Zika Overshadows Haiti’s Continuing Cholera Epidemic

By Emma Fawcett *

Haiti Cholera Treatment Center

Inside a cholera treatment center in Haiti. Photo Credit: CDC Global / Flickr / Creative Commons

As the number of Zika victims rises into the tens of thousands and dominates the media, Haiti’s cholera outbreak rages on reaching 785,530 cases and 9,361 deaths since 2010.  According to the Haitian Ministry of Public Health and Population, more than 3,500 people were infected and 26 died in June alone.  Ten communes in Haiti’s Center and West departments are on “red alert,” indicating a surge of cholera cases.  This surge is expected to continue throughout hurricane season, as the increased rainfall leads to further contamination of open water sources.  Recent research by Doctors Without Borders has indicated that, if anything, the Ministry’s death tolls have understated the severity of the epidemic, as several of the hardest hit communities experienced death counts three times higher than officially recorded.

  • Unlike Zika, cholera can be prevented through hand-washing and water purification, but campaigns to distribute soap and chlorine tablets and increase public education have met with limited success. Moreover, those infected require immediate treatment with intravenous fluids and oral rehydration therapy, and there are too few cholera treatment centers to handle the number of patients.

The crisis is all the more dismaying because cholera is not endemic to Haiti.  The disease was brought to the country in the wake of the 2010 earthquake by Nepalese United Nations peacekeepers with poor sanitation controls.  The UN delayed by more than a year the release of its own audit report, which found that wastewater was not properly managed or treated and was released directly into a tributary of the Artibonite River.  The UN has been sued in New York federal court by a group of 5,000 cholera victims, who have demanded that the UN provide a national water and sanitation system, pay reparations to victims, and issue a public apology.  The UN claims that international treaties give it immunity.  The case is currently before the U.S. Court of Appeals.  Some 130 members of the U.S. Congress, in a rare bipartisan effort, sent a letter to Secretary of State John Kerry accusing the UN of failing to “comply with its legal and moral obligations” to assist cholera victims and noting that “the State Department’s failure to take more leadership in the diplomatic realm might be perceived … as a limited commitment to an accountable and credible UN.”

Public awareness of Haiti’s ongoing cholera epidemic – one of many tragedies in the hemisphere’s poorest country – has been eclipsed by fears about the Zika virus.  While the more than one thousand reported cases of microcephaly are devastating and frightening, Zika is very rarely fatal.  Unlike Zika, cholera has not spread throughout the hemisphere or grabbed headlines at the Olympics, and so the disease rages on in a country plagued by political dysfunction and grinding poverty.  Virtually every institution has abdicated responsibility.  The United Nations has been accused of actively covering up its own role, and its attempts at combating the epidemic have been slow and poorly executed.  Haiti’s medical residents and interns have been on strike for the last four months, protesting low pay and poor conditions, resulting in the closure of many public hospitals.  The Haitian government has been more focused on political infighting and securing international funding for its next round of elections than for additional cholera support, and even nongovernmental organizations render most healthcare services in haphazard fashion.  While bureaucrats point fingers, politicians dawdle, and global attention turns elsewhere, Haiti’s poorest continue to suffer through the worst cholera outbreak in recent history largely in silence. 

August 15, 2016

*Emma Fawcett recently completed a PhD in International Relations at American University.  Her doctoral thesis focused on the political economy of tourism and development in four Caribbean case studies: Haiti, Dominican Republic, Cuba, and the Mexican Caribbean.

Haiti: Crisis Upon Crisis

By Fulton Armstrong

Haiti OAS

OAS Secretary General Almagro visits Haiti. Photo Credit: OAS / Flickr / Creative Commons

Haiti is stumbling, again, from one crisis into another, but the timing of this ongoing mess puts the United States and other international partners in a particularly bad position.  The country’s political institutions are dysfunctional, without an elected executive nor fully legitimate legislature, and efforts to rebuild them continue to be haphazard.  Under Interim President Jocelerme Privert (formerly leader of the Senate), the government has missed another deadline for resolving disputes over the first round of presidential elections held last October and re-running them or scheduling the second round.  Instead, Privert, who assumed the Presidency in February, on 28 April formed a five-member “verification panel” to take yet another look at allegations of first-round fraud and determine which candidates should participate in the runoff, with a 30-day deadline.  The deadline for Privert to step down passed on 14 May.

  • The move coincides with growing perceptions that Privert is enjoying the perquisites of the job and may be dragging things out on purpose. Both sides to the contested elections – supporters of Jovenel Moïse, former President Martelly’s hand-picked successor, and the opposition party’s Jude Célestin – are mobilizing crowds, some numbering thousands, for almost-daily protests.  Calls for Privert to resign are growing intense as suspicions of his own ambitions and imputed bias for or against one of the candidates surge.  Several dozen gunmen, allegedly directed by an enemy of Privert, shot up a police station in the southern city of Les Cayes earlier this week, resulting in six dead.
  • International reactions to Privert’s delays have been mixed but predictably of frustration.  The former leader of an official OAS mission to Haiti in early April supported the verification process, and OAS Secretary General Almagro said recently that elections “shouldn’t be rushed.”  But U.S. Secretary of State John Kerry last month condemned “this process of delay” and urged Haiti’s “so-called leaders” to act.  His Special Coordinator for Haiti Affairs, veteran diplomat Kenneth Merten, called the new verification process a “black box” and said it was “opaque and non-democratic.”

