The Lancet: Cholera in Haiti Takes a Turn for the Worse

Haiti's Ministry of Health has published a 10-year plan to halt cholera transmission, but aid groups say help is needed now to treat a surging caseload. Patrick Adams reports.

Nearly 2·5 years after it began, Haiti's cholera epidemic is getting worse, not better, and efforts to treat the sick are desperately short of funds, say aid groups on the ground.

Since the first reported cases in October, 2010, cholera has killed 8000 people and sickened some 649 000 more, wreaking havoc in a country bereft of effective water and sanitation systems and among a population with no natural immunity to the disease.

Now, with the rainy season fast approaching, some fear a surge in new cases could overwhelm Haiti's ill-equipped cholera treatment centres, many of which have struggled to retain staff and replenish supplies in the face of donor fatigue and errors of perception about the state of the epidemic.

“For those of us who are providing care to patients with cholera, the emergency phase is still ongoing”, says Louise C Ivers, a senior policy and health adviser at Partners in Health (PIH), the largest non-governmental health-care provider in Haiti. “It's not as dramatic as it was in 2010, but we've seen in our clinics double the number of cases early this year compared to last.”

Ivers says that uptick observed in PIH clinics may be explained in part by the fact that many smaller non-governmental organisations (NGOs) have since pulled out, leaving more patients to those providers that remain. But it's probably also a reflection of the overall increase in cholera cases nationally. According to the UN Office for the Coordination of Humanitarian Affairs, 11 220 cholera cases were registered in Haiti in December, 2012—an increase of more than 3000 over the same period the previous year. “What's clear is that it hasn't burned itself out”, she says. “Cholera in Haiti won't just go away.”

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