First Came an Earthquake. Then a Hurricane. Now, Haiti is Bracing for an Outbreak of Disease.

Two days after a 7.2 magnitude earthquake struck Les Cayes, Haiti on Aug. 16, 2021, residents waited for food distribution.
Two days after the earthquake, residents wait in line for food distribution in Les Cayes (Haiti), Aug 16, 2021. Credit: Joseph OdelynAP

August 14th saw a devastating earthquake of 7.2 magnitude that struck southwestern Haiti. It left 2,189 dead, 12,268 hurt, and at least 332 people missing. The complex search and rescue mission was hampered by Tropical Storm Grace, which swept through the devastated landscape a few days later. Aid groups claim that this is just the beginning of the crisis.

In just a few short weeks, the island nation of 12 million people has been hit with one after another. Jovenel Moses, the president of the country, was assassinated in July amid growing corruption allegations. Since the 2010 earthquake that killed more than 200,000 people, the country has struggled with poverty and disease.

Haiti is now in ruins after another earthquake, followed by a hurricane. U.N. estimates that 40% of Haiti's total population is in dire need of humanitarian aid. Flash flooding and landslides caused by heavy rains in some areas blocked roads leading to relief-seeking communities.

On Aug. 15, a firefighter searches inside a building that was damaged to find survivors. Joseph OdelynAP

People gather in front of the Petit Pas Hotel that was destroyed by the earthquake at Les Cayes on Aug. 14. Joseph OdelynAP

People were evacuated by the earthquake in Les Cayes, Aug. 19. Adriana ZehbrauskasThe New York Times/Redux

Ann Lee, CEO of CORE (a community-oriented aid agency), tells TIME that there is a lot more death and destruction. We are slowly seeing the numbers rise and it is a lot worse that what I was afraid.

Around 61,000 homes were destroyed in the worst affected regions, including Sud, GrandAnse, and Nippes. People have been forced to take refuge in unstable buildings because of flooding from the storm.

Workers in humanitarian aid are also at risk. TIME spoke with Wes Comfort, the recovery and response leader at Heart to Heart International. He explained that his medical team preferred to sleep on their car roofs. Everybody is wary about sleeping indoors. Last night, we camped out on the streets and listened as the aftershock rattled the tin roof at the [mayors] offices.

Aid organisations now fear that the dangerous combination of flooding, falling debris and landslides will increase the likelihood of local disease.

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During a funeral procession to remember a loved one who died in the earthquake that struck L'Asile, Aug. 18, people cross a river. Adriana ZehbrauskasThe New York Times/Redux

One man walks on rubble left over from the landslide that occurred in River Glass, Aug. 18. Matias DelacroixAP

Due to the insufficient number of beds in Les Cayes, Aug. 16, some of those who were injured in the earthquake are being assisted on the floors or in corridors of the general hospital. Orlando BarraEPA-EFE/Shutterstock

There is also the ongoing COVID-19 pandemic, which is a concern. Haiti has recorded 184 COVID-19 cases per 100,000 people, and 582 deaths over the course of this pandemic. However, the infrastructure is poor and testing is difficult. The confirmed cases are likely to be higher.

This week's natural disasters could increase the spread of coronavirus among a population that is barely vaccinated. Haiti was the western hemisphere's last country to be given COVID-19 vaccines. It received its first dose of Moderna on July 16th.

CORE had just opened several COVID-19 vaccination clinics at the time of the earthquake. Lee tells TIME that they are mostly located in the west [part of the country]. This happened because we were expanding to the south. This will make it more difficult to travel as far south as we planned.

TIME spoke with Muhamed Bizimana (Assistant Country Director in Haiti for CARE aid organization) about the possibility of another round of COVID-19. He said that they are worried about the potential for another COVID-19 outbreak due to the devastation caused by the entire event.

Aid organisations say they encourage people to stay at home and not in camps. This could spread the virus further. The earthquake occurred on Saturday. Bizimana stated that we are now in the incubation phase.

On Aug. 16, a woman who was injured by the earthquake is taken to Les Cayes Hospital. Ricardo ArduengoReuters

After recovering Francois Elmay's body from the rubble of his home, men load the coffin with the remains of Francois Elmay. This was done in Les Cayes on August 18. Joseph OdelynAP

After earthquakes in Les Cayes on August 19, people gathered outside to rest after the tremors. Ricardo ArduengoReuters

Concerns about waterborne disease are also being raised by poor sanitation and water system damage. Nearly 1,800 water tanks in Pestel, GrandAnse were damaged by the earthquake.

Floodwater stagnation can also make it a breeding ground. Dr. Maureen Birmingham is a representative of the Pan American and World Health Organizations in Haiti. She said that the country had made significant progress in controlling malaria before the setbacks caused by COVID-19, political instability, and other factors.

Birmingham's medical teams are on alert for respiratory disease, diarrhoea, and skin conditions due to poor sanitation, poor hygiene and crowded areas. It is difficult to determine which one is most concerning.

Everyone is concerned about Cholera. The country's first epidemic occurred after the 2010 earthquake that resulted in almost 10,000 deaths. The spread of waterborne diseases continued throughout the country, with an especially significant increase following Hurricane Matthew in 2016.

UNICEF reports that the last confirmed cases of cholera in Haiti occurred in February 2019. Birmingham says that the risk is on the radar.