ⁱCholera in Haiti: Social Disorder, Difficult Environment and Climate Change

The initial Cholera outbreak in Haiti had its roots in four hurricanes of the 2008 storm season -Fay Gustav, Hanna, and Ike. Collectively the four hurricanes dumped massive amounts of water on Haiti causing widespread flooding, deforestation, and taking the lives of 800 people, injuring 600 and resulting in 300 people missing. Flooding wiped out 70% of the crops totaling more than $1 billion in damages. The results of the storms further stressed the island’s health care system that was already highly dependent on foreign NGO’sii. Hurricanes were not the only problem faced by the Haitian people; a massive 7.0 earthquake struck Haiti on January 12, 2010. For the next two weeks, the quake was followed by 52 aftershocks of 4.5 or greateriii. The quake heavily damaged buildings and infrastructure. As a result, 300,000 people were killed and another 300,000 were injured. An additional 105 million people were made homeless. Two years later a half million were still living in tents. Few had access to clean water, effective sanitation or adequate food and medical care. The remaining population largely scattered across the island beyond the reach of medical services.

It was in this this significantly disrupted environment that Cholera made its contemporary appearance in Haitiiv -- breaking out during 2010 in rural Artibonite, about 100 miles north of Port-au-Prince. Harvard Medical School researchers described it as a “super bug” which spread rapidlyv. In the next 10 weeks cholera reached Port-au-Prince then spread to all of Haiti. By October 20, 2010, outside of Port-au-Prince cholera had killed at least 3,500 people and sickened over 340,000vi. Given the nature of the bacterium, the consensus among researchers was that cholera was brought to the island from the outside. The continuing failure of the central government and civil organizations to maintain order and to serve the population adequately, consequently, foreign governments and NGOs had to carry heavy loads of service.

A hotly contended debate developed over the issue of just how cholera traveled to Haiti. After much research the general consensus was that cholera came with the contingent of UN peacekeepers from Nepal. Presumably, they set up their camp near a tributary of the Artibonite River which was widely used downstream for drinking, laundry and other needs. As the troop left Nepal, that country was experiencing an outbreak of cholera. The troops were not screened in Nepal before they left. Nor were they screened when they arrived in Haiti. Later researchers found that the Haiti cholera bacterium was the same as that found in Nepal. As this information became public, the Haitian population rioted over four days and demanded that the troops leave Haiti. This was followed by a lawsuit against the UN brought by Haiti that raged on for 10 years^vii,viii.

As time went on, Haiti had to deal with continuing earthquakes, hurricanes and floods. They also had to deal with a down economy and a crumbling government. Nevertheless, health authorities in February 2022 reported that after 3 years with no new cases of cholera reported-- that the 2010 outbreak was “over” But not quite! On October 2, 2022, two more cases of Vibrio cholera were confirmed in the greater Port-au-Prince area. By January 3, 2023, more than 20,000 cases had been reported throughout Haitiix. On-the-scene observers have argued that multiple factors lead to the emergence and spread of Cholera at this time. They include unending general social unrest and instability, uncontrolled youth gang violence, terrible security, and corruption over strained health care system capacityx. As the UN summarized it, “Haiti remains in ‘acute political and institutional crises^xi.

This crisis is well illustrated by:
A. The assassination in 2021 of president Jovenel Moise.
B. The last held national elections in 2016.
C. The legislature seats are empty; and
D. The only remaining elected officials departed. Rrampant gang violence has forced 150,000 from their homes and forced aid groups such as Doctors Without Borders to close their facilities and move their staff^xii. These conditions make it highly unlikely that the remaining health care professionals can make headway against Cholera in the foreseeable future.

Recently Haiti has been ranked first of the world’s countries in vulnerability to climate changexiii. This index includes many serious conditions such as: flooding, droughts, hurricanes, earthquakes, and landslides all of which will be aggravated as temperatures rise. Haiti already is located in the Caribbean’s direct strike alley. So, there should be more and larger storms. Haiti will need to enhance its social order and government functioning soon in order to be able to respond to the challenges produced by what is likely to be a long run climate change. The countries that have provided assistance in the past will likely have to shift more attention to their own climate problem demands.

The conditions that foster Cholera’s spread will increase. This will place a greater stress than in the past on medical surveillance, health care personnel, facilities, and supplies. Unless Haiti becomes governmentally stronger and much better organized than it has been the past, it is likely that Cholera will become endemic to Haiti.