200,000 at risk in Haiti cholera epidemic

By Patrick Martin
13 November 2010

More than 800 have died in the cholera epidemic in Haiti, 12,000 have been hospitalized, and some 200,000 people are at risk, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) announced Friday, issuing an appeal for $164 million in emergency aid.

The epidemic was first reported three weeks ago and it has spread to both Gonaives, Haiti’s fourth largest city, and to the capital, Port-au-Prince, where more than 1.3 million people live in tent encampments established after last January’s catastrophic earthquake, which killed an estimated 250,000.

A doctor with Medecins Sans Frontieres (Doctors Without Borders) said Friday that cholera epidemic was taking off in Port-au-Prince. “It’s a really worrying situation for us at the moment,” he told Agence France Presse. “All hospitals in Port-au-Prince are overflowing with patients and we’re seeing seven times the total amount of cases we had three days ago.”

In the capital, the disease is centered in Cite Soleil, a slum on the north side which is closest to the road from the Artibonite valley, where the outbreak began last month. MSF recorded 216 cases of cholera in Cite Soleil Thursday, a ten-fold increase over the beginning of the week.

“If the number of cases continues to increase at the same rate, then we’re going to have to adopt some drastic measures to be able to treat people,” the MSF doctor said. “We’re going to have to use public spaces and even streets.”

The OCHA estimate that up to 200,000 will show some symptoms of the disease was worked out in conjunction with the World Health Organization and the US Centers for Disease Control. There is no recent precedent for an outbreak on such a scale in the western hemisphere.

Haiti itself has never had a documented case of cholera until last month, but now five of the country’s ten departments have been affected.

Cholera is a bacterial infection spread by drinking water contaminated by the feces of infected people. It is easily and cheaply treated with saline solutions, but without immediate treatment patients go into shock and die quickly of dehydration. The disease has been virtually wiped out by modern sanitation systems, and the outbreak in Haiti is a direct byproduct of the January earthquake and the longstanding poverty of the country.

A WHO spokesman said that the fatality rate from the current outbreak was at least 6.5 percent higher than expected, an indication both of the virulent strain of the disease—believed to be derived from South Asia, perhaps via Nepalese peacekeeping troops—and the virtually nonexistent public infrastructure for both sanitation and medical care.

The WHO estimated that less than half the country uses “improved drinking water sources,” while a 2008 Partners In Health report found that 70 percent of Haitians lacked continuous direct access to clean water.

Since the outbreak began in the Artibonite Valley, healthcare workers have waited anxiously for its arrival in urban centers. The first city to be hit was Gonaives, which is closest to the Artibonite region. “Sick people died on the way to the hospital, the bodies were covered in blankets and left near the town cemetery,” mayor Adolphe Jean-Francois told AFP.

Dozens have died in Gonaives in the past week, and cemetery workers told the Los Angeles Times they had dumped 48 bodies into pits there on November 9.

The propagation of the epidemic is tracked in the figures on deaths: 538 nationally by Tuesday, over 600 Wednesday, 724 on Thursday, over 800 on Friday. There have been 1,000 new cases each day this week. The first fatality in Port-au-Prince came on Tuesday, with three more in the next two days, then six on Friday.

Yves Lambert, head of infectious diseases at the main public hospital in downtown Port-au-Prince, told the press, “If cholera cases continue to rise at this rate, we’ll quickly be overwhelmed.”

The charity Oxfam said its water, hygiene and sanitation program had reached about 100,000 people to distribute soap, water purification tablets, buckets and rehydration salts, but this represents less than 10 percent of those living in tent cities around the capital.

The organization said in a statement, “It is a very serious development that cholera has spread in Port-au-Prince. However, it is understandable. With heavy rains and flooding over the weekend, in an environment where there is poor sanitation, waterborne diseases like cholera spread very rapidly.”

Hurricane Tomas killed more than 20 people in Haiti last weekend, striking the country a glancing blow that mainly affected the southeastern peninsula, which is less populated than the Port-au-Prince area but equally devastated by the earthquake, whose epicenter was near the town of Jacmel in that region.

Tomas produced heavy rains in most of the country and reflooded the Artibonite River, believed to be the original source of the cholera. The St. Marc River, a tributary of the Artibonite, has tested positive for the cholera bacteria.

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