bcholmes: watching the watchment (minustah)

Hinche, Haiti - The residents of Sully in Hinche (east) are angry after several MINUSTAH trucks dumped human waste materials in sites a few meters from the river Guayamouc. Local residents were up in arms but could not stop the operation, according to evidence gathered on site by AlterPresse.

At the moment, the prevailing concern is that foot traffic is diverted away from a local district due to the odor. The Mayor, Andrew Fox, who visited the scene along with several journalists, did not hide his indignation at what he called "an affront to human dignity."

"Once again I've asked the Nepalese contingent to depart. They brought cholera to us, they come to exterminate us, and it is the time they leave," he adds. Andrew Fox urged people to organise watch brigades to prevent dumping in their neighbourhoods.

The first senator of the Central Plateau, Francisco Delacruz (Alternative), describes the dumping of human waste near the River Guayamuc an act of "vagrancy". The elected representative of the center says that he intends to meet with UN authorities to correct this situation.

[...]

Members of various social organizations interviewed by AlterPresse expressed their disapproval of MINUSTAH's actions. They feel that UN forces do not value the lives of Haitians. These organizations also also criticize the seemingly carefree attitude of those responsible for the state.

"Haiti : Des matières fécales déversées par la Minustah près d’une rivière à Hinche", original in French

It's not bad enough that MINUSTAH introduced a cholera epidemic to Haiti. It's not enough that they spent all that effort trying to deny their culpability... but, hey, the idea that they might actually try to engage with communities on their dumping issues is just too much to ask, no?

Some interesting notes: Hinche is in the Central Plateau region of Haiti, close to the Artibonite where the cholera epidemic first broke out in Haiti. I also find the reference to vagrancy interesting; to call a Haitian a vagrant is a tremendous insult.

bcholmes: (haiti)

In the three months between October and December 2010, about 150,000 people in Haiti contracted cholera and about 3,500 died.

Around this time, the United Nations projected that the total number infected would likely rise to 400,000.

But researchers at the University of California, San Francisco, say this is a gross underestimate.

They believe the toll could reach 779,000, with 11,100 deaths by the end of November 2011.

Dr Sanjay Basu and colleagues reached their figures using data from Haiti's ministry of health.

They say the UN estimates were "crude" and based on "a simple assumption" that the disease would infect a set portion (2-4%) of Haiti's 10 million population.

Dr Basu's calculations take into account factors like which water supplies have been contaminated and how much immunity the population has to the disease.

They predict the number of cholera cases will be substantially higher than official estimates.

"The epidemic is not likely to be short-term," said Dr Basu. "It is going to be larger than predicted in terms of sheer numbers and will last far longer than the initial projections."

But the researchers say thousands of lives could be saved by provision of clean water, vaccination and expanded access to antibiotics.

A spokesman for the World Health Organization said: "We have to be cautious because modelling does not necessarily reflect what's seen on the ground.

"Latest figures show there have been 252,640 cases and 4,672 deaths as of 10 March 2011.

"Haiti cholera 'far worse than expected', experts fear"

bcholmes: watching the watchment (minustah)

UN peacekeepers were the most likely source of the cholera epidemic sweeping Haiti, according to a leaked report by a French disease expert. Epidemiologist Renaud Piarroux conducted research in Haiti on behalf of the French and Haitian governments. Sources who have seen his report say it found strong evidence that the cholera outbreak was caused by contamination of a river by UN troops from Nepal. The UN said it had neither accepted nor dismissed the findings. The cholera epidemic has killed 2120 people, and nearly 100,000 cases have been treated, according to the Haitian government. The report by Mr Piarroux found that the source of the outbreak was a Nepalese peacekeeping base, whose toilets contaminated the Artibonite river, according to a copy seen by the Associated Press news agency.

"Haiti cholera: UN peacekeepers to blame, report says", BBC

Also:

As Haiti’s deadly cholera epidemic spreads, it may seem irrelevant to ask where the disease came from. The World Health Organization certainly thinks it is, describing the question as "unimportant".

That could not be further from the truth. Haitians themselves care deeply about how their country got cholera. There is widespread suspicion that the disease was brought in by United Nations peacekeepers from Nepal, and that the UN is now covering it up. This suspicion has sparked riots that have killed people, both directly and by impeding medical efforts.

We should care too. Haiti's cholera tragedy - more than 1600 dead and 30,000 hospitalised as New Scientist went to press - tells us something important about our highly interconnected planet, and how we should - but still don't - govern it.

Cholera bacteria thrive on poverty and disruption, and Haiti has plenty of both. The country was free of cholera when the earthquake struck in January, but when the disease broke out in October it quickly took off.

When the news broke on 20 October, suspicion fell rapidly on 454 Nepalese UN peacekeepers based in the town of Mirebalais, 60 kilometres north of the capital Port-au-Prince. Haitian officials tested the river by the base two days later.

There were reasons to suspect these Nepalese. Cholera, which is carried by faeces-tainted water, is endemic in Nepal: there was an outbreak in Kathmandu, the country's capital, just before the peacekeepers flew in from there between 9 and 16 October. Their camp in Mirebalais dumped sewage straight into a stream that led to Haiti's main central river. The first cases were in Mirebalais and downstream, areas barely touched by the earthquake. What is more, the DNA in Haiti's cholera shows it was a single, recent introduction of a strain from south Asia, though we don't know if it is circulating in Nepal.

All of this is just circumstantial evidence, of course. The UN insists it is in the clear because the tests on water on or near the base did not find cholera, and none of the peacekeepers had symptoms.

