In March, 8-year-old Belizaire Selfanord started to feel sick after he came home from school.

By the following morning, he was so ill with diarrhea and vomiting that he could hardly stand up. His mother, a widow raising six children alone, knew where to go—the Partners In Health cholera treatment center in Mirebalais, in central Haiti.

Inside the fenced collection of large tents, Dr. Thelisma Heber asked him a few questions about his symptoms, but there was no doubt Belizaire needed IV fluids immediately. “He’s a severe case. You can see his eyes are sunken,” Heber said.

Belizaire’s mother, Sentane Pierre, helped him onto a wooden bed with a hole and a bucket beneath. Heber examined him, pulling the skin on his belly. It was stretchy like bread dough—a sign of dehydration. According to data from Partners In Health and our Haitian sister organization, Zanmi Lasante, PIH/ZL has treated twice the number of cholera cases this January and February than during the same months last year. As the spring and summer rainy season in Haiti begins, PIH/ZL clinicians are concerned that cholera could spike again, especially because emergency cholera funding has largely ended, causing many prevention and treatment activities to cease.

“In most of the areas we serve, it seems that we are the only cholera health care provider, and that puts more pressure on our services,” said Dr. Ralph Ternier, director of community care and support at PIH/ZL.

PIH has treated more than 100,000 patients for cholera and has worked to prevent cholera’s spread since the epidemic began in late 2010. PIH/ZL also supported the delivery of Haiti’s first cholera vaccination program, which has since provided evidence for wider use of the vaccine in Haiti. PIH/ZL continues to operate cholera treatment centers in central Haiti, and conduct prevention activities and educational outreach. In January and February, PIH/ZL treated more than 2,000 patients for cholera.

The impact of the loss of funding is clear. It has threatened the quality of care at the few centers that still provide cholera treatment, Ternier said, because fewer staff have been on hand to care for patients. And because untreated cholera can result in more infections, a lack of treatment also affects prevention. When people fall ill in communities without a treatment center, they not only go without care but also spread the bacteria, which could then infect others.

“How many people will have to die in a stupid way? Dying of diarrhea is stupid,” Ternier said. The cholera epidemic has killed more than 8,000 people in Haiti and sickened more than 650,000, according to Haiti’s Ministry of Health. “Donors get distracted unless there’s a big spike in numbers and people start to die rapidly. Otherwise people have gotten used to the idea that cholera is here.”

Belizaire wasn’t the only patient Heber and the rest of the staff were treating at the cholera treatment center. Heber, 40, examined and admitted a half-dozen patients in less than an hour. He triaged them to either receive oral rehydration solution or, for more severe cases, to be hospitalized and given IV fluids. In different tents designated for men or women, two sisters and their father were also receiving fluid from IVs. They each had to pay for a car to bring them to the cholera treatment center as they each became sicker over the course of the night. Heber said families can become infected when they eat the same contaminated food or water, don’t wash their hands, or take care of a sick relative.

Heber said that continuing to fight cholera can be difficult, as Haitians and foreigners perceive that the crisis is over. Because Haiti lacks proper water and sanitation systems, individuals must try to prevent the disease themselves through hand-washing and good sanitation, but they can’t always afford to buy soap or treat their water.

“It’s a big battle to combat cholera,” Heber said.