Water, Sanitation and Hygiene in Haiti: Past, Present, and Future

Abstract

Haiti has the lowest rates of access to improved water and sanitation infrastructure in the western hemisphere. This situation was likely exacerbated by the earthquake in 2010 and also contributed to the rapid spread of the cholera epidemic that started later that same year. This report examines the history of the water, sanitation, and hygiene (WASH) sector in Haiti, considering some factors that have influenced WASH conditions in the country. We then discuss the situation sine the earthquake and subsequent cholera epidemic, and the responses to those events. Finally, drawing on Haiti's National Plan of Action for the Elimination of Cholera in Haiti 2013–2022, we suggest some actions that could help bring about long-term WASH improvements for the future. Because the current WASH situation has evolved over decades of limited attention and resources, it will take a long-term, sustained effort to improve the situation.

Geographical Perspectives on Epidemic Transmission of Cholera in Haiti, October 2010 Through March 2013

“…When the disease did finally arrive in October of the same year, it found a set of pre-and post-disaster circumstances that were highly conducive to its rapid transmission. Earthquake damage to the country's already poor sewage and water systems was compounded by overcrowded and insanitary living conditions and deficiencies in public health infrastructure to treat and prevent the disease (Gelting et al 2013;Santa-Olalla, et al 2013). cases, an incubation period of 2-5 days is usually followed by the sudden onset of diarrhoea and vomiting, giving rise to massive fluid loss and dehydration.…”

Centers for Disease Control and Prevention Public Health Response to Humanitarian Emergencies, 2007–2016

“…Recognizing that population displacement could exacerbate Haiti’s already poor access to improved water sources and sanitation facilities, ERRB staff and the Haiti National Directorate for Potable Water and Sanitation performed a rapid assessment of access to WASH services in 308 IDP settlements in February 2010 and found that <10% of sites met the minimum Sphere Project standards for emergency sanitation ( < 50 persons/latrine) ( 29 ). This work provided the impetus for the Haiti National Directorate for Potable Water and Sanitation and the humanitarian WASH sector to increase emphasis on improving WASH in IDP sites, actions that likely reduced the number of cases among IDPs early in the cholera epidemic ( 30 , 31 ). …”

The national alert-response strategy against cholera in Haiti: a four-year assessment of its implementation

“…It then experienced the largest national-level epidemic of the past few decades with 816,066 suspected cases and 9,748 suspected deaths recorded on December 30, 2017 by the Haitian Ministry of Public Health and Population (MSPP, acronyms summarized in Supplementary Table S1) [3]. Following international recommendations [4], a cholera surveillance and early warning system was established while Haitian authorities and services, together with numerous international and nongovernmental organizations (NGOs), struggled to mitigate the death toll and case incidence by supporting cholera treatment institutions and providing efforts to provide safe water, and to improve sanitation and hygiene practices (WaSH) in affected communities [5][6][7][8]. Cholera incidence gradually receded in 2011-2012, with alternating troughs and peaks influenced by seasonal rainfall [9].…”

“…Cholera incidence gradually receded in 2011-2012, with alternating troughs and peaks influenced by seasonal rainfall [9]. Although Haiti then remained the most cholera-affected country worldwide [10], emergency funds for cholera dried up and most organizations eventually interrupted or drastically reduced their activities in 2012 [7,11]. The few remaining programs often lacked the precise epidemiological data necessary to target their efforts to the appropriate areas [11].…”