Humanitarian Access

SCORE Report: Haiti

Survey on the Coverage, Operational Reach,
and Effectiveness of Humanitarian Aid
 Humanitarian Access SCORE Report: Haiti
Survey on the Coverage, Operational Reach, and Effectiveness of Humanitarian Aid

Abby Stoddard, Paul Harvey, Mariana Duque-Diez, Monica Czwarno, Meriah-Jo Breckenridge

July 2023

www.humanitarianoutcomes.org
www.aidworkersecurity.org

SCORE reports
Under the CORE research programme, supported by USAID’s Bureau for Humanitarian Assistance (USAID/BHA),
Humanitarian Outcomes is studying how aid reaches people in hard-to-access emergency contexts. In partnership
with GeoPoll, the project conducts remote telephone surveys of crisis-affected people on their perceptions of the
effectiveness of the aid response and the access challenges in their areas. Combined with key informant interviews
with humanitarian responders and other contextual research, the survey results help to identify the humanitarian
providers and practices that have achieved the greatest presence and coverage in difficult environments.

This SCORE report presents findings from a mobile telephone survey of 1,011 people in Haiti, conducted by
GeoPoll for Humanitarian Outcomes in May 2023. The survey reached 515 men and 496 women across
10 regions. Humanitarian Outcomes researchers also conducted remote interviews with 21 key informants
representing national and international humanitarian organisations working in Haiti, donor government
representatives, and external experts.

Full survey results and additional information on the SCORE research methodology, including an interactive
dashboard of response data, are available at: www.humanitarianoutcomes.org/projects/core

ACRONYMS
AAP accountability to affected people MSF Médecins Sans Frontières
ACLED Armed Conflict Location & Event Data Project OCHA UN Office for the Coordination of
AWSD Aid Worker Security Database Humanitarian Affairs
CDC Centers for Disease Control and Prevention SCORE Survey on the Coverage, Operational Reach,
and Effectiveness of Humanitarian Aid
FTS Financial Tracking Service
SISNU The Single Health Information System
HNO Humanitarian needs overview
USAID United States Agency for International
HRP Humanitarian response plan
Development
IASC Inter-Agency Standing Committee
WASH water, sanitation and hygiene
IOM International Organization for Migration
Summary

Haiti’s humanitarian crisis has resulted from a political and economic implosion,
compounded by natural shocks, but with consequences similar to major armed
conflicts – including severe constraints to humanitarian access. The collapse of law
and order after the assassination of the president in 2021, and a wave of violence
perpetrated by armed criminal gangs, has displaced over 100,000 people from their
homes and contributed to the breakdown of basic social services. These developments
contributed to a resurgence of cholera on the island, which to date has taken hundreds
of lives, many of them children. Although over 100 humanitarian groups are present in
Haiti, the threat of violence prevents them from responding
​​ in the places and at the
level required to meet the needs.

A survey of affected people and interviews with humanitarian practitioners in Haiti

revealed that:

• aid has only reached a small fraction of people who say they need it, mostly in
the form of food and household items

• according to people surveyed, the aid received mostly did not reach where it
was most needed and did not cover priority needs

• humanitarian presence and access issues were obscure to many affected people,
who lacked information on what aid was available and what was preventing it
from getting to where it is needed.

A UN-led scale-up of humanitarian assistance began in April 2023, introducing a new

collective strategy and joint initiative to expand access – a promising development with
the potential to change the trajectory in Haiti. While the political and protection crisis
is well beyond the scope of humanitarians to mediate, recent efforts suggest that
humanitarian access can be meaningfully improved through assertive negotiation efforts
that are backed up by results in the form of aid delivered, and by working closely with
the NGO sector – particularly local organisations that have been able to maintain access
through active acceptance measures at the community level and the willingness to
negotiate with all power holders.
 Humanitarian organisational presence and people in need in Haiti

Nord-Ouest Monte Cristi

Nord

Nord-Est
Dajabón
Artibonite

Centre
Elías-Piña

Port-au-
Grand’Anse Prince
Ouest
Nippes Independencia

Sud Sud-Est

Pedernales

Number of organisations People in need

14
20
202,0441,755,764
30
40
52

Data source: OCHA 20231

1
UN Office for the Coordination of Humanitarian Affairs (OCHA). (2023a). Haiti - Operational presence. HDX.
Retrieved 1 June from https://data.humdata.org/dataset/haiti-operational-presence; OCHA. (2023b).
Haiti: Humanitarian response plan at a glance (April 2023). Humanitarian Needs Overview. April 13 2023.
https://reliefweb.int/report/haiti/haiti-humanitarian-response-plan-2023-glance-april-2023-enht
 The spiralling crisis of violence in Haiti

Haiti is again in the grip of a severe humanitarian emergency, caused by a combination of gang violence,
governance breakdown, natural disasters, and economic recession. The confluence of factors has
deprived the Haitian population of basic services and driven forced migration and food insecurity.
A resurgence of cholera has further escalated the crisis.

