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Georgianne Nienaber Headshot

Who Will Respond to Haiti's Cholera SOS?

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HAITI CHOLERA
AP

Ninety-nine years ago this month, on April 15 1912, the RMS Titanic hit an iceberg and sent over 1500 people to their deaths in the icy waters of the North Atlantic. Ironically, the ship Californian was floating not 10 miles away, but ignored the visual SOS from Titanic. It fell to the frustrated crew of the ship Carpathia, 58 miles away, to attempt a rescue that was too little and too late.

In January 2010 a 7.0 earthquake in Haiti killed 300,000 immediately, left 1.5 million homeless, and now threatens untold hundreds of thousands with a cholera epidemic that is certain to ramp up once the rainy season begins. Like the crew of the Californian, the international community seems to be watching this disaster unfold with little more than puzzled glances and impotent responses that offer less assistance than the Titanic's inadequate lifeboats. There is no Carpathia ready to set sail and pick up the survivors, and no one to bury the uncounted dead who still rest, mummified, in the rubble like the Titanic's victims who reside at the bottom of the icy Atlantic.

The Titanic metaphor is one I have used when writing about injustice in Congo, and it is fitting to revisit the literary conceit as Haiti faces the possibility of a reemerging cholera epidemic that could affect 800,000 people -- double the initial estimates. Haitian health workers, the Pan American Health Organization, UN's OCHA, The World Health Organization (WHO) and the displaced and dispossessed have been broadcasting urgent cries for help since the January 2010 earthquake that devastated the infrastructure of the Western Hemisphere's poorest nation.

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The epicenter of the outbreak outside the UN compound in Mireabalais by Georgianne Nienaber

Since the outbreak began in mid-October 2010, Haiti has recorded 280,450 cholera cases and 4,835 deaths -- over three times the deaths in the Titanic disaster. We do not need to rely upon a blinking Morse Code signal from a sinking ship's lantern to understand what is happening. The country-wide fatality rate is 1.7 percent, but rural Sud Est department stands at a disastrous 7.9 and Grande Anse is not far behind with a 5.4 percent death rate. The Ministere de la Sante Publique et de la Population (MSPP) provides statistics that usually lag behind real time, but you can find them on the webpage.

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The Face of Cholera in Mireabalais in November by Leah Millis

In a better assessment from the ground in Mirebalais, the epicenter of the outbreak, PBS reports that the Partners in Health cholera center saw 500 cases in the three weeks prior to the recent rains. They have seen 1,000 cases in the last two weeks.

While the UN has offered estimates of up to 400,000 total cases by October 2011, a new study in the British medical journal, The Lancet, predicts nearly 800,000 cases and over 11,000 deaths from the cholera outbreak.

Fighting cholera does not come cheap. A World Health Organization mechanism called the Consolidated Appeal Process provides a coordination mechanism for charitable and aid organizations. It claims to "foster closer cooperation between governments, donors, and aid agencies, in particular United Nations agencies, non-governmental organizations (NGOs), and components of the International Red Cross and Red Crescent Movement."

It costs $1 million to run a 200 bed Cholera Treatment Center (CTC) for three months. This includes 45 nurses, 80 support staff and 9 doctors. This represents an overwhelming list of needs, considering that many NGOs have left and cholera remains underfunded. It is ironic that some of the same agencies, who have created a comprehensive document on Haiti's needs, have packed up their tents, banners, and personnel. They say that they will return when the money flows along with increasing disease numbers.

Food shortages are predicted due to the devaluation of crops in the fertile Artibonite Region by misplaced foreign aid.

On April 6, 2011, the joint military and civilian Southern Partnership Station (SPS 2011) crew aboard the High Speed Vessel Swift (HSV 2) delivered more than 135 metric tons of donated food and humanitarian supplies, valued at nearly $1 million, to the Port-au-Prince wharf, according to an Embassy press release.

But, the Associated Press reports that the Navy's aid program, Project Handclasp, said the supplies got held up at the U.S. base at Guantanamo Bay, Cuba, because of various transport difficulties and the bulk of the food passed its expiration date and had to be tossed.

Double SOS

On April 6, United Nations Secretary-General Ban Ki-moon addressed the Security Council regarding Haiti and the withdrawal of humanitarian agencies.

