**3.2 Canaan: its creation and its history**

The 2010 earthquake was the founding element of many camps established in the metropolitan region of Port-au-Prince while waiting for the issue of the homeless due to the destruction of numerous housing losses to be addressed, and for the right to living in a viable space is applied. The omnipresence of camps throughout the devastated region highlights an often hidden population in Haiti with a major component, that of the poorest. Inside the camps - places of waiting - there is a diversity of people among whom their houses had been destroyed, others coming from disadvantaged neighborhoods and who found in the camps of better living conditions [71].

Canaan is located in the far north of the Metropolitan Region of Port-au-Prince (RMPP), about 18 km from the city center, precisely on a house formerly called Corail Cesselesse, in the communal section of Varreux II, Municipality of the Croixdes-Bouquets. Before 2010, this vast virgin and arid space housed a few peasant families who practiced animal husbandry. For more than 250,000 people, this space has accommodated informally, outside of any urban planning. This dry and hot region with low rainfall (on average 900 mm/year) was declared a public utility area in 1971 with a view to tourist development [72]. Among others, private projects of great importance were considered as part of a master plan for the development

of the North Pole. Canaan was the subject of another declaration of public utility published in the Official Journal le Moniteur of March 22, 2010 for the purpose of relocating the victims of the earthquake. This decision first appears to provide a solution to emergency needs following the numerous housing losses and under the weight of land pressure facing the metropolitan region of Port-au-Prince (RMPP). However, previous initiatives never went beyond the project framework for several reasons, including lack of political will for follow-up, lack of funding and the complexity of the land issue. Since then, this space has experienced rapid development with newcomers coming from all over, in search of better living conditions and land ownership [73] to constitute a vast informal habitat [71]. As a system of predatory land developed, "land speculators" saw the opportunity for cheap land to be valued [72]. However, the presidential decree declaring the zone of public utility in its article 2 - Monitor of March 22, 2010 - stipulates that "all construction work, road boring, subdivision or other exploitation of the land, as well as any transaction or real estate alienation"were prohibited there. But over time, the complexity of making it a public space given the high rate of compensation that this population would claim for their relocations would be far too costly. The geographic coordinates of Canaan are 18 ° 38 '46 "N, 72 ° 16' 23" W [74].

## **3.3 The territory of Canaan: morphology and modes of occupation**

Bodson et al. [75] consider that "the recent settlement of the territory of Canaan in the communes of Croix des Bouquets, Thomazeau and Cabaret is part of a major trend which affects all areas near Port-au -Prince. On the other hand, it constitutes a unique phenomenon by the speed of its emergence and by its importance. At the beginning of 2010, the territory was almost unoccupied. The trigger for this meteoric expansion was the presidential decree of March 22, 2010. It followed a very rapid "spontaneous" occupation of the territory". **Figure 8** presents the map of Canaan [76].

The very dry climate and the very dispersed plant cover make the territory a semi-desert area. Along with the poor vegetation cover, the territory is exposed to three major natural environmental risks. Risks related to irregular surface water flows and the lack of availability of quality water have been identified, seismic risks and risks of landslide and surge of friable tailings [77].

In addition to the natural vulnerabilities of the territory, there were major deficiencies in the process of allocating plots and in the organization of services, which could not keep up with the accelerated pace of residential construction. When the post-earthquake emergency response organizations left, national and municipal public authorities did not take over. Besides, could they have done it in the face of the speed and enormity of the current phenomenon? In the absence of the involvement of national and municipal public authorities, the new inhabitants, in collaboration with numerous private initiatives, have organized themselves according to priority emergencies and limitations in the means available. Together with the increase in housing, a relatively dense network of streets and dirt roads (see map below) has thus developed under the control of "local solidarity" and has emerged with the help of private organizations (Protestant missions, Catholic organizations …) a set of initiatives offering fragments of basic services. The result is a relatively large and complex urban fabric but private, despite the many partial achievements in progress, important basic services to the population, in particular as regards the availability of water for the daily needs of the population. and treatment of sewage and waste.

