In the wake of last week’s letter by 53 members of the U.S. Congress urging prioritizing the needs of IDP’s, Georgianne Nienaber underscores the urgency of the situation in a new piece for Haiti Live News and other publications. Likening the looming disaster of an expected spike in cholera deaths with the sinking of the Titanic, Nienaber suggests that the current international response is akin to that of the SS Californian, which, although having been less than 10 miles away from the Titanic on April 15, 1912, made no attempt to rescue the doomed voyagers.

Nienaber writes that the number of cholera cases is already growing quickly with the onset of the rainy season:

The country-wide fatality rate is 1.7 percent, but rural Sud Est department stands at a disastrous 7.9 and Grande Anse is not far behind with a 5.4 percent death rate. The Ministere de la Sante Publique et de la Population (MSPP) provides statistics that usually lag behind real time, but you can find them on the webpage.

In a better assessment from the ground in Mirebalais, the epicenter of the outbreak, PBS reports that the Partners in Health cholera center saw 500 cases in the three weeks prior to the recent rains. They have seen 1,000 cases in the last two weeks.

While the UN has offered estimates of up to 400,000 total cases by October 2011, a new study in the British medical journal, The Lancet, predicts nearly 800,000 cases and over 11,000 deaths from the cholera outbreak.

While millions of dollars collect interest in the bank accounts of large NGO’s, and while pledges by various foreign governments go unfulfilled, treatment for cholera remains greatly underfunded. Nienaber notes that UN Secretary General Ban Ki-moon spoke about the urgent, but still neglected needs earlier this month:

[T]he withdrawal of some humanitarian agencies from cholera treatment centres and camps risks creating a shortage in the provision of services. The Cholera Appeal is 45 per cent funded, and the overall Haiti Appeal received only 10 per cent of the requested funds.

The New York Times noted over the weekend that

Only about 37 percent of the more than $5 billion pledged last year by foreign governments and international agencies has been disbursed to the Haitian government, the Haiti reconstruction fund, nongovernmental organizations or other entities, according to the United Nations.

Nienaber puts these billions into perspective:

It costs $1 million to run a 200 bed Cholera Treatment Center (CTC) for three months. This includes 45 nurses, 80 support staff and 9 doctors. This represents an overwhelming list of needs, considering that many NGOs have left and cholera remains underfunded. It is ironic that some of the same agencies, who have created a comprehensive document on Haiti's needs, have packed up their tents, banners, and personnel. They say that they will return when the money flows along with increasing disease numbers.

Of course, as we have also described repeatedly, the dangers of underfunding cholera treatment are compounded by the underfunding of sanitation. Nienaber writes:

Obviously, the absence of latrines, desludging activities, and safe drinking water, provides an opportune environment for cholera and other water borne diseases. Incredibly, temporary shelters do not include sanitation. People are defecating into plastic bags, or going on the ground or in streams. Water purification tablets are in short supply, if they can be obtained at all in rural areas. The villagers of Chinchion we visited in February were traveling miles to market to buy bleach for water purification. It works, but where are the promised purification tablets? Some villages were paying for the tablets on the black market.

The most recent OCHA bulletin [PDF] confirms Nienaber’s account. The report notes that the WASH cluster is just 19 percent funded, and:

this lack of funds to support programs will have direct consequences on the health situation of vulnerable populations. In the absence of latrines, desludging activities, and safe drinking water, individuals living in densely populated areas are at heightened risk of cholera and water borne disease contamination, particularly during the rainy and hurricane seasons.

The international neglect of IDP camps – including ongoing failure to stem rape and other violence and crime – has led many IDP’s to leave, sometimes moving into damaged structures. As The New York Times reported over the weekend:

More than half of the Haitians driven into tent cities and makeshift camps by the January 2010 earthquake have moved out of them, officially bringing down the displaced population to 680,000 from a peak of 1.5 million, according to the International Organization for Migration.

But what may seem like a clear sign of progress, officials warn, is also a cause of concern.

Very few of the people who left the camps — only 4.7 percent, by the group’s estimate — did so because their homes had been rebuilt or repaired. Instead, a vast majority appear to have been forced out through mass evictions by landowners, or to have left the camps on their own to escape the high crime and fraying conditions there.

Now, most of the former camp dwellers are doubled up in their friends’ or families’ homes, scattered at random in tents and improvised dwellings, or living in “precarious housing” that is dilapidated, damaged or partly collapsed, the organization says. In some cases, the cinder blocks that were toppled by the quake are being cobbled together to make walls again, only more unevenly and wobbly than before.

In addition, even those families who have moved into a “transitional shelter” are often left without adequate sanitation. The most recent OCHA bulletin notes that 40 percent of the “transitional shelters” lack any WASH services. The international community plans to build over 50,000 more of these shelters this year, but it is predicted that upwards of 60 percent of the additional shelters “will not receive any sanitation and water services either.”

The New York Times reports that the often un-tracked dispersal of camp residents also creates new challenges for containing cholera, highlighting the importance of treatment in the IDP camps:

Giovanni Cassani, a coordinator with the migration organization, said the mass departures from camps made it harder to track and help people, complicating treatment and prevention of a cholera epidemic that has killed nearly 5,000 people since October. “Those returning to unsafe conditions risk falling off the radar because they are much more difficult to find and assist,” Mr. Cassani said.