The MINUSTAH base (misspelled “MINUSTHA” on Google Earth) in Méyè, on the banks of the Méyè Tributary.Artibonite RiverMéyè TributaryThe town of Mirebalais, located just north of Méyè, where the Méyè Tributary meets the Artibonite River.11 minustah and the cholera outbreak in haiti
B. The Outbreak of Cholera Has HadDevastating Consequences for theHaitian Population.On October 19, 2010, Haitian health officialsdetected an unusually high number of cases ofacute diarrhea, vomiting, and severe dehydrationin two of Haiti’s ten geographical regions known asadministrative departments. 33 Officials sent stoolsamples for testing to the Haitian National PublicHealth Laboratory (LNSP), and four days later, theLNSP confirmed the presence of Vibrio cholerae(V. cholerae), the bacterium that causes cholera. 34The first set of cases was localized in the upperArtibonite River region, where the Méyè Tributarymeets the Artibonite. By late October 2010, Haitianofficials reported a second set of cases in the lowerArtibonite River region, near the river’s delta. 35 Byearly November, cholera had reached the capital ofPort-au-Prince. 36 Cholera had also spread to citiesacross the North-West and North Departments. 37By November 19, the Haitian Ministry of Health(MSPP) reported positive cholera cases in all tenadministrative departments. 38 By then, over 16,000Haitians had been hospitalized with acute waterydiarrhea and over 900 had died from cholera. 39As Chapter II details, cholera is transmitted bythe consumption of food or water contaminatedwith V. cholerae. 40 The main sources of an outbreakare usually contaminated drinking water andinadequate sanitation; feces from those infectedwith V. cholerae contaminate the water supply,and the bacterium spreads when others drinkthe contaminated water. 41 A gastrointestinaldisease characterized by vomiting, diarrhea, anddehydration, cholera is easily treatable. Withaggressive electrolyte replacement—often simplydelivered in drinking water—fatalities are reducedto less than 1%. 42In Haiti, poor water, sanitation, and healthinfrastructure has facilitated the spread of choleraand prevented its effective treatment. Even beforethe earthquake, the country had an ineffectual andinstitutionally fragmented water and sanitationsector. 43 Approximately 10% of Haitians had accessto running water and only 17% had access toimproved sanitation services. 44 Additionally, untilAugust 2009, the water and sanitation sector hadneither a single national coordination authoritynor sufficient funds. 45 Instead, the sector wasregulated by several governmental institutionsthat were unable to ensure quality water andsanitation services. 46 After a 2009 reform, the waterand sanitation sector still lacked sufficient fundingand was unable to prevent the spread of cholerain the early stages of the epidemic. 47 Meanwhile,the public health sector in Haiti has been unableto treat cholera effectively. The health system inHaiti is supervised and coordinated by a singleentity, the MSPP. 48 Due to financial constraints andthe lack of local capacity to coordinate health careservices, the MSPP has been unable to guaranteeadequate cholera treatment for all Haitians.The Haitian cholera epidemic is one of theworld’s largest national cholera epidemics inrecent history. 49 In 2010 and 2011, Haitiansaccounted for roughly half of cholera cases anddeaths reported to the World Health Organization(WHO). 50 In the first year of the epidemic, over470,000 Haitians were infected and over 6,600 diedof cholera. 51 By October 2012, over 600,000 Haitianshad been infected and over 7,400 had died fromcholera. 52 As of April 2013, the MSPP has reportedover 650,000 infections, and over 8,100 deaths. 53Due to unreported cases in remote areas, thesenumbers likely underestimate the actual harmcaused by the cholera epidemic in Haiti. 54Although more than two years have passedsince the outbreak began, cholera still poses anongoing threat to people in Haiti. 55 The diseasecontinues to contaminate Haiti’s drinking watersources. As rivers overflow with each rainy season,inadequate sewage systems allow for continuedcross-contamination between infected feces anddrinking water sources, perpetuating the cycle ofdisease. Additionally, treatment programs remaininadequate due to a shortage of funding. 56 Expertsexpect Haiti will suffer from cholera for at least adecade more. 57C. Independent Investigations HaveTraced the Source of the Epidemic toMINUSTAH <strong>Peacekeeping</strong> Troops.As Chapter II discusses, nearly every majorinvestigation of the cholera crisis has identified12 minustah and the cholera outbreak in haiti
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