Cholera and violence leave Haiti in a precarious position

Wednesday, November 17, 2010; 9:08 PM

UTTERLY UNFORESEEN as recently as four weeks ago, cholera is now on a pace to kill as many as 5,000 to 20,000 Haitians in the coming year, and conceivably many more - a tragic sequel to the devastation of January's catastrophic earthquake. There are growing fears that the widening epidemic, which follows despair at the slow pace of reconstruction, may provide the trigger to a wave of violence that has been feared in Haiti since the quake. International donors and agencies, which have already done so much to ease suffering in Haiti this year, must now once again respond urgently.

The disease is spreading rapidly from the central plains, where it was first detected last month, to the capital of Port-au-Prince and the country's northern and southern peninsulas. In just four weeks, at least 14,000 people are reported to have been infected, and nearly 1,000 to have died from the disease. There's little doubt the actual tally is much higher, given the disease's foothold in Haiti's river system, the state of the country's public health system and the portion of the population living in remote areas.

Rumors that U.N. peacekeepers in Haiti were the source of the cholera bacterium have sparked two days of rioting this week. The violence reflects the desperation of people traumatized by disaster, disappointed by the failed promises of a herculean rebuilding effort and left rudderless by an ineffective, depleted and often invisible government.

With national elections for president and parliament scheduled for Nov. 28, this is an exceptionally volatile juncture in Haiti. In Port-au-Prince, international aid agencies are warning that already jampacked hospitals may be forced to treat patients in the streets. Health experts expect the illness to spread across the border to the Dominican Republic. If ever there were a moment for the United States and other donor countries to show their concern, this is it.

The United Nations has appealed for $164 million in emergency aid; as The Post's William Booth has reported, the country is short of soap, bleach, intravenous fluids, powdered rehydration solutions and health specialists trained to deal with the disease. In some cases, warehouses in the capital have plenty of supplies, but there is no efficient distribution system to get the life-saving goods to far-flung hamlets where the disease is now appearing.

An equal but longer-term priority is to improve Haiti's severely inadequate water systems so that drinking water is not contaminated by sewage - a common method of cholera transmission. Fewer than half of Haitians are thought to have access to safe drinking water, and supplies were further degraded when Hurricane Tomas caused widespread flooding in the country this month.

Medical trainers and public health specialists are scrambling to do what they can to prevent cholera deaths, and Haitian authorities backed by the United Nations are trying to maintain order. But without urgent help, those efforts on the ground will be swamped, and a bad situation in Haiti may easily become much worse.

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