SITUATION REPORT: Cholera Outbreak in Haiti

Haiti • Cholera
Situation Report
16 November 2010

Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

Situation Overview

The Ministry of Public Health (MSPP) reports the latest statistics on the cholera epidemic as 1,034 deaths and 16,799 hospitalised cases according to data collected up to 14 November. To date, cases have been confirmed in the Artibonite, Centre, North, Northwest, Northeast, South and West departments. To respond to needs of cholera patients, 30 cholera treatment centres (CTCs) and 27 cholera treatment units (CTUs) are operational across the country as well as a number of rehydration stations where oral rehydration salts are distributed.

Civil unrest in Cap Haitian on 15 – 16 November has slowed cholera prevention and treatment supplies from reaching the area in the past two days. The Nord Department is currently experiencing a case fatality rate of 7.5 per cent, which is the highest in Haiti. Prevention of cholera transmission through water, sanitation and hygiene initiatives has also been affected. Oxfam reports suspension of a project to chlorinate water for 300,000 people living in and around Cap Haitian until the violence subsides. A nearby World Food Programme (WFP) warehouse was looted of 500 metric tonnes of food and subsequently burned. WHO/PAHO reports that cholera training of health professionals has halted while noting the lack of public information materials available to sensitize the population in prevention of cholera.

Humanitarian Needs and Response

In metropolitan Port-au-Prince, cases of cholera have been confirmed in six of seven communes. Nine CTCs are operational, with an estimated bed capacity of 600-1,000. Médecins du Monde -Canada is operating three mobile clinics which serve a population of 45,000 people in 14 camps in Cite Soleil as well as 55,000 people who live in areas surrounding the camps. Health cluster partners are particularly concerned with cholera cases increasing in Cite Soleil due to poor sanitation, lack of access to clean water and crowded living conditions.

Nationwide, 30 CTCs operated by health cluster partners treat patients daily with estimated bed capacity of 1,600-2,000 beds. There are 27 smaller cholera treatment centres, across the country CTUs often established to compliment CTCs or hospitals where the prevalence of cholera requires treatment of 40 patients or less.

The establishment of new CTCs and increasing beds in existing CTCs are planned as is the construction of additional rehydration stations.

Health experts estimate needing 15 nurses for every doctor. Nurses, nurses’ aides and cleaners are all needed urgently. In the department of Artibonite, departmental health authorities have stated the need for 260 “community health workers” who can administer oral rehydration salts and help with cleaning and disinfecting areas where patients in communities are being cared for.

Water, Sanitation and Hygiene (WASH)
The International Federation of the Red Cross (IFRC) is training volunteers in Léogane and Jacmel over the next two weeks and be accompanied by the distribution of 20,000 informational leaflets and 10,000 jerry cans and bars of soap and 1.5 million water purification tablets (Aquatabs) for 20,000 households for 30 days.

Distribution of water purification tablets, oral rehydration salts/zinc by ACTED and Action Contre la Faim in Artibonite have so far covered an estimated 130,000 people out of a total target of 450,000. DINEPA, the water and sanitation directorate has made available trucks and equipment for de-sludging latrines at CTCs pending a memorandum of understanding with WHO, the MSPP and the IFRC. As a prevention measure, the Netherlands Red Cross together with the Haitian Red Cross in the South East & West Department is working to contain the spread of cholera through hygiene promotion and Jerry Cans, soap, and water tablets distribution.

As part of its scaled-up hygiene promotion and cholera prevention efforts, the American Red Cross will have 82 health promoters working this week on health messaging in public places across Pétion-Ville, including markets, churches and bus stations. In its first two weeks of this scaled-up programming, the American Red Cross trained more than 220 promoters in hygiene promotion and cholera prevention, who then worked in a total of 41 camps. In the first phase, the promoters were deployed to a total of 34 camps

Gaps & constraints
Reports that water purification tablets are being eaten and oral rehydration salts taken as a means to prevent cholera transmission demonstrate for the further need to sensitize the population on the use of such materials.

Camp Coordination and Camp Management (CCCM)
CCCM carried out sensitization activities in 170 camps throughout the earthquake affected communes to inform the people on how to prevent the disease. As of 15 November, CCCM partners have assessed 75 sites of the 89 identified by the Ministry of Health as potential sites for Cholera Treatment Units (CTU) implementation. CCCM partners continue to distribute hygiene kits across IDP camps and 1 million water purification tablets to Cite Soleil in the coming days.

Two rounds of SMS messages to over 120,000 households respectively with information on cholera prevention and treatment were sent by CCCM partners during the weekend. To date, CCCM partners have assessed 75 sites of the 89 identified by the Ministry of Health as potential sites for Cholera Treatment Units (CTU) implementation.

WFP has assisted over 3,600 beneficiaries with 71,598 meals-ready-to-eat (MREs), 0.67 metric tonnes of high energy biscuits (HEB) and 4.3 metric tonnes of dry rations as part of the cholera response. WFP met with the head of the public hospital in Les Cayes yesterday to discuss possible food support to patients, hospital staff and caretakers. WFP has distributed to schools in affected areas 2,037,420 water purification tablets in Gonaives and 496,500 in Hinche. Soap will be distributed this week. WFP plans to distribute a total of 8,342,550 water purification tablets in schools to 278,085 children in affected areas and then expand to reach 941,411 children in schools in all non-affected areas with 28,242,330 tablets.

The education cluster continues to focus on the response to cholera in schools. To date, cluster partners have conducted sensitization in 634 schools: 120 schools in Artibonite, 106 in Centre, 170 in the West, 122 in the Southeast and 116 in Northeast, with different forms of interventions. The Cluster partners are also advancing with the quick planning of the cholera response: more than 10,000 schools will be covered with various types of interventions, being almost 50% of the total school network in the country. The Ministry of Education and representatives from WASH and health clusters are to discuss the strategy on the cholera response in schools.

Following advocacy by the logistics cluster, the Government of Haiti is considering the re-implementation of special procedures for incoming humanitarian cargo that were initiated after the earthquake, to allow relief items to be imported quickly. These new customs clearance procedures have been signed by the Prime Minister this week. The endorsement by the Ministry of Finance is pending.