What helping Haiti teaches us about global public health

by David Nabarro | @davidnabarro | United Nations
Thursday, 12 January 2017 08:51 GMT

* Any views expressed in this article are those of the author and not of Thomson Reuters Foundation.

More than 700,000 of the nation’s 11 million people have been infected with cholera

As the New Year gets underway, one image of 2016 continues to haunt me. 

It is from last October, shortly after Hurricane Matthew hit the island nation of Haiti. Days later I watched a little girl pick her way through the rubble in the streets of Jeremie, a large town in the country’s southwest.  She was going to a brook to collect water for her family. 

After the hurricane hit Jeremie looked like a scene from a disaster movie. But it was real, you could see destruction everywhere you looked.  Most of the houses had been badly damaged by the savage hurricane which moved slowly across the South West peninsula. 

The gusts were ferocious. Uprooted trees and tin roofs became projectiles.  Houses, gardens, fields, roads and water points were ripped up and smashed. Septic tanks were leaking.

I arrived in the southwest 10-days after the hurricane hit. Despite the level of destruction, I was impressed by the extent to which Haitians had organized themselves under local leadership. They had begun to clear streets, organize food distributions and to find shelter.  I was impressed, too, by the way national disaster management authorities had taken matters in hand.

The little girl was determined. Not only did she need to find water, she also knew that the water had to be treated to prevent disease.  And she was hanging on to her precious bottle of chlorine concentrate because, as she told me, she had to use it.  It was for the good of her family.  Even though, as she put it, the water then tasted strange.

This, together with many images, is emblematic of the challenges faced by many Haitians: poverty, natural disasters and public health threats.

Haiti is still recovering from the 7.0 magnitude earthquake in January 2010 that killed an estimated 220,000 people. Since then, more than 700,000 of the nation’s 11 million people have been infected with cholera, while more than 9,000 have died from the disease.

The impact of last year’s hurricane was immediate. It scoured the surface of the country’s southwest. Life and livelihoods for nearly a million people were interrupted. Houses, clinics, schools and crops were destroyed or damaged. Childhoods brutally interrupted.

Yet, the people of Haiti have shown tremendous fortitude. Together, they have carried the wounded and sick to places where they can recover, they have joined hands to rebuild their homes, hospitals and lives.

Every community was potentially affected by cholera. Health workers walked for hours to access isolated rural hamlets when communications were cut off; humanitarians persisted with deliveries of essential supplies for water purification along unpassable roads. Haitians are focused on making their country strong. 

They know what is needed. Combating cholera, tackling threats to health and ensuring that everyone has access to safe drinking water and sanitation. At present only a quarter of Haitians have functioning toilets. 

They depend on the international community for responses to their needs.  Outsiders recognize that Haiti is not an easy context in which to operate. There is minimal infrastructure, security is a concern, and the terrain is difficult. 

I have seen how well-organized and coordinated action can reduce the risk of cholera and malnutrition.  I have seen how the international system is able to support the national effort.  To namecheck a few: the Pan American Health Organization and the World Health Organization, the United Nations Children’s Fund, the Office for the Coordination of Humanitarian Affairs (OCHA), the World Bank and the Inter-American Development Bank, the Global Vaccine Alliance (GAVI), the Red Cross movement, and many non-Governmental Organizations, all joining forces with the Government of Haiti and overseas governments to offer support.

The scale of this effort really does depend on funding, and there remains a serious shortfall in both the response to cholera and the repair of livelihoods following the hurricane. Here are my suggestions to the international community on how we address these issues:

Firstly – recognition. On December 1st the UN Secretary General recognised the UN’s role in the cholera outbreak, apologized for it, and said he wished we could have done more to reduce its consequences.   

Secondly – reassurance. External support related to the cholera outbreak is being spent effectively and makes a real difference. 

Third – a request.  In recent weeks more than 700,000 people have been vaccinated by a dedicated team of 5,000 workers and the mobile cholera response teams are working effectively.  But the available finance is drying up.  Funds are sorely needed to complete the vaccination program, to secure the cholera response and to support a longer-term coalition for water and sanitation – as well as to support post-Hurricane reconstruction. 

As executor for a trust fund set up by the UN, I am responsible to ensure all funds we receive are used as efficiently and effectively as possible.  Over the next three-years, we will require at least $400M to support the Haiti Cholera Response.  We not only ensure that donors have a say in how the funds are used, but we will also ensure that funds are properly applied to both the cholera response and to enabling all Haitians to have access to drinkable water and sanitation. 

Pressures on donor countries to top-up the coffers of humanitarian agencies working in war situations are important and well understood. But the needs of the people of Haiti, in towns like Jeremie, are less well documented. They need and deserve our attention: they rely on the support we are able to afford them.

David Nabarro is the UK’s candidate for Director General of the World Health Organization (WHO)