Haiti Case Study - The Department of Global Health and Social ...

CHALLENGE TO THE HEALTH SYSTEM
Annex C
NARRATIVE:
CHOLERA – THE SECOND SHOCK
1. Ten months after the devastation wreaked by the earthquake, a second dreadful threat
to the population materialized: cholera. In Haiti, as of January 2012, over 500,000 people
have become infected and more than 7,000 have died from cholera. 148 The sudden lethal
outbreak was incomprehensible to the Haitian population. One blogger described the
reaction in her neighbourhood to the epidemic: "terrified residents saw stricken young
neighbors die within hours of developing symptoms. The speed and violence of the illness
convinced residents the water must have been deliberately poisoned with a chemical, not a
germ or bacteria because they had drunk the same dirty water their whole lives and had
never fallen ill before." 149
2. There was great concern over waterborne diseases in the aftermath of the earthquake.
The population had limited access to safe water because of underlying poor levels of
sanitation compounded by the destruction of water system infrastructure during the
earthquake. In March 2010, the Center for Disease Control (CDC) estimated the chance of
an outbreak of waterborne diseases as high, although it determined that an outbreak of
cholera was unlikely because cholera was historically not endemic to Haiti. 150 Nonetheless,
ten months after the earthquake, in late October 2010, Haiti saw its first officially reported
cholera case and the epidemic soon spread to all Haitian Departments. 151
3. The cholera epidemic broke out first along Artibonite River. The proximity of one UN
peacekeeper compound to the Artibonite River and the identification of an Asian string of
cholera indicated that a UN battalion from Asia could have brought the bacteria into the
country. 152 After the association of cholera fatalities with the UN mission, anger, frustration
and unrest among the Haitian population broke out very quickly. 153 A deputy mayor told the
New York Times of his anger towards MINUSTAH and that he had even considered killing
Nepalese UN soldiers. He added that, “If they hadn’t left, we would have burned it [the
Nepalese UN Camp] down.” 154
4. Elections held at the end of November 2010 contributed to an increase in violence on
the streets 155 and in the weeks following the first cases of cholera, protests and riots erupted
in the affected areas and soon spread across the whole country 156 . Outbreaks of violence
requiring MINUSTAH intervention were not only directed at MINUSTAH but also, as a result
of fear among the population, directed at cholera treatment facilities provided by NGOs. For
example, terrified residents violently protested the opening of a 400-bed cholera clinic nearby
for fear that the clinic would bring more cholera into the region. MINUSTAH had to respond
to these protests and the clinic was not opened. 157 Another NGO clinic required protection
because people’s frustration with the slow cholera response turned into violent riots. 158
5. The increased violence and instability made it more difficult to circulate response
resources which in turn hampered the fight against the epidemic. 159 Besides the increase in
instability, the cholera outbreak also impacted food security. According to a FAO report,
many farmers feared that the water irrigating the rice fields could have been infected. 160 The
security ramifications of the epidemic led Haitian health authorities to declare the epidemic "a
national security problem”. 161
6. The impact on the health system has been immense. Cholera patients have overrun
clinics and hospitals, with many hospitals seeing hundreds of patients per day. 162 The
consumption of health supplies, provider time, and money necessary to treat these patients
has distracted and continues to distract from efforts to strengthen Haiti's health system. Fear
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