The political mess coincides with other serious challenges.

  • The World Food Program (WFP) is increasingly concerned about hunger caused by a three-year drought, aggravated by El Niño, and the country’s economic situation. Some 3.6 million Haitians (one third of the population) face “food insecurity,” including 1.5 million who are “severely food insecure.”  A U.S. program to send Haiti surplus peanuts, which is one of Haitian farmers’ most successful crops, has deflated prices and further hurt local food production.
  • Shortages of medical supplies, worsened by corruption, have prompted doctors to conduct strikes. High-profile cases, including the death of a bleeding pregnant woman at the entrance of the Port-au-Prince General Hospital, have led to dramatic demonstrations, on at least one occasion parading around a victim’s corpse.
  • Fear of spread of the Zika virus is rampant. The University of Florida recently confirmed that Zika was present in Haiti before the outbreak in Brazil last year.  (Carried by the same mosquito, Aedes aegypti, it was mistakenly identified as chikungunya, which has almost identical symptoms except microencephaly.)  Haiti’s cholera epidemic, which has killed 9,200 people since 2010, continues to claim about 50 lives a month, according to some estimates.

The usual threats by the United States and Haiti’s other international partners to suspend aid if the government doesn’t resolve the political impasse have been muted presumably because they’re unlikely to be credible while such major threats to Haitian citizens’ wellbeing loom large.  Haiti’s political and economic elites assume that the outsiders will care for the Haitian people and continue bailing the country out while they pursue their internecine struggles.  Former President Martelly, who is not free from blame for the elections impasse, has been in Miami these days to promote his autobiography ($50 a copy) and reestablish himself as a naughty boy Kompa musician.  The international community is, once again, in a lose-lose situation.  A previous caretaker government, headed by Gérard Latortue, lasted two years (2004-2006).  The United States and others can ill afford a deeper humanitarian disaster, so while Haitian elites fiddle, outsiders will try to put out the fires.

May 19, 2016

The Zika Virus and a New Debate on Reproductive Rights

By Rachel Nadelman*

Zika Women

Photo Credit: Day Donaldson and PresidenciaRD / Flickr / Creative Commons

The call by half a dozen Latin American and Caribbean governments for women to put off pregnancies – as the World Health Organization warns the feared Zika virus is “spreading explosively” – is stimulating a new debate on reproductive rights in the region.  El Salvador’s Health Ministry has urged women to “avoid becoming pregnant this year and next,” and Brazil, Jamaica, Colombia, and others are issuing similar advisories.  A mosquito-borne disease spreading rapidly in the Western Hemisphere for the first time, Zika is blamed for causing devastating neurological birth defects in newborns whose mothers contract the virus during pregnancy.  The U.S. Center on Disease Control has advised pregnant women to avoid travel to the more than 20 Latin American and Caribbean countries now hosting the disease.

Named for the Uganda forest where it was discovered in the late 1940s, Zika is carried and transmitted by the Aedes Aegypti mosquito, best known as the vector for life-threatening viruses like yellow fever and dengue.  Within the Western Hemisphere, the Aedes population has increased drastically in recent years, linked by scientists to changes in climate.  Yet Zika’s arrival in Latin America last year, first documented in Brazil, and subsequent expansion did not attract major attention until the pattern of birth defects emerged.  Zika’s symptoms are sometimes imperceptible or typically mild, including fever, joint aches, and conjunctivitis, so health officials did not consider it a major threat to the general population.  Although definitive clinical proof is still lacking, Zika is now linked to microcephaly, a rare neurological condition that causes children to be born with small heads because of abnormal brain development in the womb or immediately after birth.  The emergence of Zika in Latin America has coincided with a more than 20-fold increase in the incidence of microcephaly.  (Brazil has reported 4,000 cases in the past year, a drastic increase from just 150 in 2014).  The babies suffer from poor brain function and reduced life expectancy.  Doctors are finding traces of the virus in the brains of microcephaly-inflicted babies who were stillborn or died soon after birth.

Warnings and advisories offer no help to the millions of women who live in afflicted countries.  Governments are launching fumigation programs to reduce the Aedes mosquito population and thereby limit disease transmission.  Asking populations to refrain from having children appears a bit facile, if not cynical, in a region with low levels of access to birth control for reasons that range from religious dictates to economic obstacles.  Severely restrictive abortion laws also complicate potential parents’ options.  Five Latin American countries (including Honduras and El Salvador, hard hit by Zika) ban abortion without exception, even to save the mother’s life.  Others criminalize abortion with few allowances.  According to the Guttmacher institute, 95 percent of abortions in Latin America are unsafe, contributing to high maternal mortality rates. It’s not surprising, therefore, that Zika’s link to these devastating birth defects has generated unprecedented public discussion throughout Latin America about women’s and families’ rights and responsibilities for taking control of reproduction.  It is far too early to know if the health advisories will have practical impact on the incidence of microcephaly – or on attitudes toward reproductive rights over the longer term.   

February 1, 2016

* Rachel Nadelman is a PhD candidate in International Relations at the School of International Service.  Her dissertation research focuses on El Salvador’s decision to leave its gold resources unmined.