Nurse consults the mother of a child suffering from cholera at the cholera treatment center (CTC) installed at the Doctors Without Borders Emergency Center of Turgeau. Haiti, October 2022. © MSF/Alexandre Marcou
Since the end of October, we have been treating an average of 270 patients a day in our centres, compared to about 50 in the first two weeks. In total, we have admitted more than 8,500 patients and have recorded 97 deaths; the evolution is very worrying.Mumuza Muhindo, Country Director
Doctors Without Borders is one of the few organisations working in collaboration with the health authorities to combat the spread of cholera, whose resurgence is a symptom of a catastrophic humanitarian and health situation. This outbreak is taking place in a context of unprecedented political, economic and security crisis. Port-au-Prince is now a city surrounded and suffocated, with the main roads linking it to the rest of the country controlled by armed groups.
The provision of fuel following the unblocking of the main oil terminal on November 4, in the hands of an armed group for several weeks, has not led to a significant change of the country’s situation. Access to fuel is too expensive for a large part of the population, which is going through an acute economic crisis, and the functioning of health facilities remains affected, with services closed and ambulance traffic reduced. Access to clean water – a crucial element in the fight against cholera – also depends on the circulation of tankers, which in turn depends on access to fuel, and on the security context.
"The city is full of garbage that hasn't been collected for months,” says Muhindo, “and there is no water distribution in neighbourhoods like Brooklyn in Cité Soleil, where roads are cut off by garbage and flooded by clogged canals and sewers, causing massive flooding".
Part of the neighborhood of Cité l'Eternel is flooded due to the clogging of canals caused by poor waste management. Cholera spreads rapidly in areas with inadequate treatment of sewage and lack of access to clean water. Haiti, October 2022. © MSF/Alexandre Marcou
Doctors Without Borders alone is managing more than 60 per cent of the bed capacity to treat cholera patients in the capital. Mobile teams composed of water and sanitation specialists and health promoters are working in the most affected neighbourhoods to raise awareness of the barrier measures against the spread of the disease; they have also organised the chlorination of approximately 100 water points and the installation of eight oral rehydration points where basic commodities and clean water are distributed. Despite these activities, Doctors Without Borders and the few organisations present in the response will not be able to adequately address this cholera outbreak. Other humanitarian actors and donors must join the response effort, either by setting up treatment centres or by urgently scaling up access to safe water and sanitation activities.
In addition, it is extremely important that vaccination be used as a fundamental tool in dealing with the disease. Several hundred thousand doses of vaccine have been allocated to the country by the International Coordinating Group, the international mechanism for vaccine response to epidemics. The authorities have submitted an official request to the International Coordinating Group (ICG) to obtain a number of vaccine doses. Doctors Without Borders stands ready to begin implementing a vaccination campaign in support of the health authorities and to complement other water and sanitation and health promotion activities.
As the number of cholera cases increases in the different communes of the capital but also in other departments, it remains difficult to assess the real extent of the outbreak.
The overload of cholera treatment centres which prevents all patients from being treated, the difficulties for patients to travel due to fuel shortages and insecurity, and the increase in community deaths, which is difficult to quantify, are worrying signs. In neighborhoods with high levels of insecurity, patients with severe symptoms at night often have to stay home because motorcycle cabs refuse to take them to a health centre.Michael Casera, Epidemiologist
For more than 30 years, Doctors Without Borders teams have been providing free medical care in Haiti and currently run seven projects throughout the country, in the capital Port-au-Prince, in the South and Artibonite departments, treating life-threatening emergencies, trauma cases, burns, survivors of sexual violence, and providing reproductive healthcare. Doctors Without Borders also regularly intervenes in emergency situations, such as disasters. In 2021, Doctors Without Borders teams conducted 25,000 emergency consultations, treated 3,220 people for violence-related injuries and supported 1,560 survivors of sexual violence.
