Haiti struggles to deal with major cholera outbreak

Haiti’s capital Port-au-Prince is bracing itself for an outbreak of cholera as the disease which has killed 200 in the countryside makes itself known in the city. The five confirmed cases in the capital are among more than 2,000 people who were infected in an outbreak mostly centred in the Artibonite region north of Port-au-Prince. At least 208 people have died with that figure likely to rise in the country’s first outbreak of cholera since 1960. The outbreak is the latest disaster to hit the poverty-stricken country still struggling to recover from the devastating 7.0 earthquake which left much of the country in ruins last January. (photo: David Darg)

Medecins San Frontieres sent assessment teams to the Artibonite region including the coastal town of St Marc, 70km north of Port-au-Prince. MSF said St Marc’s hospital was becoming overcrowded and does not have the capacity to handle a cholera epidemic. MSF staff are giving patients an oral rehydration solution to replace fluids lost from diarrhoea and vomiting symptoms of a cholera infection. Patients too sick to drink the ORS are given infusions intravenously. “The most important thing is to isolate the cholera patients there from the rest of the patients, in order to best treat those people who are infected and to prevent further spread of the disease,” the local MSF coordinator said. “This will also enable the hospital to run as normally as possible. We are setting up a separate, isolated cholera treatment centre now."

David Darg, of the US-based Operation Blessing International, drove the two hours from Port-au-Prince to find a “horror scene” at St Marc hospital. Darg said he had to fight his way through the gate through crowds of distressed relatives while others carried dying relatives into the compound. “Some children were screaming and writhing in agony, others were motionless with their eyes rolled back into their heads as doctors and nursing staff searched desperately for a vein to give them an IV,” he said. “The hospital was overwhelmed, apparently caught out suddenly by one of the fastest killers there is.”

Cholera is an acute intestinal infection caused by bacteria carried in human faeces and can be transmitted by water, some foodstuffs and, more rarely, from person to person. The main symptoms are watery diarrhoea and vomiting, which lead to severe dehydration and rapid death if not treated promptly. According to the World Health Organisation, there are an estimated three to five million cholera cases every year causing between 100,000 to 120,000 deaths. The WHO is worried about the emergence of a new and more virulent strain of cholera that now predominates in parts of Africa and Asia, as well as the unpredictable emergence and spread of antibiotic-resistant strains. And because brackish water and estuaries are natural reservoirs of this strain, cholera could increase where there are rising sea levels and increases in water temperatures.

While it is too early to tell what is causing the Haitian outbreak, conditions in the IDP camps remain primitive and conditions were ripe for disease to strike in areas with limited access to clean water. 230,000 people died in the quake. 1.2 million people were displaced as of August 2010 and a further 1.8 million are affected. According to a post-earthquake fact sheet produced by USAID, the majority of IDPs in Artibonite are “residing with host families, straining resources and creating housing space issues for both groups.” It noted deficiencies in disease reporting processes. As well there has been a mass migration of 120,000 people from Artibonite to Port-au-Prince in search of a better life.

So far there has been no reports of cholera in the camps, but if it does a public health crisis could be imminent. "It will be very, very dangerous," Claude Surena, president of the Haitian Medical Association, said. "Port-au-Prince already has more than 2.4 million people, and the way they are living is dangerous enough already. Clearly a lot more needs to be done."

Scammers use Haiti earthquake for online fraud

The Haiti earthquake had an unintended consequence of driving up phishing and scam attacks across the Internet in the first month of this year. In the days after the Haiti quake, scammers asked users to donate money to a charity however any donation disappeared into an offshore bank account. Building on this, spammers began to send phishing messages, pretending to be from legitimate organisations like UNICEF. Hackers also took advantage of the tragedy to deliver malware. In one example, users download a Trojan when they click on the link to view a supposed video of the earthquake damage. The findings were in the monthly State of Spam and Phishing report from Symantec. (photo by alex_lee2001)

The report found both scam and phishing categories doubled as in percentage of all spam in January 2010 compared to a month earlier. The total of scam and phishing messages came in at 21 percent of all spam, which is the highest level recorded since the inception of the report. As well as Haitian scams, the report found the well-known Nigerian 419 scam (named for the section of the Nigerian penal code which addresses fraud schemes) was on the rise again as was online pharmacy spam.

Symantec say spammers have changed their tactics regarding online pharmacy spam. They have now taken to using subject lines such as “Must-Know Rules of Better Shopping” and “You Must Know About This Promotion” which are vaguer than “RE: SALE 70% OFF on Pfizer.” Other misleading subject lines such as “Confirmation Mail” and “Special Ticket Receipt” were also used for online pharmacy spam messages.

