Thursday, October 28, 2010


(AP) - By Ingrid Arnesen and Mike Esterl

Cholera Epidemic Underscores Need to Overhaul Crumbling Sanitation Network; Helicopters Ferry in Supplies of Chlorine

U.N. investigators seeking the cause of the cholera epidemic gathered human waste this week from a peace-keeping base in Mirebalais, Haiti.

ST. MARC, Haiti—Haiti's cholera epidemic is adding fresh urgency to the need to upgrade the country's water and sanitation network, a pivotal step to containing the highly infectious and deadly disease that spreads through contaminated water.

The government and international aid groups are rushing emergency supplies to combat the illness, including enlisting helicopters to rapidly distribute tons of chlorine to disinfect municipal water supplies. But more permanent solutions will take years, they acknowledge.

The current outbreak could cause about 105,000 illnesses within the first year and last for several years, the U.S. Centers for Disease Control and Prevention said Thursday. That projection, however, is based on a number of factors including the spread of cholera in other countries in the Americas as well as refugee camps in Africa. So estimates range widely, from 30,000 to 950,000 possible illnesses in the first year, and are likely to be refined, cautioned Scott Dowell, head of the CDC's Haiti response.

A CDC spokesman said the projections represent a scenario that public-health officials use for emergency planning for the potential treatment of large numbers of people.

About half Haiti's population doesn't have access to filtered water and less than 10% has water piped into their homes—a situation that existed before a massive earthquake in January turned much of the Caribbean nation's capital to rubble.

Clean water is harder to secure in the country's rural areas, including the Artibonite valley, which largely escaped earthquake damage but is the epicenter of the outbreak that has killed more than 300 people and is spreading fast.

"Cholera is the latest reminder, that we didn't need, how urgent it is to revise many things," said Pierre Yves Rochat, rural sector representative of the national water agency Dinepa. "In 2010, the population of Artibonite is drinking only river water, like it did in 1804," when Haiti became independent, he noted.

The infrastructure is so poor that aid groups say more people in the capital, Port-au-Prince, have access to clean water today than they did before the earthquake. International organizations have been distributing water by truck to more than a million Haitians in hundreds of crowded refugee camps in and near the capital since January.

The Inter-American Development Bank estimates that Haiti needs to invest $850 million to ensure that just three-quarters of its population has access to clean water, up from 50% in cities and 30% in rural areas.

Funding for long-term water and sanitation projects remains a work in progress. The IDB and the Spanish government offered $115 million in support earlier this year, but the Haitian government is waiting for more commitments from other organizations.

"We get water delivered twice a day, but it is not enough. It barely allows us to wash, but there is not enough to drink," said Jatelin Daniel, a refugee in a camp in front of the collapsed presidential palace in Port-au-Prince.

Authorities aren't clear where the epidemic began. This week, U.N. investigators took samples of foul-smelling waste that was trickling behind a peacekeeping base in Haiti, toward an infected river system, the Associated Press reported. The investigation followed persistent accusations that excrement from the newly arrived unit caused the cholera epidemic.

Aid groups say they hope to end the emergency trucking of water supplies to camps by the end of the year. But there's no clear plan yet for replacing the stopgap service. Only about 10% of homes in the capital had water connections before the earthquake, which leveled tens of thousands of buildings.

Progress on longer-term projects has moved at a snail's pace in recent years. The IDB approved a $54 million loan in 1998 to bring clean water to several rural towns, including St. Marc. But the project was stalled for several years amid political instability and debt defaults. Ten years later, after being converted to grants, only a little over half of those funds have been disbursed.

In St. Marc, the local water utility now sends water through its pipes about 10 hours a day, up from a bit over an hour a day two years ago. But many residents still aren't hooked up and the water, while cleaner than river water, still requires treatment before drinking.

In some rural areas, the situation is worse than it was two years ago. The government estimates 250 water-supply networks in the countryside that were damaged by several hurricanes in 2008 still haven't been repaired.

In Cap Haitien, the country's second-largest city, Oxfam and other aid groups have laid more than 12 miles of water pipes and installed a pumping station and drainage canals since 2006. The $5 million project, mostly funded by the European Union, was supposed to be providing clean water to as many as 100,000 people by now. But Oxfam says no water is being distributed, and blames the delay on a dearth of local contractors.

The government also is struggling to professionalize its water-management ranks. Dinepa, or the National Water and Sanitation Directorate, was created last year in a bid to overhaul a bureaucracy that wasn't working.

"This is a problem that hasn't gotten the level of investment needed. But it's also an institutional problem," said Federico Basañes, chief of the IDB's water and sanitation division.

The regional lender and Spain announced in July they would provide $50 million in grants in part to "strengthen" Dinepa.

Some of that money will be directed to Port-au-Prince. "There are very few people who know where the network is, the magnitude of the network, and the conditions of pipes. It's a very difficult situation," said Mr. Basañes.

Port-au-Prince also doesn't have a sewage system—a critical shortcoming plaguing the rest of the country. Only 29% and 12% of urban and rural Haitians, respectively, had ready access to sanitation in 2008.

Dinepa began working on a detailed master plan for improving access to water and sanitation last year. "But the earthquake arrived and postponed that discussion," said Sergio Mazzucchelli, a senior Dinepa official. Mr. Mazzucchelli said authorities hope to cement plans next year, following national elections next month.

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