Institute for Justice and Democracy in Haiti

Cholera Outbreak Highlights Clean Water Crisis

By Ansel Herz, IPS

PORT-AU-PRINCE – The man arrived from Arcahaie, near St. Marc in central Haiti where a cholera outbreak exploded last week, initially overwhelming the local medical grid. It was an hour’s journey to a hospital in Lafiteau, near the capital, where he died on Sunday.

“We tried to give him some liquids but it was too late,” Dr. Pierre Duval told IPS. He said it was the second cholera death in three days. Five other patients who arrived from the epidemic zone showed the same symptoms: profuse liquid diarrhea and vomiting.

They looked gaunt and sickly on beds inside the tiny hospital’s dimly lit patient ward, taking up one of its three rooms. Family members said they had bathed and eaten, then fallen gravely ill.

The two patients who died in Lafiteau are not counted among the 303 officially-recognised cholera deaths in Haiti. A United Nations spokesperson said they were not “confirmed” cases of cholera because they occurred outside the epidemic zone and lab tests had not confirmed the presence of cholera bacteria.

Dr. Duval said no officials or medical teams had visited his hospital since the outbreak began.

“The mission is preparing for a nationwide cholera outbreak,” the U.N.’s Office for the Coordination of Humanitarian Affairs spokesperson Jessica DuPlessis told IPS, before adding, “I’m sure there are gaps in the response at this point in time.”

Haitian and U.N. officials are citing a dwindling number of new fatalities each day as an indication that the cholera outbreak is “leveling off” and “stabilised” in central Haiti, while saying the peak of the epidemic is still to come.

“Affected zones are increasing. More capacities for implementation and coordination are needed” in central Haiti, according to a situation report by the St. Marc sanitation cluster of humanitarian groups. A video report by Al Jazeera English showed human waste from toilets at a Nepalese U.N. peacekeeping base running off into the river in Mirebalais, where there are over 50 confirmed cholera cases.

On Wednesday, a medical clinic operated by the charity group Samaritan’s Purse in Cite Soleil reported treating a patient for “rice water diarrhea” and vomiting. The clinic’s physician believes it to be cholera, according to an alert on the Haiti Epidemic Advisory System, an independent biosurveillance network.

The patient did not come from Haiti’s central region, where the epidemic broke out, unlike the five cholera cases in the capital already confirmed by authorities. Cite Soleil is an impoverished slum on Port-au-Prince’s northern tip, a 30- minute drive from Lafiteau. There are 20 cases in the capital under investigation, a Tuesday U.N. logistics cluster report says.

Humanitarian groups say they are promoting hygiene and educating the capital’s populace about cholera, which can spread easily through contaminated water and food. Some groups distributed soap in tent camps where 1.3 million people still live exposed to the elements nine months after the January earthquake.

“Some of them do nothing because of lack of funding,” according to an internal overview of humanitarian activities by the water and sanitation cluster.

Charpon Davidson, 22, received soap from Catholic Relief Services (CRS) at Camp Carradeux, where at least 20,000 people live in tents and makeshift tarps. “They can’t just give us soap as a solution. There are a lot of people already carrying the disease,” he said.

“If we can’t drink treated water, then we’ll never have a solution to this sickness,” Davidson told IPS. “Because where the problem started, in Artibonite, it’s water – water that people take, they drink, they eat – where the disease started.” Another woman asked the reporter if cholera was a natural disease or a poison from outside the country.

Camp Carradeux was battered weeks ago by a fierce storm that destroyed an estimated 10,000 tents. A walk-through of the lower camp showed that most families who lost tents, but not all, had received new ones. A few were given tiny backpacking tents that stand barely three feet off the ground.

A chain-link fence was recently erected around an area in the camp where CRS plans to build 650 one-room structures called transitional shelters.

Down the road from Carradeux, a gate with a white Catholic Relief Services sticker faces the street. Inside is a sloped area crammed with about 300 families living under fraying tents and tarps, with a driveway in the middle running up to a second CRS-stickered barrier.

The camp is on the property of Catholic Relief Services just outside its materials depot. Humanitarian goods pass by the camp every day, but its residents have no water supply because their plastic water tanks are empty – just like a camp in Cite Soleil that IPS described in a previous report.

“We’re inside the depot of CRS. Now, we’re told to wash our hands before eating. The epidemic is present. CRS said they’d help us. They said that,” said Jacques Pierre, the camp’s committee leader.

In August, the camp’s three pit toilets were full of human waste. At the time, Jacques told IPS his request for a functioning set of toilets was met with threats from CRS personnel to force them off the property. But after another aid group put pressure on CRS, construction began. They now have four working toilets.

“They started to do some small things, but actually what’s necessary for us is water,” Pierre said. “That’s what is most important for us and for kids with diarrhea. The epidemic is becoming grave now, it may be just starting. So we need potable water to drink as well as food – these are most important for us.”

Asked if any organisation had come to educate them about cholera, Pierre replied, “No, we haven’t seen any group come here and say anything to us. We’ve been ignored here in this space.”

The Chronicle of Philanthropy reported in July that Catholic Relief Services had spent $30 million out of $140 million raised for earthquake relief in Haiti. Some $21 million came from the United States Agency for International Development (USAID), designated specifically for shelter, water and sanitation services in Port-au-Prince’s displacement camps.

A senior member of another relief group, who requested anonymity, told IPS that CRS does not intend to install water purification systems in the camps until next year.

“That seems like a long time for someone living in the camps,” the aid worker said. “The situation on the ground has been a ticking bomb waiting to go off.”

The water and sanitation coordinator for CRS confirmed it has no plans to install water purification systems in camps at this time, but is delivering extra-chlorinated water to some camps by truck. A joint report in September by the City University of New York’s Haiti Initiative and Haiti’s Faculty of Ethnology found that 40 percent of camps don’t have access to water and 30 percent have no toilets.

But it’s not just Port-au-Prince’s makeshift camps that urgently need water. The percentage of the population without access to safe drinking water increased by seven percent from 1990 to 2005, according to a 2008 report by Partners In Health, a medical organisation currently responding to the cholera outbreak in Haiti’s central region.

“Combined with unsanitary conditions, the lack of water is a major factor in exacerbating Haiti’s health crises,” the report notes.

The Interim Reconstruction Commission of Haiti has approved only one water and sanitation project, designed to expand the public water supply in Port-au-Prince. It would cost $200 million over five years, but is only 57 percent funded by international donors at this time.

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