Gangs worsen Haiti’s cholera plight
Those stricken with disease risk death in seeking treatment
PORT-AU-PRINCE, Haiti — To reach the hospital, the mothers traveled the front lines of a gang war, bringing sick babies during lulls in gunbattles and passing corpses along the way.
They had no choice: Cholera, resurgent in Haiti, had come for their children.
“I didn’t want to come, because I was so scared,” said Benette Regis, clutching her 5-year-old son, Lovelson, as he vomited, his frail body at war with cholera. “But I knew he could die.”
Cholera is soaring across the globe, as a record number of outbreaks have strained already reeling health systems in regions including Africa and South Asia.
But cholera’s resurgence is a particularly cruel turn of fate in Haiti, which in February declared the disease eliminated after battling it for more than a decade.
Now that triumph has been snatched away by the same forces plunging the nation into extraordinary depths of chaos and despair: armed groups that have turned vast swaths of the capital into lawless hellscapes of violence, and a government unable to take control.
In October, the country registered its first case of the disease in three years, and cases have spiked since then.
Haiti has experience beating back cholera, which spreads through contaminated water and is relatively easy to treat with simple rehydration. But the health authorities cannot deliver the most basic care in poor neighborhoods where gangs have choked off access, preventing doctors from entering, and leaving the sick to die at home.
“There are areas of the
country where nobody would set foot in,” said Dr. Jean Pape, the director of GHESKIO, a local health provider that operates two cholera treatment centers in Port-au-Prince, the capital city. “They are afraid to get kidnapped; they are afraid to get killed.”
“It’s very sad,” he added, “because it’s a simple disease, and there are simple ways to intervene, yet the authorities and the medical teams are unable to do their work.”
The battle against cholera has been stymied by several intertwined crises.
In September, armed groups took control of Haiti’s biggest port, blocking the delivery of fuel across the country for nearly two months and setting off a chain of events that created ideal conditions for the spread of disease.
Trash collection ceased entirely in parts of Port-auPrince, turning streets of
urban shantytowns into rivers of squalid mud and creating mountains of garbage next to food markets.
The nation’s water utility stopped functioning normally and clean water became scarce in its large slums. Thousands fleeing violence took refuge in a public park near the airport in Port-au-Prince, where many slept next to human waste before the authorities recently forced everyone out.
Hospitals reduced their services, lacking the fuel needed to keep machines working. Oxygen supplies were left stranded at ports, killing newborns who were unable to breathe on their own. The number of ambulances on the streets plummeted.
The United Nations reported last month that for the first time, hunger, which has long haunted Haiti, had reached “catastrophic” levels in the Cite Soleil neighborhood
— a designation of the most extreme hunger possible that has left thousands facing famine-like conditions. Some residents say they resort to drinking rainwater and making meals out of boiled leaves.
The devastation gripping Haiti has shocked a country accustomed to agony.
“This is not a typical humanitarian crisis at all,” said Jean-Martin Bauer, country director for the World Food Program in Haiti. “It’s something much worse.”
Last month, the Haitian government made a remarkable request for armed intervention from abroad to confront its cascading challenges, but it remains unclear whether any countries will send troops.
Gas stations opened recently for the first time in about two months in Portau-Prince after the police finally took control of the main fuel terminal. But even that relief came with
the potential for fresh pain: Fuel, doctors fear, will make people more mobile, whipping cholera through the country at a faster rate.
Since October, the disease has killed more than 100 people and sickened 8,000 more — though experts say the official numbers probably understate the disease’s true toll.
Cholera, which scientists say was brought to Haiti more than a decade ago by United Nations peacekeepers, is caused by a bacterial infection and leads to relentless waves of diarrhea and vomiting. The treatment is straightforward — rehydration, intravenously in the more extreme cases — but has to be given quickly.
The disease can kill its victims within a day, especially children suffering from malnutrition who can quickly progress from dehydration to organ failure.
But making it to the Doctors Without Borders hospital in Cite Soleil is no easy feat, as it’s situated on a gravel road that separates territory controlled by rival gangs.
“All the severe cases arrive in the morning, because they cannot travel at night,” said Dr. Mouna Hanebali, a physician helping oversee the hospital. “There are many already dead when they arrive.”
One of the easiest ways to prevent widespread death is to set up outposts to deliver oral rehydration inside the shantytowns where the most vulnerable live, experts said.
Now that fuel is flowing once more throughout the country, it’s technically feasible to travel to those neighborhoods — but often only by risking lives.
“We need to get access to all the slums regardless of who controls them,” Pape said. “That’s what people are asking of us.”
Because gangs control most of Haiti’s capital, aid groups have to constantly negotiate for safe passage in and out of their territory. Sometimes gang leaders refuse them entry.
“They don’t respect the ambulances, they threaten employees,” said Johanne Gauthier, the head of a fleet of ambulances in Port-au-Prince, referring to the gangs. Gauthier said three ambulances had been hijacked this year.
Inside a treatment tent at the cholera treatment center in Cite Soleil, a thud broke through the moans of sick children, and nurses went running: A writhing 10-month-old baby, left on a bed for hours, had plunged a few feet to the floor.
The boy’s mother had dropped him off in the morning and then rushed home. She came back with her second child, a 6-yearold boy, as fast as she could.
“I had to go check on my other son,” said the mother, Beatrice Medina. “When I arrived home, I saw my other son was just as bad.”