Cholera outbreak strikes Haiti

By Maura O’Connor

SAINT MARC, Haiti—Fathers became nurses and children lay side by side with grandparents as a deluge of violently sick cholera patients overwhelmed the staff at St. Nicholas hospital in this small Haitian town.

Desperate family members held up IV bags for the hundreds of patients lying on the floors of every corridor and hospital room available. All suffered from severe diarrhea and vomiting, some patients laid their heads in basins of water for relief from fevers that drenched their clothes with sweat.

“I’ve talked to all of my colleagues who are Haitian and they’ve never seen anything like this, on this scale, before,” said Koji Nakashina, an American doctor with Partners in Health, who was working at the hospital on Thursday. “There’s still a lot coming in.”

The death toll has reached 142 with more than 1,500 infected, according to local news media. Haitian President Rene Preval confirmed cholera was the cause of the outbreak, according to Reuters.

The source of the cholera has not been determined but the first known case occurred on Saturday in Mirebaleis, located in Haiti’s central region, according to government officials. It has since infected people in Douin, Marchand Dessalines and Saint Marc, all in the Artibonite region.

Fears are rising that if the disease spreads to the densely populated capital of Port-au-Prince 60 miles south—and particularly to the camps filled with tens of thousands of Haitians displaced by the earthquake in January—the death toll could soar.

“If that gets into Port-au-Prince that will spread much more further than what we get in the countryside,” said Yolaine Suruna, a coordinator for Haiti’s Civil Protection Department. “In the camps you have the situation of people on top of each other.”

The earthquake that struck Haiti on Jan. 12 took 300,00 lives and left 1.5 million people homeless and living in tents in miserable conditions and with inconsistent access to water. Haiti’s health system collapsed after the quake and sanitation systems—unreliable even before the devastating event—were further compromised.

The United Nations and humanitarian agencies feared outbreaks of disease in the ensuing months and until now, they had been averted in the country.

The Artibonite region had the highest numbers of displaced people from the earthquake, outside of Port-au-Prince.

The condition of the camps compounded by frequent rains and flooding in recent days “are perfect for a mass epidemic” said one Haitian doctor who did not want to be named.

Cholera is caused by the bacterium Vibrio cholera and is usually transmitted through food or water contaminated with fecal matter. Cholera is not common in Haiti and this is the first known epidemic of the disease here.

At least 600 patients were treated at St. Nicholas hospital on Thursday, many brought on motorcycles and pickup trucks and in the early stages of shock. “It’s very fast,” said Narka Tacas, a Peruvian doctor at the hospital, about the speed of mortality in cases she was treating. “The problems are huge, people are going into shock and having complications.”

Just then a man in his 30s was rushed to the front of a long line—his eyes rolled into his head as his brothers tried to resuscitate him by calling his name repeatedly. Tacas inserted an IV into each of his arms, handed both bags of serum to his brothers, and moved onto the next patient, a small girl.

“The physicians and nurses are fighting,” said Suruna. “They are trying to give as much water to the patients because they are losing water.” Fifty more nurses had been requested from Port-au-Prince, and tents were said to be on their way to create triage centers and shelter from the rain for the patients.

Meanwhile, at the hospital gates, security guards struggled to let people leave while keeping hundreds of other family members out in order not to completely overwhelm the hospital compound. Women who had lost a loved one left the hospital sobbing and wailing. One man made it to the hospital gates only to die before he could get inside.

Taking in the chaotic scene, all one of St. Nicholas’ doctors could say was, “Beaucoup probleme.”

Cholera outbreak latest failure for United Nations and Ban Ki-moon

The outbreak could be another failure on a growing list that has many here, and elsewhere in the world, wondering if the United Nations and its secretary general, Ban Ki-moon, are fulfilling its humanitarian role.

On one recent day here, in front of a garbage-littered, shanty-lined alleyway, a convoy of U.N. jeeps came to a stop. Sixteen military peacekeepers in camouflaged fatigues, flak jackets, blue helmets, and armed with automatic rifles, stepped into the hundred-degree heat and began to walk.

Every two hours, day and night, this battalion of Brazilian nationals conducts foot patrols in Cite Soleil, the slum in Port-Au-Prince victimized for years by violence between armed gangs and a dismal lack of basic services. The battalion is part of MINUSTAH (United Nations Stabilization Mission in Haiti), which has been trying to maintain security in the city since 2004.

