In July, one Haitian fell ill with cholera every minute. In August, after the "second peak" from the May/June rains receded, that rate has slowed and yet still one Haitian falls ill every two minutes. In our report, "Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti", we noted that funding was withdrawn from the cholera response right as the rainy season was about to begin, despite the predictable spike in cases from the increased rains. Thankfully, the case load has receded some, as Jacqueline Charles of the Miami Herald pointed out yesterday:
Health experts anticipate that Haiti might experience one more deadly peak before the end of this hurricane season. After that, there are chances that the disease might become endemic in Haiti with frequent peaks over the years.
Recently, health organizations and the Haitian government have sounded the alarm over the lack of funding to combat cholera in Haiti. Al Jazeera's Craig Mauro spoke with Romain Gitenet of the health organization Doctors Without Borders, who explained:
"We just noticed that the funding for cholera is decreasing, and some actor, well some funder, who was giving money, stopped giving money which is something we don't understand."
As NGOs have retreated from the field, Haiti's Ministry of Health has taken over many of their operations and has become stretched thin. As Charles writes:
“Funding is not enough to fight against cholera in the upcoming months,’’ said Dr Gabriel Thimothé, executive director of Haiti’s Health Ministry, which lacks money to provide even basics, such as water at treatment centers.
Although the cholera response has been much stronger in the capital and surrounding areas, as we pointed out in our report, there are wide discrepancies in the response between departments. Rural areas are hard to access and often lack the cholera response facilities necessary. As Charles writes:
But the disease, which has infected more than 400,000 Haitians since its initial outbreak a year ago, is continuing to have a major impact on far flung villages surrounding communities like this one in the lower Aribonite Valley. It’s main water supply, the 199-mile Artibonite River, was the initial source for spreading the epidemic.
“It’s a big headache,’’ Romain Gitenet, head of mission for the French humanitarian aid group Doctors Without Borders who supervises the mobile cholera response team, which registered 10,000 new cholera cases in the valley over 10 weeks earlier this summer. “Cholera has no limits.’’
More than half of Haiti’s 10 million citizens live in remote rural communities, many of them accessible only by foot and mules. And at least 40 percent have no access to a doctor or nurse, much less sanitation or potable water. With even cell service lacking, alerts aren’t often heard until too late.
With funding from international donors and NGOs waning, and with recent scientific studies confirming that MINUSTAH troops introduced cholera into Haiti, there have been growing calls for some sort of compensation from the UN peacekeepers. Charles continues:
Earlier this year, Haitian lawmakers formed a cholera commission in parliament. The commission’s objectives are unclear, but with recently erected billboards around Port-au-Prince saying cholera and the peacekeeping mission are “one and the same,” calls are increasing for U.N. compensation.
“They have a moral responsibility to find money so these people can get help,’’ said Sen. Simon Desras of the Central Plateau.
After a recent study provided the clearest evidence yet that MINUSTAH troops introduced cholera into Haiti, French epidemiologist Renauld Piarroux suggested there could be a “practical upshot” of the study:
The study should have a practical upshot, Piarroux says. Now that there's evidence beyond a reasonable doubt, the United Nations should accept responsibility and make amends to Haiti, he says—for instance, by offering financial compensation or by supporting an all-out effort to make the country cholera-free again. "More than 6000 people are dead," Piarroux says. "It's our fault, as the people of the world."
Haiti Begins Construction of First Sewage Treatment Plant
Although treatment efforts are critical, without a commitment to improving the water and sanitation infrastructure in Haiti, cholera will continue to flourish. BBC's The Health Show, which took a look at the cholera epidemic in Haiti during their program over the weekend, also points out that Haiti is beginning work on their first sewage treatment plant. Wilson Etienne of the Haitian Ministry of Health and Sanitation told the BBC:
"It would be a huge improvement for Haiti, it's a facility where all the excreta can be disposed of, it can go through a treatment process so any excreta that potentially has cholera in it would be contained, it will be treated so that it's not disposed of maybe as it currently is being done in canals and ravines."
Although the sewage treatment plant would be a terrific advancement, it is far from complete and in the meantime the response to the cholera epidemic has done little to strengthen the public water system. The Health Cluster noted in July that “the conditions that led to the spread of the epidemic are largely unchanged,” and that “health infrastructure in the country has seen little to no benefit.” It is because of this that Dr. Paul Farmer, Jeffrey Sachs and others advise using the cholera response “as a wedge to bolster primary health care services and strengthen the Haitian health system." This is consistent with the findings of a report from the UN Special Envoy for Haiti on aid effectiveness, which concluded that “aid is most effective at strengthening public institutions when it is channeled through them.”