Armed criminal gangs have operated in Haiti since the 1950s, but their impact has surged since 2021.
The assassination of President Jovenel Moïse and the devastating August 2021 earthquake triggered
political and socio-economic turmoil, accompanied by widespread insecurity. Violence has been
concentrated in Port-au-Prince and its metropolitan area throughout 2022 and 2023, with clashes
between the G-9 alliance, led by Jimmy Cherizier, and the rival G-Pèp gang alliance, headed by
Gabriel Jean Pierre (Ti Gabriel).2 The UN estimates that gangs control 80% of the capital city,3 and the
level of violence has been staggering, with 600 killings reported in the month of April alone. While
some gang leaders espouse political goals, their actions principally involve illicit economies, some with
transnational links. Gang connections with members of some politicians and affluent business interests
in Haiti further complicate any international or homegrown efforts to root them out.

Lacking any sense of safety and protection, communities have resorted to vigilante measures. The
emergence of self-defence groups in various parts of the capital and the Artibonite department has
become a complicating factor and a growing concern, as they have contributed to the rising violence.4
As gangs consolidate control over territories and set up roadblocks, people in inaccessible communities
can find themselves effectively trapped, no longer able even to travel away from home to access the
services they need.

Three consecutive years of economic recession and an inflation rate of 48% have added to the misery
of the population. Haiti is one of the poorest countries in the world, with nearly 90% of Haitians living
below the poverty line, according to the World Bank, and nearly a third in extreme poverty, defined as
a per capita income under $2.15 per day.5 Basic public services like health and education have become
dependent on aid groups to fund and run. In recent years, many of them, including medical facilities,
have been forced to shut down due to deteriorating security conditions.6

Against this grim backdrop, an outbreak of cholera was confirmed in October 2022, after more than
three years without any recorded cases.7 The coordinated response to the outbreak was fatally slow,
due in part to the fact that high levels of violence limited movements and the ability to quickly identify
and treat new cases, leading to a rapid spread across all 10 departments and almost 600 dead as of
February 2023.8
2
ACAPS. (2023). Haiti: Humanitarian impact of gang violence (02 June 2023). ACAPS briefing note.
https://reliefweb.int/report/haiti/acaps-briefing-note-haiti-humanitarian-impact-gang-violence-02-june-2023
3
InterAction. (2023). Member recommendations for the Haiti humanitarian response.
https://reliefweb.int/report/haiti/interaction-member-recommendations-haiti-humanitarian-response
4
According to local media reports, vigilante groups committed at least 164 of 600 reported killings in April alone. (USAID. (2023).
Haiti – Complex emergency – Fact sheet #5. Fiscal Year (FY) 2023.
https://reliefweb.int/report/haiti/haiti-complex-emergency-fact-sheet-5-fiscal-year-fy-2023
5
World Bank (2023). The World Bank in Haiti. Overview. https://www.worldbank.org/en/country/haiti/overview
6
As evidenced by the closure of the Médecins Sans Frontières (MSF) hospital in Cité Soleil on 28 February 2023.
See: https://www.doctorswithoutborders.org/latest/haiti-violent-clashes-force-temporary-closure-msf-hospital-cite-soleil
7
Centers for Disease Control and Prevention (CDC). (2023, 25 January). Cholera in Haiti.
https://www.cdc.gov/cholera/haiti/index.html
8
As of 28 February 2023, the Ministry of Health reported 33,661 suspected cholera cases, over 2,439 confirmed cases, and 594
deaths across the country’s ten departments. (UNICEF. (2023). Haiti. Humanitarian situation report #1. January-February 2023).
https://www.unicef.org/media/139356/file/Haiti-Humanitarian-SitRep-February-2023.pdf

5 | Humanitarian Access SCORE Report: Haiti

The UN estimates there are currently 5.2 million people in need in Haiti this year, with 4.9 million of
those severely food insecure.9 More than 165,000 people that were displaced by gang violence have
sought shelter and safety in overcrowded, often squalid makeshift encampments in Port-au-Prince,10
which increases the risk of cholera transmission. Likewise, the flooding caused by heavy rains in June,
and other severe climate events anticipated with the coming hurricane season, could add to the
numbers of people in need of assistance.

