The Haitian cholera epidemic which first appeared in October 2010 has affected over 645,000 people, or more than 6% of the population, causing 8028 deaths, according to the World Health Organization (WHO).
In 2013, a total of 120,000 cases are projected, equal to the number of cases in 2012. More than half of all cholera cases worldwide were in Haiti in 2012 and roughly one third of all deaths, according to a new study by Renaud Piarroux and Stanislas Rebaudet from the University of Aix-Marseille.
While international organizations with expertise in health and water-sanitation-hygiene face funding cuts and are withdrawing from the fight against cholera, the epidemic continues to kill. The number of cases in Haiti at the beginning of 2013 is comparable to the same period last year, raising fears of a new upsurge in cases during the current rainy season. The case fatality rate is above the "acceptable" level of 1%, and in fact is much higher in some departments.
At the same time, a significant number of CTCs / CTUs have been closed or abandoned. In Port au Prince, the number of CTCs decreased from 84 to less than 20 within five months. At the community level, capacity to respond to a cholera outbreak with emergency water treatment and sanitation has scaled back dramatically, This problem is even more critical in the context of limited capacity (and resources) of the MSPP and DINEPA in the short and medium term. As a result, response capacity is near zero in several “high-risk” departments.
Emergency response capacity—necessary to eliminate the cholera epidemic-- is further weakened by an information and early warning system characterized by gaps in surveillance and whose reliability is not assured.
Finally, it is regrettable that no NGOs contributed to the development of the national plan to eliminate cholera, even though they played a key role in the response to recent outbreaks.Haiti is famously the "Republic of NGOs," foreign agencies with more power than the Haitian government itself. Their influence has not always been constructive, but the government's public health policy for decades has been simply to abdicate to any outsider willing to pour money into a bottomless pit.
The only factor that counts in Haiti is not its government, nor the NGOs, nor the Pan American Health Organization; it's the United States. For two centuries, successive American governments have treated Haiti as either a threat or an annoyance: The presence of a free black country in the western hemisphere was a threat to the slaveholding US, and it becomes an annoyance when its governments default on their debts or act as if they were independent of foreign influence.
Ideally, from the American point of view, Haiti would shut up and stop drawing attention to itself. The Americans have no interest in a Haiti that goes its own way; if it can't provide a cheap workforce for American investors, a poor black nation has no reason to exist.
When military occupation became politically awkward, the US resorted to the "our son of a bitch" policy that has served it so well around the world, tolerating the Duvaliers.
But an American son of a bitch inevitably becomes an American enemy. Remember Saddam Hussein and Manuel Noriega? Or Ho Chi Minh working with the Americans at the end of World War II?
So the Americans ousted Baby Doc Duvalier and put up with Aristide, and then with his ouster, and his restoration, and his ouster again. The 2010 earthquake must have been really annoying, because the world cared even if Washington didn't.
So the Americans effectively parked Haiti with the UN, which at least spread the cost of babysitting over more countries. And so things have remained for years, despite the embarrassing importation of cholera by the Nepalis. At least it was the UN that was embarrassed, not Washington.
Until and unless the Americans experience more direct political embarrassment, Haitians can contract 10 million cholera cases for all that Washington cares. A few NGOs will beg for money to deal with some of the cases, but that will be as far it goes: politics will always trump public health, not to mention simple decency.