When Haiti’s health ministry reported it had only registered 2,228 cases of cholera at the end of a two-month period this year, it was the first time since the outbreak exploded almost four years ago that so few people had become sickened by the disease.
But the dramatic drop earlier this year also came with a somber reality: Haiti, according to the World Health Organization, still boasts the largest number of the world’s reported cholera cases in 2014.
And that, says the United Nations’ envoy charged with raising millions of dollars to help eliminate the waterborne disease from the impoverished island, makes cholera a deadly medical emergency even if the rest of the world doesn’t agree.
“We are making progress, but this shouldn’t be an argument to consider that we are out of the woods,” said Pedro Medrano, U.N. senior coordinator for cholera response in Haiti. “There is a silence; nobody is concerned about the cholera epidemic. People are paying more attention to the legal case.”
Five months into the job, Medrano said he is struggling to not only raise $2.27 billion for the U.N.’s 10-year cholera eradication plan, but also awareness. If donors don’t loosen the purse strings, he said, he fears cholera will surge and worse, spread to other countries in Latin America beyond the cases that have already been reported in the neighboring Dominican Republic, Cuba, Mexico, Venezuela and the United States.
Haiti’s Health Minister Florence Guillaume agrees, saying donors need to do more to align their funding with Haiti’s priorities, which includes a two-year cholera plan that is “concise and results-oriented.”
“If they were to listen to us, the problem would already be halfway solved,” she said.
The concerns over the lack of donor support for Haiti’s cholera problem comes as the country enters its rainy season after months of an alarming drought that had the World Food Program still distributing food to desperate farmers on Thursday. It also comes as Haiti and the U.N. prepare to establish a long-promised high level cholera commission to tackle the ground response.
“The legal case has its own path,” Medrano said, adding the priority is stopping the transmission and getting rid of cholera. “It’s an emergency and we need to strengthen the health system and water and sanitation.”
So far, the cholera bacteria has killed more than 8,500 Haitians and sickened more than 700,000. At least three lawsuits have been filed in U.S. federal courts, against the U.N., which has invoked immunity while refusing to take responsibility for the disease despite scientific studies linking it to a leaking sewage at a base in the Central Plateau region that housed Nepalese peacekeepers.
Brian Concannon, director of the Institute for Justice & Democracy in Haiti, blames the lack of donors’ response on the U.N. “minimizing the extent of the cholera epidemic and overstating the extent to which it has been under control, in order to reduce calls for it to respond better.”
“The UN’s failure to be honest about the epidemic undermines the credibility it needs to attract donors,” said Concannon, whose group filed one of the first class-action lawsuits. “It is possible that potential donors fear that an organization that lies about the causality of cholera and its own sanitation system, when everyone knows it is lying, then refuses to take responsibility for its mistakes, might not be the safest steward.”
Concannon said while Medrano has been “much more honest about the risks and extent of the cholera for the last three months,” he is fighting against three years of minimizing the problem.
For his part, Medrano focuses his pitch with donors on the short- and long-term needs of Haiti, where access to water and sanitation are the lowest in the hemisphere. Just 1 in 5 Haitians, for instance, have access to sanitation.
“We know in the rainy season we have floods, issues of access in many communities. We need antibiotics, aqua tablets. We need to prepare the community and have the elements to respond,” he said, thinking about the rains that have already brought floods to Port-au-Prince neighborhoods.
Looking at the long-term, Medrano cites last year’s 55,000 suspected cases, and the international community’s paltry response of about “$200 million more or less,” toward a U.N. campaign to raise $450 million in three years of the $2 billion needed.
“Any country in the world with 55,000 cases, we would consider it an emergency,” he said. “There is no doubt that this is a major, major emergency that needs to have the attention of the international community.”
Last week, during a U.N. Security Council meeting, several nations called on the international community to make good on their pledges.
Donors, such as the U.S., agree that fighting cholera in Haiti is important, but say they are not being stingy with their dollars.
The U.S. has spent more than $95 million on cholera treatment and prevention in Haiti, a State Department spokesman said. The U.S. government also has budgeted about $1 billion over five years to help Haiti build a comprehensive health care system that can address all diseases that disproportionately affect Haitians.
“These efforts have helped to dramatically lower both the incidence and death rates of cholera in Haiti today,” the spokesman said. “In fact, the Haitian Ministry of Health reports that cholera cases in 2013 are down 83 percent from 2011. Over the past three years, the mortality rate has averaged below 1 percent.”
But investing in water and sanitation would make a huge difference in the cholera fight, said Jordan Tappero, director for the division of Global Health Protection with the Centers for Disease Control and Prevention’s.
“Until water and sanitation is improved, we will continue to see cholera,” Tappero said. “It’s important not to lose focus even though the total numbers have dropped.”