Woman at Leogane camp saying the latrines behind her are full and smell foul. Photo credit: Haiti Grassroots Watch
Haiti should focus on stemming the cholera outbreak that has killed more than 7,000 people since 2010, rather than on levying blame against the source of the disease, UN special envoy to Haiti, Bill Clinton, said. While studies have suggested that the cholera came from a Nepalese soldier serving as a peacekeeper, Clinton pointed out that the country’s lack of proper sanitation was the real cause of the outbreak. [1]
In November 2011, the Boston-based Institute for Justice and Democracy in Haiti (IJDH) filed a demand for hundreds of millions of dollars in compensation from Haitian cholera victims. [2]
Money to empty refugee camp toilets has run out
Clinton’s own foundation, together with UNICEF and USAID, supplied some 11,000 mobile toilets for the refugee camps that emerged after the 2010 Haiti earthquake. The NGOs that distributed the toilets and paid for them to be emptied are now pulling out one by one, leaving overflowing toilets behind, according to an IPS report. [3]
Donor funds are being used to set up excreta treatment centres, one is now in operation in Morne-à-Cabri while a second centre is planned for Titanye, but these are not servicing the remaining refugee camps, home to nearly half a million people.
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The cholera outbreak that has so far killed 4,888 people in Haiti was caused by a strain “very similar but not identical” to current South Asian strains, a U.N. independent panel of experts said. The source of the outbreak was due to contamination of the Meye Tributary of the Artibonite River, used by tens of thousands of people for washing, bathing, and drinking.
Many people in Haiti blamed the epidemic on U.N. peacekeepers from Nepal, who had been accused of poor sanitation at their base near Mirebalais, the town where the epidemic first began. In November 2010, this lead to violent protests against the UN peacekeeping forces. Others believed that the outbreak was linked to voodoo. More than 50 voodoo followers have been killed since the outbreak of cholera following accusations that they spread the disease with occult power. However, U.N. panel declined to point the finger at any single group for the outbreak, saying it was the result of a “confluence of circumstances”.
“The introduction of this cholera strain as a result of environmental contamination with faeces could not have been the source of such an outbreak without simultaneous water and sanitation and health-care system deficiencies,” the report concludes.
The UN panel of experts provides several recommendations to the U.N. and the Haitian government including:
UN staff and other relief workers travelling from cholera-endemic areas should either receive a prophylactic dose of appropriate antibiotics before departure or be screened for cholera strains
UN peacekeeping missions operating in areas with cholera outbreaks should ensure that staff be immunized with oral vaccines, receive prophylactic antibiotics, or both,
the UN should install and supervise their own on-site sanitation systems that inactivate pathogens before disposal
the Haitian Government and the UN should prioritise investing in piped, treated drinking water supplies and better sanitation throughout the country; and until this can be put in place, they should promote household water treatment, hand washing with soap, and the safe disposal of faecal waste.
Read the full report of the UN Independent Panel of Experts on the Cholera Outbreak in Haiti.
According to estimates from the Health and WASH Clusters, US$ 39.38 million is still neededto respond to essential needs of the cholera response in the areas of Water, Sanitation and Hygiene (WASH) and health. This unfunded requirement is part of the general US$ 175 million cholera appeal which is so far 48 per cent funded, according to the latest UN Humanitarian Bulletin for Haiti.
In response to the cholera outbreak in Haiti, the World Bank is preparing a US$ 10 million Cholera Emergency Grant as part its US$ 479 million reconstruction support. As of 22 November 2010 the outbreak has caused 1,523 deaths and could kill up to 10,000 people and affect 40,000 if the outbreak is not contained, according to the Pan American Health Organization (PAHO). The UN has appealed for US$ 164 million for additional treatment centres, scaled-up public information campaigns, supplies of medical equipment, rehydration salts, water purification tablets and bars of soap to respond to the outbreak.
The US$ 10 million grant will bolster the surveillance and monitoring capacity of the Ministry of Public Health and Population (MSPP) and the Haitian National Directorate of Water Supply and Sanitation (DINEPA). The initiative is aligned with the Cholera Inter-Sector Response Strategic Plan for Haiti, under the leadership of MSPP and DINEPA.
