disparities! according! to! urban/rural! status,! the! EMMUS! IV! survey! found! significant!differences!in!the!probability!of!living!with!both,!either,!or!neither!parent/s!on!the!basis!of!child!gender!(Figure!55!and!Figure!56).!In!urban!areas,!boys!aged!10`14!were!almost!50%!more!likely!to!be!living!with!both!parents!and!27%!more!likely!to!be!living!with!only!their!mother!than!urban!girls,!while!they!were!only! 61%! as! likely! to! be! living! with! neither! parent.! In! rural! areas,! differences! according! to! the! child’s!gender!were!not!as!significant,!but!boys!remained!less!likely!to!be!living!with!neither!parent!than!girls.737!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!735 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!736! M.!Justesen!and!D.!Verner,!Factors&impacting&youth&development&in&Haiti,!World!Bank!policy!research!working! paper!No.!4110!(2007).!Available!at!http://ddp`ext.worldbank.org/EdStats/HTIprwp07.pdf!!737 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 107!
    • !Figure.55:.Parental.residence.in.household,.by.region,.urban/rural.status,.and.childs.gender,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!A! number! of! studies! have! found! that,! in! Haiti,! the! gender! of! a! single! head! of! household! affects! their!children’s! enjoyment! of! rights.! In! 2001,! Family! Health! International! found! that! households! headed! by!women!tended!to!be!poorer!than!those!headed!by!men.738!This!finding!was!supported!by!a!subsequent!World! Bank! analysis,! using! data! from! a! 2001! survey,! which! found! that! female`headed! households! in!rural! Haiti! were! 11%! more! likely! to! be! deemed! “poor”! than! those! headed! by! men.739! The! Population!Council! suggested! that! lower! incomes,! lack! of! social! power,! and! a! dearth! of! protections! afforded! to!single!mothers!in!Haitian!society!might!contribute!to!greater!risks!for!their!children.740!However,!while!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!738! Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!739! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!740! Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!108! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&these! analyses! found! indirect! associations! between! female`headed! households! and! children’s!enjoyment! of! their! rights,! a! 1996! study! by! Devin! and! Erickson! showed! that! children! in! male`headed!households! were! more! likely! to! experience! certain! poor! outcome! measures! than! children! in! female`headed!households.!In!particular,!they!found!that!children!in!male`headed!households!were!more!likely!to!be!malnourished!than!children!with!a!female!caregiver.!The!authors!hypothesized!that!this!could!be!a!result! of! the! men’s! relative! lack! of! nutritional! awareness,! as! well! as! a! higher! propensity! to! leave! the!house! and! any! young! children! therein! in! the! care! of! older! siblings.! In! the! absence! of! grandmothers,!older! daughters,! or! other! female! relatives! who! could! care! for! younger! children,! men! were! generally!perceived!as!the!caregivers!of!last!resort,!as!children!in!male`headed!households!were!thought!to!be!at!greater!risk.741!!Figure.56:.Parental.residence.in.household,.by.urban/rural.status,.and.childs.gender,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!Fewer!data!exist!on!the!prevalence!of!orphan!children!in!Haiti!than!on!the!status!of!parental!residence!with! children.! The! EMMUS! IV! survey! again! provided! the! most! robust! estimate! of! the! proportion! of!children!who!experienced!the!death!of!one!or!both!parents!prior!to!the!2010!earthquake.!In!2005`6,!the!survey! estimated! that! 11%! of! all! Haitian! children! had! lost! at! least! one! parent,! and! that! 1.3%! of! all!Haitian! children! had! no! surviving! parents.742,743,744! A! larger! proportion! of! urban! children! were! orphans!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!741 !R.!B.!Devin!and!P.!I!Erickson,!“The!influence!of!male!care!givers!on!child!health!in!rural!Haiti,”!Social&Science&&& Medicine!43/4!(1996),!pp.!479`488.!742! Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of&services& survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!743! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 109!
    • !(13%)!than!rural!children!(10%),!potentially!as!a!result!of!urban`focused!civil!unrest!prior!to!the!survey!period.745!Small!differences!were!observed!according!to!the!child’s!gender!(Figure!57).746!!Figure.57:.Parental.survival.among.children.aged.10T14,.by.gender.and.urban/rural.status,.2006. !Source:!Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!!!The!January!2010!earthquake!undoubtedly!had!a!profound!impact!on!the!proportion!and!composition!of!children! without! parental! care! in! Haiti.! As! there! have! been! no! nationally! representative! surveys!assessing! children’s! living! situation! since! the! earthquake,! deriving! estimates! that! are! methodologically!comparable!to!the!set!of!EMMUS!surveys!is!impossible.!However,!the!perspective!is!widely!shared!that!the! proportion! of! children! living! in! households! with! only! one! or! neither! parent! has! increased,747!especially!given!that!one!in!five!families!in!earthquake`affected!areas!experienced!the!death!of!at!least!one! family! member.748! This! perspective! is! in! keeping! with! findings! made! in! other! contexts! that! large`!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!744 !UN!DESA,!The&millennium&development&goals&report&2009!(New!York,!July!2009).!Available!at! http://www.un.org/en/development/desa/news/statistics/mdg`2009.shtml!!745! Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of&services& survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!746 !Population!Council/UNFPA,!The&adolescent&experience&in5depth:&Using&data&to&identify&and&reach&the&most& vulnerable&young&people:&Haiti&2005/06!(2009).!Available!at! http://www.unfpa.org/youth/docs/AdolescentDataGuide_Haiti2005`06.pdf!!747! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!748 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!110! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&scale! disasters! often! lead! to! family! separation,! as! family! members! cannot! as! easily! trace! and!communicate!with!one!another.!After!the!earthquake!many!children!were!sent!to!live!with!friends!and!family! members! outside! of! earthquake`affected! areas.749,750,751! Additionally,! the! practices! of! sending!children! to! become! domestic! servants! and! of! placing! children! in! orphanages! as! a! response! to!poverty,!rather!than!parental!death,!was!likely!to!have!intensified!following!the!earthquake!due!to!the!suspension! of! economic! opportunities! and! the! dissolution! of! prior! livelihood! strategies.752! These! two!motivations! are! discussed! further! in! Sections! 9A.& Children& in& domestic& service& and& servitude! and! 5D.i.&Orphanages&and&other&private&institutions,!respectively.!!Due!to!the!progressive!registration!of!additional!separated!and!unaccompanied!children;!the!continuing!flow!of!children!between!family!members,!friends,!and!institutions;!the!confidentiality!of!the!UN!Child!Protection!Sub`Cluster!database!of!registered!separated!and!unaccompanied!minors;!and!the!absence!of!a!nationally!representative!survey!enumerating!vulnerable!children,!estimates!of!the!total!number!of!children!without!parental!care!vary!by!time!periods,!sources,!and!assessment!areas.!In!February!2010,!the! U.S.! Centers! for! Disease! Control! and! Prevention! stated! that! 27`49%! of! sites! surveyed! by! the! UN!Initial! Rapid! Assessment! reported! the! presence! of! unaccompanied! children.753! In! March! 2010,! a! rapid!assessment!conducted!by!World!Vision!across!60!sites!in!Port`au`Prince!and!four!of!the!organization’s!operational!regions!found!that!community!leaders!reported!approximately!2,280!separated!children!in!21! communities.! Of! those! children,! 168! were! identified! across! six! communities! in! La! Gonâve,! 1,678!across!seven!communities!in!Sud!Department,!134!across!six!communities!and!camps!in!Plateau!Central,!and!more!than!300!across!two!communities!in!the!Nord!Department.!Household!interviews!yielded!an!estimate! of! 1,545! children! separated! from! their! families! in! 20! surveyed! camps! and! communities.754! In!March! 2010,! the! Haitian! Government! stated! that! 103,000! cases! of! children! without! parental! care! had!been! identified! nationwide,755,756! while! by! July! 2011,! UNCEF! stated! that! 8,212! separated! and!unaccompanied! children! had! been! registered.757! It! is! unclear! what! proportions! of! these! children! were!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!749! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!750 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!751! ICRC,!Inter5agency&guiding&principles&on&unaccompanied&and&separated&children!(January!2004).!Available!at! http://www.ecdgroup.com/docs/lib_004784237.pdf!!752! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!753! CDC,!CDC&summary&of&initial&rapid&assessment&conducted&by&UN&OCHA&in&Haiti!(February!2010).!754! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!755 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!756! ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!757 !Haiti!Child!Protection!Sub`Cluster,!Child&protection&sub5cluster&meeting&minutes:&28&July&2011!(July!2011).! Available!at!http://translate.google.com/translate?sl=auto&tl=en&js=n&prev=_t&hl=en&ie=UTF` 8&layout=2&eotf=1&u=http%3A%2F%2Fhaiti.humanitarianresponse.info%2FPortals%2F0%2FChild%2520Protect ion%2FMinutes%2FCPSC_Meeting_Sept22.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 111!
    • !considered! separated! and! unaccompanied! minors,! orphans,! children! in! or! of! the! street,! or! living! in! a!single`parent! household;! neither! is! it! evident! how! these! children! were! distributed! across! Haiti.! As! a!matter!of!urgency,!the!U.S.!Centers!for!Disease!Control!and!Prevention!has!stated!that!further!research!and!intervention!should!be!conducted!to!remedy!the!inadequacy!of!currently!available!information!on!children!without!parental!care.758!!Following!the!earthquake,!available!evidence!suggested!that!familial!and!friendship!networks!played!a!significant! role! in! responding! to! the! needs! of! many! children! without! parental! care.! Numerous! reports!cite!the!placement!of!vulnerable!children!with!extended!family!and!friends!outside!earthquake`affected!areas.759,760,761!These!placements!are!not!a!new!phenomenon,!having!commonly!been!used!as!a!strategy!to!spread!risk!and!meet!children’s!needs!even!prior!to!the!earthquake.762,763! At!the!time!of!the!1994/95!EMMUS!II!survey,!28%!of!urban!and!24%!of!rural!households!were!caring!for!foster!children,!with!most!of!those!children!constituting!part!of!the!household’s!extended!family.764!Many!children!not!placed!with!family!or!friends!were!sent!to!orphanages!in!the!hope!that!these!institutions!would!better!provide!for!the! child! than! did! their! former! household! (discussed! further! in! Section! 5D.i.& Orphanages& and& other&private& institutions).765,766,767,768! Many! children! today! also! live! without! parental! care! in! IDP! camps!established! following! the! 2010! earthquake.! World! Vision’s! March! 2010! rapid! assessment! found! that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!758! CDC,!CDC&summary&of&initial&rapid&assessment&conducted&by&UN&OCHA&in&Haiti!(February!2010).!759 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!760! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!761! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!762 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!763! S.!C.!Wortham,!“The!young!child!and!social!relationships!in!developing!countries,”!in:!M.!R.!Jalongo!(ed),! Enduring&bonds:&the&significance&of&interpersonal&relationships&in&young&children’s&lives!(Indiana:!Springer,!2007).!764 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!765 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!766 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!767 !M.!Loudon,!A&study&of&integrated&interventions&for&children&made&vulnerable&by&HIV/AIDS&in&Haiti:&A&case&study& of&La&Maison&l’Arc5en5Ciel,!UNAIDS/UNICEF!(2006).!Available!at!http://www.unicef.org/lac/Haiti_Case_Study` Children_made_Vulnerable_by_AIDS(1).pdf!!768 !Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!112! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&separated! and! unaccompanied! children’s! residences! in! camps! were! especially! prevalent! in! Plateau!Central,!compared!to!La!Gonâve!and!Nord!and!Sud!Departments.769!!In!general,!children!without!parental!care!face!greater!risk!of!discrimination,!physical!and!sexual!abuse,!exploitation,! lack! of! representation,! and! impaired! emotional! and! social! development.770! Children!without! parental! care! in! Haiti! face! heightened! risk! of! domestic! servitude,771! trafficking,772,773!abandonment,774! involvement! with! gang! activity! and! urban! violence,775! and! forced! prostitution.776!Smucker!et&al.!note!that!children!in!orphanages!may!be!vulnerable!to!sexual!abuse!by!staff.777!In!many!cases,!these!risks!were!present!before!the!2010!earthquake.!However,!the!magnitude!and!prevalence!of!threats! to! the! protection! of! children! without! parental! care! has! been! exacerbated! by! the! earthquake,!leaving! many! without! access! to! requisite! basic! services! or! support! systems.778,779! Additionally,! those!living!in!temporary!camps!or!precarious!dwellings!face!increased!vulnerability!from!flooding!and!other!environmentally! related! events.! This! further! increases! the! likelihood! of! secondary! displacement,!morbidity,!and!mortality!among!these!children.780!In!order!to!effectively!mitigate!these!risks,!response!and!reconstruction!efforts!must!be!buttressed!by!information!that!both!facilitates!the!effective!targeting!of!children!most!at!risk!and!enables!appropriate!assessment!of!the!impacts!of!these!risks!on!children’s!realization!of!their!rights.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!769! World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!770! UNICEF,!Child&protection&information&sheets!(May!2006).!Available!at! http://www.unicef.org/publications/files/Child_Protection_Information_Sheets.pdf!!771 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!772 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!773! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!774! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!775! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!776! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!777! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!778 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!779! ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!780! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 113!