This situation is not unique to Canaan. It is found in various forms throughout the neighborhoods of the wider area of Port-au-Prince. It is nevertheless

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

**Figure 8.**

*Map of Canaan [76]- (map: Reprinting with permission of authors).*

particularly acute there because of the characteristics of the site and the circumstances which led to its rapid settlement. Canaan is a very vulnerable epidemiological environment today. Little is known about living conditions there. It is in this perspective that we conducted a survey of a sample of 439 households [15]. Carried out within the framework of the research program "Water in the human settlements of the future", of the Center for Research and Support for Urban Policies (CRAPU) of the University of Quisqueya, this survey aimed to analyze the problems of availability and use of water for households located in Canaan and their possible link to the vulnerability of its population to water-borne diseases. Households were selected on the basis of a Simple Systematic Sampling (SSS) design. This plan had to adjust the sounding pitch to take into account the peculiarities of the terrain and as such must be considered non-standard. The selected households are spread over 6 territorial sections of Canaan (11.62% in Canaan 1, 18.68% in Canaan 2, 38.50% in Canaan 3, 5.01% in Canaan 4, 8.66% in Canaan 5, 17.54% in Jerusalem and Bellevue). These 6 sections do not cover the whole of the territory commonly referred to by Canaan, but include most of the nucleus behind the current expansion [15, 75].

#### *3.3.1 Socio-economic characteristics of households*

The households appearing in the sample present characteristics similar to those highlighted by the ECVMAS 2012 survey [78] for the metropolitan area, but some traits are modified due to the contribution massive migration that Canaan has experienced since the 2010 earthquake.

Heads of household are on average 42 years old. They are mostly men (60%). These figures contrast with the data from ECVMAS 2012 for the metropolitan area where the average age of heads of household is 46 and where the proportion of women heads of household is 49% [78]. Their level of education is generally slightly

#### *Environmental Health*

lower than that observed in the metropolitan area. The vast majority of heads of household (98%) live in the household. 72% of these are married or "placed".

4.56% of the households surveyed nevertheless have a dwelling provided by humanitarian aid. The homes are located in plots that are generally larger than those in precarious neighborhoods in the metropolitan area. The plots are not systematically contiguous. The result is a relatively dispersed residential space in contrast to the majority of urbanized spaces in the metropolitan area. Residential housing is systematically built on one level. The materials used reflect a very great precariousness.

These households have an average of 5.11 people. In the metropolitan area, this average is 4.5. There are many under 18 s in the households surveyed: 2.25 on average per household, which at least partially explains the difference observed compared to the metropolitan area. The household profile thus partially resembles the mononuclear family without however excluding the extended family profile. The size of the households leads to an overloading of inhabited spaces.

In addition to the overload of occupancy, there are major deficiencies in the services directly associated with homes. Toilets are systematically rudimentary or non-existent. Private toilets are nevertheless predominant (73%). These are very generally located near the inhabited structure or are contiguous to it. Access to electricity from city power is limited to 26.7% of the households surveyed.

Solid waste is treated in a very rudimentary manner. Evacuation by truck from the town hall is almost non-existent (0.5%). The majority of solid waste is incinerated, most often near the house, but dumping in the ravine or in vacant lots is also a common practice (16.6%). In addition, 5.3% of households do not specify what to do with their solid waste. In turn, wastewater receives virtually no specific treatment. For 87.2% of the households interviewed, wastewater is simply thrown outside. 3.2% nonetheless have a canal or ditch to facilitate the evacuation of wastewater, while the remaining 9.1% use another system without specifying the details.