The grant will also help NGOs provide clean water and basic health services to affected people, and safe sanitation and waste management in high risk areas. These activities will complement existing hygiene awareness and prevention efforts such as the creation of a “Public Health Brigade”.
Through a Global Facility for Disaster Reduction and Recovery grant of US$ 200,000, the World Bank is identifying national and international actors already involved in these tasks, preparing a standardized training plan and training a core group of 250 trainers. It will also finance an awareness and prevention campaign.
The Bank has also provided assistance to the Directorate of Civil Protection since the beginning of the cholera outbreak to coordinate the response of the Government and its partners. This assistance has supported the setup and manning of the National Emergency Operation Center and management of the national campaign “Konbit kont Kolera,” which raises awareness on cholera and its prevention.
Civil unrest since 15 November 2010 has slowed down several activities, particularly in the Northern city of Cap Haitian. Trainings on cholera treatment and initiatives to chlorinate water for 300 000 people had to be postponed.
For the latest updates on the Haiti cholera outbreak go to ReliefWeb.
As the death toll from Haiti’s cholera epidemic reached 917 on 12 November 2010, Save the Children says the best way to reduce the disease’s spread is to arm people with information and supplies to improve hygienic practices.
Cholera has reached the capital Port-au-Prince, where 27 deaths have been recorded and over 1.3 million earthquake survivors living in tent camps are at risk. Throughout the country 14,600 cholera victims have been hospitalised.
The United Nations forecasts up to 200,000 Haitians could contract cholera as the outbreak extends across the country of nearly 10 million, and says $163.9 million in aid is needed over the next year to combat the epidemic.
Cholera prevention poster in Haiti. In reality clean water, sanitation and nearby health clinics are absent in most rural communities. Photo: PAHO
Safe water and sanitation, vital tools to combat the current cholera epidemic, are absent in most communities in Haiti, reports IRIN. The death toll rose to 501 on 6 November 2010, up from 442 on 3 November, and hospitalisations for cholera totaled 7,359, up from 6,742.
Haiti is one of the few countries in the world where both urban and rural sanitation coverage has steadily decreased between 1990 and 2008, according to the WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation (WHO/UNICEF, March 2010).
Historical legacies of inequality, corruption, and extreme poverty all contribute to the Haitian government’s systemic inability to deliver safe water and sanitation.
Although more than 3,000 people have been infected, health officials affirm there are signs that the cholera outbreak in central Haiti may be stabilising.
Officials indicate that the disease is a serious threat to the 1.3 million survivors of January’s earthquake who are living in tented camps surrounding the city.
The poor sanitary conditions make them vulnerable to cholera, which is caused by bacteria transmitted through contaminated water or food.
The director general of Haiti’s health department, Gabriel Thimote, said yesterday (24.10.2010) that the number of people who had died in the outbreak was rising, but more slowly than during the previous 24 hours.
“We have registered a diminishing in numbers of deaths and of hospitalised people in the most critical areas,” he told reporters.
“The tendency is that it is stabilising, without being able to say that we have reached a peak,” he added.
Haitian officials said more households were following advice on drinking clean water and taking care with personal hygiene.
The Chilean government said Friday the 27 of August that significant reconstruction progress has been made in the six months since a devastating earthquake that left nearly 500 dead and caused some $30 billion in damage.
President Sebastian Piñera’s administration, which took office two weeks after the Feb. 27 quake struck just off the coast of central Chile, praised advances in education, health, public infrastructure, housing, employment and industry. Continue reading →
The International Federation of Red Cross and Red Crescent Societies (IFRC), in a report published [on 8 July 2010], has called on the international community to recognize sanitation as one of the priorities in Haiti’s reconstruction.
The report – From sustaining lives to sustainable solutions: the challenge of sanitation in Haiti – calls sanitation the “neglected twin” of water provision in the aftermath of disasters.
“Equal emphasis must be given both now and in the future to improving sanitation facilities,” it says, noting that resources and innovative solutions are urgently needed to support Haitian authorities to provide improved sanitation services to the 2 million people affected by the quake.