    • !The! domestic! and! international! response! to! the! needs! of! Haitian! children! without! parental! care! has!been!subject!to!a!range!of!challenges,!including!a!lack!of!comprehensive!disaggregated!assessments,!the!inherently! hidden! nature! of! the! phenomenon,! lack! of! access,! and! the! devastation! massed! by! the!earthquake! on! already! insufficient! human! resources,! logistical! capacity,! and! physical! infrastructure.781!Prior! to! the! earthquake,! only! 5%! of! households! hosting! orphans! and! other! vulnerable! children! were!receiving! at! least! one! form! of! external! support.782! Two! flagship! initiatives! introduced! since! the!earthquake! have! attempted! to! respond! to! the! needs! of! these! children.! In! the! months! following! the!disaster,! UNICEF! directed! the! establishment! of! a! call! center! for! frontline! relief! workers! to! register!children! identified! as! separated! and! unaccompanied! minors.783! The! situation! of! these! children! is! then!evaluated! by! an! organization! responsible! for! the! child’s! geographical! region,! and! their! information! is!added! to! a! secure! database! that! is! used! to! trace! families.! By! July! 2011,! 8,212! separated! and!unaccompanied!children!had!been!registered.784!In!addition,!the!Haitian!Government!has!identified!as!a!priority! the! establishment! of! transit! centers! for! separated! and! unaccompanied! children! in! each!earthquake`affected! town.! These! transit! centers! help! to! trace! children’s! families! and! provide! basic!services!and!financial!assistance.785!Without!comprehensive!baseline!data,!it!is!unclear!how!effectively!these!initiatives!have!addressed!the!enormity!of!need!created!in!the!wake!of!the!earthquake!for!Haiti’s!children!without!parental!care.!However,!the!successful!reunification!of!more!than!1,265!children!with!their!families!by!January!2011!is!cause!for!hope.!!!i..Orphanages.and.other.private.institutions.!Despite!prominence!in!international!media!reports!following!the!2010!earthquake,!the!issue!of!Haitian!children!living!in!orphanages!and!other!private!care!facilities!either!before!or!after!the!earthquake!has!received!relatively!little!assessment.!According!to!UNICEF,!approximately!50,000!children!were!living!in!roughly! 600! institutions! across! Haiti! prior! to! the! earthquake.786,787,788! Family! Health! International!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!781! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!782! Institut!Haitien!de!l’Enfance,!HIV/AIDS&in&Haiti:&Key&findings&of&the&mortality,&morbidity,&and&utilization&of&services& survey!(2006).!Available!at!http://www.measuredhs.com/pubs/pub_details.cfm?id=767&srchTp=home!783! UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!784! Haiti!Child!Protection!Sub`Cluster,!Child&protection&sub5cluster&meeting&minutes:&28&July&2011!(July!2011).! Available!at!http://translate.google.com/translate?sl=auto&tl=en&js=n&prev=_t&hl=en&ie=UTF` 8&layout=2&eotf=1&u=http%3A%2F%2Fhaiti.humanitarianresponse.info%2FPortals%2F0%2FChild%2520Protect ion%2FMinutes%2FCPSC_Meeting_Sept22.pdf!!785 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!786 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!787 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!114! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&estimated! that! between! 7`8%! of! all! vulnerable! children! were! housed! in! orphanages! or! other! private!organizations!in!2001,!although!they!also!noted!that!the!true!number!remains!unknown.789!The!capacity!of!the!Haitian!state!to!license,!regulate,!monitor!and!report!on!orphanages!is!extremely!limited,!and!the!absence!of!oversight!and!regulation!of!this!sector!has!made!it!difficult!to!estimate!precisely!the!number!of!children!living!in!orphanages,!as!well!as!the!number!of!orphanages,!themselves.!The!result!is!a!dearth!of! information! regarding! the! sector! and! the! need! for! further! enquiry! regarding! both! the! number! of!children!living!in!orphanages!in!Haiti!and!their!living!situations!within!these!care!facilities.!!The!government!department!responsible!for!the!oversight!of!this!sector,!the!Institute!for!Social!Welfare!and!Research!(Institut&du&Bien5être&Social&et&de&la&Recherché,&or!IBESR),!suffers!from!severely!constrained!human! and! financial! resources.! As! a! result,! few! orphanages! are! registered,! and! a! smaller! proportion!monitored,! ensuring! that! children’s! experiences! in! orphanages! are! a! largely! hidden! phenomena. 790!Officially,! private! orphanages! are! required! to! receive! a! license! from! IBESR! before! commencing!operations.!In!reality,!however,!the!proliferation!of!private!institutions!run!by!charitable!organizations,!operate!completely!outside!of!the!sphere!of!government!oversight.!IBESR!also!lacks!sufficient!absorptive!capacity!for!the!number!of!children!entrusted!to!its!care,!and!thus!refers!temporary!placement!of!these!children! to! private! facilities! until! they! can! be! returned! to! their! families! or! permanent! placement!arranged.791,792!!!Socioeconomic!and!livelihood!factors!play!a!significant!role!in!the!decision!to!place!a!child!in!institutional!care,!where!parents!often!believe!their!child!will!benefit!from!greater!access!to!education,!healthcare,!and!other!basic!needs.793,794,795,796!The!vast!majority!of!children!living!in!Haitian!orphanages!are!not!true!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!788 !UN!OCHA!Haiti,!Haiti&before&January&12th,!Internal!document!(2010).!Available!at! http://ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1165439!!789 !Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!790 !UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!791 !UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!792 !UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!793 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!794 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!795 !M.!Loudon,!A&study&of&integrated&interventions&for&children&made&vulnerable&by&HIV/AIDS&in&Haiti:&A&case&study& of&La&Maison&l’Arc5en5Ciel,!UNAIDS/UNICEF!(2006).!Available!at!http://www.unicef.org/lac/Haiti_Case_Study` Children_made_Vulnerable_by_AIDS(1).pdf!!796 !Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 115!
    • !orphans,! in! the! sense! that! they! have! lost! one! or! both! of! their! parents.797! Many! children! are! instead!placed!in!orphanages!in!what!is!seen!as!a!temporary!arrangement.!Often,!parents!continue!to!visit!these!children,!with!plans!to!remove!them!from!the!orphanage!once!the!family’s!situation!improves.!As!such,!these! facilities! are! viewed! in! a! manner! consistent! with! an! informal! and! time`limited! fosterage!arrangement,! underscoring! the! temporary! and! financial! motivation! for! their! children’s!placement.798,799,800,801!!!Children’s! placement! in! orphanages! carries! significant! developmental! risks,! which! must! be! weighed!against!expected!benefits!before!determining!whether!institutionalization!is!in!the!true!best!interests!of!the! child.! These! risks! include! sexual! assault,! which! Smucker& et& al.! found! to! be! significantly! more!common! among! children! in! Haitian! orphanages! than! those! living! with! their! families.802! Tolfree! neatly!summarizes!the!risks!faced!by!children!in!institutionalized!care!in!Haiti!as:!! …! the! segregation,! discrimination! and! isolation! that! institutionalised! children! often! experience;! the!fact!that!admission!is!often!based!on!the!needs!of!parents,!not!the!interests!of!children;!the! lack!of!personal!care!and!stimulation;!the!lack!of!opportunities!to!learn!about!the!roles!of!adults;! the! high! risk! of! institutional! abuse;! the! lack! of! attention! to! specific! psychological! needs;! and! finally,! reflecting! all! of! these! features,! the! fact! that! institutionalised! children! often! experience! 803 problems!in!adjusting!to!life!outside!of!the!institution. !!Several! promising! initiatives! were! undertaken! in! the! decade! before! the! earthquake! to! improve! the!quality! of! care! for! children! living! in! orphanages.! At! the! national! level,! the! Chambre! de! l’Enfance!Nécessiteuse!Haïtienne!(CENH)!was!established!to!register!orphanages!and!improve!the!quality!of!their!operation! through! management! training! and! accountability! mechanisms.! Supported! by! USAID,!orphanage! registration! was! conditional! upon! the! satisfaction! of! established! criteria.804! While! this!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!797 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!798 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!799 !UNICEF,!Progress&for&children&number&8:&A&report&card&on&child&protection!(September!2009).!Available!at! http://www.unicef.org/protection/files/Progress_for_Children`No.8_EN_081309(1).pdf!!800 !M.!Loudon,!A&study&of&integrated&interventions&for&children&made&vulnerable&by&HIV/AIDS&in&Haiti:&A&case&study& of&La&Maison&l’Arc5en5Ciel,!UNAIDS/UNICEF!(2006).!Available!at!http://www.unicef.org/lac/Haiti_Case_Study` Children_made_Vulnerable_by_AIDS(1).pdf!!801 !Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!802 !G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!803 !Cited!in:!M.!Loudon,!A&study&of&integrated&interventions&for&children&made&vulnerable&by&HIV/AIDS&in&Haiti:&A& case&study&of&La&Maison&l’Arc5en5Ciel,!UNAIDS/UNICEF!(2006).!Available!at! http://www.unicef.org/lac/Haiti_Case_Study`Children_made_Vulnerable_by_AIDS(1).pdf!!804 !Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!116! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&initiative!is!a!positive!step!towards!improving!the!lives!of!children!in!orphanages,!the!extent!of!its!impact!remains!unclear.!As!only!those!orphanages!meeting!the!established!criteria!are!registered,!it!can!be!said!that!management!training!and!accountability!mechanisms!were!only!established!for!those!orphanages!least!in!need;!meanwhile,!orphanages!that!did!not!meet!the!criteria!remained!hidden!due!to!a!lack!of!registration,!and!were!of!lower!quality!and!capacity!due!to!the!absence!of!training.!!Also! of! note! are! two! orphanages! that! have! provided! a! model! for! integrated! HIV/AIDS! orphan! care! in!Haiti.! Maison! LArc`en`Ciel,! in! Port`au`Prince,! provides! a! family`! and! community`based! system! of! care!for! HIV/AIDS! orphans,! and! provides! support! to! HIV`affected! families! in! surrounding! communities!through! counseling,! training,! and! food! aid.805! Similarly,! CHOAIDS! employs! HIV`positive! women! to! care!for! children! orphaned! by! HIV/AIDS! and! establish! a! family! support! environment.! Anecdotal! evidence!suggests! that! this! “mother”`child! relationship! benefits! both! parties,! as! the! children! are! reared! in! an!individualized,!supportive!atmosphere,!while!the!women!feel!trusted!and!empowered!as!caregivers!and!decision`makers.806!!Since! the! January! 2010! earthquake,! little! public! information! has! become! available! regarding! the!situation!of!children!living!in!Haitian!orphanages!and!other!private!care!institutions.!Children!from!many!orphanages! were! removed! from! Haiti! following! the! earthquake,! many! with! surviving! relatives,! as!governments! and! international! organizations! rushed! to! safeguard! children! from! potential! harm! (See!Section!4C.&Adoption).!By!July!2010,!the!United!Nations!had!recruited!forty!social!workers!to!investigate!orphanages!and!other!childcare!institutions!in!earthquake`affected!areas,807!while!International!Medical!Corps!planned!to!conduct!an!evaluation!of!200!orphanages!before!December!2010.!The!results!of!these!assessments!were!unavailable!at!the!time!of!this!writing.!!!!E.&Children&in&and&of&the&street&!For! analytical! and! programming! purposes,! it! is! necessary! to! differentiate! between! “children! in! the!street”! and! “children! of! the! street.”! Children! in! the! street! are! generally! considered! to! be! those! who!spend! some! or! all! of! their! time! living! and! sleeping! in! the! street,! but! do! have! families! or! households!where! they! spend! at! least! some! nights.! In! contrast,! children! of! the! street! are! those! who! spend! all! of!their! time! living! and! sleeping! in! the! street,! either! because! they! have! no! known! living! relatives! with!whom! to! stay,! because! they! choose! to! live! and! sleep! in! the! street,! and/or! because! their! current!situation! precludes! them! from! staying! with! their! families! or! in! other! households.! Several! studies!conducted! in! Haiti! have! noted! that! many! “street! children”! have! surviving! family! members! in! their!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!805 !Family!Health!International!(FHI),!The&situation&of&orphans&in&Haiti:&A&summary&assessment:&A&preliminary& assessment&of&orphans&and&vulnerable&children&with&a&focus&on&children&affected&by&HIV/AIDS!(2001).!Available!at! http://dspace.cigilibrary.org/jspui/handle/123456789/8649?mode=full!!806 !N.!Romera`Daza,!A.!Ruth,!and!M.!Denis`Luque,!“An!alternative!model!for!the!provision!of!Sservices!to!HIV` positive!orphans!in!Haiti,”!Journal&of&the&Health&Care&for&the&Poor&and&Underserved!20/4!(2009),!pp.!36`40.!807 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 117!
