Cholera in the Age of Privatized Water

by Isabeau Doucet (Haiti Liberte)
I contracted cholera two years ago by the breezy beaches of Port Salut, while attempting to escape burnout, a broken heart, and the lingering pangs of Dengue fever in Port-au-Prince, Haiti’s capital.
            Cholera’s not a whole lot different from food poisoning and is no big deal if you have a clean toilet, potable water, know how to treat it, and aren’t malnourished.
            But in hunger-wracked Haiti, where there is no sewage system and where water and sanitation are almost completely privatized, cholera has been a death sentence for over 8,000 people. According to a host of scientific studies (including the UN’s own investigators), the South Asian strain of the disease was likely imported by UN troops from Nepal in October 2010. Having sickened over 640,000, it is now the worst cholera epidemic in modern history.
            A week before the long-delayed release of an international $2.2 billion 10-year eliminate-cholera plan at the end of February, the UN rejected outright a legal claim filed by over 5,000 cholera victims seeking financial compensation, an apology for the UN’s gross negligence, and a commitment that the world body rebuild Haiti’s water and sanitation infrastructure.
            Invoking immunity under its1946 convention, the UN snubbed the suit as “not receivable.” It has not apologized and has committed only 1% ($23.5 million) to the plan, recommending Haiti get the rest from the “private sector” or from “major venture philanthropist individuals,” according to Nigel Fisher, the new head of the UN military occupation force in Haiti known as MINUSTAH.
            “Combating water born diseases, cholera, is actually a good investment if you want to attract investors,” Fisher added.
            With some 9,000 armed soldiers and police officers, MINUSTAH had an annual budget of over $800 million last year. Its current one-year mandate ends on Oct. 15, 2013.
            In a country where nearly 80% of people live on less that $2 a day, the water-and-sanitation-access-for-profit model has left over 80% without adequate sanitation and nearly a third without potable water.
            “When you look at the price of a bag of water, supposedly treated, it costs more to buy a gallon of water when you’re poor than a gallon of diesel fuel,” said veteran political activist Patrick Elie, looking at water vendors weave through traffic and crowds to sell as many 300ml 5 cent bags of iced water as possible before they turned hot under Haiti’s blistering sun.
            Those in tent camps and shanties who can’t pay for a toilet, defecate into plastic bags that end up in the nearest canal or ravine.
            While the poorest of the poor get their water and get rid of their waste in plastic bags, the rest are subject to the pay-as-you-go free-market chaos of water and waste tanker-trucks, run almost entirely by the local and international NGO private sector. A sharp rise in petrol’s price, if some event, say, changes Hugo Chavez’s PetroCaribe deal under which Haiti gets cheap oil largely on credit, could quickly deepen Haiti’s water and sanitation crisis.
            DINEPA, Haiti’s National Water and Sanitation Agency founded in 2008, says around a dozen private companies collect and dispose of sewage along with an unregistered number of manual merchant toilet cleaners, know as “bayakou.” DINEPA could not answer how many private water provision companies operate in Haiti and directed the query to the Ministry of Commerce and Industry, which sent the question back to DINEPA. There is evidently no registration of water companies and no state regulation of water quality.
            Haiti is one of the few countries in the world where water security has deteriorated since the implementation in 2000 of the Millennium Development Goals, while, since 2004, the UN has maintained a multi-billion dollar military occupation in a country with no war and one of the lowest homicide rates in the region.
            Jon Andrus, Deputy Director of the Pan American Health Organization (PAHO), concedes that the privatization of Haiti’s water and sanitation has threatened Haiti’s most vulnerable people and that PAHO and partners “have failed for decades to reverse that situation.”
            Andrus is optimistic about the new plan having seen first hand the eradication of polio, rubella, and measles in some of the poorest parts of the world, despite “naysayers” even at high levels of government.
            The challenge of raising $2.2 billion in the face of international donor fatigue is not small, even though only 1% of post-earthquake funds actually went to the Haitian government, and international donors still owe Haiti $2.5 billion in unfulfilled pledges. The U.S. alone has yet to come through on $650 million pledged in post-earthquake “build back better” funds, which could neatly cover the next two years of the cholera eradication plan.
            “I can’t think of another country where they built the infrastructure from the ground up in an emergency context” said Dr. Daniele Lantagne, a U.S. cholera expert specializing in emergency water and sanitation interventions in developing countries. Lantagne is one of the leading scientists who concluded the UN’s camp of Nepalese soldiers in Mirebalais on Haiti’s Central Plateau was “the most likely source of the introduction of cholera into Haiti.”
            On Feb. 27, 2013, the UN billed the 10-year cholera eradication plan as its own (the Haitian and Dominican governments had originally proposed it in January 2012). Yann Libessart, the communication officer of Doctors Without Borders (MSF), was not impressed by the lofty rhetoric of UN Secretary General Ban Ki-moon and others that day. Only $238 million, barely half of the plan’s funding for the next two years, has been scraped together, most of that ($215 million) coming from money already pledged during the Mar. 31, 2010 post-earthquake UN conference.
            Meanwhile cholera treatment centers which MSF passed on to the government are currently “degenerating” into “contamination zones,” he says. When asked who should fund the plan, Libessart is blunt: “the people who are responsible for the introduction of the disease into the country, for example.”
            The same sentiment was expressed by Dr. Ralph Ternier, Partners In Health Director of Community Care and Support in the Central Plateau, where cholera originated and persists today at a rate double the national average.
            “What’s important for this kind of institution is their image,” said Ternier, not surprised by the UN’s parsimony on cholera relief. “The fact that they’d give more money would mean they are guilty.”
            Emergency funds for cholera – only 2.5% of which ever went to the Haitian government – dried up in January. Most NGOs have left and the funding vacuum is squeezing DINEPA, putting the water and sanitation jobs of two dozen qualified Haitians on the firing line.
            In January, white UN sewage trucks could be seen offloading their contents into the tailing ponds of Haiti’s first sewage treatment plant in Morne à Cabrit. Now, that plant has been closed for maintenance due to lack of operational funds. It opened only 18 months ago.
            Since sewage treatment is central to stopping cholera, why aren’t international funds forthcoming? “It beats me,” says Wilson Etienne, a DINEPA official who oversaw the the building of the treatment site.
            DINEPA still aims to open two dozen treatment sites, one in each urban center, but the only business model Etienne foresees making this possible is one that charges $4 per cubic meter of human waste.
            For now, the Morne à Cabrit plant remains closed. “This site should have been something Haitians could be really proud of,” laments Etienne, shaking his head.
An earlier version of this article was published in The Nation.
Cholera victims in a Haitian clinic. With Haiti’s water and sanitation almost completely privatized, cholera has been a death sentence for over 8,000 people.