Epidemic outbreak

The death toll from Haiti's cholera epidemic has reached more than 900 and the disease is present in six of the 10 provinces of the earthquake-battered Caribbean country, the Health Ministry said over the weekend.

More than 15,000 people have been infected since the epidemic's outbreak in late October, the health ministry said Sunday, and the epidemic showed no sign of abating. There were 120 new deaths since Friday's toll. According to the ministry on Monday, 917 people have died of the disease so far.

Worse expected to come

According to UN estimates, up to 200,000 people could fall ill with cholera. The world body on Friday applied for another $163 million (120 million euros) in donor aid.

The disease broke out in the northern Artibonite region, where it continues to be most concentrated. It is contracted through contaminated water and causes severe diarrhea and vomiting.

Authorities and international aid agencies were struggling to contain the latest crisis afflicting the impoverished island nation. Efforts are centering on preventing the disease from spreading in crowded city slums and tent camps that house over 1.3 million homeless people who survived the cataclysmic earthquake, nearly a year ago.

But the facts of the epidemic raise the question of how such a preventable disease could break out in a country that has been flooded with hundreds of millions of euros in foreign assistance since the earthquake.

Resource coordination is problem

"Huge sums in aid money have gone there, but the people in the North seem to have been left to their own devices," Sven Stockrahm, a journalist with German newspaper Die Zeit who wrote about the earthquake, told Deutsche Welle.

Stockrahm stressed that his critical remarks were not aimed at humanitarian aid workers, who by all accounts are doing vital work under very trying circumstances. The key question is whether a better coordination of the resources in place could have prevented cholera from occurring in the first place.

But clear answers are difficult to come by where Haiti is concerned.

The causes of cholera, lack of clean drinking water and poor sanitation are well-known, but at present, no one is sure exactly how the disease even broke out in Artibonite.

Poor sanitation, even pre-earthquake

What is certain is that conditions in Haiti even before the earthquake were far from adequate. A study by the World Health Organization and UNICEF found that open defecation was prevalent among just under half of rural Haitians and that 3.7 million of Haiti's total population of 9 million had no reliable source of clean drinking water. Moreover, from 1990 to 2008, conditions deteriorated.

A similar study by the United Nations in 2009 determined that 42 percent of Haitians were not using an "improved water source." Haiti ranks dead last among countries in South America and the Caribbean in all major water and hygiene categories.

"Cholera is a sickness of poverty that is common in refugee camps where there’s not enough drinking water," Ernst Diekmann - a doctor with Germany's Society for Technical Cooperation, or GTZ - told Deutsche Welle. "Haiti was already an underprivileged country, and the situation was exacerbated by the natural catastrophe."

Problem exacerbated by refugees

Nonetheless, aid workers acknowledge that pre-existing deficiencies and the slow recovery process are two parts of the same overall problem that encouraged the cholera outbreak. And the issue of earthquake refugees only exacerbates those problems.

"The dramatic thing about Haiti is that even before the earthquake the health infrastructure was fully inadequate," said Joost Butenop, a medical adviser to the aid organization Caritas.

"Aid organizations have concentrated on the region specifically affected [by the earthquake] and haven't been following the refugees to any great extent."

Organizational challenges

Earlier this year, the humanitarian organization Refugees International went even further, claiming that recovery efforts in Haiti were not just sluggish, but "paralyzed." Off the record, many people who work in the aid and assistance sector say that shortcomings in coordination often prevent help from getting where it's needed - or problems from being effectively anticipated.

That task falls to the United Nations and the Haitian government, and representatives of the former have openly admitted that the situation in Haiti tests their limits.

The will to help is there. Germany's Ministry for Economic Cooperation and Development, for instance, says that most of the 51.4 million euros ($72 million) it was allocated for Haiti has already been distributed or earmarked for future projects.

Yet merely distinguishing between emergency needs and long-term developmental requirements, and figuring out which government ministry is responsible, can be a complicated process. And coordinating the enormous number of private and public organizations trying to help in Haiti represents an organizational task of the highest order.

At this point, no one can say definitively whether any particular authority should have foreseen the danger of cholera in Haiti and taken precautionary steps to prevent it. But the outbreak of the disease in a country that has been the focus of so much international assistance suggests that overall organization and coordination remain problems that hinder aid initiatives from having their maximum possible effect.

Author: Jefferson Chase/AFP/dpa
Editor: Jennifer Abramsohn