Port-au-Prince - The number of cholera cases is rising at an alarming rate in the Haitian capital of Port-au-Prince, and in several areas of the country, warns international medical organisation Médecins Sans Frontières (MSF). 

We call for an immediate intensification of the response to the outbreak; more organisations and donors must be mobilised, and essential tools, such as vaccination, must be made available to medical teams and to people in Haiti.  

“Our current centres are filling up, and we will soon be at maximum capacity,” says Mumuza Muhindo, MSF country director in Haiti, referring to the 389 beds that are often full in the six cholera treatment centres set up by MSF since the first cases appeared on 29 September.

“Since the end of October, we have been treating an average of 270 patients a day in our centres,” says Muhindo, “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.”  

MSF 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 4 November, which was controlled by 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 most people, who are suffering from an acute economic crisis.

In addition, health facilities remain 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. “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,” he says. 

Our teams are managing more than 60 per cent of the bed capacity to treat cholera patients in the capital. Mobile teams, consisting 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.

We 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, MSF 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. The authorities have submitted an official request to the International Coordinating Group (ICG), the international mechanism for vaccine response to epidemics, and so far several hundred thousand doses of vaccine have been allocated to the country.

MSF 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 are worrying signs,” says Michael Casera, MSF epidemiologist.

“In neighbourhoods 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,” he says.