Haiti Cholera Update #13

The last report of the MSPP (Ministère de la Santé Publique et de la Population) on 12 November 2010 reports 14,642 cases of cholera and 917 deaths. The hospital mortality rate is 3.8%. Cholera promptly treated has a mortality rate of 1-2%. It is probably worthwhile to bear in mind that in the view of James Wilson at Haiti: Operational Biosurveillance, the number of cases is likely enormously under-reported. He currently estimates approximately 100,000 people have been infected. If 75% of these cases are subclinical, and we accept a (conservative) 3.8% mortality rate, the estimated number of deaths would be 950 — a figure strikingly close to official reports.The United Nations is estimating 200,000 persons will be infected during the epidemic. According to Nigel Fisher, Deputy Special Representative and Resident and Humanitarian Coordinator, MINUSTAH,

The Cholera continues to, the number of cases continue to expand quite rapidly as foreseen. We do have cases now in every ‘Department’ as well as in Port Au Prince. The numbers of cases that we’ve had so far have been Ministry of  Health cases of hospitalized patients, we’re now trying to ramp up the collection of data from communities so that we can get a more realistic figure. We expect to have, once that data comes in, a significant increase in recorded cases so people should not be surprised at that.

The U.N. has launched a US$164 million appeal to combat the epidemic in Haiti.

The World Health Organization meanwhile has declared that finding a definitivre source of the epidemic is not a priority:

A WHO spokeswoman says controlling the outbreak and helping those infected is more important.

Fadela Chaib told reporters in Geneva on Tuesday that “at some time we will do further investigation but it’s not a priority right now.”

One protester was killed late Mondays as anti-U.N. riots spread to several Haitian cities in what WHO described as politically motivated unrest.

The U.N.’s spokeswoman in Geneva, Corinne Momal-Vanian, described the suspicion that Nepalese troops were to blame for the outbreak as “misinformation.”

Rioting has been reported in were reported in Cap-Haïtien, and The Guardian is reporting UN soldiers shot and killed one protester. Mediahacker is reporting two deaths, and other civil disturbances in Hinche and Gonaives. In Hinche, says Mediahacker, “protesters tried to leave the coffin of a man who died of cholera in front of the city’s UN peacekeeping base.” The violence has been variously attributed to the presence of MINUSTAH (United Nations Stabilization Mission in Haiti), who are widely suspected by the Haitian people and politicians of bringing cholera in to the country, the upcoming national elections on the 28th, or the establishment of cholera treatment centres in the community, which has been a point of contention in other places. One account:

The earthquake, the hurricane, and now the cholera. The manifestasyon which began this morning around 6:30 a.m. is strictly about Cholera and the UN, and people are serious about wanting them out. I asked a man on the street if he thinks this will go on into tomorrow: “Wi, demen sidyevle,” yes, God-willing, he says, “we won’t stop until Minustah quits the country. They brought cholera here and many many people died.” One woman told me that there are riots like this in Port-de-Paix and Hinche, but this is so far unconfirmed.

Spanish Minustah soldiers are coming from Ft. Liberte, but groups of protesters went out to Limonade to set up road blocks earlier today. Rt 1 leading into Cap from the south and out to the east are blocked. The picked-apart skeletons of trucks make quick barricades across the roads, sometimes within 100 yards of another. Groups have also set burning tires up to block paths. You have to identify yourself as NOT Minustah or else people will throw rocks. One man told me “Ameriken se Ameriken, Minustah se Minustah.”

We heard helicopters around 2:00 p.m., but haven’t seen them since. The airport is closed and the US Embassy has sent out a new warning on their site. Earlier this afternoon, protesters burned the police stations at Pont Neuf and Barriere Bouteille before heading to the one at l’Arsenal in downtown Cap. As of 3:00 p.m., one person has died and 26 others are hospitalized from the altercations. The man who died was shot by a Minustah soldier.

Médecins sans frontières on the present course of the outbreak:

The situation in the north of Haiti remains extremely serious. MSF teams working in the region are overwhelmed by the needs of the many new patients arriving at facilities in Cap Haitien, Port de Paix, Gonaives, and Gros Morne every day. Fears persist in the communities, including in Port-au-Prince, over the presence of cholera treatment centers (CTCs), in spite of their importance to immediate lifesaving measures against the epidemic.

[snip]

In the lower Artibonite region, where the outbreak started, MSF teams in Petite Rivière and St. Marc are still very busy. While there are some indications of the epidemic possibly stabilising, the CTCs in both places are at capacity. The caseload in Dessaline, however, is still increasing; 177 people were admitted on Friday and a 280-bed capacity facility is being built. In general, as in the north, it is still difficult to reach remote areas to offer treatment where it is needed. MSF has resorted, in some cases, to dropping materials from helicopters to support some local health centres.

In Port-au-Prince, the picture remains chaotic and troubling. The Cite Soleil neighbourhood, a sprawling slum, is essentially the frontline of the outbreak in the capital. Efforts are underway to increase admissions to 250 per day at the MSF-supported, Ministry of Health, Choscal Hospital. People presenting with severe symptoms are transferred to CTCs in MSF facilities in the nearby Sarthe and Tabarre neighborhoods. Teams are also looking for another place to construct a cholera treatment unit (CTU) in the neighbourhood.

I missed this quote in the last update, but it’s worth going back to. From James Wilson, somewhat facetiously:

Direct quote from senior US government official:

…we think [the cholera epidemic] can be managed effectively, as the response has been good in Haiti, and the GOH with our help has gotten out ahead of the curve, and are working hard to stay there…This is not to say that 1,500-2,000 or so deaths from cholera a year in Haiti for the next several years is acceptable, and we hope to get the mortality rates down well below that. But this is not in the same league as the earthquake either, so I think you can turn off the alarm bells.

Cholera has spread to inside Haiti’s prison system:

After the death, last month, of 5 prisoners to the Civil prison of Hinche (of the cholera), it is the turn of the National Penitentiary to be affected by the cholera epidemic. In recent days, four prisoners died, reported a spokesperson for the Haitian National Police (PNH), indicating that more than ten others presented all the symptoms of the cholera.

The National Penitentiary, principal prison of the capital, houses 1.469 inmates (figure of October 2010) with sub human living conditions, compared to that, the life is good in the IDP camps. Danielle Boisvert, who heads the correctional unit of MINUSTAH since June 1st, 2010 was declared in September “On average, each prisoner has access to less than 1 m2 and in certain prisons such as the National Penitentiary, they have less than 0.5 m2. In less than one half-m2 a person cannot sleep wide nor even squatted” ideal conditions for the spread of cholera.

I will post thew next update Thursday or Friday, or sooner if events warrant. For more immediate updates, I highly recommend Crawford Killian at his blog H1N1.

More resources:

Haiti: Operational Biosurveillance (Twitter)

H5N1

HaitiLibre (English) (français) (Twitter — English and French)

Mediahacker: Independent multimedia reporting from Haiti (Twitter)

Ministère de la Santé Publique et de la Population (Homepage) (Cholera Updates) (in French)

PAHO’s Haiti Cholera page. (PAHO Situation Reports and other documentation.) (Blog.)

Praecipio International (HEAS)

On the ground, good sources of information and of course needing donations:

Partners in Health (Twitter).

Médecins sans frontières

[Cross-posted at Those Emergency Blues]