With COVID-19 infections spiking in Haiti, where fevers are quickly spreading inside the country’s overcrowded prisons, hundreds of inmates risk dying of the novel coronavirus, the government’s chief ombudsman says.

And so far, the government doesn’t seem inclined to do anything about it.

“They are turning a deaf ear,” said Renan Hédouville, director of the national Office for the Protection of Citizens.

Haiti has confirmed 1,174 cases of COVID-19, the deadly disease caused by the virus, and 33 deaths so far. Of the confirmed infections, 11 are inmates at the hellish National Penitentiary in Port-au-Prince, the director of the prison system confirmed to the Miami Herald.

Hédouville and other human rights watchers, however, believe the number of infections are far greater given the overcrowded, inadequate infrastructure and irregular supply of food and essential medication to meet basic inmates’ needs. Inhumane conditions inside the teeming prison and provincial jails mean 20, 40, even 80 prisoners are often crammed shoulder-to-shoulder inside poorly ventilated, filthy cells that defy acceptable international norms of 14.8 feet of prison area per person.

With the areas of some cells sometimes no more than about six feet by six feet on average and an inmate population of 10,666, Haiti’s prison system is one of the world’s most crowded, with an occupancy rate of 330 percent.

“In practically all of the prisons, there are dozens of prisoners suffering from a fever, but we can’t say for certain it’s COVID-19,” Hédouville said. “The director general of the ministry of public health recently said that once someone has a fever it’s coronavirus. That’s what’s creating the headache. The National Penitentiary already has dozens of prisoners who have a fever; Petit Goave, where prisoners are kept in a police station...and living in cruel conditions, they have a fever; in the Croix-des-Bouquets prison there are about 30 prisoners with a fever.”

Charles Nazaire Noël, the director of Haiti’s prison administration, said the 11 prisoners are being kept in an area that they had used to treat cholera, away from the others.

Other than isolating those who are ill, “there is nothing we can do,” he said as far as enforcing social distancing inside the prisons.

“The state of Haiti has to take its responsibility,” he said. “We are holding the prisoners for the Haitian state. What we do is reports, request and we explain the situation.”

Noël refused to acknowledge that inmates were feverish due to COVID-19, which has started to surge in Haiti. He also downplayed reports there was “a fever epidemic” despite having described it as such in a local radio interview earlier this month.

“I wouldn’t call it a fever epidemic; there are some cases of a fever among prisoners in other prisons,” Noël told the Herald.

“It’s not only during coronavirus that we’ve discovered fever in the prisons. It’s something that’s habitual. I can’t assume just because someone has a fever it’s coronavirus.”

Dr. Jean William “Bill” Pape, who is co-president of the president’s commission on COVID-19 response along with the director general of the health ministry, said he heard on social media that some prisoners had “a fever-type” illness and the health ministry is investigating.

“At present, the COVID-19 disease is so prevalent in Port-au-Prince, that you do not need to be tested anymore,“ Pape said. “All patients presenting with the COVID-19 symptoms have over 80 percent probability to have it. Hence a clinical definition is essential. This was the case for cholera in Haiti and most recently with COVID-19 in New York.”

Pape said the national laboratory and GHESKIO, the health center he founded, continue to perform daily tests and are awaiting additional kits in order to decentralize testing nationwide.

Concerns of a COVID-19 outbreak in prisons isn’t isolated to Haiti. Amnesty International has raised concerns about prisons in Colombia and the Dominican Republic as infections in both countries skyrocket.

In Haiti, where the health system is already weak and there are not enough beds to treated those infected with the deadly disease, a coronavirus outbreak could be particularly disastrous. In addition to the cases in the capital, human rights watchers say they have confirmed two cases in the northern city of Cap-Haïtien prison and four in a prison in nearby Fort-Liberté.

Even before the global pandemic, the Haitian prison system was facing a host of challenges. To begin, its overcrowding is due to inefficiencies in the judicial system and the fact that 75 percent of inmates are in pre-trial detention and still waiting to see a judge — a wait that can sometimes be longer than the sentence a prisoner would receive if found guilty. Healthcare, medicine and food shortages are common, as are fevers and diarrhea.

The Office for the Protection of Citizens said the prison system is a catastrophe waiting to happen.

“Before the period of the coronavirus pandemic, the situation was inhuman, cruel and unacceptable in prisons and police stations that served as prisons,” the office said in a nine-page investigation of the prison system amid the virus’ outbreak in the country.

“This situation, in the middle of a state of health emergency facing coronavirus, has completely worsened with no special measures or support for prisoners, food problems, no drinking water, no health kits and also almost total absence of health personnel.”

In the report, the office asks that the ministries of health and justice create a task force to investigate what’s happening inside the prison system, where the Coconut Creek based charity Food for the Poor had to step in last week to provide food for prisoners.

“Up to this point,” Hédouville said, “it is either total indifference or carelessness from the ministries of health and justice.”

He also added that the lack of transparency over testing has also made it difficult to determine how extensive the problem is. For example, his team has said that of three prisoners tested in Cap-Haïtien, two were confirmed to be positive.

The health ministry, which is leading the response on COVID-19 and in charge of the country’s only two testing sites, did not respond to the Herald’s request for comment.

Noël, the prison director who insisted there were no other positive cases, said he recently met with the health ministry and asked for testing. He said they have agreed to “do tests for all of the National Penitentiary and the staff and we will go to the other prisons. We don’t have a date [on when it will start]. We are working on it.”

Haiti, which has received 9,000 test kits from the Pan American Health Organization and has started to increase its testing with 3,475 tests completed as of Wednesday, does not have the capacity to test all of the prisoners or the prison staff. And so far, testing has not been part of the government’s strategy.

Prior to the spike in COVID-19 cases, the international community, led by the United States and United Nations, had pressed the government of Haiti to take urgent action to reduce the number of inmates in prolonged pretrial detention to prevent a potential humanitarian disaster resulting from a COVID-19 outbreak in the prison system. After adopting 11 criteria under which an inmate could be released, Haitian judges released 459 prisoners between March 19 and April 15, 2020, said Perre Esperance, the director of the National Human Rights Network.

Esperance said the numbers are not a lot, and qualified prisoners are victims of a judiciary in that has been working in slow motion.

In a report it released last month, Esperance’s human rights group also sounded the alarm on a pending COVID-19 crisis inside the prison system. It noted that while some contingency measures had been taken by the prison administration, more were needed.

“The prison system, which is dependent on the Haiti National Police, is not getting what it needs to put in place mitigating measures,” the report said. “In several prisons in the country, a compulsory hand washing station is installed. However, despite the adoption of a contingency plan and the implementation of certain mitigating measures to prevent COVID-19 from entering prison, officers do not have the means to protect themselves while performing their tasks.”