#### *3.3.2 Problems of water availability and use*

How are the problems of availability and use of water addressed in this environment marked at the same time by semi-desert climatic conditions, by very rapid population growth, widespread poverty, rudimentary development of residential habitats and degradation? of the environment associated with it? In Canaan, easily accessible quality water resources are systematically lacking. The rains there are relatively infrequent and flow quickly to the surface in a torrential manner. The water in the first levels of the aquifer is salty.

237 water points had been identified, the vast majority of which are located in the 6 sectors of the area covered by the survey. For 166 selected households, an average of 16% of the household head's income is devoted to water. For 25% of households, the percentage of water weight in monthly income exceeds 24% [15].

#### *3.3.3 Vulnerability to diseases associated with the environment*

The vast majority of households settled in Canaan are confronted with extremely precarious situations which come from constraints from the natural environment, income limitations, installation conditions (land tenure, quality housing, lack of infrastructure) and the progressive degradation of the environment. The health conditions associated with this context have serious shortcomings and expose the population to increased risk of disease. The households contacted by the survey were affected in various ways by several diseases (diarrhea - 54%;

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

cholera - 3.6%; malaria - 28.9%; typhoid - 19.8%) associated with the modalities according to which health relations are managed at the environment.

The occurrences per household of the diseases mentioned were grouped together and calibrated into an "index of vulnerability to environmental diseases scaled from 0 to 10. The value 0 corresponds to the absence of any "environmental" disease in the household considered, taking into account the sector where it is located. The value 10 corresponds to a situation where all the households surveyed in a sector would have incurred all the diseases considered by the survey. Over the entire area covered by the survey, the vulnerability index to "environmental" diseases stands at 3.06. The vulnerability index is higher (3.10) in sectors 1, 2, 3 compared to sectors 4, 5 (2.97). On the other hand, this difference fades as certain social-demographic characteristics of households are taken into consideration, the quality of drinking water and water for other domestic uses, and the attitude towards - with regard to the various uses of water (whether or not to distinguish drinking water from other uses), supply systems, certain housing infrastructures, additional water treatment.

The vulnerability index to "environmental" diseases is positively correlated with the size of households (.16 \*\*), with the proportion of young people under 18 in the household (.16 \*\*), but more weakly with proportion of women in the household (.08). It is also negatively correlated in a very statistically very significant way with the quality of drinking water (−.25 \*\*) and with the quality of water for other domestic uses (−.22 \*\*). The explicit distinction by households between drinking water and water for other domestic uses seems to play an important role (F: 9.96, Sig. 002) on the level of vulnerability to environmental diseases. This index stands at 2.97 if the distinction is explicit, but rises to 3.32 otherwise. The choices of supply systems also seem to have a determining influence on the level of vulnerability to environmental diseases. If the drinking water supply is by gallon / sachet, the environmental disease vulnerability index is 2.98, but rises to 3.29 when using other water supply systems. The F-test (8.54) for the relationship between the two variables is statistically very significant (.004). The use of the truck-based supply system when it comes to water for other domestic uses also seems to have a beneficial, but statistically less precise, effect on vulnerability to environmental diseases (F: 3.61 Sig: .058). The environmental disease vulnerability index is 2.99 if the truck-based supply system is used, but rises to 3.17 if other supply systems are preferred.

Whether it is water for drinking or water for other household uses, a number of households resort to water treatment. Do these practices, which are both diverse and variable in their application, help reduce the vulnerability of households to "environmental" diseases? It should be noted first of all that these practices concern a limited percentage of households: 39.2% of households if it is water for drinking and 64.7% of households if it is water for other uses. Domestic workers.

With regard to drinking water, recourse to the Aquatab methods - sodium hypochlorite tablet - (2.95), water filter (2.91) and "Other" (2.59) seem to promote a reduction in vulnerability to environmental diseases. It is quite different if it comes to the use of sodium hypochlorite in liquid form. In this case, the Vulnerability Index increases (3.36) suggesting that this method, as used, makes the situation worse.

