Institute for Justice and Democracy in Haiti

Cholera Cases Down but Disease Still Deadly in Haiti

Jacquline Charles, The Miami Herald
May 3, 2013

As the rainy season looms, cholera is still a deadly threat in Haiti, where resources to combat the disease are lacking and international donations have slowed.

Five months after U.N. Secretary General Ban Ki-moon promised to “use every opportunity” to push for funding to eliminate cholera from Haiti and the neighboring Dominican Republic, government officials in both nations are still waiting on donors to open their wallets.

The feet-dragging comes as the rainy season begins and a new French study says the disease could quickly be eliminated from Haiti if investments are made to restrain transmissions.

“Cholera is only shrinking and has not yet disappeared. But it can disappear if the fight is correctly managed,” said Dr. Renaud Piarroux, who has studied the deadly waterborne disease in Haiti since it first appeared in October 2010.

Piarroux’s study first came to light last week when Prime Minister Laurent Lamothe was asked at Columbia University about the government’s plan to combat cholera.

But he mischaracterized the report’s findings when he stated that “cholera right now is disappearing” from Haiti and the country is seeing less than three cases a day. Lamothe’s Ministry of Health statistics show an average of 150 cholera cases a day so far this year.

His comments triggered a debate in Haiti about whether the government was underplaying the seriousness of the epidemic. He later backed off the statement when asked by The Miami Herald for clarification.

“This isn’t a sign of cholera’s disappearance, but rather its persistence and the reasons are simple — funding for the cholera response has greatly declined, and the response capacity has therefore diminished,” said Jake Johnston, international research associate and lead blogger on Haiti’s relief and reconstruction for the Center for Economic and Policy Research.

“This is now the third year that funding for cholera has diminished prior to the rainy season when cases will predictably spike, leading to more easily preventable and unnecessary deaths,” Johnston added.

Johnston said he isn’t surprised by the U.N.’s inability to mobilize funding to eradicate cholera in Haiti, where more than 654,000 have been sickened and more than 8,100 have already died.

More than three years after the international community pledged $5.4 billion to help Haiti rebuild after its devastating Jan. 12, 2010 earthquake, more than $2 billion remains outstanding. Meanwhile, emergency cholera funds in Haiti are quickly drying up.

A $32 million appeal after an upsurge in cholera cases following Hurricane Sandy in October only received 32 percent of funding, said George Ngwa, spokesman for the U.N. Office for the Coordination of Humanitarian Affairs. And as of Tuesday, a $37 million Haiti Humanitarian Action Plan (HAP) has only received 19 percent of funding.

“Water, sanitation and health activities related to cholera are so far the least funded sectors of the HAP,” Ngwa said. “The impact of this drastic underfunding is glaring on the ground.”

Not only are the number of non-governmental organizations responding to cholera in Haiti dwindling but the number of cholera treatment centers and units have fallen from 186 in December 2010 to 38 today. Even a surveillance system implemented to save lives by detecting outbreaks is dysfunctional, said the head of mission for Doctors Without Borders/Médecins Sans Frontières in Haiti.

“With a disease like cholera, the first hours are the most important to save lives and make a significant difference. With a surveillance and alarm system that does not give exact data, more lives are in danger,” Oliver Schulz said.

Doctors Without Borders and Partners in Health, a Boston-based medical aid group working in Haiti’s Central Plateau, said while the number of people contracting cholera is down from the onset of the disease, too many Haitians continue to get sick — and die — from it. They agree with Piarroux that the low incidences of the disease in the dry season provides the opportunity to eradicate it.

“There is a sense that it’s OK for people to be getting sick from a preventable disease,” said Dr. Louise Ivers of Partners in Health, which saw a spike in January and February. “No deaths from cholera should be acceptable. We should be striving for zero deaths.”

Both Ivers and Schulz say they welcome the 10-year cholera elimination initiative, and Haiti’s National Cholera Plan, which the Health Ministry launched in February as part of the initiative. But while the plan details the government’s roadmap for eradicating the disease, concerns about funding remain unclear.

“We do not know how the $2.2 billion will be raised and how patients will be treated in the coming weeks, in case numbers rise again,” Schulz said.

Christophe Boulierac, a spokesman with UNICEF in Haiti, said the U.N. has discussed funding with the government and is awaiting approval of how the money should be disbursed.

In lending his support to eliminating cholera, Ban announced that the U.N. was chipping in $23.5 million — about 1 percent of the plan’s $2.27 billion price tag — for 2013.

Johnston, who blames the global body’s peacekeepers for introducing cholera to Haiti, said it “has the moral, if not the legal responsibility to fund the cholera eradication plan itself.”

His criticism of the U.N. joins that of Boston-based Physicians for Haiti, which on Friday accused the U.N. of not doing enough to stop the spread of the disease.

Two years after an independent panel of experts issued a report on Haiti’s cholera outbreak, the U.N. has failed to implement many of its own recommendations, the group said. The report, commissioned by Ban, steered clear of placing blame for the outbreak but listed seven recommendations to move forward.

A spokesman for the U.N. secretary general said five of the seven recommendations are being implemented. For example, additional wastewater treatment centers have been installed along with septic tanks and other sanitary measures at all U.N. camps in Haiti.

Meanwhile, as the rains begin, Piarroux said it’s important for Haiti to view eliminating cholera “as an emergency” issue.

“We can stop cholera transmission before providing safe water to the entire population,’’ he said. “Of course, the end of cholera will not be a reason to stop investments in water supply.”

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