And the withdrawal of some humanitarian agencies from cholera treatment centres and camps risks creating a shortage in the provision of services. The Cholera Appeal is 45 per cent funded, and the overall Haiti Appeal received only 10 per cent of the requested funds. Additional financial support is urgently needed. Strong coordination between UN agencies, the Interim Haiti Recovery Commission and the new Government will also be crucial.

Ban Ki-moon warned, "Only large-scale investments in Haiti's water and sanitation system will protect against another outbreak."

Haiti is drowning in sewage and only 17 percent of the $915 million in promised international aid has been funded.

There are also huge unmet water and sanitation gaps for camp and transitional shelter residents. The UN Office for the Coordination of Humanitarian Affairs (OCHA) published this grim March report.

Gap analysis from the Shelter, Water, Sanitation and Hygiene (WASH), CCCM Clusters and the Office for the Coordination of Humanitarian Affairs (OCHA) reveals the magnitude of the task ahead to meet basic water and sanitation needs of transitional shelter and spontaneous camp residents. The WASH funding requirement of US$175 million is 19 percent met ($32 million) and this lack of funds to support programs will have direct consequences on the health situation of vulnerable populations.

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Pleading for clean water in Chinchion by Georgianne Nienaber

Obviously, the absence of latrines, desludging activities, and safe drinking water, provides an opportune environment for cholera and other water borne diseases. Incredibly, temporary shelters do not include sanitation. People are defecating into plastic bags, or going on the ground or in streams. Water purification tablets are in short supply, if they can be obtained at all in rural areas. The villagers of Chinchion we visited in February were traveling miles to market to buy bleach for water purification. It works, but where are the promised purification tablets? Some villages were paying for the tablets on the black market.

As of April 7.39 percent of the 56,107 T-shelters hosting 235,649 individuals do not receive any WASH services, reports the Shelter Cluster. Not all of the 65 implementing partners have the capacity and the expertise to implement WASH programming and it is predicted that 42 percent of the additional 116,000 T-shelters to be built this year will not receive any sanitation and water services either.

OCHA also reports that the communes of Léogâne, Port-au-Prince, and Croix des Bouquets are the most affected by the lack of access to water and sanitation services by T-shelters residents. Other communes with a high number of cholera cases, such as Carrefour, are also particularly vulnerable.

The Truttier waste dump sits over the main aquifer that supplies Port-au-Prince with drinking water. As Ayiti Kale Je reports:

Near the capital, a giant, unlined, uncovered excreta pool contains thousands of gallons of feces, some of it likely infected with cholera. The pool a mile or so from the Bay of Port-au-Prince, and on top of the Plaine de Cul de Sac aquifer.

Medical waste, including sludge from cholera facilities was being dumped there in February:

The United Nations High Commissioner for Refugees' (UNHCR) Emergency Response Manual recommends the installation of one latrine per family, a maximum distance of 100 metres from a shelter to a water point, and two garbage containers per community of 80 to 100 individuals. It also recommends all kinds of other emergency responses that are not happening as Haiti's earthquake refugee crisis approaches its 16 month.

In his remarks to the Security Council, Ban Ki-moon promised "The United Nations will continue to stand shoulder to shoulder with the Haitian Government and people in the noble and necessary work of building a more just and prosperous future."

The April Haiti Health Cluster Bulletin #23 says an "independent evaluation mission has arrived in Haiti to assess the efficiency and effectiveness of the coordinated national and international response to cholera, both in terms of immediate and medium term impact. The results will assist the MSPP and its international and national partners to draw lessons from successes and shortcomings..."

More studies and promises flow from the United Nations.

Someone please give these people a Morse Code manual. Three dashes and three dots (··· --- ···). The 1918 Marconi Yearbook Marconi of Wireless Telegraphy Manual states, "Stations hearing this distress call were to immediately cease handling traffic until the emergency was over and were likewise bound to answer the distress signal, which can mean "Save Our Souls."

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Photo by Georgianne Nienaber

Aid Workers and funding institutions, answer your wireless cell phones, please. We don't need any more studies on what Haiti needs in the way of basic human rights of clean water, shelter and food. Don't watch, dumbfounded, as yet another disaster unfolds.

Around the Web

CDC - 2010 Haiti Cholera Outbreak

Cholera in Haiti | CDC Travelers' Health

Cholera cases in Haiti could be double U.N.'s estimates, study ...

BBC News - Haiti cholera 'far worse than expected', experts fear

WHO | Haiti