    • !current! area! of! residence! or! their! area! of! emigration.808,809,810! Some! of! these! children! may! be! better!described! as! children! in! the! street,! as! they! may! visit! and! stay! with! relatives,! often! bringing! money! or!gifts! home! with! them.811,812! As! such,! while! their! link! with! their! families! may! be! weak,! children! in! the!street! have! occasional! access! to! a! residence! where! they! may! sleep,! rather! than! lacking! any! type! of!residence!whatsoever.813!!Notably! in! Haiti,! many! street! children! define! themselves! as! “timoun& lari”! (children! of! the! street)! in!apposition!to!“timoun&lekol”!(children!in!school),!rather!than!“timoun&lakay”!(children!in!homes),!as!the!applicability! of! the! latter! is! negated! by! the! fact! that! many! street! children! have! surviving! families! that!they! occasionally! stay! with.814! Another! effect! of! this! choice! of! definitional! contrast! is! that! stigma!surrounding!living!in!the!streets!is!lower!in!rural!areas,!where!fewer!children!attend!school!in!general!than!in!urban!areas.815!Rather!than!where!they!live!and!work,!the!contrast!these!children!use!to!identify!themselves! also! suggests! that! lack! of! education! (with! education! being! a! highly! prized! characteristic,!discussed! further! in! Chapter! 8.& Education)! may! therefore! be! the! more! important! characteristic!distinguishing!them!from!other!Haitian!children.816!!As! a! group,! children! in! and! of! the! street! are! inherently! difficult! to! quantify,! as! traditional! survey!methods!rely!on!definitions!of!a!household!incorporating!a!permanent!physical!structure,!such!as!a!roof.!Children! in! the! street! are! more! easily! enumerated! than! children! of! the! street,! as! they! spend! at! least!some!of!their!time!living!in!a!household.!However,!the!lack!of!methodologically!rigorous!survey!sampling!strategies!for!street!children!means!that!estimates!are!unreliable,!and!the!true!number!and!prevalences!of!children!in!and!of!the!street!are!likely!to!be!higher!than!those!reported.817!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!808 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!809! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!810! H.!Lunde,!Youth&and&education&in&Haiti:&Disincentives,&vulnerabilities&and&constraints,!Fafo!paper!2008/26!(2008).! Available!at!http://www.fafo.no/pub/rapp/10070/10070.pdf!!811 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!812! H.!Lunde,!Youth&and&education&in&Haiti:&Disincentives,&vulnerabilities&and&constraints,!Fafo!paper!2008/26!(2008).! Available!at!http://www.fafo.no/pub/rapp/10070/10070.pdf!!813! H.!Lunde,!Youth&and&education&in&Haiti:&Disincentives,&vulnerabilities&and&constraints,!Fafo!paper!2008/26!(2008).! Available!at!http://www.fafo.no/pub/rapp/10070/10070.pdf!!814! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!815! H.!Lunde,!Youth&and&education&in&Haiti:&Disincentives,&vulnerabilities&and&constraints,!Fafo!paper!2008/26!(2008).! Available!at!http://www.fafo.no/pub/rapp/10070/10070.pdf!!816! H.!Lunde,!Youth&and&education&in&Haiti:&Disincentives,&vulnerabilities&and&constraints,!Fafo!paper!2008/26!(2008).! Available!at!http://www.fafo.no/pub/rapp/10070/10070.pdf!!817! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!118! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&Due!in!part!to!these!methodological!challenges,!the!estimated!number!of!children!in!and!of!the!street!in!Haiti! has! varied! markedly! over! the! past! decade! depending! on! source.! In! 1999,! a! survey! by! Quisqueya!University’s! Unit! for! Children! in! Difficult! Situations! estimated! that! there! were! between! 6,226`7,833!children! in! or! of! the! street! aged! 5`17! in! Port`au`Prince,! with! a! further! 163! in! Cap`Haitien! and! 41! in!Jacmel.818!This!estimate!is!roughly!equivalent!to!the!UN!Committee!on!the!Rights!of!the!Child’s!estimate!of!6,400!–!8,000!in!2002.819!By!2004,!however,!Smucker!and!Murray!estimated!significantly!fewer!street!children!in!Port`au`Prince,!with!an!estimate!of!approximately!2,000.820!As!there!were!no!major!initiatives!undertaken! within! this! time! period! to! reduce! the! number! of! street! children,! it! is! probable! that! the!majority! of! variation! between! these! estimates! was! the! result! of! survey! error,! rather! than! a! three`fold!decrease! in! the! true! number! of! children! in! or! of! the! street.! Over! the! period! 2004`2009,! most! sources!referenced!UNICEF’s!estimate!of!2,500!street!children!Haiti`wide.821,822,823,824,825!!Smucker! and! Murray! also! noted! that! the! number! of! street! children! in! provincial! towns! had! increased!dramatically!between!1994!and!2004.826!This!finding!was!supported!by!a!follow`up!study!in!2009,!which!found!that!a!larger!proportion!of!children!in!troubled!urban!neighborhoods!outside!Port`au`Prince!were!living! in! the! streets! compared! to! those! in! Port`au`Prince! (Figure! 58).827! Although! the! survey’s!methodology!precluded!enumerating!children!of!the!street,!the!finding!suggests!that!the!phenomenon!is! now! prevalent! nationwide,! rather! than! limited! to! Port`au`Prince! and! the! surrounding! metropolitan!areas.! The! authors! suggest! that! greater! access! to! education! in! Port`au`Prince! may! account! for! the!relatively!low!prevalence!of!street!children!compared!to!other!urban!areas!in!Haiti,!where!educational!access!is!more!limited.828!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!818! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!819! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!820 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!821! UN!ESC,!Situation!of!human!rights!in!Haiti,!UN!Doc.!E/CN.4/2006/115!(2006).!Available!at! http://ap.ohchr.org/documents/dpage_e.aspx?m=47!822! Amnesty!International,!Overcoming&poverty&and&abuse:&Protecting&girls&in&domestic&service&in&Haiti!(November! 2009).!Available!at!http://www.amnesty.org/en/library/info/AMR36/004/2009!!823! UNICEF,!UNICEF&humanitarian&action&report&2007!(2007).!Available!at! http://www.unicef.org/har07/index_37587.htm!!824! UNICEF,!UNICEF&humanitarian&action&report&2008!(2008).!Available!at! http://www.unicef.org/har08/index_haiti.php!!825 !UNICEF!Executive!Board,!Revised&country&programme&document:&Haiti&(200952011)!(2009).!Available!at! http://www.unicef.org/about/execboard/files/Haiti`FRS2009`revised_feb2010`English.pdf!!826 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!827! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!828! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 119!
    • !!Figure.58:.Children.in.the.street.(%).in.troubled.neighborhoods.in.Haiti,.2009. Site Street children (%) Carrefour Feuilles / Fontamara / Martissant 0 Solino / Bel-Air 1 Cité Soleil 1.8 Delmas / Tabarre 0 Mon Repos / Lamentin 0.7 PORT-AU-PRINCE 0.7 Cap: Bassin Rodo 1.1 Cap: Centre Ville 2.4 Cap: Petite Anse 1.9 CAP HAITIAN 1.8 Gonaïves 2.9 Saint-Marc 6.3 Petit-Goâve 0.9Source:!G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,& restavèks,&&&victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project! (November!2009).!Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!!!Unfortunately,! estimates! of! the! number! of! children! in! and! of! the! street! following! the! January! 2010!earthquake!are!unavailable.!The!earthquake!undoubtedly!resulted!in!a!massive!increase!in!the!number!of! street! children,! due! to! both! economic! necessity! stemming! from! the! loss! of! an! income`generating!family! member! or! the! destruction! of! pre`earthquake! residences.! Prior! to! January! 2010,! most! street!children! were! migrants! from! the! provinces.! However,! in! the! wake! of! the! earthquake,! a! significantly!higher! proportion! are!likely! to! be! urban! residents! whose! pre`existing! support! strategies! are! no! longer!adequate!to!meet!their!needs.!!!The!literature!identifies!various!causes!for!children!living!in!or!on!the!street.!A!number!of!studies!suggest!that! a! significant! proportion! of! street! children! are! dismissed! or! runaway! child! domestic! servants! who!must! now! make! a! livelihood! without! the! benefit! of! education! or! permanent! home.829,830,831! Poverty! is!identified! as! another! primary! driver! of! the! prevalence! of! street! children.! Due! to! their! families’! lack! of!means,! many! children! are! either! forced! or! volunteer! to! find! work! in! the! streets! to! supplement! their!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!829 !U.S.!Department!of!Labor,!Findings&on&the&worst&forms&of&child&labor:&2006&report:&Haiti!(2006).!Available!at! http://www.dol.gov/ilab/map/countries/haiti.htm!830 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!831 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!120! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&family’s! income.832,833,834! This! economic! motivation! is! probably! applicable! to! a! greater! proportion! of!children!in!the!street!than!of!the!street,!as!its!primary!reference!point!is!the!socio`economic!situation!of!the!family,!rather!than!of!the!child!alone.!In!contrast,!Kovats`Bernat!states!that!some!children!choose!to!live!in!the!street!because!it!provides!them!with!greater!freedom!and!economic!opportunity!than!staying!at!home.!He!notes!that!performing!odd!jobs,!such!as!washing!cars,!begging,!and!carrying!groceries,!may!allow!the!child!to!earn!twice!the!Haitian!minimum!wage.835!Finally,!some!children!are!forced!to!live!on!the! streets! after! being! deported! from! the! Dominican! Republic,! having! been! separated! from! their!relatives!and!family!and!left!at!the!border!crossing.836!!!Haitian!street!children!are!in!an!extremely!vulnerable!position,!facing!a!multitude!of!risks!to!safety!and!wellbeing.! Foremost! among! these! concerns! are! vulnerability! to! violence! and! adverse! health,! gender`based! violence,! and! lack! of! recourse! to! an! acceptable! juvenile! justice! system,! all! of! which! in! turn!contribute! to! greater! insecurity.! Street! children! face! the! risk! of! violence! from! both! the! justice! system!and!from!other!street!children.!Due!to!their!lack!of!parental!oversight,!moreover,!they!are!often!abused!and! targeted! by! the! police,! and! account! for! a! disproportionately! high! percentage! of! child! prisoners!during! neighborhood! sweeps! by! the! Haitian! National! Police’s! Anti`Gang! Unit.837,838,839,840! Of! the! 57!children!held!at!the!Juvenile!Prison!in!January!2000,!all!but!five!were!previously!living!on!the!streets.841!Street! children! also! face! significant! risks! of! violence! from! other! street! children,! often! related! to! gang!violence.842,843,844,845!Many!street!children!carry!razor!blades!scavenged!from!dumpsters,!and!altercations!between!them!often!lead!to!injury!and,!occasionally,!death.846,847,848!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!832! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!833! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!834 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!835! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!836 !G.!R.!Smucker!and!G.!F.!Murray,!The&uses&of&children:&A&study&of&trafficking&in&Haitian&children,!USAID/Haiti! Mission!(December!2004).!Available!at!http://pdf.usaid.gov/pdf_docs/PNADF061.pdf!!837! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!838! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!839! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!840! J.!Moncrieffe,!“When!labels!stigmatize:!Encounters!with!‘street!children’!and!‘restavecs’!in!Haiti,”!in!J.!Moncrief! and!R.!Eyben!(eds),!The&power&of&labelling:&How&people&are&categorized&and&why&it&matters!(London:!Earthscan,! 2007).!841! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!842! P.!S.!Pinheiro,!World!report!on!violence!against!children,!United!Nations!secretary`general’s!study!on!violence! against!children,!UN!Doc.!A/61/299!(2006).!Available!at! http://www.unicef.org/violencestudy/reports/SG_violencestudy_en.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 121!