The rise in crisis-level needs over the past few years has not been matched by humanitarian
contributions, which have been inconsistent, with the average coverage of funding requirements
during 2018–2022 not exceeding 30% (Figure 1a). The UN’s decision in April to scale up the response,
and the evident willingness of donors to focus more attention on Haiti, has improved the total amount
of funding received in 2023 to date, but coverage rates remain low (Figure 1b).

Figure 1: Needs and funding

a. Number of people in need vs. people targeted (millions) b. Financial requirements (USD$ millions)
6 800
People in need not targetted Shortfall

People targetted 700 Covered 547

5 2.8 2.0
2.4
600
3.0
4
500
319
3 3.2 400
0.3 0.6 188
1.3 2.5
2.4 2.3 300
2 0.8 2.2
85
200 172
1.5 125 115 186
1.3 1.3 173
1 153
100 85
69 77 64
0 0 30 41
2016 2017 2018 2019 2020 2021 2022 2023 2016 2017 2018 2019 2020 2021 2022 2023

Data sources: OCHA 2023 11

The SCORE survey of 1,011 randomised respondents across Haiti reflected the vast scope of unmet
needs among the population, with 90% reporting they needed aid. Equally alarming, only 6% of those
who needed aid reported having received any (Figure 2).

Figure 2: Answers to “Did you need aid” vs. “Did you receive aid”
1,000
900 954 948
800
700
600
500
400
300
200
100
Yes No
0 54 59
Needed aid Received aid

Data from Survey on Coverage, Operational Reach, and Effectiveness (humanitarianoutcomes.org/projects/core)

9
OCHA. (2023b). Haiti: Humanitarian response plan at a glance (April 2023).
https://reliefweb.int/report/haiti/haiti-humanitarian-response-plan-2023-glance-april-2023-enht
10
International Organization for Migration (IOM). (2023, 8 June). Gang violence displaces 165,000 in Haiti, hinders aid efforts.
https://www.iom.int/news/gang-violence-displaces-165000-haiti-hinders-aid-efforts
11
OCHA. (2023c). Haiti plan de réponse humanitaire 2023. Financial Tracking Service. https://fts.unocha.org/appeals/1121/summary

6 | Humanitarian Access SCORE Report: Haiti

 A strangled humanitarian response

Crime-based insecurity, coupled with the logistical hurdles of fuel shortages, poor road conditions,
and mountainous terrain, have prevented most Haitians who need it from reaching – or being reached
by – critical aid. Arguably, an effective response was thwarted from the start by the absence of a single,
sudden onset event to galvanise attention and action from the international community, such as the
massive earthquake in 2010. Instead, the current crisis slowly and inexorably mounted as the institutions
of government failed and gangs proliferated and grew in strength, filling the power vacuum.

When cholera re-emerged and the Haitian authorities requested international military intervention to help
restore order,12 it was undeniable that the situation in Haiti had become a fully-fledged humanitarian
emergency. This was punctuated in late 2022 when gangs blockaded the port for two months, which
not only prevented much required goods from entering the country but also sparked a major shortage
of fuel. Nearly every person interviewed for this report mentioned the fact that the two main roads
connecting the capital to rest of the country (north and south) were controlled by gangs creating
major impediments to aid.

The UN humanitarian coordination body activated a system-wide scale-up on 17 April and,13 by 12 May, the
total number of humanitarian organisations operating in Haiti had grown to 110 (including 54 international
NGOs and 33 national NGOs) – the highest number over a 7-year period (Figure 3).14 Going by the
numbers in the latest humanitarian response plan, the apparent operational presence is on a similar level
to other humanitarian emergency contexts reviewed as part of this research programme (Figure 4).

