**2.1 Urban socio-spatial organization of Port-au-Prince**

Port-au-Prince is the political and economic capital of the Republic of Haiti. It is, according to Millian and Tamru [16], "a town founded on an exceptional site, between sea and hill: the bay of Gonâve and the foothills of the Selle chain, surrounded by two fertile agricultural plains, that of Cul-de-sac and that of Léogâne. The map of the Republic of Haiti is presented in **Figure 1**. Despite these favorable geographical conditions, the city suffers from a degraded environment: few green spaces, urbanization of the hillsides, polluted coastline occupied by unsanitary neighborhoods, poor quality of the building, generalization of precarious housing". Port-au-Prince testified and still testifies today to the symptom of urban macrocephaly which characterizes certain under-urbanized countries. In the Haitian

universe, this city has long been seen as an island of urban civilization, in a largely rural space [17]. There was Port-au-Prince and there was, as Barthélémy [18] put it, "the land outside".

Between 1950 and 1982, the population of the city of Port-au-Prince increased from 143,534 inhabitants to 719,517 inhabitants [18]. In fact, in order to attract foreign capital and promote the establishment of subcontracting industries, the Haitian State began during the second half of the decade 1970–1980, a process of liberalization of the economy [19]. Centralized largely in the Metropolitan Region of Port-au-Prince (RMPP), this process has, among other things, led to a significant displacement of the country's rural population to the urban space of Port-au-Prince [20]. If the census metropolitan area includes the following six cities: Port-au-Prince, Delmas, Cité Soleil, Tabarre, Carrefour and Pétion-Ville, public urban planning bodies speak more of eight Communes (adding Kenscoff and Croix- des-Bouquets to the previous six), when they deal with the metropolitan area of Port-au-Prince [21]. In 2015, the city's population was estimated at 987,310 inhabitants, with the metropolitan area estimated at 2,618,894 inhabitants [22]. At the turn of the new millennium, the Haitian capital spread out in all directions, without a comprehensive development policy, and its inhabitants are mostly poor or impoverished (workers and soldiers made redundant, pensioners without means) [16]. The evolution of the urban task of Port-au-Prince between 1980 and 2016 is presented in **Figure 2**.

The great attractiveness of the capital for rural populations causes deep urban changes (unprecedented spatial extension, densification and degradation of the existing urban fabric) and an aggravation of the problems facing the Haitian metropolis [23]. The socio-spatial modifications characterizing the urban organization of precarious neighborhoods in Port-au-Prince can be summed up perfectly in the definition of the five levels or dimensions of precariousness in the slums:

#### **Figure 2.**

*The evolution of the urban task of Port-au-Prince between 1980 and 2016 [16] - (map: Reprinting with permission of authors).*

*The Challenge of Water in the Sanitary Conditions of the Populations Living in the Slums… DOI: http://dx.doi.org/10.5772/intechopen.96321*

"(i) physical precariousness, which highlights the environmental dangers due to the very location of the neighborhoods (presence of ravines, swamps, rubbish, etc. (ii) environmental precariousness, which results from the absence of basic services (drinking water, sanitation, elimination of excreta) and the resulting health risks. (iii) land insecurity, which highlights the invasion of land by populations who are not legally the owners. (iv) economic insecurity, because the level of poverty is generally very high. (v) social precariousness, insofar as the inhabitants of precarious neighborhoods are hardly recognized by the public authorities" [24].

## **2.2 Sustainable access to safe water supply and basic sanitation services**

In the joint WHO/UNICEF [13] water and sanitation monitoring program, safe drinking water and basic sanitation are defined as follows: (a) drinking water means water used for domestic purposes, drinking, cooking and personal hygiene; (b) access to drinking water means that the source is located less than one kilometer from the place of its use and that it is possible to obtain regularly at least 20 liters of water per inhabitant and per day; (c) drinking water is water with microbial, chemical and physical characteristics that meet WHO guidelines or national standards for the quality of drinking water; (d) access to drinking water is indicated by the proportion of people using improved drinking water sources: home connection; public standpipes; sounding holes; protected wells; protected sources; rainwater; and (e) basic sanitation is the least expensive technology that ensures hygienic disposal of black and gray water, as well as a clean and healthy living environment both at home and in the vicinity of users. Access to basic sanitation services includes safety and privacy in the use of these services. The coverage shows the proportion of people using improved sanitation services: connection to a public sewer; connection to a septic tank; flush latrine; simple pit latrine; improved latrine with self-ventilated pit.

