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Tuesday, November 16

Convergence, Part 5: Epidemic and Civil Unrest - Cholera outbreak in Haiti, violent protests against UN peacekeepers suspected of spreading cholera

(Photo: Reuters)

"This is a grossly uncontrolled, uncontained epidemic of cholera that has exceeded public health capacity to investigate and assess every site reported and every sample received."

"In Haiti most of the population believes it came from the Nepalese and that the UN will do its best to hide it," said Prospery Raymond, country director of the UK-based NGO Christian Aid. "If it is confirmed to be from them this will be damaging for the UN and their peacekeeping all over the world."


There is an additional panic factor because before the outbreak cholera was unheard of in Haiti, which meant Haitians didn't understand the disease and didn't know the protection measures, which in any case are difficult to practice in the DP [displaced persons] camps.

Below are two news reports, one from AFP last night, one from the (U.K.) Guardian today, and an update from the Veratect Biosurveillance website. (If the name rings a bell -- they were the American biosurveillance organization that sounded the earliest warning about the swine flu outbreak in Mexico.)

The Biosurveillance site has updated reports on the progress of the outbreak and also a map of the outbreak pattern in Haiti, as well as tons of other information, including tips for journalists going into the region to cover the story, and background reports on the outbreak. Note their mention of under-reporting on cholera cases:
While the UN OCHA maps and official MSPP reporting tends to focus on Artibonite and points north, there are other areas routinely not included on the OCHA maps that have reported cholera. We opt on the side of "cholera until proven otherwise" or when political sensitivity is such that full disclosure and transparency allows.

Current official stats are more than 14,600 cases and 917 fatalities. In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics.

There is no question of under-reporting. If we assume the case counts are 1/4 the true community load, then we now have nearly 60k cases shedding pathogen into the environment. We believe the true statistic to be closer to more than 100k based on the degree of under-reporting. It is extremedly difficult to estimate the true scale of this epidemic now. This is a grossly uncontrolled, uncontained epidemic of cholera that has exceeded public health capacity to investigate and assess every site reported and every sample received.

Evidence now suggests the epidemic has crossed the border into the Dominican Republic, which was expected.
AFP via Wall Street Journal
15 November 2010, 10:17 P.M. ET
Two Killed In Violent Protest Over Haiti Cholera Crisis

PORT-AU-PRINCE (AFP)--Two men were killed Monday as protesters in northern Haiti clashed with U.N. peacekeepers over a deadly cholera outbreak, and the U.N. said it fired in self-defense on one of the demonstrators who was killed.

The body of a 20-year-old man was found in front of a base of the U.N. Mission in Haiti, or Minustah, in Quartier-Morin, on the outskirts of Cap-Haitien, according to local official Bimps Noel, who confirmed the death.

It was the scene of violent clashes earlier between demonstrators angry at Haiti's spiraling cholera crisis and U.N. peacekeepers.

"At first (the blue helmets) fired to disperse the crowds, and then later, I have the impression they fired on a man," Noel said.

The young man was shot in the back, the official said, noting that the "U.N. tanks were hit by stones."

"There was a demonstrator who had a weapon and fired at a soldier, and the soldier returned fire in legitimate self-defense," said Minustah spokesman Vicenzo Pugliese. "The soldier was not injured," he said.

Another Haitian young man was killed by gunfire on a street in Cap-Haitien, amid the clashes with the U.N. force, a police source said.

Protesters in northern Haiti set fire to a police station and clashed with U.N. peacekeepers earlier as anger turned to violence over a cholera outbreak that has claimed almost 1,000 lives.
Rory Carroll reporting from Port-au-Prince, Haiti
Guardian
Tuesday 16 November 2010 05.00 GMT
Protestors in Haiti attack UN peacekeepers in cholera backlash

Protestors in Haiti have attacked UN peacekeepers over suspicion that Nepalese soldiers brought the cholera epidemic which has swept the country and killed 1,000 people.

Crowds in two northern towns hurled rocks, set up burning barricades and blocked roads to protest the foreign troops and the government's response to the crisis, rattling authorities and the UN in the run to a November 28 election.

Cap-Haitien, the country's second city, was this morning cut off from the rest of Haiti after a day of rioting shut its roads and airport and left more than a dozen people wounded. Clashes in the town of Hinche injured seven Nepalese peacekeepers, according to local radio.

The flare-ups followed mounting anger and fear over a disease which many blame on effluent from a base used by Nepalese troops in the Artibonite valley, where the outbreak began three weeks ago.

The US Centers for Disease Control and Prevention found that the strain, which has infected more than 15,000 people and reached all 10 departments, resembled one from south Asia. Haiti's first epidemic in living memory began in the valley a week after the Nepalese arrived.

UN officials have admitted problems with the base's sanitation but denied its soldiers brought the disease, which is spread by contaminated faeces. No official investigation into the epidemic's origin has been launched despite appeals from Haitian leaders and foreign epidemiologists.

"In Haiti most of the population believes it came from the Nepalese and that the UN will do its best to hide it," said Prospery Raymond, country director of the UK-based NGO Christian Aid. "If it is confirmed to be from them this will be damaging for the UN and their peacekeeping all over the world."

The outbreak has flooded clinics and hospitals with vomiting, diarrhea-stricken patients. Experts say more than 200,000 could become infected in coming months.

With no previous knowlege of cholera many Haitians are unsure how to avoid contagion. Experts say washing hands with soap, especially after going to the toilet, is the best prevention. Treatment - usually an IV drip and rehydration - is relatively simple and fast and saves the vast majority of those infected.

Even so, emergency teams are worried. "If it keeps accelerating we will not be able to keep up," said Francois Servranckx, spokesperson for Doctors Without Borders, an NGO which has treated 10,000 patients at improvised tent clinics.

Donors credit the UN peacekeeping force, known as Minustah, with keeping the Caribbean nation relatively stable in recent years despite food price riots, hurricanes and January's earthquake. Many Haitians however brand the blue helmets an expensive and useless occupation force.

Haitians are also critical of their government for letting the disease spread from the Artibonite valley to cities where millions live in slums, rubble and tents. "Now it's here and they're wringing their hands. Not good enough!" said Alfred Roberts, a father of two in the capital Port-au-Prince.

The outbreak has put a question mark over whether presidential and legislative elections, already troubled by logistical and political problems, will go ahead on schedule later this month.

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