Haitian Clinical Guidance
Center of Excellence in Newcomer Health

Haitians have a long history in the United States and represent the second largest Black immigrant population. U.S.-Haiti relations date back to the American Revolution with complex, interrelated histories as the first and second free republics in the Western Hemisphere, respectively. Haitian migration to the U.S. dates back to the Haitian revolution in 1791.¹ There was a dramatic increase in migration starting in the 1960s-1980s as a result of those fleeing successive Duvalier dictatorships. Migration has steadily increased since then due to political instability, economic crises, and natural disasters. Haiti is highly vulnerable to natural disasters, including hurricanes, droughts, and earthquakes.^2,3 This includes the 2010 earthquake that killed approximately 220,000 Haitians, the 2015 drought that led to 70% crop loss, and Hurricane Matthew in 2016. In 2021, approximately 2,250 people were killed and over 600,000 needed humanitarian assistance after an earthquake and tropical storm. The limited funding for emergency preparedness has resulted in urgent and innumerable challenges for rebuilding, several disease outbreaks, the deterioration of the population’s health status, and increased vulnerability.⁴ This, coupled with the escalation of gang violence, especially following the assassination of President Moise in 2021, economic recession, 48% increase in inflation in 2023, and collapse of the government in March 2024 has forced Haitians to seek refuge in other countries, primarily in North and South America.⁵ Due to sociopolitical factors, about 90% of Haiti’s population lives in poverty, with a significant portion of the population having limited access to essential goods such as clean water and telecommunication services.⁶

For more information on the history of colonialism and slavery in Haiti and its effect on Haiti’s politics, chronic under-development, and relationship with aid organizations, reference the following resources:

• An Introduction to Structural Competency for Haitian-Identified Patients: History, Culture, and Access to Care by Pardo et al
• Haiti History 101: The Definitive Guide to Haitian History by Kreyolicious, 2017 
• History of Haitian Migration

Pathway, destination, & visa statuses

The U.S. is a top destination for Haitians, followed by the Dominican Republic, Canada, and countries in South America. As of 2021, the highest concentrations of Haitians in the U.S. are in Florida (49%), followed by New York, Massachusetts, and other states in the northeast. Due to Haitians’ highly variable migration routes, it is recommended that clinicians ask their Haitian patients about their migration journey to determine geographic risk for various health conditions. While some come directly from Haiti, many Haitians come by way of South America, starting in Chile or Brazil, and ultimately crossing the Darien Gap (between Colombia and Panama) to enter the U.S. via the southwest border.

Temporary Protected Status

After the 2010 earthquake, the Department of Homeland Security designated “Temporary Protected Status” (TPS) to Haitians, which granted work permits and time-limited protection from deportation based on “extraordinary and temporary conditions within the country.” TPS holders are not eligible for ORR benefits but may be eligible for state-specific insurance programs. TPS is not a path to lawful permanent resident status. Extension of Temporary Protected Status designation is an executive branch decision. While it has been extended each year since its inception, past administrations have made efforts to end TPS for Haitians (and other nationalities). Read more about TPS at Federal Register: Designation of Haiti for Temporary Protected Status.

Haitian Entrants

The term “Haitian Entrant” was first used in 1980 during the Carter administration, where Cubans and Haitians (“Cuban-Haitian Entrants” often referred to as CHEs) were able to enter the U.S. with eligibility for assistance and services in the U.S. (Refer to the table on Brief Overview for Clinicians Caring for Haitian New Arrivals for details on ORR benefits). This program has been challenged and has evolved over time. “CHE” or “Haitian Entrant” refers to benefit eligibility rather than an immigration status.

Brief overview for clinicians

Resources

Health profiles

• CDC: HIV and TB Overview: Haiti
• ECHO Colorado: Newcomer Health Series
  Clinical Considerations for Haitian Newcomers session from May 28, 2024 with Dr. Jean Mesidor

Health screening and care