Matthias Schmale, the IFRC’s Under Secretary General for programme services said: “Looking to Haiti’s future, we need the international community to get behind sanitation and support the Haitian authorities. The sanitation situation in Haiti was already dire before the earthquake and this disaster was as bad as it gets. There is a huge opportunity to make a difference, but we have to take action now to build sanitation into the plans for Haiti’s future.
“Simply returning to pre-earthquake levels of sanitation would be unacceptable.”
The report outlines the long-term challenges and opportunities to improve pre-disaster sanitation infrastructure in Haiti, the only country in the world where access to improved sanitation had decreased in recent years: before the earthquake, only 17 per cent of the population had access to a toilet [according to UNICEF].
The Red Cross and Red Crescent, led by the Haitian Red Cross, has, to date, built almost 2,700 latrines in camps across Port-au-Prince, and each day produces and distributes 2.4 million litres of clean water – enough for 280,000 people. However, despite considerable achievements, at least half of the directly affected population are yet to see any improvement in their sanitation and water situation.
“Six months after the earthquake, the Red Cross Red Crescent and other humanitarian agencies continues to provide a large proportion of water and sanitation services on behalf of the Haitian authorities,” said Gianluca Salone, IFRC water and sanitation coordinator in Haiti.
“However, this is a much broader urban reconstruction issue that falls outside the capacity and remit of humanitarian agencies. We are all stretched to our capacity and are simply containing a critical situation, rather than solving it. From now on sanitation must be integrated into wider plans to rebuild Haiti and long-term solutions must be found.”
The IFRC believes that the situation is untenable. It is calling for the development of innovative, sustainable and appropriate technological systems that, dependent on the availability of land, will give large numbers of Haitian people safe and reliable sanitation for the years to come.
As the reconstruction effort continues, the focus is shifting to ensuring that those returning to their homes or moving to transitional shelters will have access to adequate sanitation. The integration of sanitation into reconstruction plans is critical for a healthy future.
The report also highlights some potential longer-term solutions that could help stimulate Haiti’s economy as well as address the challenges of waste management and sanitation. For example, research into the viability of large-scale waste composting and biogas production could provide dual benefits such as energy production, or boosting agricultural activity. Scoping out such solutions needs input from the international community to help build the capacity of Haiti’s authorities.
Led by the Haitian Red Cross, the Red Cross Red Crescent to date has provided medical treatment for 95,000 people, vaccinated more than 150,000 against measles, diphtheria and rubella, and provided 120,000 families – almost 600,000 people – with emergency shelter material.
H2O for Life together with Save the Children, will fund a WASH in Schools project for Nationale Louis Lamartiniere de Hatty primary school in the Maissade area of Haiti. This area is welcoming refugees after the recent earthquake, and now more than ever a sustainable source of water, sanitation and hygiene education is needed.
Students currently must carry water to school each day, and walk significant distances to collect water from polluted sources. Current latrines are in poor condition and do not meet the needs of the students attending school. Hygiene education, particularly hand-washing are essential to increase the overall health of the school.
H2O for Life’s mission is to promote US school partnerships with schools in developing countries that are in need of WASH in Schools and can make a difference for students attending Louis Lamartiniere de Hatty school.
H2O for Life will provide a transformational service learning opportunity for students to study the issues surrounding the water crisis, both in the US and around the world, while also providing an action opportunity for students to raise funds and bring water, sanitation and hygiene education to their partner school. Students will see that their actions can change lives around the world.
A WASH in School Project has been planned with the help of the local community, and is ready for implementation upon receipt of funds. H2O for Life Schools raise half the funds needed for the project, and the other half will be matched by our in-country implementing partner. All projects are sustainable and are designed to be appropriately managed by the school community upon completion.
Sanitation conditions in Haiti are gradually improving thanks to the efforts of aid workers following the earthquake that devastated the capital Port-au-Prince on 12 January 2010. However, progress has been slow and there are many obstacles that still need to be overcome.
As of 31 January 2010, the damage from the earthquake has left 112,405 dead, 196,595 injured and over 11 million people homeless, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).
The Haitian capital lacks sewerage infrastructure and the earthquake ruptured the city’s water lines. Garbage is also accumulating in the streets which is exacerbating the health risks.
