Date October 2010-present | ||
 | ||
Location United Nations camp Artibonite Valley, Haiti Cause Infected United Nations troops.
Haiti 9,200+ dead (4 Mar 2015)
Dominican Republic 472 dead (Nov 2014)
Cuba 3 dead (Jun 2012)
Mexico 1 dead (18 Oct 2013) | ||
The ongoing Haiti cholera outbreak is the worst epidemic of cholera in recent history, according to the U.S. Centers for Disease Control and Prevention. After the 2010 earthquake, in little over two years, as of April 2013, it has killed at least 7,000 Haitians and sickened a few hundred thousand more while spreading to neighboring countries including the Dominican Republic and Cuba. Since the outbreak began in October 2010, more than 6% of Haitians have had the disease. While there had been an apparent lull in cases in 2014, by August 2015, after the rainy season that year brought a spike in cases, more than 700,000 Haitians had become ill with cholera and the death toll had climbed to 9,000.
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The outbreak began in mid October 2010 in the rural Center Department of Haiti, about 100 kilometres (62 mi) north of the capital, Port-au-Prince, killing 4672 people by March 2011 and hospitalising thousands more. The outbreak occurred ten months after a powerful earthquake which devastated the nation's capital and southern towns on 12 January 2010. It is widely believed to have been introduced by Nepalese peacekeepers from the UN. By the first 10 weeks of the epidemic, cholera spread to all of Haiti's 10 departments or provinces.
As of 12 December 2012, hospitalizations (2,300 per week) and deaths (40 per week) are roughly triple since Hurricane Sandy struck the island in what was expected to be a quiet cholera season, causing more deaths than the cyclone took in all countries combined. In November 2010, the first cases of cholera were reported in the Dominican Republic and a single case in Florida, United States; in January 2011, a few cases were reported in Venezuela. The epidemic came back strongly in the 2012 rainy season, despite a localised delayed vaccine drive. In late June 2012, Cuba confirmed three deaths and 53 cases of cholera in Manzanillo, in 2013 with 51 cases in Havana. Vaccination of half the population is urged by the University of Florida to stem the epidemic.
In August 2016, after a report from the United Nations Special Rapporteur Philip Alston, the Secretary General of the United Nations accepted responsibility for the UN's role in the initial outbreak.
Background
During the 19th and 20th centuries, six major cholera pandemics had spread around the world. At the time of this outbreak, the world was experiencing the seventh, caused by a new strain of the Vibrio cholerae bacterium, El Tor. Epidemics involving this strain started in 1961 in Indonesia, and spread rapidly elsewhere in eastern Asia and then to India and Bangladesh, the USSR, Iran and Iraq. This was the first outbreak in Haiti ever recorded of El Tor. Professors at Duke University have argued that none of the previous pandemics affected Haiti either.
On 21 October 2010, the Haiti National Public Health Laboratory confirmed that cases of diarrhea illness that hospitals in the Artibonite region had been receiving had been identified as cholera. Haiti has not had a cholera outbreak in recorded history, so it triggered panic and confusion in the populace, complicating relief efforts.
The spread was partially blamed on the poor distribution of health supplies due to logistical problems. The Pan-American Health Organization said there was also a lack of access to untainted drinking water. According to the US CDC, in most instances cholera does not spread widely within countries where drinking water and sewage treatment are adequate. When water and sewage treatment is inadequate, as in Haiti after the 2010 earthquake, cholera can spread rapidly.
On 28 October, the head of Haiti's health department, Gabriel Thimoté, said 4,147 people were being treated. WHO's cholera chief, Claire-Lise Chaignat, said the epidemic was not contained and that she thought it had not yet "reached the peak", so Haitian authorities should be prepared for a "worst-case scenario" of cholera spreading in the capital, Port-au-Prince.
On 10 November, Gabriel Thimote, Haiti's senior health official, said that the outbreak was "no longer a simple emergency, it's now a matter of national security."
The outbreak of cholera became an issue for candidates to answer in the 2010 general election. There were fears that the election could be postponed. The head of MINUSTAH Edmond Mulet said that it should not be delayed as that could lead to a political vacuum with untold potential problems.
Initial spread
By the end of October cholera had been confirmed in four of Haiti's ten departments: Artibonite, Centre, Nord and Ouest, including the capital Port-au-Prince, and the capital's Cité Soleil district. By the 25th of October the Ministry of Health of the government of Haiti had reported 3,342 confirmed cases which resulted in 259 fatalities. By 16 November it had spread throughout the country. In addition to those hospitalized, others were unable to receive treatment due to overcrowded hospitals. Health workers also feared the disease would spread after Hurricane Tomas hit the island causing more flooding.