    • !!While! living! in! the! street,! children! are! exposed! to! deplorable! sanitary! and! nutritional! conditions! that!underlie!a!wide!range!of!health!problems.!Street!children!are!at!greater!risk!of!acquiring!communicable!diseases!than!other!children,!especially!tuberculosis!and!gastrointestinal!ailments.!They!also!have!little!access! to! safe! drinking! water! or! adequate! nutrition,! suffer! from! headaches,! fatigue,! mental! and!psychosocial! conditions,! skin! diseases,! higher! rates! of! sexually! transmitted! infections,! and! pervasive!drug!use,!especially!sniffing!siment!(cobbler’s!glue).849,850,851,852,853!Young!girls!are!at!higher!risk!of!sexually!transmitted! diseases,! sexual! and! gender`based! violence,! rape,! and! unintended! pregnancy.! These! risks!are! heightened! by! the! fact! that! many! are! forced! into! prostitution! to! survive,! marking! female! street!children!as!an!extremely!vulnerable!population.854,855,856,857!No!quantitative!data!exist,!however,!on!the!prevalence!of!these!health!conditions!and!risk!factors!of!Haitian!street!children.!!Haitians’!perception!of!street!children!is!overwhelmingly!negative,!with!little!compassion!for!their!plight.!Street!children!are!seen!to!be!the!root!cause!of!urban!Haiti’s!crime!rate.!They!are!regarded!as!thieves,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!843 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!!844 !UNICEF!Executive!Board,!Revised&country&programme&document:&Haiti&(200952011)&(2009).!Available!at! http://www.unicef.org/about/execboard/files/Haiti`FRS2009`revised_feb2010`English.pdf!845! J.!C.!Kovats`Bernat,!“Anti`Gang,!arimaj,!and!the!war!on!street!children,”!Peace&Review!12/3!(2000),!pp.!415`421.!846! J.!C.!Bernat,!“Children!and!the!politics!of!violence!in!Haitian!context:!Statist!violence,!scarcity!and!street!child! agency!in!Port`au`Prince,”!Critique&of&Anthropology!19/2!(1999),!pp.!121`138.!847! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!848! J.!C.!Kovats`Bernat,!“Anti`Gang,!arimaj,!and!the!war!on!street!children,”!Peace&Review!12/3!(2000),!pp.!415`421.!849! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!850! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!!851! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!852! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!853! J.!C.!Kovats`Bernat,!“Anti`Gang,!arimaj,!and!the!war!on!street!children,”!Peace&Review!12/3!(2000),!pp.!415`421.!854! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html!855! G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,&restavèks,&&& victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project!(November!2009).! Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!!856 !U.S.!Department!of!State,!Trafficking&in&persons&report&2009,!Office!to!Monitor!and!Combat!Trafficking!in! Persons!(June!2009).!Available!at!http://www.state.gov/documents/organization/123357.pdf!857! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!122! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 5.&Child&protection&killers,!drug!dealers,!and!prostitutes.858859860!As!a!result,!little!action!was!taken!prior!to!the!earthquake!at!the! institutional! level! to! accommodate! these! children! and! develop! programs! and! policies! to! address!their!needs.!In!fact,!prior!to!the!earthquake,!street!children!were!often!denied!access!to!domestic!and!international! faith`based! orphanages,! due! to! the! perception! that! they! would! corrupt! the! other!children.861! Since! the! earthquake,! a! number! of! initiatives! have! been! undertaken! to! improve! this!situation.! UNICEF! is! supporting! the! establishment! of! residential! care! facilities,! both! “overnight”! and!permanent,! to! provide! street! children! with! an! entry`point! to! services! and! support—although! demand!far!out`strips!supply.862!In!July!2011,!President!Martelly!also!declared!his!intention!to!create!a!fund!to!support!programs!for!street!children!similar!to!the!National!Fund!for!Education,!though!further!details!have!not!been!released!as!of!this!writing.863!!To!cope!with!their!precarious!situation!and!ostracism,!Haitian!children!in!and!of!the!street!often!form!their! own! social! organizations! and! support! networks,! sharing! food! and! other! goods! between!members.864,865!In!essence,!these!groups!provide!a!social!safety!net!for!street!children!not!provided!by!formal! structures,! but! may! reinforce! negative! perceptions! of! street! children! participating! in! deviant!gang!activities.!!!Each! of! the! factors! driving! children! to! the! street! necessitates! a! different! response! to! alleviate! the!underlying!cause.!To!date,!policies!aimed!at!addressing!these!root!causes!have!met!with!little!success.!In!2002,!the!UN!Committee!on!the!Rights!of!the!Child!expected!the!number!of!street!children!to!increase!due! to! “the! growing! pauperization! in! the! country! and! the! continuous! migration! to! urban! areas.”866!Poverty!reduction!strategies!had!little!appreciable!impact!on!Haiti’s!standard!of!living!before!the!2010!earthquake,! despite! gains! in! some! areas.! Since! January! 2010,! poverty! reduction! and! increased!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!858! J.!Moncrieffe,!“When!labels!stigmatize:!Encounters!with!‘street!children’!and!‘restavecs’!in!Haiti,”!in!J.!Moncrief! and!R.!Eyben!(eds),!The&power&of&labelling:&How&people&are&categorized&and&why&it&matters!(London:!Earthscan,! 2007).!859! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!860! J.!C.!Bernat,!“Children!and!the!politics!of!violence!in!Haitian!context:!Statist!violence,!scarcity!and!street!child! agency!in!Port`au`Prince,”!Critique&of&Anthropology!19/2!(1999),!pp.!121`138.!861! J.!Moncrieffe,!“When!labels!stigmatize:!Encounters!with!‘street!children’!and!‘restavecs’!in!Haiti,”!in!J.!Moncrief! and!R.!Eyben!(eds),!The&power&of&labelling:&How&people&are&categorized&and&why&it&matters!(London:!Earthscan,! 2007).!862 !UNICEF,!Residential&care&center&provides&a&refuge&for&street&children&in&Cap5Haitian!(February!2011).!Available!at! http://www.unicef.org/infobycountry/haiti_57670.html!!863! HaitiLibre,!"Martelly!working!on!a!fund!project!for!street!children,"!HaitiLibre!(July!6,!2011).!Available!at! http://www.haitilibre.com/en/news`3116`haiti`social`martelly`working`on`a`fund`project`for`street` children.html!864! J.!C.!Bernat,!“Children!and!the!politics!of!violence!in!Haitian!context:!Statist!violence,!scarcity!and!street!child! agency!in!Port`au`Prince,”!Critique&of&Anthropology!19/2!(1999),!pp.!121`138.!865! J.!C.!Kovats`Bernat,!Sleeping&rough&in&Port5au5Prince:&An&ethnography&of&street&children&and&violence&in&Haiti! (Gainesville:!University!Press!of!Florida,!2006).!866! UN!Committee!on!the!Rights!of!the!Child,!Consideration!of!reports!submitted!by!state!parties!under!article!44!of! the!Convention:!Haiti,!UN!Doc.!CRC/C/51/Add.7!(2002).!Available!at! http://www.unhcr.org/refworld/docid/3df59ad34.html! ©!2012!FXB!Center!for!Health!and!Human!Rights! 123!
    • !opportunities! have! become! cornerstones! of! the! Post`Disaster! Action! Plan,867! raising! hopes! that! the!economic! motivation! for! children! to! move! to! the! streets,! either! voluntarily! or! at! the! behest! of! their!families,! will! be! reduced! over! time,! leading! to! a! reduced! number! of! street! children.! However,! it! is!unclear! how! the! earthquake! will! affect! Haiti’s! relationship! with! the! Dominican! Republic! in! terms! of!extradition!arrangements!that!leave!young!Haitians!at!the!border!without!a!support!network.!Similarly,!it!is!unlikely!that!the!earthquake!will!have!led!to!a!better!situation!for!children!in!domestic!servitude,!and! their! expulsion! or! flight! from! host! households! is! likely! to! remain! a! dominant! driver! for! children!turning!to!the!streets!to!meet!their!basic!needs.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!867 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!124! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&6.&Poverty,&access,&and&empowerment&!Poverty!is!an!integral!risk!factor!for!many!undesirable!child!protection!outcomes.!The!notion!of!human!security,!with!its!dual!focus!on!freedom!from!fear!and!freedom!from!want,!underlies!the!link!between!deprivation! and! threats! to! children’s! basic! rights,! including! the! rights! to! life,! health,! education,! and!development.! In! 2005,! the! Haitian! Government! reported! that! approximately! 70%! (2.66! million)! of!children! lacked! access! to! basic! social! services! such! as! financial! resources,! food,! water,! shelter,! and!information.868,869! To! assess! the! impact! of! this! lack! of! access! on! child! protection,! it! is! necessary! to!examine! access! to! each! service! in! and! of! itself,! as! well! as! the! impact! of! that! lack! of! access! on! other!outcomes!of!concern.!!!!A.&Monetary&poverty&!At!the!root!of!many!protection!challenges!facing!Haitian!children!is!widespread!monetary!poverty!that!has! undermined! development! and! delivery! of! services! and! support! to! those! in! need.! Shortages! of!financial! capital! at! the! state,! community,! and! household! levels! are! key! impediments! to! realizing! the!rights! of! Haitian! children.! Little! child`specific! information! exists! on! the! pervasiveness! and! impact! of!monetary! poverty! in! Haiti.! However,! because! children! are! dependent! on! their! families! for! means! of!financial!support,!and!because!those!households!at!the!lower!end!of!the!income!distribution!generally!have! more! children! than! those! of! higher! socio`economic! status,! this! Report! will! analyze! population`based!monetary!poverty!in!Haiti!with!a!focus!on!its!effects!on!Haitian!children’s!protection.!!The! most! commonly! used! indicators! of! monetary! poverty! are! the! proportion! of! people! living! on! less!than!US$1!or!US$2!per!day.!These!are!“headcount”!indicators,!in!that!they!assess!the!pervasiveness!of!poverty!but!not!its!depth.!The!enumeration!of!these!statistics!is!plagued!by!three!major!inconsistencies:!1)!the!specification!of!the!“base!year”!used!to!calculate!US$1!(against!which!the!value!of!US$1!can!be!said!to!increase!or!decrease!over!time!according!to!inflation),!2)!whether!or!not!Purchasing!Power!Parity!(PPP)!is!included!in!the!calculation!of!the!US$!equivalent!(so!that!differences!in!the!cost!of!basic!goods!between! countries! are! reflected),! and! 3)! the! definition! of! per! capita! income,! including! non`financial!income! (such! as! self`consumption! of! agricultural! produce).870! Although! these! and! many! other! factors!may!bias!the!calculation!of!such!indicators,!headcount!poverty!remains!the!most!pervasive!measure!of!national!poverty.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!868 !Technical!Secretariat!of!the!Preparatory!Committee,!Growth&and&poverty&reduction&strategy&paper:&Republic&of& Haiti.!IMF!country!report!08/115!(November!2007).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!869 !UNICEF!Executive!Board,!Revised&country&programme&document:&Haiti&(200952011)!(2009).!Available!at! http://www.unicef.org/about/execboard/files/Haiti`FRS2009`revised_feb2010`English.pdf!870! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 125!
    • !!Despite! its! popularity! as! an! indicator! of! poverty,! few! nationally! representative! surveys! enumerating!headcount! poverty! proportions! have! been! conducted! in! Haiti.! International! databases,! such! as! the!World! Bank’s! World! Development! Indicator! database,871! the! DevInfo! MDG! database,872! UNESCO’s!Education! for! All! database,873! and! the! State! of! the! World’s! Children! database,874! cite! the! 2001! Haiti!Living! Conditions! Survey! (HLCS)! as! the! most! recent! and! reliable! estimate! of! poverty! nationwide.!According! to! the! 2001! HLCS,! 54.9%! of! the! Haitian! population! lived! on! less! than! US$1! per! day! in! 2001!(US$1.25!in!2005!dollars),!adjusted!for!PPP.!It!was!also!estimated!that!72`76%!of!the!Haitian!population!lived!in!relative!poverty,!or!below!US!$2!per!day!in!2001.875,876,877,878! Since!2001,!but!prior!to!the! 2010!earthquake,! the! percentage! of! people! living! in! absolute! and! relative! poverty! decreased! by!approximately!8%,!to!47%!living!on!less!than!US$1!per!day,!and!approximately!68%!living!on!less!than!US$2!per!day.879!!The!prevalence!of!monetary!poverty!is!far!higher!in!rural!areas!than!in!urban!areas,!in!general,!and!in!Port`au`Prince,!specifically.!According!to!the!IMF,!77%!of!people!living!on!less!than!US$1!per!day!were!rural!residents!in!2001,!while!9%!lived!in!the!Port`au`Prince!metropolitan!area,!and!14%!in!other!urban!areas.!Extreme!poverty!was!found!to!be!more!than!twice!as!prevalent!(67%)!in!rural!areas!than!in!the!Port`au`Prince! metropolitan! area! (23%),! while! other! urban! areas! were! between! these! two! extremes!(57%).!Discrepancies!between!urban!and!rural!areas!were!also!found!in!an!analysis!of!those!living!on!less!than!US$2!per!day,!with!88%!of!rural!residents!falling!into!this!category,!compared!to!45%!of!those!in!Port`au`Prince! and! 76%! in! other! urban! areas.! The! IMF! attributes! these! discrepancies! to! the! economic!activities!engaged!in!by!rural!and!urban!residents.880!!Though! headcount! indicators! of! monetary! poverty! assess! the! population! with! regard! to! an! arbitrary!benchmark! (for! example,! US$1! per! day),! other! indicators! assess! the! distribution! of! income! within! a!population.! These! indicators! include! the! Gini! Coefficient,! the! share! of! income! held! by! population! sub`!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!871 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!872 !DevInfo,!MDG&database&2010:&Haiti.!Available!at!http://www.devinfo.info/mdginfo2010/!873 !UNESCO,!Education&for&all&database:&Haiti.!Available!at! http://www.uis.unesco.org/ev.php?URL_ID=5262&URL_DO=DO_TOPIC&URL_SECTION=201!874 !UNICEF,!State&of&the&world’s&children&database.!Available!at!http://www.unicef.org/statistics/index_step1.php!875! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!876! ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!!877! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!878! IFRC,!Haiti&recovery&assessment:&Volume&1&–&Synthesis&report!(March!2010).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?fileticket=jNS41RGePVg%3d&tabid=149&mid=1043!!879 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!880! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!126! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&groups,! and! the! proportion! of! people! within! disaggregated! income! bands.! The! Gini! coefficient! is! a!measure! of! income! inequality! within! a! population,! with! a! value! of! 0! indicating! complete! income!equality,! and! a! value! of! 1! indicating! that! a! single! person! controls! all! income.! As! such,! lower! Gini!coefficients!represent!more!equal!income!distributions.!Although!estimates!of!Haiti’s!Gini!coefficient!for!2001! vary! by! source,! all! reveal! an! extremely! unequal! distribution,! ranging! from! 0.59`0.66.881,882,883,884!This!range!indicates!that!Haiti’s!income!distribution!at!that!time!of!these!studies!had!approximate!parity!to!Brazil,!though!Haiti’s!average!per!capita!income!was!less.885!The!IMF!also!reports!a!deterioration!of!income! equality! in! Haiti! over! the! past! 25! years.886! However,! while! income! inequality! is! high! in! all!Departments,! it! is! not! uniform! countrywide.! It! was! observed! in! 2001! that! Artibonite! and! Nord`Est!Departments!had!the!largest!Gini!Coefficients!(0.698!and!0.697,!respectively),!while!Sud`Est!Department!displayed! the! lowest! (0.538)! (Figure! 59).887! Troublingly! for! policy`makers! concerned! with! poverty!reduction,! the! World! Bank! notes! that! “the! more! unequally! income! is! distributed,! the! less! effective!economic!growth!is!in!reducing!poverty.”888!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!881 !UNESCO,!Education&for&all&database:&Haiti.!Available!at! http://www.uis.unesco.org/ev.php?URL_ID=5262&URL_DO=DO_TOPIC&URL_SECTION=201!882 !UNDP,!Human&development&report&2009:&Overcoming&barriers:&Human&mobility&and&development!(New!York:! Palgrave!Macmillan,!2009).!Available!at!http://hdr.undp.org/en/reports/!!883! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!884! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!885! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!886! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!887! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!888! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 127!