## **2.3 Access to water in the slums and the prevalence of water-borne diseases in Port-au-Prince**

Dynamic, regional and global pressures, such as climate change, population growth and the degradation of urban infrastructure that cities are undergoing today, are causing water scarcity, making it difficult to manage water effectively. Resource [25]. This situation deprives the populations of the slums of this vital element. The increase in demand for water and the increase in pollution of aquatic ecosystems - two situations resulting from accelerated urbanization - make regional disparities, as well as socio-spatial inequalities more and more visible [26] and make access to water one of the major challenges for humanity [27]. Developing countries are the most affected by massive urbanization. Today, 1 billion people live in the slums, the most deprived are deprived of drinking water and sanitation, the cities then turning into "real health bombs" [28].

Cities are always born and develop near water, which is necessary for the biological and economic life of any community. However, for many years the countries of the North as well as those of the South have been confronted with an increasing speed of urbanization and a growing population, which leads to an increasingly important need for space [29]. In the cities of the South, the services in charge of water management are indeed faced with the challenge of accelerated urbanization of poverty: despite the fact that socio-economic inequalities and social polarization have increased, the heterogeneity of poor households has increased, including the increase in socio-economic inequalities and social polarization [30]. In Port-au-Prince, the water supply rate is less than 50% of the population [31]. The most

disadvantaged categories of the population in the RMPP do not have access to water under satisfactory or sufficient conditions [32]. These findings allow us to suggest that water is no longer the driving force behind the creation of human settlements; it seems to become one of the factors of health risks and of crisis or of urban violence.

In Haiti, DINEPA, a public institution responsible for executing state policy in the drinking water and sanitation sector, is struggling to fulfill its role [33]. In fact, Haitian cities, more particularly Port-au-Prince, where the demand for water is already high, are increasingly exposed to demographic growth which considerably affects water and sanitation infrastructures [15]. The conditions of water supply and sanitation, which were already precarious, deteriorated with the earthquake of January 12, 2010 [34].

The assessments of the burden of disease associated with poor WASH (Water, Sanitation and Hygiene) are 90% dominated by mortality from diarrheal disease and acute morbidity [35]. By combining the multiple health effects, some researchers and research organizations in the health sciences estimate that unsafe WASH is responsible for nearly a tenth of the global burden of disease [36]. Indeed, beyond diseases of the fecal-oral cycle, the scientific literature reports several pathologies resulting from the chronic effect of exposure to poor-quality WASH [37], particularly diseases chronic associated with chemical contamination of water [38].

According to IHE and ICF [39], "73% of the Haitian population uses an improved source of water. Access to an improved source is much more common in urban areas than in rural areas (95% versus 60%). 33% of the population has improved unshared toilets, mainly cesspools with slabs (21%) and a sanitation system connected to a septic tank (9%). It is in urban areas that the proportion of the population with access to improved unshared toilets is highest (43% compared to 23% in rural areas)".

In Port-au-Prince, the risk of fecal contamination of the environment is particularly high. Clusters of fecal coliforms have been found in the water sources used to supply the population of the RMPP [40]. A more probable number (MPN) of 700 fecal coliforms per 100 ml was detected in the groundwater of the Cul-de-Sac plain [41]. This aquifer is the largest source of groundwater used by the population of the Port-au-Prince region to meet their water needs. These results highlight the existence of a bacteriological danger linked to these water resources for the health of consumers.

In addition, oocysts of *Cryptosporidium parvum*, a parasitic protozoan responsible for an infection called cryptosporidiosis, have been detected in surface water, in groundwater and in public water fountains [42]. During the cholera epidemic, declared in October 2010, Cryptosporidium oocysts ranging from 6 to 233 per 100 L of water were detected in water supply points in the RMPP [43]. Cryptosporidiosis is responsible in Haiti for 17% of acute diarrhea observed in children under 2 years of age and 30% of chronic diarrhea in patients infected with HIV [44]. Cryptosporidium oocysts are among the pathogens most resistant to conventional types of treatment such as chemical disinfection, for example [45]. The comparison of statistical data on *Cryptosporidium parvum* contamination of water resources in the City of Port-au-Prince, with those of two other cities (Cap-Haitien [43] and Cayes [46]) is presented in **Table 1**. These studies confirm the need for monitoring of the microbiological quality of water, with a view to reducing the morbidity of infections linked to the consumption of contaminated water.