Figure 3: Number of aid organisations and total people in need targeted for aid in Haiti
120 3.5
Number of partners PIN (millions) targetted 3.2

110 3.0
100

95 2.5
2.4 2.5
2.3
80 2.2
78
75 74 2.0
70
60
61
1.5
55 1.5
40 1.3
1.3
1.0

20
0.5

0 0.0
2016 2017 2018 2019 2020 2021 2022 2023
Source: OCHA 2023

12
Prospects for a non-UN rapid reaction force to stabilise Haiti have been under discussion at the Security Council, but with no
member states yet stepping forward, actions have been limited to enacting sanctions on gang leaders.
13
Inter-Agency Standing Committee (IASC). (2023). Humanitarian system-wide scale-up activations and deactivations.
https://interagencystandingcommittee.org/iasc-humanitarian-system-wide-scale-activations-and-deactivations
14
OCHA. (2023a). Haiti – Operational presence. HDX.
Retrieved 1 June from https://data.humdata.org/dataset/haiti-operational-presence

7 | Humanitarian Access SCORE Report: Haiti

Figure 4: Number of hu​​manitarian organisations responding in emergency contexts (2023)
250
Other
220
RCM
200
180 UN

NNGOs
150 146
135 132 INGOs
126
110
100

50

21

0
Myanmar Afghanistan NE Nigeria CAR Yemen Iraq Haiti Tigray
Source: HDX OCHA 2023 3W’s

While the apparent increase in humanitarian presence would appear most welcome and appropriate, the
numbers may obscure the low level of access and movement these organisations have, as programmes
and services have been suspended or shut down since 2022 due to the levels of violence.15

Interviewees described the pre-scale-up period as a low ebb of international assistance, citing a
general lack of humanitarian actors and weak coordination. “Everyone had left post-earthquake, and
it was just development and state-building that was the main focus, but there’s no state to build at the
moment.” The same interviewees acknowledged the renewed efforts but expressed concern that it
was proceeding “with not nearly enough presence or funding”.

While some humanitarian representatives we interviewed perceived the scale-up to be making a

meaningful difference in terms of aid presence on the ground, others were far more restrained in their
optimism. On the positive side, the infusion of additional funding and air assets has helped expand
reach to some areas that were previously inaccessible, and a revitalised h
​ umanitarian coordination
system has mobilised joint access efforts and brought in experienced humanitarian staff. The major
UN humanitarian agencies, an interviewee noted, “can now get everywhere”. On the other hand, the
interviewee said that generally, humanitarian presence across the country “is still low”.

The perception of sparse aid presence was clearly reflected in the May 2023 SCORE survey (though it
is possible that at that time the public had yet to register the effects of the scale-up that had started
just a month earlier). Most Haitians we surveyed (of those who had an opinion – almost a third did not)
said that the presence of aid workers in their area had either stayed the same or reduced (Figure 5) and
that aid was mostly not reaching where it was most needed (Figure 6).

Reuters. (2023, 8 March). Medecins Sans Frontieres shuts Haiti hospital amid gang violence.
15

https://www.reuters.com/world/americas/medecins-sans-frontieres-shuts-haiti-hospital-amid-gang-violence-2023-03-08/

8 | Humanitarian Access SCORE Report: Haiti

Figure 5: Has the presence of aid providers in your area changed in the last year?
40

34%

30

20
17%

12%
10

6%

1%
0
Reduced a lot Reduced Neutral/stayed the same Increased Increased a lot

Data from Survey on Coverage, Operational Reach, and Effectiveness (humanitarianoutcomes.org/projects/core)

Figure 6: Does aid reach where it is needed most?

40
38%

31%
30

20

10 9%
8%
5%

0
Not at all Not really Neutral Mostly yes Yes – very much
Data from Survey on Coverage, Operational Reach, and Effectiveness (humanitarianoutcomes.org/projects/core)

When asked to name the most present and effective aid providers, a few survey respondents were able
to name groups like the Red Cross, World Vision, and the World Food Programme – but by far the
most frequent response was “okenn” (none).

9 | Humanitarian Access SCORE Report: Haiti

 Crime at the scale of war: Prospects for negotiated access

Despite an operational environment and security conditions that are routinely described by
humanitarians as the worst they have ever experienced, negotiated access is not only taking place in
Haiti but growing – and showing some signs of success.

