Doctors Without Borders (MSF) warned on Wednesday that not enough has been done to prepare for the rainy season and the corresponding surge in cholera that is expected. The international humanitarian organization stated:

While Haiti’s Ministry of Health and Populations claims to be in control of the situation, health facilities in many regions of the country remain incapable of responding to the seasonal fluctuations of the cholera epidemic. The surveillance system, which is supposed to monitor the situation and raise the alarm, is still dysfunctional, MSF said. The number of people treated by MSF alone in the capital, Port-au-Prince, has quadrupled in less than a month, reaching 1,600 cases in April.

Data from the Ministry of Health (MSPP) backs up this increase noted by MSF. While the average daily case load reported by the MSPP was around 50 throughout March and early April, in the last two weeks of reporting (April 10-23) the average number of daily cases has increased to over 150. MSPP reports that 25 people have died due to cholera through in the first 23 days of April. While these numbers are still lower than last year, they point to an increasing caseload as the rainy season begins. Last year, just as cases were spiking, many NGOs were winding down their operations as donors pulled funding. MSF notes that the same phenomenon may be occurring this year as well:

“Too little has been done in terms of prevention to think that cholera would not surge again in 2012,” said Gaëtan Drossart, MSF head of mission in Haiti. “It is concerning that the health authorities are not better prepared and that they cling to reassuring messages that bear no resemblance to reality. There are many meetings going on between the government, the United Nations and their humanitarian partners, but there are few concrete solutions,” he said.

An MSF study in the Artibonite region, where approximately 20 percent of cholera cases have been reported, has revealed a clear reduction of cholera prevention measures since 2011. More than half of the organizations working in the region last year are now gone. Additionally, health centers are short of drugs and some staff have not been paid since January.

“Rain is just one of the risk factors for contamination. But as soon as the rains end, cholera subsides, and funding stops until the next rainy season, instead of money being channeled towards cholera prevention activities. As a consequence, people are still highly vulnerable when cholera comes back,” said Maya Allan, MSF epidemiologist.

MSF concludes, “Only major improvements of Haiti’s water and sanitation systems will provide durable solutions to the epidemic, but that will take time.” This point has been echoed by Pan American Health Organization (PAHO), UNICEF and the U.S. Centers for Disease Control (CDC).  It was also recently made by the Institute for Justice and Democracy in Haiti (IJDH), which together with Bureau des Avocats Internationaux (BAI), filed a legal complaint against the UN for introducing cholera. The case argues for the UN to pay damages as well as invest $1 billion to help build adequate water and sanitation infrastructure in Haiti. Yesterday the groups put out a press release noting recent comments from the UN’s Nigel Fisher:

Rights groups in Haiti and the United States commend last week’s acknowledgment by United Nations official Nigel Fisher that the current efforts to alleviate cholera in Haiti are “patchwork, band-aid work on a fundamental problem.”  Fisher, the UN Resident and Humanitarian Coordinator for Haiti, acknowledged in a May 3rd interview with the UN News Centre that “What we are doing in the short-term … is necessary, but we all agree that the long-term solution is investment in improved drinking water sources and in waste management.”

“Mr. Fisher’s statement is a strong step in the right direction towards a sustainable response to the UN cholera epidemic,” said Brian Concannon Jr., Director of the Institute for Justice & Democracy in Haiti (IJDH) and an attorney on a case filed by 5,000 cholera victims against the UN last November.  He added, “Now the UN needs to take responsibility for its harmful actions and actually start installing the comprehensive water and sanitation infrastructure that is the only long-term solution to the cholera epidemic.”

BAI Director, Mario Joseph pointed out that the UN spends significant resources on MINUSTAH, the 10,000 or so troops in Haiti ostensible under a UN “peace keeping” mission. Joseph states:

“If the UN shortened the peacekeeping mission’s mandate by just one year, that would save $800 million.  Fewer ‘boots on the ground’ and more wells in the ground would save tens of thousands of lives every decade.  That is peace keeping.”

Tags: aid | cholera | minustah | sanitation