"If six years was too long to wait for an apology, then another day is too long to wait for action."
BY: LOUISE C. IVERS, MD, MPH
Sunday, October 9, 2016
The clock is ticking for United Nations Secretary-General Ban Ki-moon to have a lasting positive impact on Haiti and to lift the stain on his legacy there. The U.N. was responsible for starting a deadly cholera epidemic in Haiti that has killed at least 10,000 people so far. Mr. Ban recently conceded this fact. If six years was too long to wait for an apology, then another day is too long to wait for the U.N. Secretariat to have action to follow their words in Haiti. After Hurricane Matthew, thousands more lives are now in danger here from this illness that results from drinking unsafe water, and that can kill in a few hours without treatment.
Cholera had never been known in Haiti before 2010, but U.N. soldiers inadvertently introduced the bacteria that causes the disease when their human waste was leaked or dumped into the country’s largest river. U.N. humanitarian staff have been working on prevention and control efforts, but they, the Haitian Ministry of Health, and other organizations, such as Partners In Health, have been woefully underfunded to deal with the problem. After six years of diminishing support, PIH’s cholera treatment facilities, built as temporary structures with emergency funding in 2010, are expected now to both have weathered the hurricane, and to deal with an expected surge of cholera cases.
In the south of Haiti, key health facilities have been completely destroyed or rendered dysfunctional by Hurricane Matthew. With over two million people affected by the storm and 1.4 million in need of urgent humanitarian assistance, many families are displaced with no access to clean water and no access to healthcare. This is a deadly combination. Every individual case of cholera results in the shedding of hyper-infectious bacteria through diarrhea — putting the water supply, and other people at risk. Explosive outbreaks of cholera can occur, especially amongst vulnerable people. Children and pregnant women are particularly at risk of dying. Cases of cholera and tetanus are already being described in news reports from hurricane-affected areas of Haiti.
How many new cases of cholera we expect is uncertain, meaning that a combination of prevention and treatment is key. Before Hurricane Matthew, Haiti had reported 26,000 cases of cholera in the first 9 months of 2016. This was even more than in 2015, when they reported more cases of cholera per population to the World Health Organization than any other country. The outbreak here has been massive over the past six years — almost 800,000 people have formally sought care for suspected cholera, and probably many more were sick in the community and not counted. This has put unmeasured strain on individuals, communities, and on an already overburdened health system. The last thing that anyone needs right now in Haiti is a major surge of cholera cases but that threat is looming large.
In 2010, PIH faced grand opposition when we called for the inclusion of cholera vaccination as part of comprehensive control of the outbreak. Ultimately, cholera vaccination campaigns in Haiti moved forward and were successful in preventing cases, but were too small in scope. We now know even more about how effective cholera vaccines are in preventing outbreaks as well as stopping them mid-track. While vaccines are in short supply, a major push on manufacturers, coupled with a commitment to purchase the vaccines could encourage an increase in production to meet the need and have a big impact on cholera in the country.
The Haitian government, national and international agencies, and non-governmental organizations like ours know how to eliminate cholera transmission in Haiti. We can interrupt the spread of cholera using a combination of mass vaccination and household water treatment. We can stop cholera altogether by supporting Haitians to create the public water and sanitation infrastructure that they want.
The U.N. owes Haitians a remedy for the problem that they helped to start. The timeline for that remedy has now been urgently moved forward. Regret to have contributed to the suffering of almost a million people is one thing, acting to raise money and resources to stop others from suffering is another. Hurricane Matthew should not displace the idea of justice on this issue, but rather it should force its urgency.
Louise C. Ivers is an infectious disease physician, senior health and policy advisor for Partners In Health, and an associate professor at Harvard Medical School and Brigham and Women’s Hospital. Ivers has served with PIH in Haiti since 2003, and is on the board of directors of St Boniface Haiti Foundation in Haiti. She has worked in major disasters in Haiti over the past 13 years.
(Updated October 11, 2016: The World Health Organization announced on Oct. 11 that they would send 1 million doses of cholera vaccine to Haiti as part of its response to the crisis.)