Thousands of Haitians infected with cholera could be suffering and dying without any help as aid agencies warn they are overwhelmed by the scale of the disaster. The official death toll of 800 is widely regarded to be a "serious underestimate", as only cases confirmed by the national laboratory are being counted. Thousands may already be dead.
Across the impoverished nation, the medical charity Médecins Sans Frontières has set up makeshift hospitals on the streets and in car parks, as its doctors and nurses try and cope with the daily influx of sick patients. The number of new patients doubled everyday this week in MSF clinics as hospital cases topped 12,000. But little is known about the fate of three-quarters of the population who live in rural areas, with little if any access to medical care or clean water.
Aid agencies last night took the unusual step of severely criticising both the government and the UN for failing to deal with an epidemic that has been threatening for more than a month. This comes amid clear evidence that the disease is spreading fast across the country and prevention efforts have thus far been woefully inadequate.
ActionAid yesterday confirmed the first cases in Lascahobas, a city in the central plateau which is located just an hour from the border with the Dominican Republic. On Friday there were reports of around 30 people "dropping dead" in the streets of Gonaïves, a city in the north of the country where the epidemic seems to be taking hold. The mayor is said to have joined residents in burying the dead, according to Jane Moyo of ActionAid. In rural areas surrounding the city, there were unconfirmed reports of whole families dying without any help, as local people shun the sick amid growing fear of the disease. The threat of contagion from improperly disposed of bodies is also causing increasing alarm, according to Jim Emerson, from the agency Plan International.
Cholera is caused by a highly contagious water-borne bacterium. Its spread is easily preventable but less than half of Haiti's population have access to clean water. In Cap-Haïtien, the country's second largest city, supplies were running dangerously low even in the medical centres where doctors struggled to cope with hundreds of people suffering from dehydration, vomiting and diarrhoea.
Stephane Reynier, MSF's director of operations, last night said: "The situation is very alarming. MSF structures are overrun by the number of patients, not just in Port-au-Prince, but nationally. We are fast and on the frontline but we cannot control a national epidemic alone. Where is the UN? Where are the NGOs? Where are the billions of dollars that were promised after the earthquake? There have been enough meetings, now we need action. "
The cause of the outbreak in Haiti is unknown but the bacteria strain causing deaths originates from south Asia, according to the US Centers for Disease Control. The bacteria can travel the globe in either contaminated food or water or through the movement of an infected person. It causes little trouble where water sanitation and hygiene controls are well established, but January's earthquake and last week's tropical storm Thomas have left the island extremely vulnerable. Less than 40 per cent of the aid pledged by all countries for 2010/11 has been delivered so far.
The arrival of cholera in the capital last week was no surprise, and authorities most fear the epidemic taking hold in the refugee camps of Port-au-Prince. More than one million people left homeless by the earthquake are still living in overcrowded camps, where there is no running water or sewage system and people share portable toilets. Aid agencies such as Oxfam are shipping in huge tankers of water but there is not enough to go round. Water waste, rubbish and sewage all run into ditches that run along the sides of roads.
Ms Moyo from ActionAid said: "Wherever you look there is dirty water. You see young men, entrepreneurs, selling sealed bottles of water and hand-sanitising products on street corners but most people are too poor to buy these products to protect themselves, especially those in the camps where there are few work opportunities.
"Cholera is highly contagious but it is preventable. Everyone knows what is needed: nationwide action to prevent the spread, but this is not happening. Even though the agencies are doing their best, the government is fractured, the infrastructure is limited and, with an election coming up, there are other priorities. People are very afraid and the government must step in and take affirmative action. There is still a window of opportunity to stop the spread but that window is getting smaller by the day."
Around 80 per cent of Haitians live in rural areas, most in abject poverty, and there are real concerns that hundreds of thousands of vulnerable people are cut off from medical help. The country had not seen cholera cases for decades before last month, which means its people are very susceptible to the bacteria, warned Gregory Hartl from the World Health Organisation. The current fatality rate of 6.5 per cent is much higher than normal, and now that cholera is in Haiti, the disease is likely to remain for years, Mr Hartl said.
On Friday the United Nations appealed for £102m from donors to fight the outbreak in an attempt to inject some much-needed momentum. The money would be used to bring in extra doctors, medicines and water purification equipment to treat the hundreds of thousands of people who could be affected by the disease, said Elisabeth Byrs from the UN.
But agencies on the ground say better co-ordination and expert medical advice is needed more urgently than cash. Mr Emerson from Plan International said: "This is a major medical emergency and we need much more technical advice. We have resources but we are not medical experts, so we need urgent advice on who and what to support. The UN must step in now. There is a very strong feeling among all the NGOs that the number of cases has been very seriously under-reported, especially in rural areas where there are few public health services, and we don't know how to handle that alone."
Personal view: Cholera - Terrifying, but easy to prevent and cure
I have been shouting at the radio at reports of cholera spreading through Haiti. There is no doubt that cholera is an ugly, stinking disease involving watery diarrhoea, vomiting and intense dehydration. The speed with which people decline and die gives cholera its terrifying reputation. Yet amid the fear-mongering I have not yet heard a sensible report on how easy it is to prevent and cure.
Fifteen years ago I was in Zambia making a film about cholera for the World Health Organisation and ITN. If I learnt one thing it was that cholera can be controlled. What is needed is clean water, decent sewage systems and, in the absence of these, education. Simple steps like hand-washing with soap before eating, or boiling water before drinking, will radically cut the chances of contracting cholera. Even when contracted, it is easy to cure with intense rehydration – clean water mixed with sugar and salt does the trick.
Cholera need not be rampant if agencies co-ordinate their strategies and resources to educate people and make clean water an absolute priority.
Charlotte Metcalf is a documentary film-maker