    • !Figure.59:.Gini.indices,.by.Department.and.urban/rural.status,.2001*. !*The!Gini!Index!is!the!Gini!Coefficient,!multiplied!by!100.!Source:!D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey& for&Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!!!The! degree! of! income! inequality! in! Haiti! is! similarly! evident! when! assessing! the! proportion! of! total!income!held!by!subsets!of!the!population.!Figure!60!illustrates!the!share!of!income!held!by!the!lowest!and!highest!income!deciles!in!Haiti,!as!well!as!the!share!held!by!each!income!quintile!in!2001.!In!2001,!the!richest!10%!of!the!population!controlled!54!times!the!wealth!of!the!lowest!10%!in!that!year,!while!the! richest! quintile! controlled! 25! times! the! wealth! of! the! poorest! quintile.889! More! recent! estimates!indicate!that!this!situation!has!deteriorated!further!since!2001.!In!2008,!the!IMF!stated!that!the!richest!quintile!controlled!68%!of!the!nation’s!wealth!and!that!the!richest!2%!controlled!approximately!26%!of!the!nation’s!wealth,!while!the!poorest!80%!of!Haitians!controlled!only!32%!of!all!income.890!Similarly,!in!2010! the! Haitian! government! stated! that! the! richest! 10%! of! the! population! controlled! 50%! of! all!revenue.891!!Figure.60:.Income.share.held.by.quintile.and.extreme.deciles,.2001. Income.share.held.by. Lowest. Highest. Lowest. Second. Third. Fourth. Highest. 10%. 10%. 20%. 20%. 20%. 20%. 20%. 0.88! 47.83! 2.53! 5.92! 10.48! 18.1! 62.97!Data!source:!World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!889 !World!Bank,!World&development&indicator&database.!Available!at! http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2!890! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!891 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!128! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&!As!Figure!61!shows,!moreover,!78.4%!of!Haitian!workers!earned!less!than!5,000!gourdes!(US$124!as!of!January! 18,! 2011)! per! month! in! 2008,! while! 44.7%! earned! less! than! 2,000! gourdes! (US$47.7! as! of!January! 18,! 2011).! The! monthly! income! distribution! has! remained! heavily! skewed! to! low`income!categories,! with! only! a! small! percentage! of! Haiti’s! population! earning! above! 20,000! gourdes! per!month.892!!Figure.61:.Monthly.income.(%),.2006.and.2008. !Source:!IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!!!Overabundance!of!unskilled!labor!in!Haiti!is!a!driving!factor!of!low!wage!levels!and!is!a!contributor!to!the!perpetuation!of!poverty!in!the!country.!Decades!of!high!population!growth!have!led!to!large!numbers!of!people! entering! their! working! ages,! which! has,! in! turn,! has! led! to! a! surplus! supply! of! labor.893! Two!consequences! of! this! phenomenon! have! been! downward! pressure! on! wages! for! those! who! have! jobs!and! decreasing! intensity! of! economic! activities! across! the! country.! Figure! 62! demonstrates! that! a!minority!of!the!working`age!population!engaged!in!economic!activities!each!day!in!2008,!which!reduced!the!monthly!income!of!those!with!jobs.!Due!to!these!factors,!Gross!Domestic!Product!(GDP)!per!capita,!expressed! in! 2005! U.S.! dollars! with! PPP! adjustment,! fell! from! $1,380! to! $1,165! over! the! 17! years!between!1991!and!2008.894!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!892 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!893! D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!894 !UNESCO,!Data&center:&Custom&tables:&Haiti.!Available!at! http://stats.uis.unesco.org/unesco/TableViewer/document.aspx?ReportId=136&IF_Language=eng&BR_Topic=0! ©!2012!FXB!Center!for!Health!and!Human!Rights! 129!
    • ! Figure.62:.Intensity.of.household.economic.activity,.by.city,.2008. CITY Total Port-au- Cap- Saint- Port-au- Gonaïves Petit-Goâve Prince Haitian Marc Prince Every day 31% 28% 30% 36% 34% 31% Intensity of Sometimes 19% 17% 26% 27% 18% 20%economic activity No activity 50% 54% 43% 36% 48% 49% Total N 771 267 167 121 119 1445 100% 100% 100% 100% 100% 100% Source:!G.!R.!Smucker,!Y.!F.!Pierre,!and!J.!F.!Tardieu,!Lost&childhoods&in&Haiti:&Quantifying&child&trafficking,& restavèks,&&&victims&of&violence,!Pan!American!Development!Foundation!Protecting!Human!Rights!Project! (November!2009).!Available!at!http://www.crin.org/docs/Haiti_lost_childhoods.pdf!! ! ! Figure.63:.GDP.per.capita,.expressed.in.2005.Purchasing.Power.ParityTadjusted.2005.U.S.. dollars,.1991T2008. ! Data!source:!UNESCO,!Data&center:&Custom&tables:&Haiti.!Available!at! http://stats.uis.unesco.org/unesco/TableViewer/document.aspx?ReportId=136&IF_Language=eng&BR_Topic=0! ! ! Low! per! capita! income! is! not! uniform! across! Haiti,! with! significant! differences! between! Departments! and! between! Port`au`Prince,! urban,! and! rural! areas! (Figure! 64).! Those! in! Port`au`Prince! had! a! significantly!higher!median!income!than!their!rural!and!other!urban!area!counterparts.!The!World!Bank! notes! that! for! any! position! on! the! income! distribution! (by! decile),! earnings! are! roughly! four! times! greater! in! the! Port`au`Prince! metropolitan! area! than! in! rural! areas.895! While! median! incomes! were! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 895! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf! 130! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&higher! in! the! urban! areas! of! six! Departments! than! in! rural! areas,! the! inverse! was! true! in! four!Departments.!Overall,!Nord`Est!Department!exhibited!the!lowest!median!per!capita!income!(US$671.7),!while!strong!performance!in!the!metropolitan!area!drove!the!Ouest!Department’s!dominance!(median!per!capita!income!of!US$4,366.7).896!!Figure.64:.Median.annual.income.per.capita,.by.Department.and.urban/rural/metropolitan.area.status,.2001. !Source:!D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey& for&Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!!!Remittances!play!a!significant!role!in!Haitian!families’!livelihood!strategies!and!their!ability!to!overcome!monetary! poverty.! In! 2008,! 49.2%! of! Haitian! households! were! receiving! monetary! transfers! from!abroad,!an!increase!from!28.8%!in!2006.897!With!a!total!value!of!approximately!US$1.3!billion!in!2008,898!remittances! accounted! for! approximately! 19%! of! all! income! in! Haiti.899! Remittances! account! for! over!50%! of! income! inequality! relative! to! other! sources,! and! represent! a! substantial! proportion! of! Haiti’s!GDP.900!!In!addition!to!whether!the!family!receives!remittances!from!abroad,!several!other!factors!are!associated!with! the! probability! that! an! individual! or! household! will! be! in! monetary! poverty:! 1)!urban/rural/metropolitan!status,!2)!gender,!3)!age,!and!4)!level!of!education.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!896 !D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!897! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!898! ALNAP,!Haiti&earthquake&response:&Context&analysis!(July!2010).!Available!at! http://www.alnap.org/pool/files/haiti`context`analysis`final.pdf!!899! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!900! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 131!
    • !Though!rural!areas!account!for!a!larger!proportion!of!those!in!absolute!poverty!than!do!Port`au`Prince!and!other!urban!areas,!it!must!be!considered!that!rural!Haitians!account!for!a!greater!share!of!the!total!population! than! their! non`rural! counterparts.! Assessments! by! the! World! Bank! and! the! IMF! agree! that!once! this! population! differential! is! taken! into! account,! and! that! once! other! poverty! risk! factors! are!included! in! the! analysis,! urban/rural! status! is! not! in! itself! a! strong! determinant! of! monetary!poverty.901,902,903! According! to! the! IMF,! regional! status! accounts! for! 17%! of! all! inequality,! while! intra`regional!variation!accounts!for!approximately!83%.904!Verner!states!that!poor!access!to!services!is!highly!correlated!with!monetary!poverty,!which!explains!much!of!the!association!between!geographical!status!and!poverty!prevalence.905!!A! number! of! analyses! show! an! association! between! the! gender! of! the! head! of! household! and! the!probability! that! the! household! would! be! in! monetary! poverty.! In! 2008,! the! IMF! observed! that! 58%! of!households!in!which!females!were!the!main!income`earners!were!living!in!monetary!poverty,!compared!to!53%!of!households!where!males!were!the!primary!income`earners.!Differences!in!the!probability!of!household!monetary!poverty!based!on!the!head!of!household’s!sex!were!observed!in!metropolitan!(26%!female! versus! 17%! male)! and! other! urban! (64%! female! and! 48%! male)! households.906! Also! in! 2008,!Verner!noted!that!female`headed!households!in!rural!Haiti!were!8%!more!likely!to!live!in!poverty!than!their! male`headed! counterparts! (62%! of! female`headed! households! versus! 54%! of! male`headed!households).907!Counter`intuitively,!the!same!analyses!found!that!on!average,!women’s!median!income!was! 10%! higher! than! men’s! in! urban! areas.908,909! One! explanation! for! this! disparity! may! be! that!households!with!female!workers!are!more!concentrated!in!the!lowest!income!quintile,!as!women!have!a!higher! propensity! to! stop! working! as! household! income! rises.910! As! such,! women! may! be! over`!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!901! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!902! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!903! D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!904! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!905! D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!906! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!907! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!908! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!909! D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!910 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www`132! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&represented! in! households! below! the! poverty! line,! despite! the! fact! that! those! who! are! working! have!higher!wages.!!Although!age!was!not!considered!to!be!a!strong!determinant!of!the!probability!of!monetary!poverty,!it!was! one! of! several! factors! taken! into! account! in! the! IMF’s! “Haiti:! Poverty! Reduction! Strategy! Paper”!(accounting!for!1%!of!all!variance).911!This!paper!found!that!households!headed!by!younger!people!were!less! likely! to! live! in! monetary! poverty! than! those! headed! by! older! people.! Of! households! whose! head!was!aged!24!or!under,!40%!were!in!absolute!poverty!in!2008,!compared!to!47%!of!those!headed!by!a!person!aged!25`44,!51%!of!those!headed!by!a!person!aged!45`65,!and!52%!for!those!headed!by!a!person!aged!66!or!older.912!!Education!is!the!strongest!factor!associated!with!poverty!reduction!in!Haiti.!Verner!states!that!all!levels!of!educational!attainment!are!significantly!associated!with!a!reduced!probability!of!an!individual!falling!into! monetary! poverty.! Monetary! returns! on! education! exponentially! increase! with! each! additional!institutional! level! attained.913! In! 2001,! the! World! Bank! observed! that,! “the! median! Haitian! worker!experiences!a!return!of!83,!203,!and!1,272!percent!for!having!completed!primary,!secondary,!and!their!tertiary!education.”914!This!phenomenon!is!discussed!further!in!Section!8C.&Education&engagement.!!Over!the!past!two!decades,!negative!economic!growth,!combined!with!high!inflation,!has!undermined!Haiti’s! ability! to! dramatically! decrease! the! proportion! of! the! population! living! in! poverty.915! Between!1990! and! 2009,! GDP! per! capita! fell! on! average! by! 2%! per! annum,! while! inflation! averaged! 18%.916!Recurrent! natural! disasters,! including! floods! in! 2004! and! hurricanes! in! 2008! (the! damage! of! which!totaled! approximately! 15%! of! Haiti’s! GDP),917! coupled! with! insecurity! and! political! unrest,! were!considered! to! be! the! main! drivers! of! poor! economic! performance! and! lack! of! investment! during! this!period.918,919! As! noted! previously,! even! if! macroeconomic! performance! had! improved! significantly,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!911! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!912! D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!913! D.!Verner,!Labor&markets&in&rural&and&urban&Haiti:&Based&on&the&first&household&survey&for&Haiti,!World!Bank! Sustainable!Development!Division!(March!2008).!Available!at!http://go.worldbank.org/MYDYDJHFS0!!914! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!915! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!916 !UNICEF,!State&of&the&world’s&children&database.!Available!at!http://www.unicef.org/statistics/index_step1.php!917! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!918! PAHO,!Health&situation&in&Haiti&before&the&2010&earthquake,!Presentation!at!Haiti!Health!Cluster!(January!2010).! Available!at!http://ec.europa.eu/echo/files/aid/countries/Haiti_paper_01102010.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 133!