They also say phishing attacks are getting more and more targeted in nature and are focused on attacking major brands rather than being mass attacks. Symantec observed a 25 percent decrease from the previous month in all phishing attacks. The decline was primarily due to a decrease in the volume of phishing toolkit attacks which have halved from the previous month. A 16 percent decrease was observed in non-English phishing sites as well. More than 95 Web hosting services were used, which accounted for 13 percent of all phishing attacks, a decrease of 12 percent in total Web host URLs when compared to the previous month.

The US remains the most likely point of origin of spam. Approximately one in four of all spam is American-based with Brazil next most likely far behind in second place with just 6 percent. India, Germany and Netherlands are responsible for 5 percent each. The US is even more dominant in the categories of geo-location of phishing lures and hosts with 52 percent of the former category and 49 percent of the latter. Germany is second far behind with 6 percent in both categories.

Symantec notes that China has clamped down on spamming by suspending new overseas .cn domain registrations. The China Internet Network Information Center stated this suspension will allow them to implement a better procedure to verify registrant information from overseas registrations. This was a follow-up action to a related move in mid-December that required additional paperwork with registrations. As a result, spam messages with .cn domain URL dropped by more than half in January, compared to December with a steep drop towards end of January.

The report also found a new trend in adult oriented phishing. The phishing site tempts the unwary by promising free pornography after logging in or signing up. These scams affect users who enter their credentials in the hopes of obtaining pornography. Upon entering login credentials, the site redirects to a pornographic website before leading to a fake antivirus site containing malicious code. An incredible 92 percent of adult phishing scams were on social networking sites. The phishing sites were created using free webhosting services.

The report offers advice so familiar it beggars belief so many people are still falling victims. It talks about unsubscribing from lists, keeping your mail address secret, deleting all spam, avoid clicking on suspicious links and email attachments or replying to spam, don’t fill in forms online that ask for personal information and finally don’t forward virus warnings which are usually hoaxes. Spamming is a multi-billion dollar industry that relies on the truth of the hoary phrase that “there’s a sucker born every minute”.

Dominican Republic anxious to show difference to Haiti

Haiti’s neighbour on the island of Hispaniola, the Dominican Republic has said its country was undamaged in last week’s massive earthquake and the country is available to offer support to the relief effort “in any way necessary”. A statement released by Ministry of Tourism said “the DR is making available its medical facilities for earthquake victims and is providing international relief organizations access to Haiti through the airport and seaports.” The statement also said the Republic’s transportation systems, communications systems, hotels, resorts, beaches and natural environment suffered no damage, a message designed to tell the world not to cancel its holiday bookings. (photo: Getty Images)

The statement also said the nation’s eight airports were open and receiving flights. However, the New York Times says the relief effort is using three key airports and a roadway in the Dominican Republic’s southern region to ferry supplies through mostly rural areas not frequented by visitors. Millions of Dominicans have donated time, money, supplies and expertise to help Haiti. But crossing the border is not the easiest of tasks.

The border crossing between Haiti and Dominican Republic is supposed to be open between 8am and 6pm. But as this intrepid traveller found in 2007, the reality is somewhat different. “An immigration official passed by and informed us that things opened at 9. By 9:30 more people had congregated, including immigration officials. The immigration people would ask us what we needed but when we would tell them…they just nodded and continued to eat their breakfast outside the locked office. Around 11, two hours after they were supposed to open, the windows opened the process began.” Even then it was a “shoving game” until “lots of stressful Spanish, shoving, yelling, and swatting bugs” got them over the border.

The blog writer also spoke about the trust involved in handing over a passport. This will not always work out for the best as a Trinidadian journalist has just found out. Dale Enoch is now stranded in the Dominican Republic after losing his passport at the border. Enoch came to the island to cover the earthquake for a Trinidad radio station and handed his passport at the border on his way to Haiti by bus. However he was unable to get his passport back when he returned and the bus company refused to take responsibility. “It appears that there is a passport racket going on,” Enoch said. “Once your passport has a US visa in it, it is attractive.”

But despite the corruption, the Dominican Republic is like another world compared to its impoverished neighbour. Michael Den Tandt of the Toronto Sun was also at the border and he noticed a great difference between the two countries. “On the Dominican side there’s grass, palm trees. There are well-paved highways, street signs and telephone poles. There are neat, small but well-kept and painted homes, with tidy yards,” he said. Compare that to Haiti with its “partly flooded gravel track, an impossible tangle of dilapidated little trucks, [and] teeming crowds desperate to get out.”

