Haiti Health Crisis Exacerbated by Democratic Failures

It’s December 8, 2010, the day after Haiti’s election results were announced, and the streets of Port-au-Prince are covered in a blanket of tire smoke. From Delmas 33 the sounds of gunshots and tear gas canisters ring through the air every few moments, and on every street corner, loud political discussions echo through the rubble, which has been arranged to form roadblocks. On the main streets, dumpsters have been overturned and converted into more roadblocks. Public transportation has slowed to a standstill and businesses are shuttered.

Though the source of the frustration is clear and the anger is justified, this political unrest has serious implications for the current public health crisis that Haiti is facing as a cholera epidemic ravages the cities and countryside. Over 1 million people in Port-au-Prince’s sprawling IDP camps are completely dependent on trucked water and clean sanitation facilities to protect them against cholera, which is transmitted through water contaminated with infected feces. The services provided by medical facilities and public health employees are critical for containing the epidemic through treating the sick, burying the dead and decontaminating infected areas.

Imagine the implications of several days without sanitation services in Port- au-Prince. For example, in downtown Port-au-Prince and Petionville, the camps of Place Boyer, Place Saint Pierre and Champs Mars (home to over 15,000 people) rely on approximately 450 portable toilets for sanitation. These toilets are cleaned and emptied daily by a private company. The toilets have a small holding capacity and are heavily used; many of them will fill in 1 or 2 days if not emptied. Two days without desludging and the toilets of Champs Mars could be overflowing with over 5,000 pounds of poop per day.

Recent reports indicate that in downtown Port-au-Prince, portable toilets are being overturned and used as roadblocks, some spilling their contents into the streets where tens of thousands of people have gathered to express their discontent with the CEP and the UN troops.

In the most densely populated camps the only source of treated water is brought in daily by trucks. This is the water that people use to clean, cook and, often, drink. Several days without treated water and people will be forced to drink from unsafe sources, seriously increasing their exposure to cholera. What happens when the carefully placed handwashing facilities run dry and the bladders beneath their sinks are deflated?

The other major risk factor is the lack of access to medical facilities and morgue services. Though many of the cholera treatment centers have managed to stay open, the long journey to reach them is blighted by the disruption on the roads. Those who do fall ill in the coming days may face a difficult decision about whether to travel to the hospital or remain at home, and for serious cases this could significantly increase the mortality rate (as was the case during the unrest in Cap Haitien several weeks ago, when the mortality rate rose to become the highest in the country). And what if people do die in their homes, as they have been every day for the past month? Who will come to collect the bodies? Will the men in the orange shirts arrive with their chlorine sprayers, or are they too in the streets demonstrating against an unjust electoral process?

So many questions, so many potential risks. It is heartbreaking that the situation has to come to this: that a lack of honesty and humility on the part of the UN regarding the cholera outbreak could lead to an escalation of frustration and anger during such a precarious moment in Haiti’s history; that a corrupt electoral council could set the stage for unfair elections built on exclusionary policies when the country is still reeling from the earthquake and cholera; and that millions of dollars could be wasted on farcical elections at a time when over 1 million people are still homeless.

This situation was avoidable and now it is untenable. It is unfair to ask those with a legitimate grievance to go home and accept the hand that has been dealt to them, and it is terrifying to imagine a country blocked by burning tires and pent up frustrations where basic rights such as water, sanitation and medical care become increasingly scarce. And all of this is unfolding in the time of cholera.