Given how the troops saunter through the streets, this patrol might seem routine. Not so for their boss, Ban Ki-moon. His fate, and the status of the global organization he heads, is inextricably tied to the future of Cite Soleil and other earthquake-stricken neighborhoods of Port-Au-Prince.

For the United Nations, Haiti is personal. And so far, it’s not going well.

When the January 12 eartquake took 300,000 lives, it also claimed MINUSTAH’s head of operations and 100 other U.N. personnel. On the 38th floor of the Secretariat building in New York City, the disaster quickly became one of the biggest tests of Ban’s leadership since his election four years ago.

Despite the scale of tragedy, some analysts have likened Ban’s response to that of President George W. Bush’s response to Hurricane Katrina: slow, underwhelming, and off-message. The secretary general did not address the U.N. press corps until 14 hours after the quake hit. When he did, he seemed tone-deaf, saying the total death toll could “may well be in the hundreds.”

After the quake, Ban visited the country only twice—the last time was seven months ago. A report by Refugees International said that 70 percent of Haiti’s camps for people displaced by the disaster remain unmanaged, in part because of faults within the U.N.’s local organizational system. Refugees International cited complaints that the relief efforts were “disconnected from the reality outside of the U.N. compound.”

For Ban, Haiti may become yet another reason why the media and his detractors call him “Nowhere Man.” Since he began his term as secretary general in 2007, he has been perceived as uncharismatic, ineffective, and unwilling to reform the organization he runs.

Most recently, Ban’s office inspired controversy for a U.N. report alleging genocide by Rwandan military forces against ethnic Hutus between 1993 and 2003. An initial draft of the report was leaked to Le Monde last month. In comparison, the final version appeared to be toned down. Ban denied that a deal existed to “save face for any troop-contributing nations”—such as those supporting U.N. security initiatives in Africa. But analysts say the report is deeply flawed.

The Rwanda report was not the first time in Ban’s tenure that the United Nations has been perceived as compromising its stance on a conflict. During the last months of Sri Lanka’s civil war between the Tamil Tigers and Sri Lanka, the United Nations was suspected of withholding information about the true number of civilians killed or injured.

The secretary general has even garnered criticism on issues that are reportedly close to his heart, such as global warming. Ban touted the December 2009 Copenhagen climate conference as the possible “turning point in the world’s efforts to prevent runaway climate change.” But it was widely panned as a fiasco. Some called it a “historic failure.”

Some of Ban’s fiercest critics have come from the U.N.’s own staff and from the diplomatic community. In August 2009, Mona Juul, a high-ranking Norwegian diplomat, referred to Ban as “spineless” and “charmless” in a leaked memo, and gave a litany of issues that she believed the secretary general had failed to influence, from the cyclone in Myanmar to non-proliferation.

“In other ‘crises areas’ such as Darfur, Somalia, Pakistan, Zimbabwe and not least the Congo, the secretary general’s appeals, often irresolute and lacking in dedication, seem to fall on deaf ears,” Juul wrote.

Stinging as Juul’s remarks were, the worst came a year later when yet another memo was leaked, authored by Under Secretary General of the Office of Internal Oversight Services Inga-Britt Ahlenius. In her “end-of-assignment” report to Ban, Ahlenius called the secretary general’s actions “deplorable” and “reprehensible,” and said that the secretariat “now is in a process of decay.”

In Ban’s defense, acting deputy spokesperson for Ban, Farhan Haq, told GlobalPost that in regards to issues such as climate change and the Sri Lankan civil war, “it would be hard to find any leader in the world who has pushed harder on these issues than Ban Ki-moon.”

Criticisms of the U.N’s performance in Haiti after the quake, said Haq, are false.

“As for the compound, the main U.N. compound in Haiti was itself destroyed in the earthquake. The United Nations is hardly disconnected from the reality faced by Haitians, having itself lost 101 staff.”

Ban told the Guardian newspaper in July that he welcomes criticism but finds some of it unjust. “Sometimes I have found some of such criticism has been based on misunderstanding or not fully appreciating what kind of person I am and what my job requires me to do,” he said.

The question now is whether the man thought to have had the least influential tenure in the secretariat’s history will be given a second term next year. So far, speculation is that he will, based on the support of China and the United States, despite some rumored grumbling about his performance in Washington.

“The U.S. wanted an Asian who would be the complete opposite of Kofi Annan,” wrote Stanley Meisler, author of a biography of Kofi Annan, in an email to GlobalPost. “No one on the council put up much of a fight against this idea. So it’s pretty hard to carp now that they have a [secretary general] who is the complete opposite of Kofi.”