Haiti: MSF calls for urgent scale-up of cholera outbreak response

Réponse MSF à l'Urgence Choléra 2022

Haiti 2022 © MSF/Alexandre Michel

Port-au-Prince, November 16, 2022: Cholera cases are rising at an alarming rate in the Haitian capital of Port-au-Prince and throughout the country, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) Wednesday. MSF is calling for an immediate and urgent expansion of the outbreak response. More organizations and donors must be mobilized. Cholera vaccines and other essential tools must be made available to medical teams and to people in Haiti.  

"Our current [cholera treatment] centers are filling up, and we will soon be at maximum capacity," said Mumuza Muhindo, MSF country director in Haiti. MSF has set up six cholera treatment centers (CTCs), with a total of 389 beds, since the first cases appeared on September 29. “The evolution [of the outbreak] is very worrying,” said Muhindo.   

MSF alone is managing more than 60 percent of the bed capacity to treat cholera patients in the capital. Since the end of October, MSF has treated an average of 270 patients a day in its centers, compared to about 50 a day in the first two weeks of the outbreak. In total, MSF has admitted more than 8,500 patients and recorded 97 deaths.

The outbreak in Haiti is taking place amid an unprecedented political, economic, and security crisis. Port-au-Prince is now a city surrounded and suffocated, with the main roads linking it to the rest of the country controlled by armed groups. MSF is one of the few organizations working alongside local health authorities to stop the spread of cholera. The resurgence of cholera in Haiti is itself a symptom of the catastrophic humanitarian and health situation.

"The overloaded cholera treatment centers, the difficulties patients face traveling due to fuel shortages and insecurity, and the increase in community deaths are worrying signs.”

Michael Casera, MSF epidemiologist

While a main oil terminal, which had been in the hands of an armed group for weeks, has been unblocked, this has not led to an improvement in the situation. Haiti is experiencing an acute economic crisis, and access to fuel is too expensive for most people to afford. The functioning of health facilities remains affected, with services closed and ambulance traffic reduced. Access to clean water—a crucial element in the fight against cholera—also depends on the circulation of tankers, which in turn depends on access to fuel and on security conditions.

"The city is full of garbage that hasn't been collected for months,” said Muhindo, “and there is no water distribution in neighborhoods like Brooklyn, in Cité Soleil, where roads are cut off by garbage and flooded by clogged canals and sewers, causing massive flooding."

MSF mobile teams of water and sanitation specialists and health promoters are working in the most affected neighborhoods to educate people on how to prevent spread of the disease. They have organized chlorination at approximately 100 water points and installed eight oral rehydration points where basic commodities and clean water are distributed. Despite these activities, MSF and the few organizations present in the response will not be able to adequately address this cholera outbreak. Other humanitarian actors and donors must join the response effort, either by setting up treatment centers or by urgently scaling up access to safe water and sanitation activities.  

In addition, it is extremely important that vaccination be used as a fundamental tool in dealing with the disease. Several hundred thousand doses of cholera vaccine have been allocated to the country by the International Coordinating Group, the international mechanism for vaccine response to epidemics. Authorities have submitted an official request to the International Coordinating Group (ICG) to obtain vaccine doses. MSF stands ready to begin implementing a vaccination campaign in support of the health authorities and to complement other water and sanitation and health promotion activities.  

As the number of cholera cases increases throughout the capital and in other areas across the country, it remains difficult to assess the true extent of the outbreak.

"The overloaded cholera treatment centers, the difficulties patients face traveling due to fuel shortages and insecurity, and the increase in community deaths are worrying signs,” said Michael Casera, an MSF epidemiologist. “In neighborhoods with high levels of insecurity, patients with severe symptoms at night often have to stay home because motorcycle cabs refuse to take them to a health center.”

For more than 30 years, MSF teams have been providing free medical care in Haiti. MSF currently runs seven projects throughout the country, in the capital Port-au-Prince, and in the South and Artibonite departments. We provide care for life-threatening emergencies, trauma cases, burns, survivors of sexual violence, and reproductive services. MSF also regularly intervenes in emergency situations, such as disasters. In 2021, MSF teams conducted 25,000 emergency consultations, treated 3,220 people for violence-related injuries and supported 1,560 survivors of sexual violence.