Blog Post - Smart Global Health

An Epidemic after an Earthquake: The Cholera Outbreak in Haiti, Part 1

March 7, 2012

Written by Matt Fisher and Alisha Kramer

Ten months after suffering “the largest urban disaster in modern history” – a devastating 7.0-magnitude (MMS) earthquake on January 12, 2010 that killed over 316,000 and affected 3 million – Haiti faced an outbreak of cholera. Although the nation has made progress in controlling the outbreak, ending the epidemic requires a concerted, multi-sectoral effort from the Haitian government and its international partners: water, sanitation and hygiene (WASH) infrastructure needs to be (re)constructed; hygiene education needs to improve; and access to cholera treatment needs to be made universally accessible. To this end, PAHO, the Centers for Disease Control and Prevention (CDC), United Nations Children's Fund (UNICEF), and the Presidents of Haiti and the Dominican Republic recently called on the international community to invest in revitalizing Haiti’s WASH infrastructure; the “call to action” emphasized that controlling cholera “will only be possible” through investments in WASH infrastructure. Despite this high-level attention, Haiti faces a variety of challenges to rebuilding this infrastructure and preventing cholera from becoming endemic to the nation.

The Outbreak

Haiti recorded cases of cholera in its Centre and Artibonite Departments in October, 2010. Months prior to the outbreak, the CDC wrote that “[a]n outbreak of cholera [was] very unlikely.” The CDC’s assessment was reasonable: Haiti had not experienced a cholera outbreak in over a century.
Cholera rapidly spread, largely because of Haiti’s “uniformly poor water and sanitation infrastructure.” Even before the earthquake, the nation lacked adequate WASH facilities. The lack of sanitation facilities was particularly grave; as of 2008, only 17 percent of the population had access to improved sanitation facilities. Predictably, the earthquake further decimated the nation’s paltry WASH infrastructure. You can learn more about how cholera spreads in this related CSIS blog post [Cholera Bio]. Additionally, the unsanitary conditions in some displaced persons camps – where a large number of Haitians were forced to live because of the earthquake – may have also contributed to the cholera spread. However, most residents of the camps were actually “largely spared from the outbreak” because of the clean water and medical supplies that the camps provided. 
Researchers eventually determined that the strain of cholera responsible for the outbreak was consistent with strains found in South Asia and may have been introduced into Haiti by peacekeepers from Nepal who were part of the United Nations Stabilization Mission in Haiti. Furthermore, “patient zero” was identified as a 28-year-old Haitian who was exposed to cholera while bathing in, and drinking from, a river near the peacekeepers’ camp.
Ultimately, by the end of 2011, the outbreak had resulted in over 500,000 infections and 7,000 deaths. Cholera had also spread to the Dominican Republic; which, as of the end of 2011, had recorded over 21,000 cholera cases and 363 resulting deaths (you can find more information on the outbreak and subsequent response in the Dominican Republic in this related CSIS blog post

Haiti recorded cases of cholera in its Centre and Artibonite Departments in October, 2010. Months prior to the outbreak, the CDC wrote that “[a]n outbreak of cholera [was] very unlikely.” The CDC’s assessment was reasonable: Haiti had not experienced a cholera outbreak in over a century.

Cholera rapidly spread, largely because of Haiti’s “uniformly poor water and sanitation infrastructure.” Even before the earthquake, the nation lacked adequate WASH facilities. The lack of sanitation facilities was particularly grave; as of 2008, only 17 percent of the population had access to improved sanitation facilities. Predictably, the earthquake further decimated the nation’s paltry WASH infrastructure. You can learn more about how cholera spreads in this related CSIS blog post. Additionally, the unsanitary conditions in some displaced persons camps – where a large number of Haitians were forced to live because of the earthquake – may have also contributed to the cholera spread. However, most residents of the camps were actually “largely spared from the outbreak” because of the clean water and medical supplies that the camps provided. 

Researchers eventually determined that the strain of cholera responsible for the outbreak was consistent with strains found in South Asia and may have been introduced into Haiti by peacekeepers from Nepal who were part of the United Nations Stabilization Mission in Haiti. Furthermore, “patient zero” was identified as a 28-year-old Haitian who was exposed to cholera while bathing in, and drinking from, a river near the peacekeepers’ camp.

Ultimately, by the end of 2011, the outbreak had resulted in over 500,000 infections and 7,000 deaths. Cholera had also spread to the Dominican Republic; which, as of the end of 2011, had recorded over 21,000 cholera cases and 363 resulting deaths (you can find more information on the outbreak and subsequent response in the Dominican Republic in this related CSIS blog post.

Click here to read Part 2 on the response to Haiti's cholera outbreak and the challenges that lie ahead.

Alisha Kramer is an intern with the CSIS Global Health Policy Center; Matt Fisher is the project coordinator of the CSIS Project on Global Water Policy and a Research Assistant at the Global Health Policy Center

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