It has now been over two years since the first cholera death in Haiti after more than a century. Over 7,500 people in Haiti have died from the disease so far, and over 600,000 have been sickened. While there has been a drop in cholera cases in 2012 over 2011, Oliver Schulz, Doctors Without Borders’ Head of Mission in Haiti says, “We continue to see an average of 250 new cases each week in our facilities, but this is still a high number.”

Doctors Without Borders notes that

Reduced international funding is limiting the response of the humanitarian agencies working in the areas of medical care and providing access to clean water and sanitation.

“This year, MSF had to keep most of our CTCs open throughout the year because cholera  is far from being controlled. The measures to prevent and treat cholera are still not enough,” lamented Schulz.

In fact, the response capability of the Ministry of Health remains extremely low two years after the onset of the epidemic. As a result, during the most recent peak last May, MSF treated more than 70 percent of the total number of patients registered in Port-au-Prince.

Despite the overwhelming evidence pointing to UN (MINUSTAH) troops as the cause of the disease outbreak, the UN has refused to accept responsibility. Notably, its own report on the origins of the epidemic attempted to place blame on Haiti’s poor sanitation and water infrastructure, rather than UN negligence. But BBC now reports that one of the authors of that report, Daniele Lantagne, is much more convinced that UN behavior is responsible:

The 2011 UN report - co-signed by [Lantagne] - acknowledged that inadequate toilets in the Nepalese UN camp in the mountain town of Mirabalais [sic] could have leaked the cholera bacterium into the nearby Meye River which flows into the country's main waterways.

But the report stressed that the outbreak "was not the fault" of any "group or individual".

The Panel of Experts added that the subsequent spread of the disease across Haiti was due to many factors - including the country's deeply inadequate water supply and almost non-existent sewage disposal systems.

Now, Dr Lantagne says the new genome data (in addition to other evidence) has changed her view since she had co-authored the UN report which effectively said no-one was to blame.

"We can now say," Dr Lantagne said, "that the most likely source of the introduction of cholera into Haiti was someone infected with the Nepal strain of cholera and associated with the United Nations Mirabalais camp."

A few scientists have also sought to shift attention from the UN to environmental causes. Rita Colwell attributed the epidemic to a “perfect storm” of converging environmental factors. But epidemiologist Renaud Piarroux refutes Colwell’s hypothesis in a new article:

The cholera epidemic is therefore not the consequence of the “perfect storm” described by Rita Colwell, a renowned expert on cholera. For this scientist, a “perfect storm” of environmental circumstances in 2010 enabled the bacteria to surface, as the impoverished country was hit by a massive earthquake, a hurricane and a “very hot summer season.”

In reality, the epidemic started in an area spared by the earthquake, following a summer which was not especially hot and, last but not least, at the time Hurricane Tomas stroke the country, thousands of cholera cases and hundreds of deaths were already recorded.

As the BBC notes, thousands of cholera victims and their relatives are suing the UN for its role in causing the epidemic. A central goal for the Institute for Justice and Democracy in Haiti and other groups seeking justice on cholera is to obtain adequate funding to bring Haiti’s water and sanitation system up to international standards. As Doctors Without Borders states:

Only long-term imporovements to water and sanitation will make it possible to contain cholera.

“This will take time, and this is why medical care for cholera patients remains a key challenge that the Haitian authorities need to address right now,” Schulz explained

Tags: cholera | minustah | msf | sanitation