The Dominican Republic has now established a humanitarian corridor along the route between the two capitals of Santo Domingo and Port-au-Prince. Haitian President Rene Preval accepted a proposal from the Dominican Republic for 150 Dominican military troops to patrol the corridor in cooperation with a contingent of Peruvian troops from the UN Stabilization Mission in Haiti. But DR’s foreign minister was forced to deny that Preval had turned down an earlier offer of 800 troops and they had to reach a compromise for a much smaller number. “When you are helping a friend and neighbour, there is no need to negotiate,” he said. “There were no negotiations and no rejection (from Haiti).”

And while relations between the two nations haven’t always been the most cordial, there is little doubt that Santo Domingo has played a crucial role in the earthquake relief effort. Many Haitians have been crossing the border into Jimani for medical attention almost overwhelming the local hospital which is lavish compared to the facilities back in Haiti. The hospital usually has about 30 hospital beds, but over the past week, there have been as many as 150 patients per day. But it is coping thanks to overseas relief and the better quality of DR health care compared to Haiti. As Tallahassee’s WCTV.tv noted, the Dominican Republic also suffered a 7.1 magnitude earthquake in September 2003. But only one person died, which was the result of a trauma induced heart attack. “The difference in death tolls between that quake and Haiti's come down to two factors,” said WCTV.tv. “It was in the middle of the night, and the buildings in the Dominican Republic have a higher code of infrastructure.”

Earthquake in Haiti: Port-au-Prince picks up the pieces

No one really knows how many people have died in Haiti’s earthquake; it is far too early to count the bodies. The country's prime minister, Jean-Max Bellerive told CNN the final toll could be well over 100,000. Another senior Haitian politician Youri Latortue told AP the number could be as high as half a million, but both men conceded that nobody really knew. What most people did know was that the impact was utterly devastating. The 7.0 quake that struck 15km southwest of Port-au-Prince yesterday afternoon affected two million people and destroyed most of the capital’s buildings including the presidential palace, the parliament, the cathedral and most critically, all of the city’s hospitals.

Port-au-Prince is struggling to deal with the enormity of the disaster. The Times said the city's central Champs de Mars square resembled a huge open-air refugee camp but one without food, water or medicine. Medicins Sans Frontiers say there are hundreds of thousands of homeless people now sleeping in the streets. One of MSF's senior staff in Haiti, Stefano Zannini, was out for most of the night, assessing the needs in the city and looking at the state of the medical facilities. Zannini said the situation was chaotic. “I visited five medical centres, including a major hospital, and most of them were not functioning,” he said. “Many are damaged and I saw a distressing number of dead bodies.”

The country’s president René Préval said the damage caused by the magnitude 7.0 tremor was "unimaginable". The Huffington Post had a before and after shot that showed the extent of the damage at the presidential palace. But wondering where he would sleep that night was the least of Préval’s problems. “Parliament has collapsed, the tax office has collapsed, schools have collapsed, hospitals have collapsed” Mr. Préval told the Miami Herald. “There are a lot of schools that have a lot of dead people in them. All of the hospitals are packed with people. It is a catastrophe.”

The five-storey UN base at the Christopher Hotel was not spared; it also crumbled in the quake. The international body said 16 of its personnel were confirmed dead and between 100 and 150 more workers were still missing, These included UN mission chief Hedi Annabi of Tunisia and his deputy, Luis Carlos da Costa of Brazil. Annabi was meeting a Chinese delegation at the time of the quake. The Chinese are also among the missing. Just about the only good news from Haiti was the fact that most other areas of the country were spared - the capital took the brunt of the quake.

Mashable have listed ways people around the world can help. These include direct donations to organisations in the field such as Care, Direct Relief International and Oxfam, as well as via a site Google has updated to respond to the crisis Google Support Disaster Relief. Meanwhile Haitian hip-hop musician Wyclef Jean has used his Twitter feed to rally people to contribute to his grassroots Yele Haiti fund via text messages which automatically charge $5 to users’ mobile bills. The LA Times said the campaign has raised $400,000 in 24 hours.

Reuters's Lesley Wroughton says Haiti will need a lot more money than that to recover from this catastrophe. The impoverished country was already the poorest in the western hemisphere and it will take a massive, sustained global effort to rebuild the country. Wroughton says Haiti was rebuilding from its failed state status and had gradually impressed donors and investors through economic reforms, efforts to stamp out corruption and improve conditions for the four out of five Haitians who live in poverty. The IMF and World Bank had canceled $1.2 billion of debt, freeing up crucial funds for the government to build roads, bridges and prepare social programs.

