Cholera in Haiti: 3 Years Later, Solutions Still Needed

October 2013 marked the 3rd anniversary of the widely-documented 2010 cholera outbreak in Haiti, a small developing Caribbean country which shares the island of Hispaniola with the Dominican Republic.   Haiti first reported cases of cholera in October 2010; within one month cholera had spread to all parts of Haiti and the Dominican Republic.  “Between October 2010 and August 2013, more than 670,000 people in Haiti were treated for cholera, with around 8,200 deaths attributed to the outbreak.”

UNICEF and NGOs Provide Cholera Assistance to Haiti Area Cut off by Flooding

Cholera is an intestinal infection, caused by ingestion – usually in contaminated food or water – of the bacterium Vibrio cholerae.  Cholera causes diarrhea and vomiting, symptoms that can lead to dehydration and death within hours.   Every year, 3-5 million people develop symptoms and 100,000-200,000 people die due to cholera worldwide.  Many developed countries, like the United States and Canada, have largely eliminated domestic cholera.  However, global cholera incidence has increased since 2005; in 2011, more than 60% of reported cases occurred in the Americas- mostly in Haiti.

As with many other diseases, cholera usually affects vulnerable populations.  Those with low immunity are most likely to develop symptoms if exposed, and cholera can spread easily in areas with poor infrastructure and sanitation facilities.  While cholera has been largely eradicated in most of the developed world, “cholera remains a global threat to public health and a key indicator of lack of social development. Recently, the re-emergence of cholera has been noted in parallel with the ever-increasing size of vulnerable populations living in unsanitary conditions.”

While many other countries in the Americas dealt with cholera epidemics in recent decades, Haiti had not encountered cholera for 100 years when the 2010 outbreak began.  This meant that there was no natural immunity or protection within the Haitian population against this bacterium, which spread quickly.  The cholera epidemic also began a mere 9 months after a magnitude 7.0 earthquake hit Haiti, which had destroyed infrastructure and displaced 1.5 million people.  80% of cases can usually be successfully treated with oral rehydration salts, but cholera in Haiti has had a high fatality rate- partially because of limited access to health services.

Three years after the epidemic began, the emergency response is slowly winding down.  However, the underlying problems that allowed cholera to spread so quickly – most notably lack of access to clean water, sanitation facilities, and health services – remain unsolved.  Haiti has the lowest coverage of improved water and sanitation services in the Western Hemisphere.  According to the World Health Organization, in 2010 only 64% of Haitians had access to clean drinking water and only 26% had access to adequate sanitation facilities– and the number of people in Haiti with access to adequate sanitation has since decreased to 17%.  But the problems extend beyond merely providing access; one recent survey showed that 50% of improved water sources in rural Haitian households tested positive for e. coli.  To meet the Millenium Development Goal of halving the proportion of the world’s population without access to improved water and sanitation facilities by 2015, Haiti would need to achieve 74% and 63% coverage for improved water and sanitation facilities, respectively.  Unless the situation quickly improves, these goals likely will not be met.

Children in Haiti

These unsolved problems in Haiti could represent an international health threat as well.  In the years since the beginning of the epidemic in Haiti, cholera has spread to Cuba, most likely through international travel.  Health officials in Mexico detected cases of cholera in early September 2013; since then, there have been 171 reported cases in Mexico. 75% of individuals infected with the bacteria do not show symptoms- but can still infect others around them.  If cholera remains present in Haiti at current levels, many other countries are then at risk of ‘imported’ cases.

In February 2013, the Haitian government began a National Plan to eliminate endemic cholera in 10 years through improvements in water and sanitation, health care services, epidemiology and surveillance, and health and hygiene promotion.  It is estimated that the National Plan will need $2.2 billion to be successful; however, funds and resources are scarce.  A recent publication by the Center for Strategic and International Studies, Water and Sanitation in the Time of Cholera: Sustaining Progress on Water, Sanitation, and Health in Haiti, argues that the international community – specifically the United States – must step in and contribute to support these anti-cholera efforts.   Improvements in water and sanitation coverage and health care in Haiti could have far reaching effects, such as decreasing the disease burden from other diarrheal and water-born illnesses.  The report argues: “failing to adequately support Haiti’s water and sanitation activities threatens the sustainability of other U.S. development investments in the country, including improved population health, economic development, the empowerment of women, and progress toward democratic governance and political participation.”