The assassination of President Moïse set off a wave of violence that in 2022, the highest incident year
on record, claimed more than 650 victims – a 45% increase over the previous year and a seven-fold
increase from 2018.16 The UN has called the situation in Haiti a “grave protection crisis”, citing an
average of three kidnappings per day in 2022 and at least 807 people killed so far this year.17 UNICEF
also notes that schools have been gang targets with shootings, looting, and the abduction of teachers,
leading to an indefinite postponement of the start of the school year. Women and girls are at high
risk of sexual violence as gangs use rape to terrorise and control populations, much the same way
armed groups use rape as a weapon of war in conflict zones. The Single Health Information System
(SISNU) recorded 16,470 incidents of gender-based violence in 2022.18 “Virtually every metric of
insecurity, from homicide, sexual violence and kidnapping to the killing of police and migration out
of the country – is trending upward.”19

Figure 7: Incidents of violence against civilians in Haiti, 2018 - 2022

700
657

600

500
454

400
344

300

200
200

94
100

0
2018 2019 2020 2021 2022
ACLED, Data export tool, 2023, https://acleddata.com/data-export-tool/

16
Armed Conflict Location & Event Data Project (ACLED) export tool, Haiti dataset, 2023. https://acleddata.com/
17
OCHA 2023b.
18
UNFPA. (2023). Addressing gender-based violence in Haiti. ReliefWeb.
https://reliefweb.int/report/haiti/addressing-gender-based-violence-haiti-june-2023
19
Muggah, R. (2023). Haiti’s criminal markets: Mapping trends in firearms and drug trafficking.
Research and Trend Analysis Branch, United Nations Office on Drugs and Crime (UNODC).
https://www.unodc.org/documents/data-and-analysis/toc/Haiti_assessment_UNODC.pdf

10 | Humanitarian Access SCORE Report: Haiti

Increasing violence is reflected in attacks against aid workers as well. Ten incidents were recorded in
the Aid Worker Security Database (AWSD) in 2022, the highest recorded for any humanitarian context
in the region. Most of the perpetrators were criminal actors but the database is only able to identify
affiliations to criminal gangs in three incidents since 2020. The rest are either unidentified or
unaffiliated criminal actors.

Of the violence affecting humanitarians, international NGOs have experienced the largest number
of reported major incidents (13 attacks and 25 victims since 2013), followed by UN agencies
(11 attacks, 12 victims). National NGOs have experienced two major incidents according to the data,
but this doubtless reflects under-reporting. Kidnappings, on an upward trend since 2020, make up
most attacks (13), followed by shooting (4 since 2020). In one highly publicised incident in 2021,
12 international aid workers were kidnapped by a criminal group when travelling outside of
Port-au-Prince (they were released after two months) – but in general most aid worker victims
are Haitian nationals.

Figure 8: Attacks affecting aid workers in Haiti, 2013-2022

16
Total kidnapped
14 14
Total wounded

12 Total killed

10

8 8

4
3
2 2 2
1 1 1 1 1 1 1 1 1 1 1
0
2013 2015 2016 2017 2018 2019 2020 2021 2022
Data source: Aid Worker Security Database (www.aidworkersecurity.org)

The insecurity in Haiti is extreme – but not unique among complex emergency contexts in terms of
organised crime gangs being the principal driver of threat. Past research has found that while political
conflict and crime overlap in many crisis contexts, humanitarians tend to think differently about the latter,
“and possess fewer risk management tools for dealing with crime, defaulting to purely protective or
deterrent approaches”20. However, the experience of Haiti has underscored that negotiated access is still
possible, and that through highly localised programming and painstaking outreach and communication
to power holders, some aid activities can be maintained, even amid an anarchic criminal environment.

Negotiating for humanitarian access with armed actors who have criminal rather than political
objectives is more challenging on its face. Compared to political militias, the power distribution in
many criminal gangs is even more fragmented and chaotic, and alliances more tenuous. There would
seem to be less compunction against targeting humanitarians as crime gangs are not concerned with
political legitimacy, or paying even superficial fealty to rules of war and, after all, aid groups possess
valuable resources to plunder. In political conflicts, it is possible to strike deals with opposition forces

Stoddard, A., Harvey, P., Czwarno, M., and Breckenridge, M.-J. (2021). Aid Worker Security Report 2021: Crime risks and
20

responses in humanitarian operations. Humanitarian Outcomes. https://www.humanitarianoutcomes.org/AWSR2021

11 | Humanitarian Access SCORE Report: Haiti

once they have consolidated control over a territory because they have a political interest in providing
for the populations they control, whereas this is usually not seen among organised crime gangs unless
they are at the scale of major syndicates and drug cartels.