    • !Haiti’s! extremely! unequal! income! distribution! would! have! continued! to! limit! the! country’s! ability! to!translate!this!growth!into!poverty!reduction.920!!On!the!eve!of!the!January!2010!earthquake,!most!Haitians!were!extremely!vulnerable!to!income!shocks.!The!Haitian!government!points!out!that “most!Haitians!have!no!retirement!provision,!no!social!security!and!no!savings,”921!such!that!inability!to!find!work!for!even!a!short!period!of!time!can!be!disastrous!for!a!household’s! financial! situation.! Alarmingly,! a! rapid! assessment! by! World! Vision! from! February! 3`6! in!earthquake`affected!areas!found!that!only!6%!of!household!members!were!receiving!any!income,!and!that!60%!of!families!had!lost!their!former!pre`earthquake!livelihood!strategies.!As!a!result,!most!families!had!sold!assets!and!gone!into!debt!to!pay!for!consumption!goods,!such!as!water,!food!and!healthcare.922!!The!Haitian!government!estimated!that,!after!some!improvement!since!2007,!the!earthquake!returned!poverty!prevalence!to!the!level!found!in!2001,!with!71%!of!people!living!on!less!than!US$2!per!day!and!50%! living! on! less! than! US$1! per! day.923! However,! these! headcount! measures! failed! to! accurately!characterize! the! situation,! as! those! both! below! and! above! the! poverty! line! were! devastated! by! the!earthquake.!!!In!March!2010,!a!rapid!Emergency!Food!Security!Assessment!(EFSA)!conducted!by! the!Government!of!Haiti’s! National! Food! Security! Coordination! Unit! (Coordination& Nationale& de& la& Sécurité& Alimentaire! `!CNSA)! in! earthquake`affected! areas! found! that! 48%! of! the! population! was! poorer! as! a! result! of! the!earthquake,! with! a! higher! proportion! of! households! in! camps! reporting! being! poorer! after! the!earthquake! in! both! urban! (78%! were! poorer)! and! rural! areas! (70%! were! poorer)! than! the! average.924!Haitian! families’! ability! to! provide! for! their! children’s! rights! is! heavily! determined! by! their! access! to!financial! and! other! resources.! The! reduction! in! income! of! almost! half! of! households! in! earthquake`affected!areas!has!compounded!pre`existing!endemic!poverty,!preventing!many!families!from!accessing!goods!and!services!necessary!for!their!children’s!safety!and!overall!development.!The!CNSA’s!rapid!food!security! assessment! found! that! by! March! 2010,! an! additional! 20%! of! surveyed! households! were! now!categorized! as! “poor”! than! before! the! earthquake! (52%! compared! to! 32%),! based! on! pre`earthquake!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!919! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!920! World!Bank,!Social&resilience&and&state&fragility&in&Haiti:&A&country&social&analysis,!Caribbean!Country! Management!Unit,!Report!no.!36069`HT!(April!2006).!Available!at! http://siteresources.worldbank.org/SOCIALANALYSIS/1104894`1115795935771/20938696/Haiti_CSA.pdf!921 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!922! UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&2,!29!March!2010!(March!2010).!Available!at! http://groups.google.com/group/assessmentshaiti/browse_thread/thread/71f3f127213f7a06!!923 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!924 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!134! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&wealth! terciles,! and! that! fewer! were! categorized! as! “average”! (30%! versus! 35%)! or! “wealthy”! (18%!versus!34%)!(Figure!65).925!!Figure.65:.HouseholdTlevel.monetary.effects.of.the.earthquake.in.affected.areas,.by.preTearthquake.income.tercile,.March.2010. !Source:!CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!!!B.&Food&security&and&nutrition&!The! right! to! food! is! a! basic! human! right.! Undernourishment! can! lead! to! delayed! motor! development,!poor! cognitive! development,! poor! growth,! and! greater! vulnerability! to! infection! and! disease.926,927! In!Haiti,!pervasive!poverty!and!inadequate!healthcare!facility!distribution!mean!that!most!undernourished!children!are!unable!to!access!health!services!when!they!become!sick,!and!malnourishment!is!associated!with!more!than!50%!of!childhood!deaths!(See!Section!7A.&Healthcare&access).928!Those!who!survive!are!faced!with!even!greater!risk!of!recurrent!sickness!and!morbidity!due!to!their!bodies’!depleted!capacity,!contributing!to!irreversible!damage.!Additionally,!failure!to!achieve!the!basic!right!to!food!undermines!children’s! ability! to! enjoy! other! rights,! such! as! the! right! to! education! (MDG! 2).929! Malnutrition! and!undernutrition! refer! to! various! related! phenomena,! including! hunger,! macro`,! and! micro`nutrient!deficiencies,! which! in! turn! present! as! outcomes! including! stunting,! wasting,! and! social! and! cognitive!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!925 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!926! UNICEF,!Progress&for&children&number&4:&A&report&card&on&nutrition!(May!2006).!Available!at! http://www.unicef.org/progressforchildren/2006n4/files/PFC4_EN_8X11.pdf!!927! UNICEF,!The&state&of&Latin&American&and&Caribbean&children&2008:&Child&survival!(May!2008).!Available!at! http://www.unicef.org/publications/files/SOLAC_2008_EN_041408.pdf!!928 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!929! UNICEF,!Progress&for&children&number&4:&A&report&card&on&nutrition!(May!2006).!Available!at! http://www.unicef.org/progressforchildren/2006n4/files/PFC4_EN_8X11.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 135!
    • !deficiencies.! Although! nutrition! is! a! component! of! the! definition! of! food! security,! it! can! also! be!programmatically! considered! in! terms! of! the! biological! effects! of! consuming! foods! of! varying! quality.!Food!security,!in!contrast,!is!a!broader!concept,!including!access!and!cultural!context,!defined!by!the!UN!Food!and!Agriculture!Organization!as:!! …a!situation!that!exists!when!all!people,!at!all!times,!have!physical,!social!and!economic!access!to! sufficient,!safe!and!nutritious!food!that!meets!their!dietary!needs!and!food!preferences!for!an! 930 active!and!healthy!life. &!Prior!to!the!January!2010!earthquake,!Haiti!had!not!realized!its!constitutional!and!human!rights!to!food;!instead!the!country’s!population!experienced!chronic!mal`!and!undernutrition,!and!insufficient!access!to!food.931! In! 2007,! only! one! fifth! of! households! reported! that! they! were! able! to! meet! their! food! needs,!with!Port`au`Prince!households!better!equipped!to!meet!their!basic!needs!(33%)!than!rural!households!(13.1%).932!Food!consumption!was!also!found!to!be!highly!elastic!with!changes!in!income,!with!32%!of!households! declaring! that! increasing! their! food! consumption! would! be! their! first! priority! after! an!increase! in! income,! while! most! households! stated! that! reducing! food! consumption! is! their! primary!course!of!action!in!times!of!financial!strife.933!!Estimates! of! the! proportion! of! the! population! living! with! food! insecurity! differ! by! source! and! time!period,! making! it! difficult! to! draw! conclusions! about! the! direction! of! trend.! One! cause! of! these!discrepancies!may!be!the!lack!of!consensus!on!an!operational!and!assessment!definition!of!the!concept,!although!the!World!Food!Program!(WFP)!has!attempted!to!remedy!this!shortcoming.934!!Most!sources!at!the!time!of!the!January!2010!earthquake!cited!a!2007!PAHO!estimate!of!the!prevalence!of! food! insecurity! that! suggested! 40%! of! Haitian! households! were! food! insecure.935,936,937! Other! pre`earthquake!estimates!vary!considerably,!though!this!variance!may!be!the!result!of!changes!over!time!or!external!factors,!such!as!droughts!and!hurricanes.!In!2004,!the!Haitian!government!had!estimated!that!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!930 !FAO,!The&state&of&food&insecurity&in&the&world&2001!(2001).!Available!at! http://www.fao.org/docrep/003/y1500e/y1500e00.htm!!931! Droits!et!Democratie/GRAMIR,!The&human&right&to&food&in&Haiti:&Report&of&an&international&fact5finding&mission! (2008).!Available!at!http://www.dd`rd.ca/site/publications/index.php?id=2316&subsection=catalogue!!932! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!933! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!934 !World!Food!Program,!Food&security&analysis!(2010).!Available!at!http://www.wfp.org/food`security!!935! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!936! PAHO,!Health&situation&in&Haiti&before&the&2010&earthquake,!Presentation!at!Haiti!Health!Cluster!(January!2010).! Available!at!http://ec.europa.eu/echo/files/aid/countries/Haiti_paper_01102010.pdf!!937 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!136! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&approximately!two!thirds!of!rural!households!were!severely!food!insecure.938!In!2009,!Oxfam!estimated!that!approximately!one!third!of!Haitian!households!were!food!insecure.939!An!assessment!by!the!World!Food! Program! in! the! Sud`Est! Department! found! that! 17%! of! households! were! either! severely! (5%)! or!moderately!(12%)!food!insecure!in!Jacmel!on!the!eve!of!the!earthquake,!while!2`3%!were!severely!food!insecure!and!12`17%!moderately!food!insecure!in!rural!areas.940!In!comparison,!similar!WFP!assessments!in!Port`au`Prince!in!2008!and!rural!areas!in!2007!found!that!14%!and!6%!of!households!were!severely!food!insecure,!and!an!additional!17%!and!19%!were!moderately!food!insecure,!respectively.941!!!Prior! to! the! earthquake,! a! survey! of! Haitian! households! found! that! 11%! identified! food! insecurity! as!their! greatest! challenge,! second! only! to! unemployment! (28%).942! Unstable! income! sources,! lack! of!domestic! production,! low! purchasing! power! and! the! lack! of! fallback! food! strategies! contributed! to!households’!vulnerability.943!On!the!eve!of!the!earthquake,!only!44%!of!the!population!had!food!stocks,!illustrating! the! limited! ability! of! the! population! to! absorb! shocks! to! their! access! to! food.944! A! 2002!review!by!the!World!Bank!found!that!male`headed!rural!households!were!four!times!more!likely!to!be!extremely! food! insecure! than! female`headed! households.! However,! when! severe! and! moderate! food!insecurity! were! considered! together,! differences! between! the! food! security! situation! of! households!headed!by!men!and!women!were!negligible.945!!Measures! of! childhood! malnutrition! have! been! more! consistent! than! estimates! of! food! insecurity,!perhaps! due! to! better! articulation! of! measurement! standards! and! indicators.! Most! sources! have! used!statistics!derived!from!the!suite!of!nationally!representative!EMMUS!surveys!conducted!in!1990!(I),!1995!(II),! 2000! (III),! and! 2005/06! (IV)! (Figure! 66).946,947,948,949,950,951,952,953,954,955! Over! this! 15`year! period,! the!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!938 !Government!of!Haiti,!Interim&cooperation&framework&200452006:&Summary&report!(2004).!Available!at! http://haiticci.undg.org/uploads/ReportVersion8%20Eng%20FINAL%20Low%20Res.pdf!!939! Oxfam!International,!Haiti:&‘A&gathering&storm’:&Climate&change&and&poverty!(November!2009).!Available!at! http://www.oxfam.org/en/policy/haiti`gathering`storm!!940! CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!!941! CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!!942 !Oxfam,!Haitians&talk&about&rebuilding&the&country&after&the&January&12,&2010&earthquake!(March!2010).! Available!at!http://www.reliefweb.int/node/351160!!943 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!944 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!945 !World!Bank,!A&review&of&gender&issues&in&the&Dominican&Republic,&Haiti&and&Jamaica,!Report!No.!21866`LAC! (2002).!Available!at!http://www` wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/03/22/000094946_03030704005682/R endered/PDF/multi0page.pdf!!946! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!947! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 137!