Cholera is preventable with adequate water, sanitation, and healthcare services and treatable with oral rehydration salts; the most effective anti-cholera campaign in Haiti will combine all these strategies.  Three years after the epidemic began, international coverage, attention, and action are beginning to wind down.  However, these challenges persist and need permanent solutions to prevent future cases, future unnecessary deaths, and possible future epidemics in other countries.  Eliminating cholera in Haiti will require a sustainable and coordinated long-term strategy – and will require participation from a variety of actors, including domestic governments and communities, non-profits, and the international community.


Migrants of a Different Kind

Samysuddin, a current resident of Indonesia, can recall the days when he would take his trusted speargun and dive into the coastal waters of Ujung Village and be able to catch his family’s dinner. But things have since changed in the waters off the Kapoposang island of Indonesia: “I can spend the whole day motoring around, paddling and swimming, I’ll try everything. Sometimes I don’t catch any fish and we’ll go a whole day without eating any. These days, the coral reefs around Kapoposang are degrading. If the reefs continue to degrade then there won’t be any fish here. There won’t be anything left for us to do.”

A home on the water in Indonesia, a country where migration is already an inevitable method of adaptation and will be exasperated in the future. (Source: Curt Carnemark / World Bank)

Samysuddin is a part of a growing population of Indonesia migrants that have been displaced as a result of economic, social, and now adverse environmental changes.  changes.  Narratives like his are becoming a familiar tocsin. UN forecasts predict  “200 million to 1 billion” people will have to migrate as a result of climate change with 200 million being the most widely cited estimation but not devoid of misapplication and manipulation. While there is a considerable amount of research on migration as a response to various, social, political, and economic conditions, humans are now beginning to migrate as an adaptive strategy to adverse environmental conditions. Migration due to rising sea levels is in its most nascent forms as push and pull factors vary greatly among regions and social groups and are often intertwined with livelihood opportunities and public policy responses. For example, research conducted in the aftermath of Hurricane Mitch found that rural Nicaraguan families in extreme poverty were the least likely to migrate as they were unable to finance the cost of moving. Yet Costa Rica still absorbed an enormous influx of Nicaraguan migrants that have been victims of violence and have faced constraints in accessing social services.

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Russian Actions against Greenpeace International Part of a Familiar Trend

Last week, the CGP blog commented on the state of the CSO sector in Russia amidst the oncoming 2014 Winter Olympic Games in the country. The highly controversial interactions between the environmental group Greenpeace International and the Russian government in the past weeks align with the past grievances we reported on:

A Russian coastguard official points a knife at a Greenpeace International activist who tried to scale an oil platform owned by state-owned energy giant Gazprom (Source: Denis Sinyakov/Greenpeace).

30 people from 18 countries detained on the Greenpeace International ship “Arctic Sunrise” are awaiting trial on piracy charges and face up to 15 years in prison if convicted related to a September 18th  incident in which some of the activists tried to scale an oil rig in the Pechora Sea owned by the national oil-giant Gazprom. The activists may spend up to two months in pre-trial detention in a Murmansk jail awaiting the decision of Russian prosecutors. Greenpeace International director Kumi Naidoo called the seizure of the vessel and the arrest of its crew the worst “assault” on the environmental activist organization since one of its ships was bombed in 1985. The detained activists are reportedly being kept in “solitary confinement for 23 hours a day,” while others are held in “extremely cold cells.” Russian officials have called the protest “pure provocation” and an “encroachment on the sovereignty” of Russia.

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Post-2015 Debate: A “Neo-Geostrategic” Approach

“The Millennium Development Goals Work!” — says UN in the 2010 New York UN Summit.

In recent years, we have seen Africa’s economic growth, and the reduction of new HIV infections and AIDS-related deaths. The world starts to generate its post-2015 goals while celebrating the victory. Global scholars, activists and politicians hotly debate whether the international community should ascend its priority from eliminating extreme poverty to advanced objectives, such as tackling climate change and establishing healthy governance in each country.

