INTERVIEW: Tackling cholera in Haiti through improvements in water and sanitation

13 June 2016

Incidence of cholera has gone down by 90 per cent in Haiti from 2011 to last year, and the United Nations will continue to help the country tackle the root causes of the disease, such as lack of clean water and sanitation services, the deputy head of the UN mission there has said.

“Because cholera is, to a large extent, a disease of poverty, it remains a problem while there is poverty in Haiti,” Mourad Wahba of Egypt, Deputy Special Representative for the UN Stabilization Mission in Haiti (MINUSTAH) told the UN News Centre.

Cholera is, to a large extent, a disease of poverty.

Since the outbreak of cholera in Haiti in 2010, the UN has worked to contain the disease by focusing on emergency response to save lives, vaccinating the population and implementing preventive measures. Cholera deaths, which over the past six years totalled about 9,000, have dramatically decreased to 168 fatalities this year, added Mr. Wahba.

However, he stressed, the Government, the UN and the donor community must mobilize more resources as the current funding is not sufficient.

UN News Centre: Nearly six years after the first outbreak of cholera in Haiti, to what extent, is cholera still a problem there? Has the number of cholera cases change over the past years?

Mr. Wahba: Six years after the outbreak of cholera in Haiti, it remains a problem, but much, much less of one than we had at the outset. Incidence of cholera has gone down by 90 per cent. In 2011, we had 350,000 cases, and last year, under 36,000 cases. The lethality of cholera over the past six years totalled about 9,000 cases. There are 168 this year. It has gone down very radically.

Because cholera is, to a large extent, a disease of poverty, it remains a problem while there is poverty in Haiti. It is a problem because we don’t have sufficient water and sanitation to cover the whole territory, and it is a problem because we constantly need to fundraise in order to deal with emergency response to cholera and with the vaccination of the population.

UN News Centre: What are the root causes of cholera?

Mr. Wahba: As you know, cholera is Vibrio [bacteria] that is present mainly in water, and the root cause of cholera is in the unavailability of safe drinking water and of adequate sanitation. In Haiti, a large proportion of the population does not have access to sanitation – only 28 per cent has access to sanitation – and about of half of the population have access to safe drinking water. Nobody can resolve the problem of cholera in Haiti and elsewhere until you tackle the question of sanitation.

UN News Centre: What is the UN doing to fight cholera?

Mr. Wahba: The UN is taking a multipronged approach to dealing with cholera in Haiti. The first element of what we are doing is to prevent the spread of cholera. To do so, we are supporting Haiti with sanitation, provision of safe drinking water, [and] chlorination facilities for people to have access to that water. We also are working to provide latrines especially in the countryside. We have managed to declare 16 communes open-defecation-free. We are very proud of that. We are also supporting the spread of sanitation, in collaboration with our colleagues in the direction of portable water and sanitation in Haiti, also with other members of the donor community. That is on the side of prevention.

But we are doing much, much more, because we are helping to vaccinate a proportion of the population. We go to the most-affected communes and we vaccinate them. For vaccines to work, we also need WASH (water, sanitation and hygiene) interventions in the area. You need to provide chlorination of the surrounding areas. And finally, we have a policy of rapid response, working with the Ministry of Health. We respond immediately to all outbreaks of cholera with the provision of serum, with provision oral rehydration therapy, and again the sanitation of both houses affected by cholera and also the surrounding areas.

UN News Centre: Are these measures increasing access to potable water at schools and medical facilities?

Mr. Wahba: Very much so. We are focusing on providing potable water to communities. We are also working within MUNISTAH as part of the Secretary-General’s initiative on total sanitation to help schools, communities and remote villages access clear water sources for drinking and washing.

UN News Centre: What has the UN done since 2010 and what is UN doing today?

Mr. Whaba: Since 2010, UN has done several things. First, [the UN] has mobilized funding for the provision of safe drinking water and adequate sanitation throughout the country. It’s a very large endeavour that costs hundreds of millions of dollars. But we are mobilizing resources. We mobilized $59 million directly ourselves.

Also, we helped the Haitian Government to mobilize over $300 million for water and sanitation. We are working through my colleagues in the [UN Children’s Fund and the Pan-American Health Organization/World Health Organization], and worked with the Ministry of Health in the provision of emergency response services to outbreaks of cholera. That is going well, and has contributed to the 90 per cent decline in cholera cases since 2010. And finally, we are working with the international community in the provision of vaccines to gradually vaccinate the populations against the recurrence of cholera.

UN News Centre: What is rapid intervention?

Mr. Wahba: Rapid intervention is an initiative developed with the Ministry of Health. The principle of that is once you have cases that are suspected to be cholera, for instance watery diarrhoea, we have an immediate team to be dispatched to that area that does two things. First, it tests to see whether this is in fact cholera. Secondly, it provides oral rehydration serums to the affected people to save lives. We managed to save many lives in this manner. Through rapid response, we sanitize the areas where cholera has struck and houses surrounding it with chlorination to prevent the further spread of the disease in the community.

UN News Centre: What the target of the vaccination campaign this year?

Much more should be done, by all of us – by the UN and by the donor community – to improve the funding.

Mr. Wahba: This year, we are hoping to vaccinate 400,000 persons in the most-affected communes. I believe this has been a successful exercise. We are trying to do much more by the end of the year, but it requires a large number of doses to do so. Vaccination is expensive, and you need to acquire doses and the world stock is not sufficient. We also need to have expenses for people undertaking the vaccination – it is two doses taken orally – you have to follow-up on those who have received vaccines, and you have to accompany the vaccines, for the maximum efficiency with chlorination of the households. This is what we have been doing this year.

UN News Centre: What are the top priorities for fighting cholera in 2016?

Mr. Wahba: A top priority for us is two-fold. First, we would like to continue rapid response. We believe that rapid response is the key to controlling the disease and to maintaining it at a relatively low level. And for that, we will need to obtain further funding. Second is to continue with the vaccination campaign.

UN News Centre: Is UN response funded sufficiently for 2016?

Mr. Wahba: Although $8.7 million has already been mobilized for rapid response in 2016, there remains a gap of $11.6 million. Without additional funding, response measures will be reduced in September or early October.

UN News Centre: The Haitian Government has asked for $2.2 billion to implement its 10-year plan to fight cholera. But to date, the plan has been less than 20 per cent funded.

Mr. Wahba: Much more should be done, by all of us – by the UN and by the donor community – to improve the funding. Let me say funding is very visible. It goes to two main areas, in the provision of rapid response, which I believe important to contain the spread of cholera, but more importantly and for the long-term, in provision of water and sanitation, which is not only important to contain cholera, but will have health benefits for the whole population.

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