Access negotiations are made even more challenging in the Haiti context because they must take
place within dense urbanised settings like Port-au-Prince and Cité Soleil as well as in the more rural
provinces. As one NGO representative put it, “When you’re going to Cité Soleil, you must negotiate
34 times, one for each neighbourhood you’re visiting.” Interviewees talked about the need for intense,
months-long negotiations to unlock access in some key areas such as critical road routes to the rest
of the country from Port-au-Prince and the fact that access always remains fragile and has to be
continuously re-negotiated.

An important mitigating factor in the Haiti context however is that, unlike in some civil conflicts, aid
organisations are not targeted for political reasons, and forging acceptance among communities,
including those under gang control, is possible. The violence creating so much suffering in Haiti is
borne of state failure and institutional breakdown rather than military conflict over control, so
preventing aid from reaching populations is not pursued as a strategem. Many organisations that have
been working in Haiti for a long time continue to do good work, in small remits without bunkerising or
subjecting staff to any unacceptable risks. Organisations are still able to use visibility strategies (visible
brands on vehicles and premises for example).

Because gang members and their families live in the areas they control, that have personal and
organisational incentives to allow some aid programming, which may make them amenable to
negotiation. Medical services in particular are desired, despite the facilities often being the site of
incidents, simply because gang members incur heavy casualties in the fighting. A staff member of a
medical NGO accustomed to working in major conflict settings said that, at the beginning of 2023 in
Haiti, they were “treating more gunshot wounds than anywhere else in the world”. Another NGO
interviewee remarked that when they were working “We can always go in an ambulance. Usually,
gangs do not oppose our presence if there is a medical situation.”

12 | Humanitarian Access SCORE Report: Haiti

 The information gap

Information in emergencies and communication with affected people has long been recognised as
vital for effective humanitarian response. This means not only that relief organisations are informed
about the real-time needs and conditions of affected communities, but also that affected communities
have the necessary information about available aid, safety measures, and recovery strategies. As such it
is a core component in ensuring accountability to affected people (AAP). This appears to be lacking in
the Haiti response, as affirmed by interviewees, and evidenced by a pattern of responses in our survey.
The proportion of people responding “I don’t know” to questions about their understanding of the
aid response and the obstacles to access were markedly higher than in other challenging contexts
surveyed for this research programme (Figure 9). The closest comparator was in Tigray, surveyed at
the height of the conflict, where a militarily-imposed communications blackout prevented people
from accessing phone and internet services for long stretches.

Figure 9: Percentages of survey respondents answering “I don’t know”

a. What are the main obstacles to receiving aid? b. How has aid presence changed?
50 35

30
40
43% 42% 30%

25

30
20

26%
24% 15 16%
20
13%
16% 10 12%
10%
10 9%
10% 9% 5
7% 5%

0 0 2%
n

iti

Iraq

ar

eria

ray

en

iti

Iraq

ar

eria

ray

en
ista

CA

ista

CA
Ha

Ha
anm

anm
Yem

Yem
Tig

Tig
Nig

Nig
han

han
My

My
NE

NE
Afg

Afg

Data from Survey on Coverage, Operational Reach, and Effectiveness (humanitarianoutcomes.org/projects/core)

13 | Humanitarian Access SCORE Report: Haiti

 Promising developments and practices

Before it became a Level-3 emergency, Haiti exhibited the common features of a long-running
neglected emergency, including the phenomenon of ‘access inertia’, where an under-capacitated
response maintains low-scale operations within agencies’ comfort zones. The scale-up has galvanised
the response effort and enhanced coordination – an essential step towards extending the reach of
humanitarian aid. In addition, donor investments in air assets have allowed for movement of health
and WASH supplies to regions affected by cholera.

Interviewees saw substantial improvements in coordination and leadership of the humanitarian

response over the last six months. An especially important development has been the establishment of
the Humanitarian Access Working Group, which brings together the UN agencies and representatives
of the NGOs working in the country to tackle access constraints and expand the reach of aid.
The strategy, developed in May 2023, takes an area-based coordination approach, whereby agencies
with a strong presence in a particular area play a key role in joint negotiations with gang leaders and
community members. According to UN officials, this has allowed deliveries in previously inaccessible
areas of Port-au-Prince and Cité Soleil. In addition, the UN has recently established another office
for coordination and negotiations in Artibonite. A crucial focus of the strategy is to reopen the roads,
allowing people and aid to get in and out. And, in the words of a UN representative, the point is not to
“get access for its own sake” but always delivering aid immediately upon getting agreement – taking
maximum advantage of the opportunity and reinforcing the tangible value of the negotiation.