So what is our post-2015 strategy? According to the Brookings Institution, four major typologies were launched in response to the post-2015 debate: “conservative” — persistent focus on extreme poverty; “upgrading” — poverty plus one or two global challenges, either social or environmental; “geostrategic” — concentration on emerging economies; “comprehensive” — resolve every country’s poverty and social problems simultaneously while confronting environmental issues together.

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A Big Frackin’ Deal

A development boom in the energy sector is set to challenge the traditional geo-political landscape. For decades, Americans have bemoaned an energy policy dependent upon sending U.S. money for foreign oil buried deep beneath hostile sands.

‘But The Times They are A-Changin’

2012 marked a record year for U.S. energy production, and projections show that the United States is set to become the number one exporter of oil by 2020, passing Saudi Arabia. Within the next decade, the United States could actually become energy independent.

This boom in U.S. oil and gas production has become a modern day gold rush. In an economy defined by stagnant economic growth, natural gas has become big business. Massive investments into new technology and a refined process of drilling have made vast areas of shale gas available for extraction through a process of horizontal drilling and hydraulic fracturing — or fracking.

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Digital Dumping: The Growing Problem of E-waste

In an era of rapidly progressing technology, there is a constant demand for the latest and greatest electronics. Be it phones, computers, televisions, or any other electronic device, it is not long before a product becomes obsolete and is replaced with a newer one. These outdated devices, known as electronic waste or e-waste, are left to be disposed in one manner or another. By a large margin, it is the fastest growing waste stream globally and is posed for significant growth in coming years.

Annually, some 53 million tons of e-waste are produced, predominately by developed nations with large amounts of disposable income. A majority of the waste is simply thrown away, but an increasing amount is being recycled.  Recent estimates have found that about 20 percent of the waste is properly recycled. What happens to the rest? Much of the waste finds its way to developing countries, particularly nations in Africa and Asia.

A child in Ghana’s capital, Accra, searching for e-waste.

Like many other services in emerging economies, it is far less costly to break down e-waste into its reusable components than it would be in the country that produced it. The problem is that with lower environmental standards and fewer safety regulations, the recycling of e-waste can cause serious health and environmental challenges. Electronic products are laced with a plethora of toxic materials such as lead, arsenic, cadmium, chromium, and mercury. To extract the reusable materials, workers typically burn the waste or dissolve it in acid, usually with little or no protection. In essence, 21st century toxics are managed by labor that uses 17th century technology.

The impact on local populations has been devastating. Frequently, the toxic materials find their way into the air, water, and soil, poisoning the workers that recycle the waste. Communities that have large e-waste recycling operations have seen significant increases in respiratory illnesses, birth defects, developmental damage, cardiovascular disease, and cancer. The problem is further complicated by the fact that much of the recycling work is done by children, leaving them at-risk for illnesses other occupations do not have. Continue reading

Winning the War on Malaria: Part Two

Versatile as it may be, DDT is not a silver bullet in the fight against malaria. Like any other prevention method, it has its own advantages and disadvantages.

Although authoritative groups such as the World Health Organization have ruled that the benefits of indoor DDT spraying outweigh potential health risks, there are still uncertainties associated with the chemical. Toxicology reports vary in their conclusions, but most do agree that in large enough concentrations, DDT is a possible carcinogen. Consensus has yet to be established in various studies, but some have found potential links between DDT and cancer, decreased fertility, and adverse affects on the immune system.

Another major concern is that of environmental impacts. If not properly used, DDT may contaminate the surrounding environment by air, land, or water. This can become problematic if the chemicals enter food or drinking supplies of an ecosystem. Wildlife can be negatively impacted, particularly those of the aquatic and avian variety.

An inevitable outcome of DDT spraying is the development of a more resistant mosquito population

But perhaps the greatest drawback is the ability of mosquitoes to develop DDT resistance. It is possible for the effectiveness of DDT to be diminished if it is overused: natural selection has a tendency to favor mosquitoes that develop resistance. The mosquitoes that survive the encounters with DDT are more likely to breed, leading to even more resistant generations. Already, pockets of resistance exist where DDT has lost much of its effectiveness, leading to localized increases in malaria. DDT has done much to combat malaria, but it certainly has its limits. Continue reading