Haiti: controlling the cholera outbreak
As of 1 December Haiti’s Ministry of Public Health and Population (MSPP) reported 80 860 cholera cases and 1817 related deaths nationwide. All ten departments are affected. The actual number of cases and deaths remain underestimated due to the weak surveillance system. One-third of all reported deaths occur in the community. Up to 400 000 people could become ill over the next six to 12 months, half of which during the first three months.
Despite support from the international community, the health care system is under stress because of the structural damage and loss of personnel caused by the January earthquake. The response seems adequate in most IDP camps but there is much concern in slums around Port-au-Prince, where the proportion of people that could be affected could be as high as 5%. Outbreaks in remote rural areas are also of concern, because there are fewer resources to treat cases and a lack of infrastructure to implement prevention.
Violence has compromised the delivery of supplies and access, mostly in the north. Insecurity has also severely limited activities in Port-au-Prince. As of 30 November, 40 cholera treatment centres (CTCs) were operational (100 to 200 beds each) and 61 cholera treatment units (CTUs) were functional. Few oral rehydration centres (ORCs) have been established so far due to difficulties in implementing the response.
More than 70 health partners are supporting the response and at least 24 NGOs are providing health care in the CTCs and CTUs. As Health Cluster lead, WHO/PAHO is liaising with the humanitarian clusters for advancing an inter-sectoral response to the epidemic and supporting the Government to coordinate the overall response based on the National Cholera Response Plan. The plan aims to protect families at community level, strengthen primary health care facilities already operating across the nation, establish a network of special cholera treatment centres and strengthen designated hospitals for treatment of severe cases.
WHO has concentrated on the following:
- WHO/PAHO has mobilized human and material resources to support the MSPP for disease surveillance, case management, essential medicines and supplies, water and sanitation, logistics and communications. Between 19 and 22 November, WHO/PAHO, in coordination with the MSPP and WFP, distributed 87 tons of medicines and supplies, covering one-third of the expected patient caseload over the coming months;
- WHO/PAHO has set up training programmes for health providers and community workers on the prevention and treatment of cholera;
- From headquarters, WHO has deployed 11 staff members to support the Health Cluster for risk assessment coordination, logistics and environmental health. WHO is coordinating with external partners, including Global Health Cluster partners, the Global Outbreak Alert and Response Network (GOARN) and other networks, to identify additional experts;
- WHO participated in the development of the inter-sectoral strategy for the epidemic in collaboration with the Clusters for Water and Sanitation, Education, Food, Logistics, and Camp Coordination and Camp Management, United Nations agencies, NGOs and the UN Stabilization Mission in Haiti (MINUSTAH). The strategy was launched in Geneva on 16 November, seeking US$ 164 million of which US$ 42.5 million are for strengthening the health sector. It is part of the Consolidated Appeal Process 2011.
Further activities to reinforce the response are planned. They include:
- expanding the number of CTCs and CTUs to 50 and 200 respectively;
- establishing ORCs at each of the 1200 primary health care facilities across the country with trained health staff to identify, manage and refer cholera cases;
- identifying, training and deploying 350 doctors, 2000 nurses and 2200 support staff to allow the expansion of the CTC/CTU network, as well as 30 000 community health workers for the ORCs;
- ensuring appropriate management of dead bodies;
- delivering chlorine for both household and large-scale water treatment;
- conducting health education campaigns to reinforce cholera-prevention behaviours, increase early detection and treatment of cases and improve household water treatment and storage.
As of 29 November, only 16% of the US$ 42.5 million needed to strengthen the health sector had been received. Brazil, Canada, Finland and the USA have already donated funds to support WHO’s activities and Italy, Andorra and Spain have made pledges.
The Assistant Director-General for HAC visited Haiti from 22 to 26 November to review status of operations and he met with the Emergency Relief Coordinator.