An announcement from the United Nation's Secretary General on Tuesday for a $2.2 billion initiative designed to eradicate cholera in Haiti and the Dominican Republic was welcome news to health professionals and social justice activists who have witnessed the devastating impacts there.
"Cholera continues to take a heavy toll on Haiti and the Dominican Republic," said the UN chief Ban Ki-moon at a press conference in New York.
"In Haiti, [the disease] has claimed the lives of more than 7,750 people, infected over 620,000 and added a heavy weight of suffering on a country already recovering from the largest natural disaster in the history of the western hemisphere," he continued, referring to the earthquake in 2010 that claimed over 300,000 lives and left nearly a million people homeless.
Despite the good news represented by the plan, criticisms of the UN's efforts so far—based mostly on the world body's reluctance to take full responsibility for bringing the deadly disease to Haiti after the 2010 quake—say more needs to be done in order to stem the damage the waterborne disease has wrought.
“We are pleased that the UN is finally acting in accord with its legal obligations and taking action to eliminate cholera," said Beatrice Lindstrom, a staff attorney with the Institute for Justice & Democracy in Haiti. "This is a positive first step, but there is still a long way to go before justice is served and no time to lose."
The new initiative described by Ban would focus on the extension of clean drinking water and sanitation systems in Haiti as well as implementation of a vaccination program there and in the Dominican Republic.
The cholera outbreak "swept through Haiti like fire sweeps through gasoline-soaked tinder because the sanitation conditions and access to potable water were so incredibly poor," said Nate Nickerson, a public health expert and executive director of Konbit Sante*, a US/Haitian public health organization that has worked to fight the disease in and around the city of Cap Haitien.
Even before the cholera outbreak—which an investigation found was linked to a UN team from Nepal brought in during the earthquake relief efforts—Nickerson says the "incredibly high mortality of children under 5 years of age" in Haiti could be attributed to poor sanitation and water systems.
"There are a confluence of factors that created this vulnerability for the majority of Haitian people, and the sad truth is that this epidemic continues to plague the nation because those conditions continue to exist," he said. "The frustrating thing is that these diseases cannot even get a foothold where basic sanitation infrastructure exists. Building that infrastructure would probably save more lives and improve the health status of the Haitian community more than all the hospitals that could be built."
Lindstrom agreed, saying "Haitians will continue to die needlessly until there is clean water."
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In a op-ed for Al-Jazeera, the Center for Economic and Policy Research's Mark Weisbrot argued that the UN initiative is thanks in large part to the push from civil society groups inside and outside Haiti that demanded action.
The UN announcement, Weisbrot argued, shows "that organized political pressure can work."
Though he applauded the news broadly, Weisbrot said the plan is not adequate to the immediate challenges:
In the first place, the plan is much too slow. This is an ongoing national health emergency: about 700 people have been killed by cholera just since the first rains began in April, 167 of them since Hurricane Sandy caused widespread flooding. But this is a 10-year plan. We are still looking at several years before serious work begins to provide Haiti with the clean drinking water and sanitation needed to get rid of cholera.
According to the most recent data from the World Bank, only 69 per cent have access to "improved drinking water" and just 17 per cent have access to "improved sanitation", defined in the plan as "flush toilets, septic tanks, ventilated improved pit latrines and composting toilets." Among the poorest 20 per cent, only 1 per cent has access to improved water and more than 90 per cent "practice open air defecation". The necessary infrastructure work should begin immediately, not years from now.
Haiti is a very small country, smaller than the state of Maryland, with 10 million people. There is no civil war or violence that would prevent or delay the construction of water and sanitation facilities. The two-year delay in even announcing a plan has been tremendously costly in human lives; this plan needs to be implemented immediately and much faster than it appears to be scheduled for.
Part of the announcement by Ban at the UN was that he was appointing Dr. Paul Farmer, well-known founder of the group Partners In Health, as his Special Advisor to the new Haitian effort and issued a promise that the UN would put special focus "on community-based medicine and on drawing lessons from Haiti that can be applied to other places in need."
"We know the elimination of cholera is possible," Ban said. "Science tells us it can be done. It has happened in difficult environments around the world. It can and will happen in Haiti."
*Full disclosure: The author serves as a board member for Konbit Sante