Al Jazeera English, September 8, 2011
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Mirebalais, Haiti — How is it that more than 6,200 people have died in Haiti from cholera in just the past 10 months, and yet resources to fight the disease were reduced earlier this year before the rainy season predictably led to an upsurge in infections and fatalities? And this is a country where international donors have pledged $5.6 billion since the January 2010 earthquake.
The New York Times Editorial Board asked these questions on Tuesday.
Just outside of Mirebalais, in the Central Plateau region, a Cholera Treatment Center is operated by Partners In Health, an NGO providing health care in Haiti for over 25 years. A mother walks into the compound of tents and plywood structures carrying her six-year-old child, who is already too weak to walk. An old man in his 70s, frail with close-cropped gray hair, arrives a few minutes later; he is walking—barely—but vomiting.
Under two big tents we see children in one and adults in the other, hooked up to intravenous fluid that is rehydrating their bodies. Each bed has a 12-inch diameter hole in the center with a green plastic bucket underneath, for the diarrhea that makes this disease so quickly fatal if left untreated. A person can die within a few hours from the dehydration caused by diarrhea and vomiting.
But if the patient is treated in time, it is easily cured. Cholera is also easily preventable: most of the world that could be susceptible to the disease doesn’t have it because people have access to drinkable water, and because they also have access to sanitation.
Haiti didn’t have cholera either, for at least a century, until it was brought there by UN troops. Microbiological and genetic research has now confirmed that the Vibrio cholerae strain in Haiti is almost identical to the one in Nepal. It is virtually certain that the bacteria was introduced through human fecal material from the base of Nepalese UN troops, which made its way into the nearby Artibonite river.
This has infuriated many Haitians, not least because the troops that have been occupying the country since 2004 don’t have any legitimate reason to be there. (Haiti has no civil conflict or other legal justification for this large-scale UN military presence.) And the saddest thing is that since it has reached a critical mass in Haiti, cholera has now become endemic to the country and will continue to kill Haitians for many years. It wasn’t intentional, but it was gross negligence on the part of the United Nations and they ought to be held responsible. For starters, the UN could take the $875 million it is spending annually on this unwanted military occupation – nine times what it has raised for the cholera epidemic – and put it into treatment and prevention.
Prevention is ultimately the most effective way to reduce the toll of the disease and to eventually eliminate it, but for this Haiti needs water treatment facilities and delivery systems. These were urgent public health needs even before the cholera outbreak, to prevent other water-borne diseases. There were plans to build them in the mid-90s, with hundreds of millions in loans promised by multilateral lenders, but it never happened; then international aid was cut off in a U.S.-led effort from 2000-2004 to topple the elected government. The result contributed to the deaths we are seeing today. But even now that aid has been pledged and disbursed since the earthquake, we have not seen any water or sanitation infrastructure being built.
Partners In Health is spending $500,000 a month to treat cholera but they still don’t have enough supplies such as soap, oral rehydration solution and aqua-tabs to decontaminate water.
The number of NGOs responding to the cholera outbreak fell from 128 in January to just 48 in July—projects expired, funding was cut, and the number of treatment facilities declined. But because of the rainy season, the number of cholera cases predictably increased from 20,000 to more than 50,000 per month between April and June.
The international community has failed Haiti in so many ways and for so many years that it is almost unimaginable. Some of this harm was the result of political motives and interventions, as when the U.S. marines invaded in 1915 or when Washington helped topple the elected government in 1991 and 2004. But since the earthquake we have a situation where U.S. residents have given $1.4 billion to private charities to help Haiti, and the U.S. government has appropriated $1.14 billion.
Cholera in Haiti is the worst epidemic that this hemisphere has seen in decades, yet it has received relatively little attention. Perhaps if it were seen as the emergency, scandal, and outrage that it really is, international donors would be more willing to make the necessary investments in prevention and treatment. They certainly have the money this time.