AAP and communication with crisis-affected communities has also been taken up by the Humanitarian
Access Working Group, acknowledging the gap in this area and the need to significantly build up
efforts, including by recruiting staff for dedicated information management officer roles. One agency
has created a dedicated budget line for community engagement that includes projects such as training
on humanitarian principles for civil society actors and members of armed groups, community level
monitors, and expanded communication and advocacy activities.

In addition to the high-level efforts coordinated by the UN, national and local NGOs, as well as
international NGOs that have worked in Haiti for a long time, have managed to gain and maintain
access and provide aid amid the insecurity and violence, albeit at a small scale, by:

• negotiating directly with gangs and with community interlocutors, focusing on building community
acceptance and the need for long-term engagement to build trust and relationships

• using a highly localised programming approach, hiring all staff from the immediate vicinity

• stressing the need for clear and unambiguous advocacy around humanitarian space and principles.

Hu​​manitarian practitioners in Haiti emphasised the importance of constant outreach, communication,

and negotiation to make programming possible, and the need to be flexible and responsive to the local
power structures. As one said, some groups are very organised, and a single channel of communication
with the leader is possible, but others are more fragmented, with many points of engagement. They
described some urban areas where they have to negotiate “street by street”. Interviewees noted that
organisations had “really invested in building relationships at a local level” and that there was a “back to
basics” focus on strategies to develop acceptance within communities. As well as negotiating directly
with gangs, agencies were engaging with a range of community interlocutors, including religious
figures, teachers, and business leaders. Donors saw “lots of ingenuity and creativity” from aid agencies
in building acceptance and community relationships.

14 | Humanitarian Access SCORE Report: Haiti

There are also some signs of revived government capacity for disaster management through the
Haitian Civil Protection Agency, which has received capacity support from UN agencies, has played
a role in recent earthquake and flood responses, and is starting to engage with aid actors on how to
respond to displacement caused by violence in Port-au-Prince.

Local actors were described by interviewees as “doing incredible work” in the face of increasingly
challenging conditions. In doing so they face risks from more than just the criminal gangs; some
organisations have been accused of being complicit with the criminals by virtue of trying to work in
gang-controlled areas. It was seen as vital for international actors to protect and defend civil society
space and to champion the work of these local organisations.

Weaknesses

Prior to the scale-up, Haiti was a neglected crisis in which extreme levels of violence and human
misery ​​failed to trigger a commensurate response by the international aid sector, and accountability
to affected people was sorely lacking. These issues are beginning to be addressed, particularly with
the inception of a new access strategy and revived cluster coordination, but much work remains to be
done. Although the current crisis is yet another example of humanitarian action insufficiently replacing
political action for peacebuilding and good governance, it also reveals that, when a slowly worsening
crisis fails to resonate as an emergency internationally, the humanitarian machinery falls into disrepair
and stagnation.

The principal weaknesses observed in this study were as follows.

•  ack of communication with affected people: While the deficit is now acknowledged, major
L
public outreach is needed to communicate the aid situation alongside the campaigns to educate
gang members, with at least as much emphasis.

•  igh turnover and inappropriate profile of staff: Now that Haiti has appropriately been raised
H
to a Level-3 emergency, all aid groups should seek to attract and deploy humanitarian
professionals experienced in highly challenging environments (such as major conflict settings),
and skilled in negotiation.

•  lopsided approach to access and acceptance: Agencies showed a lack of engagement with the
A
government, even as their engagement with gang leadership increased. Efforts need to continue
to engage with the state on its responsibilities for law, order, and protection even if the state
actors’ capacities or willingness to fulfil those responsibilities are currently still limited.

Finally, there is the problem of the ‘hopelessness’ perception. The crisis in Haiti continues to be
relatively neglected in terms of international attention, but any media coverage it gets tends to focus
on the rampant gang violence, often overlooking the fact that aid agencies are still managing to
operate despite formidable challenges. Interviewees saw a need for more effective advocacy and
communications, both about the scale of need and the aid work that was taking place, refuting the
narrative of Haiti as a ‘lost cause’.

15 | Humanitarian Access SCORE Report: Haiti

 Conclusion

There are promising signs that the UN-led effort to scale up the humanitarian response is producing a
better response and expanding access – but challenges remain. Agencies are stretched thin, funding
against Haiti’s requirements is low, and maintaining sustained international policy attention on Haiti
amidst huge competition from other crises is daunting.