Wroughton quoted CARE’s CEO Helene Gayle who said Haiti could no longer survive from crisis to crisis and needed to get on to a path of long-lasting, sustained change. Gayle called it Haiti’s Asian tsunami, and said it was a chance for the world to be generous and commit to helping Haiti beyond the current disaster. "We need to make sure that we're building back in a way that does not only return them to where they were but gives them an opportunity to really get a leg up after this is all over," Gayle said.

food riots escalate in Haiti

Rioters in the Haitian capital Port-au-Prince attempted to storm the presidential palace yesterday demanding the resignation of President Rene Preval. UN peacekeepers drove them off the palace grounds using rubber bullets and tear gas. The palace attack was the latest escalation in violence that has been growing across Haiti for over a week with rioters are angry over rising food prices. In Port-au-Prince, they left a trail of destruction across the city smashing windows, setting fire to buildings and blocking streets with concrete barricades and burnt out cars.

The protesters tried to break into the presidential palace by charging its chain gates with a rolling dumpster truck. They were foiled by Brazilian UN troops arriving in jeeps and assault vehicles. Preval was in the palace at the time of the attack but has made no public statement as yet. Preval is a former ally of ousted President Jean-Bertrand Aristide and took over from him as president in 1994. He was replaced by Aristide again in 2001 until the 2004 coup that brought an end to that regime. Preval was elected leader again in 20006 but has been helpless to end Haiti’s unending crisis.

As well as the removal of the Washington-backed Preval, the protesters also want to the end the 9,000 strong UN mission MINUSTAH (UN Stabilisation Mission in Haiti). The force has been in place since the 2004 rebellion that led to the downfall of Aristide. It has a mandate not only to stabilise the environment but also to assist with instituting a political process and promote human rights. The force was initially popular as it aimed to curb the power of Haiti’s armed gangs. However many Haitians want the force removed after incidents where children were caught in the crossfire.

The current series of riots started in the southern port city of Les Cayes last week where 5,000 protesters shut down the city and tried to burn down a UN compound. Five people died in the violence there. Demonstrations against the high cost of living quickly spread to other cities. Hundreds protested on 3 April in Haiti’s fourth largest city Gonaives on the northwest coast. Protests there were largely peaceful, but UN workers were evacuated to a police base, and five people were injured with rocks as protesters tired to force a school's administration to let the students join the demonstrations.

The violence finally reached the capital on Monday. UN envoy to Haiti, Hedi Annabi, said international efforts to stabilise Haiti was becoming “extremely fragile” due to the country’s soaring food prices and declining living standards. He called for urgent food aid, and said 80 percent of Haiti's 8.5 million people live on less than $2 a day. These people, he said, were seriously affected by the global increase in prices for basic food items. "I think there is a need for urgent assistance to alleviate the suffering of the population," he added. "At the same time, we need to remain vigilant and respond robustly so that we do not allow these demonstrations to be exploited by people with political motivations.”

Haiti is the Western Hemisphere's poorest nation. 80 per cent of the country’s adults are unemployed. Barely one in five Haitians over 15 can read and write. There are few paved roads, an inadequate supply of drinkable water, minimal utilities, and depleted forests. Almost all its food is imported and the price of beans, fruit, rice, and condensed milk has gone up 50 percent in the past year, while the price of pasta has doubled. Many Haitians have taken to eating cookies made of dirt, vegetable oil and salt.

In stark contrast to the country’s widespread abject poverty is Haiti’s small elite. This consists of no more than several thousand families who are extremely wealthy, including many millionaires among their number. The country's wealthy are clustered around the cooler mountainside suburb of Pétionville, where French restaurants and luxury car concessions cater to expensive tastes. Education and medical services are entirely private, and the children of the elite tend to be educated abroad, either in Paris or the US.

This is very conspicuous consumption in one of the three countries of the world with the highest daily caloric deficit per person (460 kcal/day below the daily requirement of 2100 kcal/day). To address this deficiency the World Food Programme (WFP) are appealing to the international community for urgent funds to support its operations in Haiti. Last month, WFP appealed to donors for an additional US$500 million to respond to dramatic increases in global food and fuel prices. WFP Executive Director Josette Sheeran said what is happening in Haiti is repeated across the world “Rising prices that mean less food for the hungry,” she said. “A new face of hunger is emerging: even where food is available on the shelves, there are now more and more people who simply cannot afford it.”

unending hatred in Haiti

Two Jordanian UN peacekeepers were shot dead in Haiti on the weekend. Unidentified gunmen attack a UN convoy as peacekeepers were heading back to their base near a slum area of the capital Port-au-Prince. The 8,000 UN peacekeepers in the country are facing increasing slum violence. Many slum dwellers have accused them of firing indiscriminately into civilian crowds during gun battles with gangsters. Opposition is growing to the Brazilian-led force who were sent into the country to restore order after a bloody 2004 revolt ousted then-President Jean-Bertrand Aristide. The death of the two Jordanians brings the total UN dead to nine since the mission started in June 2004.

