The rising threat of cholera is shaping every aspect of the humanitarian response to Hurricane Matthew, two weeks after the storm wrought devastation across parts of Haiti.
Already, the suspected number of cholera cases in Haiti appears to be rising and is expected to continue to increase. From Oct. 4 to 13 there were 1,116 cases, but from Oct. 2 to 15 new figures showed that number had jumped to 1,351.
There have been 28,559 reported cholera cases and 267 deaths over the course of 2016 through September, a sharp decrease since the epidemic spread in 2010 when nearly 4,000 people died that year alone.
Concerns that cholera cases could rise again are compounding the challenge of meeting immediate needs such as shelter and nutrition. Aid organizations say rebuilding Haiti’s already fragile water and health systems is an urgent priority.
The Category 4 storm, which landed on Haiti Oct. 4, resulted in the destruction of 34 cholera treatment centers in the department of Grand’Anse out of a total 212, according to UNICEF. And at least 11 of 33 hospitals in three of the most impacted departments of Grand’Anse, Nippes and Sud have been damaged. An estimated 1.25 million Haitians, including 500,000 children, now require clean water and adequate sanitation to help prevent the spread of diseases, including cholera.
New partnerships between the Haitian government and nonprofits as well as a new U.N. funding initiative to tackle cholera are now taking form. These initiatives are shaping the nature of some relief work as U.N. agencies and other groups deliver cholera vaccines, water purification tablets, cholera kits and other services.
The United Nations Deputy Secretary-General Jan Eliasson on Friday announced the launch of a Multi-Partner Trust Fund, which is estimated to reach $400 million in funding over the next two years. The fund will work in parallel to a nearly $120 million flash appeal the U.N. issued for immediate emergency and short-term needs over the next three months. As of Wednesday, the appeal was 22 percent funded.
The Trust Fund is part of a new U.N.-led Haiti cholera response plan, set to roll out in the months before Secretary-General Ban Ki-moon leaves office in December. The plan aims to improve both long-term access to clean water and sanitation in Haiti. It will also offer a package of material assistance to affected people once funds become available. U.N. organizations and implementing partners, such as NGOs and government institutions, are eligible to receive money from the fund, according to Olga Aleshina, the fund’s senior portfolio manager.
“There are lots of logistical challenges. Some of the hardest hit places are in the mountains that can only be reached by walking two to three hours by foot or you can get there using horses or a donkey,” said Hervil Cherubin, Haiti country director for Heifer International during a phone call with Devex from Les Cayes.
“People need food to eat and the reserves they have had, they just lost it all so this is the most urgent needs, for people in both the urban and rural areas.”
Difficulties with accessing remote areas are causing some patients not to be treated, David Nabarro, a special adviser to the secretary-general leading the cholera response plan, said during a visit to Haiti on Oct. 18.
Service infrastructure has also taken a hit in some areas. Global health nonprofit Management Sciences for Health announced last week it is working with the Haitian government to assess health infrastructure — including data, staffing and supplies needs — in badly hit areas.
The organization, with 50 workers on the ground, has so far completed assessments in three initial southern departments of the country and is moving on to the northwest region. The final results from their work are still pending, but preliminary findings show extensive damage, including collapsed roofs, to health care clinics. Physical structures need to be repaired, and new medical equipment must be purchased before work can resume in these places.
MSH COO and Executive Vice President Paul Auxila told Devex cholera “needs to be a priority and approached differently than the international community did last time,” referring to the 2010 Haiti earthquake response.
He urged organizations to focus on “greatest impact” interventions, such as oral rehydration therapy. “Coordination is a big problem, just like it was after the earthquake,” he added. Interventions need to be more synergistic, working toward a “common goal” and not bypassing the Haitian government, he told Devex.
Cholera is also influencing the work of Heifer International, primarily a global poverty and hunger nonprofit that so far has reached more than 5,000 people with food and sanitary kits.
“People are worried about the spreading of cholera and all of us are working towards not letting that happen,” Cherubin said.
His organization is coordinating with the World Food Program to reach the cutoff island of Île-à-Vache, where approximately 15,000 people remain in need of aid. The group plans to install water tanks as it distributes goods to communities there.
After multiple scientific studies that linked the 2010 Haiti cholera outbreak to a U.N. peacekeeper base and years of denial, the United Nations accepted a role in the crisis this August.
This involvement, Auxila and Cherubin say, hasn’t fostered distrust of the U.N. and other international actors on the ground.
“Our experience is that people welcome the support, but they want all of us to be accountable and to deliver what we said we would, whether it is the U.N., the government, or MSH,” Auxila said.
Amy Lieberman is a reporter for Devex, based out of New York, where she covers global development around the city and out of the United Nations. She has previously worked as a freelancer, reporting on the environment, social justice issues, immigration and development. Her coverage has appeared in The Guardian, The Atlantic, Slate and The Los Angeles Times, among other outlets. She received her M.A. in politics and government from Columbia Journalism School in 2014.
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