Importantly, however, the experience of Haiti has shown that negotiation is possible, even with highly
fragmented criminal gang leadership amid high levels of general violence, and humanitarian access
can be achieved by aid organisations willing to take on the difficult work and donors willing to support
them and share the risks. This fact necessarily challenges the mindset that looks at the Haiti context
and sees only chaos and hopelessness. As one interviewee said, “Operationally this is the most
challenging environment I have worked in, with the worst general conditions, but it is absolutely
possible to get access to work almost anywhere.”

16 | Humanitarian Access SCORE Report: Haiti

References
ACAPS. (2023). Haiti: Humanitarian impact of gang violence (02 June 2023). ACAPS briefing note.
https://reliefweb.int/report/haiti/acaps-briefing-note-haiti-humanitarian-impact-gang-violence-02-june-2023

Armed Conflict Location & Event Data Project. (2023). Data export tool, Haiti dataset. Retrieved June 2023 from
https://acleddata.com/data-export-tool

Centers for Disease Control and Prevention (CDC). (2023, 25 January). Cholera in Haiti.
https://www.cdc.gov/cholera/haiti/index.html

Humanitarian Outcomes. (2023). Coverage, operational reach, and effectiveness.

https://www.humanitarianoutcomes.org/projects/core

InterAction. (2023). Member recommendations for the Haiti humanitarian response.

https://reliefweb.int/report/haiti/interaction-member-recommendations-haiti-humanitarian-response

Inter-Agency Standing Committee (IASC). (2023). Humanitarian system-wide scale-up activations and deactivations.
https://interagencystandingcommittee.org/iasc-humanitarian-system-wide-scale-activations-and-deactivations

International Organization for Migration (IOM). (2023, 8 June). Gang violence displaces 165,000 in Haiti, hinders
aid efforts. https://www.iom.int/news/gang-violence-displaces-165000-haiti-hinders-aid-efforts

Médecins Sans Frontières (MSF). (2023, 8 March). Haiti: Violent clashes force temporary closure of MSF hospital in
Cité Soleil. https://www.doctorswithoutborders.org/latest/haiti-violent-clashes-force-temporary-closure-msf-
hospital-cite-soleil

Muggah, R. (2023). Haiti’s criminal markets: Mapping trends in firearms and drug trafficking.
Research and Trend Analysis Branch, United Nations Office on Drugs and Crime (UNODC).
https://www.unodc.org/documents/data-and-analysis/toc/Haiti_assessment_UNODC.pdf

Reuters. (2023, 8 March). Medecins Sans Frontieres shuts Haiti hospital amid gang violence. https://www.reuters.
com/world/americas/medecins-sans-frontieres-shuts-haiti-hospital-amid-gang-violence-2023-03-08/

Stoddard, A., Harvey, P., Czwarno, M., and Breckenridge, M.-J. (2021).
Aid Worker Security Report 2021: Crime risks and responses in humanitarian operations. Humanitarian Outcomes.
https://www.humanitarianoutcomes.org/AWSR2021

UN Office for the Coordination of Humanitarian Affairs (OCHA). (2023a). Haiti - Operational presence. HDX.
Retrieved 1 June from https://data.humdata.org/dataset/haiti-operational-presence

OCHA. (2023b). Haiti: Humanitarian response plan at a glance (April 2023).

https://reliefweb.int/report/haiti/haiti-humanitarian-response-plan-2023-glance-april-2023-enht

OCHA. (2023c). Haiti plan de réponse humanitaire 2023. Financial Tracking Service.
https://fts.unocha.org/appeals/1121/summary

UNFPA. (2023). Addressing gender-based violence in Haiti. ReliefWeb.

https://reliefweb.int/report/haiti/addressing-gender-based-violence-haiti-june-2023

UNICEF. (2023). Haiti. Humanitarian situation report #1. January-February 2023).

https://www.unicef.org/media/139356/file/Haiti-Humanitarian-SitRep-February-2023.pdf

USAID. (2023). Haiti – Complex emergency – Fact sheet #5. Fiscal Year (FY) 2023.
https://reliefweb.int/report/haiti/haiti-complex-emergency-fact-sheet-5-fiscal-year-fy-2023

World Bank (2023). The World Bank in Haiti. Overview. https://www.worldbank.org/en/country/haiti/overview

17 | Humanitarian Access SCORE Report: Haiti

Cover photo by Heather Suggitt on Unsplash

Humanitarian Access
SCORE Report: Haiti