PORT-AU-PRINCE, Haiti — Nine days into a cholera epidemic that has killed at least 303 and infected more than 4,700, Haitians are holding their breath and waiting to see if the outbreak can be stopped.
Haiti’s humanitarian relief organizations are posed to call their response to the outbreak a success, pointing to the quick mobilization of doctors to affected areas and sufficient stockpiles of IV bags. So far the disease hasn't spread through Haiti’s tent camps where 1.3 million people still live, and the organizations are hopeful they'll soon be able to contain the outbreak.
But critics say Haiti’s gruesome brush with cholera represents a failure by these groups whose job is to prevent exactly this type of disaster in the first place.
There’s one thing everyone agrees on: If cholera were to enter Port-au-Princes tent camps, the epidemic would explode.
“Should it arrive in a camp without any toilets or clean drinking water, there’s no way to stop it,” said York College professor Mark Schuller.
But the cholera epidemic didn’t start in the unsanitary and crowded tent camps of the earthquake-ravaged region. Instead, it came from a rural, rice-farming area where life for most residents continued much the same as it was before the earthquake.
David Olson, medical adviser for Doctors Without Borders, said it's unfair to blame relief organizations for Haiti’s longstanding underdevelopment problems, such as the 40 percent of Haitians who don’t have access to clean water and the 80 percent without proper sanitation, including toilets and soap.
“It’d be a little harsh to judge that we’re not providing clean water in the rest of the country,” Olson said. “That’s an ongoing development issue.”
Residents of Haiti’s Grand Saline community, where at least 74 people have died from cholera, say they drink water directly from the Artibonite River — which tested positive for cholera last week — because there is nowhere to buy treated water in the area.
The coordinator for Haiti’s international humanitarian relief, Nigel Fisher, said the swift response by aid organizations showed they were well-prepared to handle the outbreak from the beginning.
“There were sufficient supplies of the critical elements needed: oral rehydration salts, the transfusion solution needed, the antibiotics,” Fisher said.
To stop the disease before it reaches other parts of the country, medical nongovernmental organizations, including Doctors Without Borders, are setting up temporary clinics in the hardest-hit areas so patients don’t need to travel as far. Other humanitarian groups like the Red Cross are broadcasting public service announcements over radio and sending text messages to advise people how to prevent the spread of cholera.
Fisher said the humanitarian response to the earthquake had no bearing on the emergence of cholera. But just three months ago, Fisher was taking a different tone.
"It's important to note what we haven't seen. We haven't seen a major epidemic of cholera or measles, for example, because most people are getting access to clean water, to regular health care,” Fisher told reporters on July 12.
In fact, less than half of the camps that house Haiti’s internally displaced provide clean water, and nearly one-third do not have toilets — a dangerous predicament in the context of a disease that spreads through water contaminated by fecal matter — according to a recent study by Schuller, the York College professor.
“The issue is how well prepared they were before the outbreak. When you don’t have drinking water and you don’t have toilets, you have a very fertile ground for cholera to develop,” Schuller said.
Schuller points out that cholera cases appear almost annually in the United States without causing panic because the disease rarely spreads in places with clean water and proper hygiene. Many cholera patients at St. Nicholas hospital in the Haitian town of St. Marc — where the first victims appeared last week — said they drink untreated water from the local canal because treated water is either too expensive or unavailable where they live.
The surrounding Artibonite region has the highest number of people displaced by the earthquake outside the tent camps of Port-au-Prince. Had humanitarian relief organizations invested more money after the earthquake building clean water and sanitation projects in these marginalized regions, cholera would not have spread, said Schuller.
“What could have happened is that when 600,000 people left Port-au-Prince after the earthquake to their families in the provinces, that could have been the opportunity to empower local people in the communities.” Schuller said. “Instead they concentrated their efforts in Port-au-Prince so people were coming back.”
Etant Dupain, director of a grassroots Haitian organization that is informing camp residents about the outbreak, said the United Nations could have helped prevent the epidemic in the first place by spending more of the $1 billion it has coordinated in post-earthquake aid on sanitation and clean water projects in rural areas like Artibonite.
“Humanitarian aid in Haiti is for crises — this is why they exist, for crises like this,” said Dupain.
Cholera may be new to Haiti, but it’s well known to Latin America. A cholera epidemic in the early 1990s spread to every country except Uruguay and the Caribbean, infecting more than 1 million people and killing nearly 9,000.
“You always have this period of time where you’re trying to get treatment sites set up and train people and that takes time," said Olson, who has responded to cholera outbreaks in Nigeria, Uganda and Zimbabwe. "In Haiti, where there hasn’t been cholera in several decades, one doesn’t expect that cholera will suddenly appear out of nowhere.”