Cholera in Haiti

Haiti is unique in Latin America, and thus can often be neglected in discussions of of the region. A Francophone nation, a Carribean one, and the only nation to have been brought into existence by a slave revolt, Haiti faces unique problems of poverty and instability, legacies of its long and often-bloody history. The nation has long been on the receiving end of international coercion by colonial powers, such as France (who extorted an “indemnity” of 150 million francs as restitution for the loss of their lucrative colony) and the United States (who installed a military occupation for two decades of the beginning of the 20th century) (Farmer, 2004). As such, Haiti has remained in deep poverty, with oft-changing governments, throughout the 20th century. These conditions, which translate directly to a lack of infrastructure and social programs, set the scene for a public health disaster of enormous proportions. Enter cholera, the 2010 epidemic of which provides an illustrative case study of government public health measures, disaster response, and tensions within the international aid community.

Cholera is a disease caused by the toxigenic bacteria Vibrio cholerae, which is spread via the fecal-oral route, often by drinking contaminated water. It causes profuse, watery diarrhea, vomiting, and cramps, and can be fatal within a matter of hours if untreated. Treatment can include antibiotics, but mainly consists of aggressive rehydration, as severe dehydration is the direct cause of death in cholera infection. This rehydration can be administered intravenously or orally, with oral rehydration being the most cost-effective and easy-to-implement treatment, especially in situations of emergency. Exposure to cholera offers some future immunity, and the disease can be vaccinated against (CDC). Naive, or unexposed, populations are particularly vulnerable to cholera outbreaks, and can become more gravely ill, a fact that greatly influenced the development of the disease in the 2010 outbreak in Haiti.

Beginning in October 2010, ten months after a devastating 7.0 Mw earthquake near Port-au-Prince in Haiti, a cholera outbreak swept through the population. Since its introduction, it has cumulatively sickened over 810,000 people and killed almost 10,000 (Guillame 2018). As a poor country with limited infrastructure, Haiti’s capital and surrounding cities were devastated by the earthquake, decimating their water, sanitation, and health systems in the process. Thus, Haiti’s public health system, underformed before this extreme natural disaster, was entirely unequipped to handle the extensive, sudden, and severe disease outbreak.

A partial cause of epidemic’s severity was the immunological naivete of the population. Prior to 2010, cholera had not been recorded in Haiti for over a century. Since cholera had been absent for generations, the population had no exposure and thus no immunity. This was likely the reason that, at the outset, the case-fatality rate of Haitian cholera was unusually high (CDC).

Particularly notable (or possibly, infamous) about the 2010 cholera outbreak in Haiti was the involvement of international aid organizations, particularly the introduction of the virus to the island by U.N. peacekeepers. Between October 8th and 21st, a group of U.N. peacekeeping troops arrived in Haiti from Nepal, where cholera is endemic and there had been a recent outbreak in Kathmandu. Further evidence tying cholera to the Nepalese troops is provided by genetic information; the genetic code of Haitian cholera is nearly identical to that of a cholera strain circulating in South Asia at the time of the outbreak (Chin, 2010). The peacekeepers were located on a base upon a tributary to the Arbonite River, a major water source for many Haitians. Independent investigations revealed that their waste removal system was grossly inadequate, and likely allowed the spread of the bacteria into Haiti’s waterways (Domonoske, 2016).

Since the outbreak, the U.N. has not directly admitted to bringing cholera to Haiti. In December of 2016, U.N. Secretary General Ban Ki-Moon released a public apology, but did not take responsibility for bringing the disease to Haiti. “We simply did not do enough with regard to the cholera outbreak and its spread in Haiti. We are profoundly sorry about our role,” he said in a statement before the General Assembly (Sengupta, 2016). A U.S.-based organization, the Institute for Justice and Democracy and Haiti, is currently representing a group of Haitian plaintiffs who are attempting to sue the U.N for reparations and a commitment to eradicating cholera in Haiti. Their lawsuits have repeatedly been dismissed in courts, due to the U.N.’s legal immunity guaranteed in a 1946 treaty. Lawyers for the plaintiffs argue that the U.N. negated their immunity through their negligence in preventing the spread of disease prior to the outbreak, and thus are responsible for reparations to injured Haitians (Weinmeyer, 2016). Unrest in Haiti regarding the U.N.’s role in the cholera epidemic continues, as the country still struggles to rebuild its decimated infrastructure to manage the ongoing outbreak (Gladstone, 2017).

Related Articles

• Disaster Preparedness in the Health Sector
• Health and Haitian Migrants to the Dominican Republic

References

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Centers for Disease Control and Prevention. (2014). Cholera in Haiti. https://www.cdc.gov/cholera/haiti/index.html

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Domonoske, C. (2016, August 18). U.N. Admits Role in Haiti Cholera Outbreak that has Killed Thousands. National Public Radio. https://www.npr.org/sections/thetwo-way/2016/08/18/490468640/u-n-admits-role-in-haiti-cholera-outbreak-that-has-killed-thousands

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Gladstone, R. (2017, June 26). The U.N. Brought Cholera to Haiti. Now It Is Fumbling Its Effort to Atone. The New York Times. https://www.nytimes.com/2017/06/26/world/americas/cholera-haiti-united-nations-peacekeepers-yemen.html

Guillaume, Y., Ternier, R., Vissieres, K., Casseus, A., Chery, M.J., & Ivers, L.C. (2018). Responding to Cholera in Haiti: Implications for the National Plan to Eliminate Cholera by 2022. The Journal of Infectious Diseases, 218(3), S167–S170.

Institute for Justice and Democracy in Haiti. Retrieved from http://www.ijdh.org/

Knox, R. (2015, January 12). 5 Years After Haiti’s Earthquake, Where Did the $13.5 Billion Go? Retrieved from https://www.npr.org/sections/goatsandsoda/2015/01/12/376138864/5-years-after-haiti-s-earthquake-why-aren-t-things-better

Sengupta, S. (2016, December 1). U.N. Apologizes for Role in Haiti’s 2010 Cholera Outbreak. The New York Times. https://www.nytimes.com/2016/12/01/world/americas/united-nations-apology-haiti-cholera.html

Weinmeyer, R. (2016). AMA J Ethics. 18(7):178-726.