    • !prevalence!of!Global!Acute!Malnutrition!(GAM)!in!children!under!five!years!of!age!has!fluctuated,!with!2006! witnessing! the! highest! recorded! proportion! (9.1%).! Fewer! data! are! available! on! Severe! Acute!Malnutrition!(SAM),!but!prevalence!estimates!for!2000!and!2006!also!show!an!increase!in!those!years,!from! 0.6%! to! 2.2%.! Unlike! estimates! of! acute! malnutrition,! chronic! malnutrition! declined! significantly!over!the!period,!from!33.9%!in!1990!to!23.8%!in!2006,!but!witnessed!an!upturn!at!the!end!of!the!period.!The! proportion! of! children! under! five! who! were! underweight! also! fluctuated,! but! was! lower! in! 2006!(22.2%)! than! in! 1990! (26.8%).! Rather! than! consistent! trends! over! time,! the! results! indicate! that! acute!interruptions! in! the! availability! and! accessibility! of! food! stemming! from! domestic! and! international!events,!such!as!sporadic!periods!of!violence!and!the!imposition!of!international!sanctions!in!1991,956,957!were!the!driving!factors!behind!poor!nutritional!outcomes.!!More! recent! estimates! suggest! that! the! nutritional! situation! of! children! under! age! five! continued! to!decline!between!2006!and!the!eve!of!the!earthquake.!In!2008/09,!it!was!estimated!that!the!prevalence!of!SAM!had!risen!to!4.5%,!the!prevalence!of!GAM!had!risen!to!10%,!and!30%!of!Haitian!children!were!chronically!malnourished.958,959,960,961!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!948! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!949! D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first&household&survey&for& Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0!!950! UNICEF,!UNICEF&humanitarian&action&report&2007!(2007).!Available!at! http://www.unicef.org/har07/index_37587.htm!!951! UNICEF,!State&of&the&world’s&children&2005!(Oxford:!Oxford!University!Press,!2005).!Available!at! http://www.unicef.org/sowc/!!952! WHO!CRED,!Haiti:&A&brief&analysis&of&surveys&from&2004&to&2005,!Briefing!note!243,!Complex!Emergency! Database!(March!2008).!Available!at!http://www.cedat.be/sites/default/files/Brief%20243%20`%20Haiti.pdf!953! WHO!CRED,!Haiti:&A&brief&analysis&of&surveys&from&2004&to&2005,!Briefing!note!243,!Complex!Emergency! Database!(March!2008).!Available!at!http://www.cedat.be/sites/default/files/Brief%20243%20`%20Haiti.pdf!954 !Government!of!Haiti,!Interim&cooperation&framework&200452006:&Summary&report!(2004).!Available!at! http://haiticci.undg.org/uploads/ReportVersion8%20Eng%20FINAL%20Low%20Res.pdf!!955! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!956! M.!Baro,!“Food!insecurity!and!livelihood!systems!in!northwest!Haiti,”!Journal&of&Political&Ecology!9!(2002),!pp.!1` 34.!957 !UNICEF,!State&of&the&world’s&children&2005!(Oxford:!Oxford!University!Press,!2005).!Available!at! http://www.unicef.org/sowc/!!958 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!959! UN!OCHA!Haiti,!Haiti&before&January&12th,!Internal!document!(2010).!Available!at! http://ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1165439!!960! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!961 !Save!the!Children,!Serving&Haiti’s&children&now,&rebuilding&for&their&future:&Six&months&after&the&massive&quake! (July!2010).!Available!at!http://www.savethechildren.org/atf/cf/{9def2ebe`10ae`432c`9bd0` df91d2eba74a}/Haiti_6_month_report.pdf!!138! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&!Although! pockets! of! food! insecurity,! malnutrition! and! under`nutrition! are! present! across! Haiti,! rural!areas!typically!display!higher!rates!than!urban!areas.962,963!In!2008,!the!IMF!stated!that!acute!and!chronic!malnutrition!were!twice!as!prevalent!in!rural!areas!as!in!Port`au`Prince.964!Artibonite!and!Sud!emerged!as!the!Departments!with!the!highest!prevalence!of!Global!Acute!Malnutrition!(GAM)!(10%!and!12.1%,!respectively)! and! Severe! Acute! Malnutrition! (SAM)! (3.1%! and! 4.4%,! respectively)! in!2006,! while! Ouest!Department!also!recorded!high!prevalence!of!SAM!(2.3%).965!!Figure.66:.Prevalence.of.underT5.malnutrition.and.undernutrition,.1990T2006. Indicator. 1990. 1995. 2000. 2006. Global.Acute.Malnutrition. 3.4! 7.8! 4.5! 9.1! (GAM). Severe.Acute.Malnutrition. ! ! 0.6! 2.2! (SAM). Chronic.Malnutrition. 33.9! 31.9! 22.7! 23.8! Underweight. 26.8! 27.5! 17.3! 22.2!Data!sources:!WHO!CRED,!Haiti:&A&brief&analysis&of&surveys&from&2004&to&2005,!Briefing!note!243,!Complex! Emergency!Database!(March!2008).!Available!at!http://www.cedat.be/sites/default/files/Brief%20243%20` %20Haiti.pdf;!D.!Verner,!Making&poor&Haitians&count:&Poverty&in&rural&and&urban&Haiti&based&on&the&first& household&survey&for&Haiti,!World!Bank!Sustainable!Development!Division!(March!2008).!Available!at! http://go.worldbank.org/AE6TJ7EPY0;!IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.! 09/290!(2009).!Available!at!http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!!Haitian!children’s!poor!nutritional!status!begins!from!birth.!UNICEF!states!that!before!the!earthquake,!25%!of!children!were!of!low!birth!weight.!Additionally,!though!breastfeeding!was!widespread!(estimated!at!96%!in!1995),966!PAHO!noted!in!2007!that!exclusive!breastfeeding!was!low,!at!an!estimated!46%.967,968!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!962! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!963! UNICEF,!UNICEF&humanitarian&action&report&2007!(2007).!Available!at! http://www.unicef.org/har07/index_37587.htm!!964! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!965! WHO!CRED,!Haiti:&A&brief&analysis&of&surveys&from&2004&to&2005,!Briefing!note!243,!Complex!Emergency! Database!(March!2008).!Available!at!http://www.cedat.be/sites/default/files/Brief%20243%20`%20Haiti.pdf!966! M.!Cayemittes,!A.!Rival,!G.!Lerebours,!and!B.!Barrere,!Survey&on&mortality,&morbidity&and&utilization&of&services& (EMMUS5II)&1994/95:&Summary&report,!Demographic!and!Health!Surveys!(November!1995).!Available!at! http://www.measuredhs.com/pubs/pdf/SR49/SR49.pdf!!967! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!968 !Save!the!Children,!Serving&Haiti’s&children&now,&rebuilding&for&their&future:&Six&months&after&the&massive&quake! (July!2010).!Available!at!http://www.savethechildren.org/atf/cf/{9def2ebe`10ae`432c`9bd0` df91d2eba74a}/Haiti_6_month_report.pdf!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 139!
    • !A! number! of! surveys! have! found! that! a! large! proportion! of! children! in! Haiti! also! suffer! from!micronutrient! deficiencies,! especially! vitamin! A! and! iodine! deficiencies! and! anemia.! In! 2005,! it! was!found! that! 33%! of! children! under! five! had! a! vitamin! A! deficiency,! and! that! 1.47%! had! a! severe!deficiency.969,970,971!In!addition,!59%!of!children!aged!6!to!12!suffered!from!iodine!deficiency,!with!rural!areas!exhibiting!a!higher!prevalence!than!their!urban!counterparts.972,973!Most!troublingly,!it!was!found!that!in!2000,!65.3%!of!children!under!five!were!anemic.974,975! By!2005,!this!proportion!had!fallen!slightly!to! 61%;! however! it! is! unclear! whether! this! level! has! been! maintained,! fallen,! or! whether! gains! have!continued!over!time.976,977,978,979!!Haitian! households! spend! a! significant! proportion! of! their! income! on! food.! In! 1999/2000,! food!expenditure!accounted!for!55%!of!total!household!expenditure.980!By!2008,!this!proportion!had!declined!slightly!to!47.5%,!with!significant!differences!between!residents!of!Port`au`Prince!(32.8%),!other!urban!(41%),! and! rural! (55.6%)! areas.981,982! For! the! poorest! income! quintile! across! Haiti,! food! accounted! for!53.4%!of!household!income!in!2008,!while!it!accounted!for!only!9.8%!of!income!for!those!in!the!richest!quintile.983! For! those! in! lower! income! categories,! economic! constraints! severely! limit! access! to! food,!contributing!to!the!population’s!lack!of!food!security!and!poor!nutritional!outcomes.!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!969! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!970! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!971! PAHO,!Health&situation&in&Haiti&before&the&2010&earthquake,!Presentation!at!Haiti!Health!Cluster!(January!2010).! Available!at!http://ec.europa.eu/echo/files/aid/countries/Haiti_paper_01102010.pdf!!972! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!973! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!974 !PAHO,!Health&situation&in&Haiti&before&the&2010&earthquake,!Presentation!at!Haiti!Health!Cluster!(January!2010).! Available!at!http://ec.europa.eu/echo/files/aid/countries/Haiti_paper_01102010.pdf!!975! PAHO,!Health&in&the&Americas&2007:&Volume&II&–&countries:&Haiti!(2007).!Available!at! http://www.paho.org/hia/archivosvol2/paisesing/Haiti%20English.pdf!!976! IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!977! UN!OCHA!Haiti,!Haiti&before&January&12th,!Internal!document!(2010).!Available!at! http://ochaonline.un.org/OchaLinkClick.aspx?link=ocha&docId=1165439!!978 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!979! UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!980 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!981 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!09/290!(2009).!Available!at! http://www.imf.org/external/pubs/ft/scr/2009/cr09290.pdf!!982 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!983 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!140! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&In!December!2008,!a!survey!conducted!by!Crabtree,!Godoy,!and!Ray!found!that!60%!of!respondents!did!not!have!enough!money!to!buy!sufficient!food!in!the!preceding!12!months.!As!reflected!by!the!share!of!household! income! dedicated! to! food,! the! cost! of! basic! items! is! a! significant! burden! to! many.! In! 2008,!price!increases!associated!with!the!global!food!crisis!led!to!civil!unrest,!resulted!in!the!deaths!of!several!people,!and!contributed!to!the!fall!of!the!government.984!The!same!year,!60%!of!the!domestic!harvest!was!destroyed!by!three!hurricanes!and!one!tropical!storm.985,986!Not!only!did!this!destruction!decrease!the!domestic!supply!of!staple!foods!(which!accounts!for!only!45`50%!of!Haiti’s!total!food!needs987,988,989),!but!also!destroyed!the!livelihood!strategy!of!farmers,!who!were!then!left!with!little!or!no!income!from!the! harvest.! The! vulnerability! of! Haitian’s! access! to! food,! due! to! the! high! cost! relative! to! household!incomes!and!the!vulnerability!of!domestic!food!supply,!testifies!to!the!low!level!of!food!security!of!most!Haitians.990!!Following! the! 2010! earthquake,! surveyed! Haitians! identified! food! as! their! highest! priority! (Figure!67).991,992! The! rapid! Emergency! Food! Security! Assessment! (EFSA)! found! that! 31%! of! the! population! of!earthquake`affected!areas!had!poor!or!borderline!food!consumption!(Figure!68).!Differences!were!also!observed!between!those!displaced!by!the!earthquake!(43%)!and!those!not!displaced!(27%).993!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!984 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!985 !UN!GA,!Report!of!the!special!rapporteur!on!contemporary!forms!of!slavery,!including!its!causes!and! consequences,!Gulnara!Shahinian,!UN!Doc.!A/HRC/12/21/Add.1!(2009).!Available!at! http://www.unhcr.org/refworld/docid/4ac0c6b42.html!986 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!987 !IMF,!Haiti:&Poverty&reduction&strategy&paper,!IMF!country!report!No.!08/115!(2008).!Available!at! http://www.imf.org/external/pubs/ft/scr/2008/cr08115.pdf!!988! Droits!et!Democratie/GRAMIR,!The&human&right&to&food&in&Haiti:&Report&of&an&international&fact5finding&mission! (2008).!Available!at!http://www.dd`rd.ca/site/publications/index.php?id=2316&subsection=catalogue!!989 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!990 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!991 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!992 !World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!993 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 141!