If it concerns water treatments for other domestic uses, the results of the statistical analysis are in the same direction as for the treatment of drinking water with regard to the System filter and Aquatab methods but are not statistically significant (F: 1.52, Sig: .20) for all the categories considered. In addition, the results are dominated by the more frequent use of sodium hypochlorite in liquid form, which appears to correspond to an increased vulnerability to "environmental" diseases.

Toilets and their use for the disposal of human excreta can be contaminating factors favoring the spread of environmental diseases. According to the survey data, the average differences in the index of vulnerability to environmental diseases after the methods of disposal of human excreta are not statistically significant. However, we should highlight the almost generalized use of private latrines (73% of households surveyed) and the higher average level of the index of vulnerability to environmental diseases associated with it (3.11), a situation which suggests poor conditions on the health plan in the organization and use of private toilets.

The various factors mentioned interact together on the level of vulnerability to environmental diseases. Their joint incidence was studied by multiple regression.

All the independent variables retained in the model give rise to statistically significant estimates that follow the same logic as that suggested by the bivariate analysis. The estimates highlight the vulnerability to environmental diseases of two categories of people: those under 18 and women. The quality of the water, whether it is drinking water or water for other household uses, contributes to reducing vulnerability to environmental diseases. Implicitly, this type of relationship concerns two major modes of water supply: the purchase of drinking water by gallon / sachet and the delivery of water by truck. These two supply methods are indeed decisive for the quality of the water. According to the estimates obtained, they also contribute directly to the reduction of vulnerability to environmental diseases.

### **4. Conclusion**

Improving living conditions in a sustainable perspective in Canaan presents major challenges. What avenues of intervention should be encouraged or prioritized to facilitate favorable development for the population while taking into account the heavy constraints that weigh on their daily lives? Examination of the data collected by the survey opens up some avenues for reflection that could guide interventions in the field, including from a short-term perspective.

The methods of integrating households in Canaan compromise the quality of life in many aspects: WASH of questionable quality, poor housing, lack or deficiencies in infrastructure and / or basic services, lack of treatment of solid and liquid waste, serious deficiencies in health infrastructures and their functioning, profound degradation of the environment.

In practice, however, local community groups occupy an almost exclusive key position in responding to the basic service needs of the populations. A greater margin for improving the situation is nevertheless accessible from the involvement of these groups and the mobilization of the local population. However, it is a complex challenge to take up because it requires from the population, at the same time an awareness of the situation and of the current issues, sustained and systematic steps of consultation and decision-making. Organization, mastery of a varied range of skills and discipline to promote the best accessible development conditions while minimizing negative external repercussions on the community and the environment.

In the current context of scarce resources and the destitution of almost all households, many loopholes are likely to arise and remain in this community approach. Analysis of the survey data revealed several:


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


To address these difficulties, targeted interventions to be implemented in consultation and with the participation of local communities would benefit from being considered.

This is particularly the case for water used by households. Measures taken by households to treat water seem unlikely at this stage to even reduce vulnerability to environmental diseases. Household training programs would no doubt be appropriate. But the problem could also be corrected at its source by means of systematic and controlled treatment of the water delivered by gallons and / or by truck.

Complementary to this systematic and controlled treatment, the density of water access points could be intensified. Well coordinated by community groups, this operation could also help reduce spatial disparities in water prices for households. This type of improvement would particularly help to reduce the percentage of households not distinguishing between drinking water and water for other domestic uses.

A support program for the functional establishment of private washrooms would also help reduce the risk of contamination and reduce vulnerability to environmental diseases.

It is also important that local health care organizations take into account the most vulnerable categories of the population, including young people and women.

In setting up these adjustments, consultation with local groups, their initiative and their involvement are essential conditions for success.

#### **Acknowledgements**

The authors are thankful to FOKAL-Open Society Foundation Haiti, the AOG (Association communautaire paysanne des Originaires de Grande Plaine) and the SCAC (Service de Coopération et d'Action Culturelle) of the France Ambassy in Haiti for their financial support.