In Haiti, the basement is primarily limestone [47]. **Figure 3** presents the general geology map of the country [48]. The northern watershed of the Massif de la Selle, the highest chain in the Republic of Haiti with an altitude of more than 2000 meters, is abundantly watered by rainwater [47, 49, 50].

*The Challenge of Water in the Sanitary Conditions of the Populations Living in the Slums… DOI: http://dx.doi.org/10.5772/intechopen.96321*


**Table 1.**

*Statistical data on* Cryptosporidium parvum *contamination of water resources in 3 large cities of Haiti.*

#### **Figure 3.**

*Geological map of the Republic of Haiti [48] - (map: Reprinting with permission of authors).*

This basin is of interest for the water resources of Port-au-Prince, it contains intensely fractured limestone, allowing the storage and circulation of underground water. It follows that this is a major aquifer, a real potential water tower for the RMPP [41]. The geological section of the northern watershed of the Massif de la Selle is shown in **Figure 4** [47]. The predominance of limestone in the geology of this aquifer increases the hardness of these water resources. The work carried out on the surface and underground water resources exploited, to supply the population of the Metropolitan Region of Port-au-Prince (RMPP), revealed a total hardness above 200 mg/L with concentrations in Mg2+ less than 7 mg/L [41, 51].

Studies on the health effects of hardness have shown that a total hardness concentration greater than 200 mg/L with a magnesium concentration less than 7 mg/L could affect various organs, including cardiovascular physiology [52]. At very high concentrations, calcium can negatively impact the absorption of other essential minerals for the body, in particular magnesium which is the agent of protection against the calcification of soft tissues due to myocytes [53]. The beneficial effects of water hardness in karst regions come from magnesium. Its deficiency could accelerate the development of atherosclerosis and the induction of platelet aggregation, thus promoting myocardial infarction and cerebrovascular pathologies [54]. The low Mg2+ concentration measured in the water resources of the RMPP may generate health risks for consumers exposed to the influence of

**Figure 4.** *Geological section of the massif de la Selle [47].*

geological and environmental factors. In Haiti, cardiovascular diseases have been placed for several years among the ten (10) leading causes of morbidity in the country [55]. In 2016, 29% of registered deaths were due to cardiovascular diseases [56]; this percentage was 57% for 2018 [57].

Fluorine concentrations ranging from 0 to 1.92 mg/L were measured in the resources of the RMPP. This concentration is distributed up to 1 mg/L in carbonate aquifers and from 1.00 to 1.92 mg/L in sedimentary formations [58]. This variation in fluorine can cause health problems, such as tooth decay in people (especially children) living in areas dominated by carbonate aquifers and fluorosis in people living in areas dominated by sedimentary formations [58].

**Figure 5.** *Map of the Cul-de-sac plain [62] - (map: Reprinting with permission of authors).*

*The Challenge of Water in the Sanitary Conditions of the Populations Living in the Slums… DOI: http://dx.doi.org/10.5772/intechopen.96321*

The salt contamination of the coastal aquifer of the Plaine du Cul-de-Sac (**Figure 5**) was investigated. According to Gonfiantini and Simonot [59], the salinity of these groundwater is the result of seawater intrusion following intensive exploitation. Between 1988 and 1999, the salinity of these waters increased by 246% [60]. Saline contamination of groundwater is manifested by a high concentration of chlorides, which is associated with dissolved solids and conductivity values in groundwater [61]. At chloride levels greater than or equal to 700 mg/L, salinity can cause problems with pregnancy toxemia or preeclampsia in pregnant women and high blood pressure [2].

Studies have shown the impact of urban pollutants on the physico-chemical quality of groundwater in the Plaine du Cul-de-sac [62]. Lead (40 to 90 μg / L), nickel (15 to 250 μg / L) and Cr (18 to 470 μg/L) concentrations were measured in boreholes in the Plaine du Cul-de-Sac [41, 63]. These values are well above the thresholds recommended by the World Health Organization (WHO) for water intended for human consumption [2]. The behavior of heavy metals (Pb, Cu and Cd) during their transfer into the slick was studied. The conclusions made it possible to understand that cadmium poses many more problems than lead and copper, by comparing their affinity to soil (Pb2 + > Cu2 + > Cd2 +) [64].
