On January 12, 2010, the Haitian community was rattled by one of the most devastating earthquakes to occur in the last century. This earthquake killed thousands and left much of Haiti’s population homeless, living in “subhuman conditions” without access to running water or latrines.1 This national disaster brought attention and assistance from many other nations, whose presence in Haitian cities led to the onset of another catastrophe—a massive cholera epidemic.
UN peacekeeping troops allegedly brought the cholera bacterium from Nepal, which spilled into Haiti’s longest river via a leaky latrine and spread throughout the country with “astonishing speed”. It wasn’t until October of 2010 that the Artibonite River in Mirebalais, commonly used for bathing and drinking water, was determined to be toxic by the Haiti Public National Health Laboratory.2 One day later, the first cholera epidemic in Haiti in over a century was announced to the public. Since the initial outbreak, over 500,000 cases of cholera have been reported in Haiti, spreading throughout every Haitian state and killing more than 6300. One year later, the case fatality ratio had dropped to below 1% due to intervention by the CDC and the Ministry of Public Health—but cholera continues to spread. 3
The cost of cholera response programs in Haiti has been expensive—totaling 230 million dollars—but programs to date have been insufficient in the containment of the disease. There has also been dispute about whether global attempts to eradicate cholera have been lacking in effort or that the campaigns are futile, taking on an “intractable problem”. 4 In combination with the controversy surrounding the methods of eradication and the allocation of funds, international attempts to contain the disease have resulted in mistrust and high tensions between Haitian citizens and international health workers—hindering the progression of cholera eradication on a local and national level.
The United Nations has been a contributing factor to the containment of cholera, but the presence of UN workers in Haiti has raised controversy regarding the ignition of the epidemic. According to microbiologic evidence, Nepalese UN workers brought cholera to Haiti, causing prevalent distrust of the UN amongst Haitians. Nepalese health workers were reportedly caught on camera improperly disposing of waste and a landfill was discovered upstream of local bathing sites, further contaminating dangerous waters. Due to these suspicious events, Haitian citizens are pushing the UN to provide compensation for the damage that they’ve caused, but UN officials claim that the epidemic “isn’t attributable to any single factor”. Whether the UN officials are telling the truth or not, the current management of this epidemic demonstrates the importance of gaining the trust of a nation that is in need of international help. A lack of personal relationships or plain mistreatment of locals can cause well-planned interventions to be counterproductive and ineffective.
According to the deputy mayor of Mirebalais, “[the UN workers] were in my face every day…I even considered killing a soldier or two”. The mayor claimed that he buried 27 bodies of cholera-stricken citizens “for fear that the workers would not take proper precautions”. While the intentions of the Nepalese UN workers are to assist the people of Mirebalais, their poor relationships with locals have led to detrimental repercussions.
The unrest between Haitians and international health workers is not only prevalent on the local level, but amongst government officials. International officers claimed to collaborate willingly with the Haitians, but in reality made all of the decisions regarding strategy and allocation of funds. This led to resentment of international assistance by the Haitian government and was only further enhanced by their belief that UN workers imported the epidemic. Haiti is a nation that is in desperate need of assistance from other countries, but if the intervening nations cannot gain the trust of the Haitians, turmoil will ensue and cholera will continue to spread. These problems of trust set the stage for an eradication effort that could be very successful, but continues to fall short.
In the coming months, the rainy season will begin in Haiti, making slums in Port-au-Prince “a perfect breeding ground for diarrheal disease”. In order for the complete eradication of cholera to be achieved, the relationship between international organizations and the Haitian government and citizens must improve. The road to improved sanitation, vaccination and elimination of cholera in Haiti is a long one, but one that must first be paved by mutual trust and respect between all involved parties.
1Knox, Richard. “In Haiti, Bureaucratic Delays Stall Mass Cholera Vaccinations”. Shots: NPR’s Health Blog. March 27, 2012. http://www.npr.org/blogs/health/2012/03/27/149403215/in-haiti-bureaucratic-delays-stall-mass-cholera-vaccinations
2Sontag, Deborah. “In Haiti, Global Failures on a Cholera Epidemic”. The New York Times. March 31, 2012. http://www.nytimes.com/2012/04/01/world/americas/haitis-cholera-outraced-the-experts-and-tainted-the-un.html?pagewanted=5&_r=2&ref=world
3“Cholera in Haiti: One Year Later”. Centers for Disease Control and Prevention. October 2011. http://www.cdc.gov/haiticholera/haiti_cholera.htm
4Salmon, Felix. “Playing the Blame Game in Haiti”. Reuters. April 1, 2012. http://blogs.reuters.com/felix-salmon/2012/04/02/playing-the-blame-game-in-haiti/