Yet this doesn't clear the matter up. Many people with the strain now circulating in Haiti do not develop symptoms but shed bacteria in their faeces up to two weeks after infection. Nor are negative water tests conclusive: cholera researchers say the bacteria are hard to find in fast-flowing rivers. To settle the matter, the Nepalese soldiers themselves should have been tested, promptly.

A single positive swab from a soldier early in the outbreak would have strongly suggested they were the source. A negative result would not have entirely cleared them - tests can produce false negatives - but it may well have calmed public suspicion.

But no such tests were done. The Nepalese government claims the water samples alone prove that its troops are not the source. The UN Mission in Haiti even phoned me out of the blue to claim that tests cannot detect cholera in symptom-free people.

They can. That is an elementary scientific fact about cholera.

"Haiti: Epidemics of denial must end ", New Scientist

The UN has previously estimated that they expect 400,000 people to be infected with cholera. The standard treatment is oral rehydration therapy. If delivered promptly, the mortality rate is only about 1%. However, there are many logistical reasons why Haitians might not get cholera treated promptly.

If treatment is not prompt and/or not properly administered, the mortality rate increases to 50-60%. Let's say, for the sake of argument, that half the infected people fail to get treated promptly. That's 100,000 deaths.

bcholmes: watching the watchment (minustah)

Stockholm - A Swedish diplomat said categorically Wednesday that a cholera outbreak in Haiti had originated in Nepal.

More than 1,000 people have died of the disease since its outbreak on October 19, with another 16,000 infected, and there have been violent protests at UN peace-keeping forces blamed by locals for the cholera.

'Unfortunately that is the case. It has proved that the cholera came from Nepal,' Claes Hammar, Sweden's ambassador to Haiti, told daily Svenska Dagbladet.

"Swedish diplomat says Haiti cholera strain came from Nepal"

Also:

STOCKHOLM: A Swedish diplomat claimed on Wednesday that Haiti's cholera outbreak originated in Nepal.

"Unfortunately that is the case. It has proved that the cholera came from Nepal," Claes Hammar, Sweden's ambassador to Haiti, told daily Svenska Dagbladet.

Hammar, who visited Haiti two weeks ago, said the information came from "a diplomatic source. It is 100 per cent true. Tests were made and the source was traced to Nepal."

"Swedish diplomat says Haiti cholera strain came from Nepal" The Times of India

I haven't seen this particular part of the story emerge in North American media.

bcholmes: (haiti)

China Miéville weighs in on Haiti.

He didn't mention the effect of the aid embargo on water treatment plans prior to the coup, but other than that, he hits all the key points.

bcholmes: (haiti)

Tomorrow (Wednesday), there are planned demonstrations in Pòtoprens, aimed at expressing anger toward the UN, who the Haitians blame (rightly, I think) for bringing Cholera to Haiti.

bcholmes: (haiti)

BOSTON - On a press conference call earlier today, Partners In Health's Chief of Mission in Haiti Dr. Louise Ivers updated the media on the status of the ongoing cholera outbreak in Haiti and PIH’s response. She reported that the situation has taken a dramatic turn for the worse, with clear signs that the outbreak has spread to the crowded slums and settlement camps in Port-au-Prince. According to the latest report from the Haitian Ministry of Public Health and Population, a total of 12,303 people have been hospitalized and 796 have died since the outbreak began.

On Monday, Partners In Health and our Haitian partner organization Zanmi Lasante (PIH/ZL) saw seven cases with classic clinical symptoms of cholera at Parc Jean-Marie Vincent, the largest of the four settlement camps in Port-au-Prince where we have been providing medical care since the January 12 earthquake. Since then dozens of additional cases have been treated at the Cholera Treatment Unit (CTU) in the camp, many of whom had come from the slums of Port-au-Prince outside the camp.

Meanwhile, PIH/ZL continued to see increasing numbers of patients with cholera in the Artibonite and Central Departments outside the capital. A total of 7,159 patients have been hospitalized in our facilities in the Artibonite/Central Plateau. Dr. Ivers reported that flooding caused by Hurricane Tomas led to a sharp increase in the number of cholera patients at the hospital in St. Marc, from 125 cases a day to over 200. A growing number of cases is also being reported from communities in the Upper Artibonite, outside the area around St.-Marc where the outbreak began in October. PIH operates the hospital in St.-Marc and two other facilities in the Lower Artibonite in partnership with the MSPP.

— Partners in Health announcement

Thanks again, MINUSTAH.

bcholmes: watching the watchment (minustah)

The CDC, World Health Organization and United Nations say it's not possible to pinpoint the source [of the cholera outbreak] and investigating further would distract from efforts to fight the disease.

But leading experts on cholera and medicine consulted by The Associated Press challenged that position, saying it is both possible and necessary to track the source to prevent future deaths.

"That sounds like politics to me, not science," Dr. Paul Farmer, a U.N. deputy special envoy to Haiti and a noted expert on poverty and medicine, said of the reluctance to delve further into what caused the outbreak. "Knowing where the point source is - or source, or sources - would seem to be a good enterprise in terms of public health."

The suspicion that a Nepalese U.N. peacekeeping base on a tributary to the infected Artibonite River could have been a source of the infection fueled a protest last week during which hundreds of Haitians denounced the peacekeepers.

John Mekalanos, a cholera expert and chairman of Harvard University's microbiology department, said it is important to know exactly where and how the disease emerged because it is a novel, virulent strain previously unknown in the Western Hemisphere - and public health officials need to know how it spreads.

"Experts: Did UN troops infect Haiti?", Washington Post

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