There were also fears that the disease would further spread because many people were still living in unsanitary camps as a result of the earthquake earlier in the year. Those concerns came despite claims that the outbreak had been contained in the north and central parts of the country. The Pan American Health Organisation predicted that 270,000 people would be infected within a year of the outbreak.
Immediate efforts in 2010 by the CDC to make treatment more accessible included increasing the number of treatment centers and rehydration points. As a result of these efforts the mortality rate decreased from 4% of all cases to less that 1%.
The first outbreak of cholera was reported in the Dominican Republic in mid-November 2010, following the Pan-America Health Organisation's prediction. By January 2011, the Dominican Republic had reported 244 cases of cholera. The first man to die of it there died in the province of Altagracia on 23 January 2011.
On 15 November the director of programming for Catholic Relief Services in Haiti, said, "Some people have been reporting that we've gotten in front of it and are in control of the spread of cholera. Actually WHO does not believe that. There's such a severe underreporting of cases that they're not sure of all of the hot spots."
In late January 2011, more than 20 Venezuelans were reported to have been taken to hospital after contracting cholera after visiting the Dominican Republic. 37 cases were reported in total. Contaminated food was blamed for the spread of the disease. Venezuelan health minister Eugenia Sader gave a news conference which was broadcast on VTV during which she described all 37 people as "doing well". The minister had previously observed that the last time cholera was recorded in Venezuela was twenty years before this, in 1991.
On 15 March 2011, a report was issued by the University of California that predicted total infections would number up to 779,000 and total deaths up to 11,000 by November 2011, compared with earlier UN estimates that around 400,000 people would end up infected. The revised numbers were based on more factors than the UN's estimates, which assumed a total infection rate of between two and four percent of the population. In a statement released at the same time, the WHO said total deaths thus far had reached 4,672, with 252,640 cases reported.
Within the time period of October 2010 to October 2014, a total of 711,442 confirmed cases of cholera occurred. Of these cases 400,103 were hospitalized and 8,646 died, resulting in a cumulative case-fatality rate of 1.2%. Variations in case-fatality rates were observed based on location. The case fatality rate in the department of Sud Est was 4.4%, compared to 0.6% in Port-au-Prince.
Casualties over the years
Even before the outbreak Haiti has suffered from infectious diseases due to crowded living conditions and lack of clean water and sewage disposal. There is also a chronic shortage of health care personnel, and hospitals lack resources, a situation that became readily apparent after the January 2010 earthquake.
Some aid agencies have reported that the toll may be higher than the official figures because the government does not track deaths in rural areas where people never reached a hospital or emergency treatment center. In 2011, reports suggested over 6,700 people had been killed during the outbreak.
By March 2011, after the initial intense flare up, some 4,672 people died and as of March 2012, cholera has killed more than 7,050 Haitians and sickened more than 531,000, or 5 percent of the population.
The next years there was significant progress reduction of caseloads and deaths, with solid backing of international medical efforts and preventative measures, including latrines installed and changes in Haitian behaviors, such as thoroughly cooking food and rigorous handwashing. However, roughly 75% of Haitian households lack running water and thousands still live in camps or similar substandard conditions. Despite all these efforts, every rainy season or hurricane has caused a temporary spike in cases and deaths. Per the Haitian Health Ministry, as of August 2012, the outbreak had caused 7,490 deaths and caused 586,625 people to fall ill. According to the Pan American Health Organization, as of 21 November 2013, there had been 689,448 cholera cases in Haiti, leading to 8448 deaths.
In the first 4 months of 2016 alone, there have already been nearly 14,000 new cases of cholera and over 150 deaths. Even 6 years after the outbreak, the disease is still killing an average of 37 people a month. To date, around 7% of the population (around 770,000 people) have been affected with cholera, and more than 9,200 have died.
Political reactions
On 12 November 2010, the United Nations issued an appeal for around US$160 million to fight the spread of the disease, saying that "all our efforts can be outrun by the epidemic" and warned of a lack of space for patients in hospitals. It also denied that the Nepali contingent were responsible for the outbreak. In November 2011, the UN received a petition from 5,000 victims for hundreds of millions of dollars in reparations over the outbreak thought to have been caused by UN members of MINUSTAH. In February 2013, the United Nations responded by invoking its immunity from lawsuits under the Convention on the Privileges and Immunities of the United Nations. On 9 October 2013, BAI, IJDH, and Ira Kurzban’s law firm (KKWT) filed a lawsuit against the UN in the Southern District of New York. The lawsuit was dismissed, but an appeal has been filed in the Second Circuit.