    • !Figure.67:.PostTearthquake.household.priorities,.by.region,.February.2010. !Source:!World!Vision,!Rapid&assessment&report:&Haiti&earthquake&response!(March!2010).!Available!at! http://reliefweb.int/sites/reliefweb.int/files/resources/Full_Report_583.pdf!!!!Figure.68:.Food.consumption.among.displaced.and.nonTdisplaced.earthquakeTaffected.residents,.February.2010. !Source:!CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!!!Official!estimates!state!that!food!insecurity!in!earthquake`affected!areas!increased!from!40%!before!the!earthquake!to!52%!by!March!2010.994,995!In!large!IDP!camps,!this!figure!was!approximately!69%.996!The!University!of!Michigan/Small!Arms!Survey!placed!these!figures!higher,!estimating!that!10.9%!of!Port`au`Prince! households! were! food! insecure! with! severe! hunger,! 32.8%! with! moderate! hunger,! 31.5%! were!food! insecure! without! hunger,! and! only! 23.6%! were! food! secure.! Among! camp! households,! only! 4.4%!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!994 !Government!of!Haiti,!Haiti&earthquake&PDNA:&Assessment&of&damage,&losses,&general&and&sectoral&needs!(March! 2010).!Available!at!http://siteresources.worldbank.org/INTLAC/Resources/PDNA_Haiti` 2010_Working_Document_EN.pdf!995 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!996 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!142! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&were!either!food!insecure!without!hunger!or!food!secure,!while!68.9%!were!food!insecure!with!severe!hunger! and! an! additional! 26.7%! were! food! insecure! with! moderate! hunger.997! The! proportion! of!households! with! food! stocks! fell! markedly,! with! only! 17%! reporting! food! stocks! post`earthquake!compared!to!44%!before.998!!Food! insecurity! remains! a! significant! concern! two! years! after! the! 2010! earthquake.! According! to! a!recent!national!food!security!survey!conducted!by!Food!Cluster!partners,!4.5!million!Haitians,!or!almost!half!of!the!total!population,!was!food!insecure!one!and!a!half!years!after!the!earthquake.!Nord`Ouest!and!Nord`Est!Departments!and!Port`au`Prince!were!particularly!affected.999!!Food!security!in!post`earthquake!Haiti!has!been!associated!with!several!factors.!Those!households!who!had!changed!their!sources!of!income!since!the!earthquake,!for!example,!were!more!likely!(63%)!to!be!food!insecure!than!those!who!had!not!(44%).!Households!headed!by!women!were!also!more!likely!to!be!food!insecure!(60%)!than!male`headed!households!(45%).1000!Remittances!also!appeared!to!play!a!role.!Almost! 75%! of! food! secure! households! received! gifts! or! remittances,! while! 0%! of! food! insecure!household!with!severe!hunger!did.1001!Income!was!a!protective!factor!as!well,!with!households!receiving!any!income!approximately!half!as!likely!to!be!experiencing!food!insecurity!with!severe!hunger!(5%)!than!average.1002!!In! March! 2010,! the! EFSA! found! that! levels! of! acute! malnutrition! remained! below! Sphere! standard!emergency! thresholds.! According! to! the! survey,! 6%! of! children! under! five! suffered! from! GAM,! while!1.3%! suffered! from! SAM.1003,1004! The! prevalence! of! child! malnutrition! was! estimated! to! be! higher! in!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!997 !A.!R.!Kolbe,!R.!Muggah,!R.!A.!Hutson,!et!al.,!Assessing&needs&after&the&quake:&Preliminary&findings&from&a& randomized&survey&of&Port5au5Prince&households,!University!of!Michigan/Small!Arms!Survey!(April!2010).! Available!at! http://www.comunidadesegura.org/files/Results%20of%20a%20Random%20Survey%20of%20Haitian%20House holds.doc!!998 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!!999 !UN!OCHA,!Humanitarian&bulletin:&19&August&–&20&September&2011!(September!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=Nutrition+Cluster%2f19_Aout_20_Septembre_2011_ Haiti+_Humanitarian_Bulletin+10+English.pdf&tabid=80&mid=1033!!1000 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!1001 !A.!R.!Kolbe,!R.!Muggah,!R.!A.!Hutson,!et!al.,!Assessing&needs&after&the&quake:&Preliminary&findings&from&a& randomized&survey&of&Port5au5Prince&households,!University!of!Michigan/Small!Arms!Survey!(April!2010).! Available!at! http://www.comunidadesegura.org/files/Results%20of%20a%20Random%20Survey%20of%20Haitian%20House holds.doc!!1002 !A.!R.!Kolbe,!R.!Muggah,!R.!A.!Hutson,!et!al.,!Assessing&needs&after&the&quake:&Preliminary&findings&from&a& randomized&survey&of&Port5au5Prince&households,!University!of!Michigan/Small!Arms!Survey!(April!2010).! Available!at! http://www.comunidadesegura.org/files/Results%20of%20a%20Random%20Survey%20of%20Haitian%20House holds.doc!!1003 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf! ©!2012!FXB!Center!for!Health!and!Human!Rights! 143!
    • !displaced! and! camp! populations,! although! sample! size! limitations! prevented! confident! sub`population!estimates.1005!Though!most!sources!refer!to!post`earthquake!levels!as!either!similar!to,!or!slightly!more!than,! GAM! and! SAM! levels! in! pre`earthquake! Haiti,1006,1007! EMMUS! IV! survey! results! from! 2006! (9.1%!GAM! &! 2.2%! SAM,! respectively)! and! estimates! from! 2008! (10%! &! 4.5%,! respectively)!indicated! higher!levels.! If! the! EFSA! results! are! accurate,! this! would! suggest! that! the! prevalence! of! child! malnutrition!decreased! between! 2008! and! 2010,! though! the! challenging! nature! of! post`disaster! population`based!surveys!necessitates!caution!for!this!observation.!!As! part! of! its! surveillance! activities,! the! Nutrition! Cluster! introduced! an! active! screening! program! for!malnutrition! across! eight! Departments.! By! October! 2011,! 393,000! children! had! been! screened,! with!results! indicating! heterogeneous! levels! of! moderate! and! severe! malnutrition.! Across! all! surveyed!Departments,! 1.1%! of! children! were! found! to! be! severely! malnourished! (4,241! children)! and! 7.4%!moderately! malnourished! (28,260).! Severe! malnutrition! was! found! to! be! highest! in! Artibonite,!Grande‘Anse,!Nord,!Ouest!and!Sud!Departments!(Figure!69),!while!moderate!malnutrition!was!highest!in!Grande‘Anse,!Nippes,!Nord,!Ouest,!and!Sud`Est!Departments!(Figure!70).1008!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1004 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!1005 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!1006 !UNICEF,!Children&of&Haiti:&Milestones&and&looking&forward&at&six&months!(July!2010).!Available!at! http://www.unicef.org/emerg/files/UNICEF_Haiti_`_Six_Months_Report_Final.pdf!!1007 !UNICEF,!Children&of&Haiti:&Progress,&gaps&and&plans&in&humanitarian&action!(April!2010).!Available!at! http://www.unicef.org/romania/FINAL_UNICEF_Haiti_90`Day_Report_13_April_2010_FINAL.pdf!!1008 !Haiti!Nutrition!Cluster,!Nutrition&cluster&update:&Issue&3!(October!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=English+Nutrition+cluster+update+issue+3.pdf&tabid =80&mid=1631!!144! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&Figure.69:.Prevalence.of.severe.malnutrition.in.mostTaffected.Departments,.by.surveyed.commune,.JanuaryTOctober.2011. !Source:!Haiti!Nutrition!Cluster,!Nutrition&cluster&update:&Issue&3!(October!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=English+Nutrition+cluster+update+issue+3.pdf&tabid =80&mid=1631!!!!Figure.70:.Prevalence.of.moderate.malnutrition.in.mostTaffected.Departments,.by.surveyed.commune,.JanuaryTOctober.2011. !Source:!Haiti!Nutrition!Cluster,!Nutrition&cluster&update:&Issue&3!(October!2011).!Available!at! http://haiti.humanitarianresponse.info/LinkClick.aspx?link=English+Nutrition+cluster+update+issue+3.pdf&tabid =80&mid=1631!!! ©!2012!FXB!Center!for!Health!and!Human!Rights! 145!
    • !!The!destruction!of!infrastructure,!logistics!capacity,!and!food!stores!led!to!a!significant!rise!in!the!price!of! basic! foods! following! the! earthquake,! limiting! access! and! placing! additional! strain! on! the! ability! of!families! to! meet! food! needs.1009! Before! the! earthquake,! imported! rice! in! Port`au`Prince! cost! 120!gourdes!per!6!pounds.!This!price!increased!to!almost!160!gourdes!by!26!January!2010!before!stabilizing!at! 150! gourdes! per! 6! pounds! by! 11! February! 2010! (Figure! 71).1010,1011! Immediately! following! the!earthquake,! the! extremely! low! proportion! of! earthquake! survivors! bringing! in! any! income! (6%)!compounded!the!impact!of!these!price!increases.1012!!Figure.71:.Price.of.basic.foodstuffs.in.PortTauTPrince.and.Jacmel,.November.2009TFebruary.2010. !Source:!CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!!!Increased!prices!and!decreased!income!meant!households!turned!to!other!survival!strategies,!including!going! into! debt.! In! March! 2010,! the! Haitian! government! estimated! that! more! than! half! of! all!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1009 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!1010 !CNSA,!Rapid&post5earthquake&emergency&food&security&assessment:&Haiti!(March!2010).!Available!at! http://documents.wfp.org/stellent/groups/public/documents/ena/wfp221395.pdf!1011 !UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at! http://www.un.org/en/peacekeeping/missions/minustah/documents/6_months_after_commemoration.pdf!!1012 !UN!OCHA!Haiti,!Haiti:&Humanitarian&assessment&key&findings&No.&2,!29!March!2010!(March!2010).!Available!at! http://groups.google.com/group/assessmentshaiti/browse_thread/thread/71f3f127213f7a06!!146! ©!2012!FXB!Center!for!Health!and!Human!Rights!
    • & 6.&Poverty,&access,&and&empowerment&earthquake`affected! households! had! become! severely! indebted,! with! 95%! of! this! debt! accrued! to! pay!for!food.1013,1014!!The!EFSA!found!that!Haitians’!survival!strategies!were!related!to!pre`earthquake!livelihood!strategies.!As!such,! those! in! rural! areas! reported! high! rates! of! eating! seed! stocks! (51%),! harvesting! earlier! (39%),!refraining! from! buying! any! or! sufficient! farm! inputs! (35%),! and! selling! additional! livestock! (32%).! In!urban! areas,! households! typically! continued! to! look! for! temporary! work,! sell! assets,! or! consider!migrating.1015,1016,1017!In!addition!to!these!strategies,!most!families!reduced!the!amount!of!food!they!ate,!thus! reducing! expenditures.! In! early! February! 2010,! 87%! of! households! in! Port`au`Prince! and! 92%! of!earthquake`affected! households! in! the! outskirts! of! the! capital! reported! that! household! members! had!decreased! food! consumption! by! one! or! more! meals! a! day.1018! For! children,! this! reduced! level! of!consumption!would!mean!heightened!malnutrition!and!vulnerability!to!disease,!as!well!as!risk!of!long`term!damage.!!Of! concern! to! child! protection! programmers! was! the! finding! that! many! families! sent! their! children! to!rural! family! members! and! friends! following! the! earthquake! to! provide! for! their! food! needs.! This!phenomenon!was!reportedly!higher!for!camp`based!populations.!EFSA!authors!noted!that!this!strategy!does! not! necessarily! pose! a! problem! if! the! children’s! host! families! provide! adequate! care! and! return!children! to! their! families! once! their! needs! are! met.! However,! some! community! members! raised!concerns!that!temporary!placement!can!result!in!a!restavek!arrangement,!discussed!in!further!detail!in!Section!9A.&Children&in&domestic&service&and&servitude.1019!!In!response!to!the!poor!food!security!of,!and!high!levels!of!malnutrition!among,!Haitian!children,!after!the! earthquake! UNICEF! and! its! partners! established! therapeutic! feeding! programs,! distributed!supplementary!food!and!infant!formula!for!pregnant!and!lactating!women,!created!and!scaled!a!school!meal! program,! provided! blanket! feeding! programs,! vitamin! A! supplementation,! and! trained! health!professionals! and! community! workers.! By! July! 2010,! 1,500! severely! malnourished! children! had! been!treated,! 500,000! children! under! five! had! received! supplementary! foods,! 3,000! babies! had! received!infant! formula,! 800,000! students! had! been! covered! by! t