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
Nicholas M. Cooper
October 2012
© 2012 FXB Center for Health and Human Rights, Harvard University

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Copyright © 2012
by the FXB Center for Health and Human Rights
Harvard University
651 Huntington Avenue, 7th floor
Boston, 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.!
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PROTECTING.HAITI’S..
CHILDREN.
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Risk.factors.and.outcomes.before.and.
since.the.2010.earthquake.
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.
Nicholas.M..Cooper.
.
.

October.2012.
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©!2012!FXB!Center!for!Health!and!Human!Rights,!Harvard!University!
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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!
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D.!Shelter!and!housing!.........................................................................................................................!158!
E.!Information!and!communication!technology!..................................................................................!164!
F:!Political!and!civic!engagement!.........................................................................................................!167!
7.!Health!...................................................................................................................................................!172!

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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!
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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!
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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!
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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!Haiti's!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!
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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!
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Figure!33:!Progress!towards!MDG!4!(U5MR),!1990`2005!..........................................................................!43!
Figure! 34:! Disaggregation! of! U5MR! by! socio`economic! group,! sex,! urban/rural! status,! and! mother's!
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!39:!Maternal!Mortality!Ratio!(MMR):!Reported!and!adjusted,!1995`2007!....................................!47!

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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! Portàu`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!
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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!
Portàu`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!Portàu`Prince!metropolitan!area,!2000!............!106!
Figure!55:!Parental!residence!in!household,!by!region,!urban/rural!status,!and!child's!gender,!2006! ...!108! .
Figure!56:!Parental!residence!in!household,!by!urban/rural!status,!and!child's!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!Parityàdjusted!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! preèarthquake!
income!tercile,!March!2010!...............................................................................................................!135!
Figure!66:!Prevalence!of!under`5!malnutrition!and!undernutrition,!1990`2006!.....................................!139!
Figure!67:!Postèarthquake!household!priorities,!by!region,!February!2010!..........................................!142!
Figure! 68:! Food! consumption! among! displaced! and! non`displaced! earthquakeàffected! residents,!
February!2010!....................................................................................................................................!142!

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Figure! 69:! Prevalence! of! severe! malnutrition! in! mostàffected! Departments,! by! surveyed! commune,!
JanuaryÒctober!2011!.......................................................................................................................!145!
Figure!70:!Prevalence!of!moderate!malnutrition!in!mostàffected!Departments,!by!surveyed!commune,!
JanuaryÒctober!2011!.......................................................................................................................!145!
Figure!71:!Price!of!basic!foodstuffs!in!Portàu`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!
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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!preèarthquake!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!

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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,!Portàu`Prince,!Leogane,!and!Jacmel!(chart),!March!2010!..!244!
Figure!107:!Damage!sustained!by!schools,!Portàu`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:!Nonènrollment!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!overàged!students!relative!to!total!enrollment,!by!grade,!1998
!...........................................................................................................................................................!263!
Figure!120:!Number!and!percent!of!overàge!students!in!basic!education,!1993`1998!..........................!264!
Figure!121:!Number!of!overàge!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!

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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!
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!
Figure!152:!Children's!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!...................................................................................................................................................!348

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!
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! preèxisting!
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!Portàu`Prince!metropolitan!
area.5! This! population! concentration! proved! disastrous! when! the! 7.0! Richter! scale! earthquake! struck!
just!25km!southwest!of!Portàu`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!!

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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! Portàu`Prince! population)! left! the! Portàu`Prince!
metropolitan! area,! although! by! the! end! of! January! 2010! migration! to! the! capital! again! exceeded!
migration!from!the!capital.!By!March!2010,!the!Portàu`Prince!population!was!an!estimated!15%!smaller!
than!before!the!earthquake.8!The!proportion!of!those!who!left!Portàu`Prince!following!the!earthquake!
that! have! since! returned,! as! opposed! to! those! migrating! to! Portàu`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
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!!

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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
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).!

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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
27
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
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!!

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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
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
39
40
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
43
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!!

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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! Portàu`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! earthquakeàffected! 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! Portàu`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
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
49
!Global!Initiative!to!End!All!Corporal!Punishment!of!Children,!Haiti&country&report!(February!2009).!Available!at!
http://www.endcorporalpunishment.org/!!
50
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!preèxisting!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!Portàu`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`contextànalysis`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! postèarthquake!
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!postèarthquake!
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
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_feb2010Ènglish.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! preèxisting! 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
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
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`workingònà`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
83
84
85
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
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
92
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
96
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

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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! earthquakeàffected! 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!earthquakeàffected!
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! earthquakeàffected! 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
104
!UN!MINUSTAH,!Haiti:&6&months&after…!(July!2010).!Available!at!
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!earthquakeàffected!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
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`managementòfàcute`malnutritionànd`micronutrient`deficiencies/!
109
110
!Population!Reference!Bureau,!PRB&datafinder:&Haiti.!Available!at!http://www.prb.org/datafinder.aspx!
111
112
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
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`dinepaàcfstrategievf&Itemid=67!

xxiv! ©!2012!FXB!Center!for!Health!and!Human!Rights!

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

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