The WASH Cluster is now reaching 500,000 people with 5 litres per person per day, according to the DFID situation report of 2 February 2010. With water provision now adequate, sanitation is the next priority. The cluster reports that 7,000 latrines are needed. A distribution plan for 1,169 latrine slabs has been agreed with partners in Port-au-Prince, Leogane and Jacmel.
UNICEF video on emergency water and sanitation in Haiti
The WASH Cluster Haiti Update of 30 January 2010 reports that 292 latrines have been completed or are under construction across the country, serving a potential 29,000 people assuming 1 latrine serves 100 people. The Sanitation Strategic Working Group composed of the WASH Cluster, UNICEF, Oxfam, Care, World Vision, ACF and ICRC are proposing the use of portable chemical toilets through a joint venture between a local sanitation firm and Armal Inc.
Slow Progress
Action Against Hunger (ACF) is distributing potable water and food, although the recovery process is moving slowly, according to Lucile Grosjean from ACF in Haiti. “There is garbage everywhere,” Grosjean said.
The local government did not allow ACF or any organization to dig trenches in the Haitian capital’s central plaza, the Champs de Mars, said Grosjean. These trenches were to be used to dispose of the accumulating waste and human feces of between 20,000 and 25,000 people which have congregated in the area.
As a result, ACF has started to build above-ground latrines and began digging trenches to install the latrines in the Croix Deprez area, according to Grosjean.
At the same time, International Migration Organization (IOM) is distributing tents, hygiene kits, blankets, jerry cans, plastic sheeting, water bladders and water purifying kits, donated by the US, Japanese and Turkish governments. These efforts are expected to benefit some 26,000 people, IOM reported on its website.
Meanwhile, international aid organization Care is distributing hygiene kits and training survivors to purify contaminated water.
Care representatives are showing people how to use the purifying packets, since the objective is for Haitians to start carrying out the process by themselves.
“We are trying to identify people in neighborhoods or communities and train them so they can then go on to train more people,” the official added.
Care will be distributing PUR packets in the coming weeks together with large buckets where water can be purified. The organization will also provide other items such as soap and sanitary napkins.
During the emergency phase of the earthquake, the International Committee of the Red Cross (ICRC) ensured a round-the-clock supply of water by trucks to Cité Soleil, the poorest area of the capital Port-au-Prince.
Removing the rubble
The UN Development Programme (UNDP) is working to remove rubble and garbage, in an effort to improve general sanitation conditions.
UNDP is currently employing more than 1,000 Haitians to restart economic activity. After the emergency, the organization hired 700 inhabitants to remove rubble and rehabilitate essential social infrastructure, such as street repairs and electricity.
Prior to the earthquake UNDP had 400 employees carrying out an ecological project in Carrefour, a neighborhood located south of Port-au-Prince. Following the earthquake, the workers and trucks from this project started to remove the rubble and clean streets so other trucks carrying aid could go through, the official said.
In spite of the urgency to reorganize capital Port-au-Prince, resources continue to be limited. UNDP estimates that a US$41.3mn donation is needed for early recovery initiatives in Haiti. This is part of a nearly US$600mn flash appeal launched by UNDP on January 15. The organization estimates some US$58.8mn needs to be invested in water, sanitation and hygiene programs.
Relocation
Using free transport provided by the government, more than 235,000 people have left Port-au-Prince and moved to rural neighborhoods where the effects of the earthquake were not so severe. Some 62,000 have relocated to Artibonite, for example. However, 800,000 people are still living in temporary camps in the capital, OCHA reported.
To avoid the spread of diseases, the government is planning to relocate another 400,000 from Port-au-Prince to new settlements which are being set up. The relocation program will be carried out in the coming weeks.
Next Steps
Haiti declared the search and rescue phase over on 23 January 2010 so international rescue teams are concentrating more on humanitarian aid for those who need it, instead of searching the rubble for survivors.
Multilateral entities such as the World Bank and IDB are already taking steps to waive debts. UK-based charity Oxfam has urged donor countries to have Haiti’s foreign debts cancelled. It called for about US$900mn owed to the UN, the World Bank and countries including the US, France, Canada and Brazil to be written off.
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