French-speaking Haiti occupies the western third of the island of Hispaniola. It shares a land border with the Spanish-speaking Dominican Republic. The island was initially inhabited by Taíno and Amarak Amerindians. The Taino called the island Quisqueya which means "mother of the earth" whereas the Arawak name, Ayiti, was reintroduced in 1804 as the name for independent Haiti. Columbus ran aground on the island in 1492 and claimed it for Spain. He named the island La Española for “the Spanish”. The name was eventually anglicised to Hispaniola. Columbus left a settlement on the island but when he returned a year later the settlers had all disappeared. He left his brother Bartholomew to start a new colony. The impact on the Taíno and Amarak was devastating and most died due to old world diseases and repression. French pirates established a toehold on the island in 1625. In 1664, the newly established French West India Company took control over the colony, and France formally claimed control of the western portion of the island of Hispaniola. Spain formally ceded control to France after the Treaty of Nijmegen ended the Franco-Dutch war in France’s favour.

Settlers begun to grow tobacco, indigo, cotton and cacao using African slave labour. An estimated 800,000 slaves were brought to work on sugarcane and coffee plantations which amounted to a third of the Atlantic slave trade. In 1681 Louis XVI enacted the code noir, which gave basis human rights to slaves and responsibilities to the master to feed and clothe them. The code sanctioned corporal punishment and many slaves escaped to the hills to avoid its harsh sanctions. The 1789 French Revolution had a powerful effect on the colony. Within two years, the slaves revolted. Over the next 12 years, slaves burnt plantations and killed their overseers. The French were weakened by a British naval blockade and Napoleon was unwilling to send reinforcements. Finally in 1804, Haiti declared independence from France, the first and only successful slave rebellion. The cost of freedom was high. Haiti was forced to make reparations to French slaveholders in 1825 in the amount of 90 million gold francs. It took 100 years to repay and turned Haiti into the poorest nation in the western hemisphere. And because of resistance from the US slave states, Haiti was not recognised by the US until 1862.

Haiti survived a period of rebellions until it achieved some stability with the constitution of 1867. This period of growth ended when in 1911 when revolution broke out and the country plunged into debt and anarchy. In four years there were six different Presidents, each of whom was killed or forced into exile. The US military occupied the island in 1915 due to threats to business interests in the country. They ruled Haiti for the next twenty years. Franklin Roosevelt removed the marines as one of his first acts of presidency. The US trained local military was only cohesive institution left in the wake of withdrawal. This resulted in a series of military-backed dictatorships over the next 50 years.

The most famous of these were the Duvaliers; Dr Francois Duvalier and his son Jean-Claude who between them ruled Haiti from 1957 to Jean-Claude’s overthrow in 1986. Francois, nicknamed Papa Doc, was a country doctor who won acclaim for his role in fighting typhus. He won office by presidential election but soon abandoned any notion of democracy. He enlisted the aid of a private army modelled on Mussolini’s Blackshirts known as the Tonton Macoute. The Tonton Macoutes were known for wearing dark glasses, wielding machetes, and leaving their victims hanging in a public place as a warning to others. Papa Doc revived the traditions of Haitian voodoo and killed nearly all of his political enemies during his 14 years in power.

He declared himself "president for life", and rewrote the constitution after a rigged election to pass power onto his overweight and dim-witted 19 year old son Jean-Claude upon his death. Known as Baby Doc he somehow managed to gain public affection and support from the US. His mistake was to marry a light-skinned mulatto and he lost much support in the black community. Pope John Paul II visited Haiti in 1983 and said “something must change here”. Within two years the country revolted. The game was up for Baby Doc when he lost the support of the US Reagan administration and he fled to France.

The charismatic Jean-Bertrand Aristide was elected president in 1991 and he ushered in a new period of optimism. It was short-lived. He was brutally deposed in yet military coup. The US invaded again in 1994 to overturn this coup and Aristide’s ally Rene Preval was elected president. Preval was the first democratically elected Haitian leader to serve out a full term. Aristide returned to power in 2001 but was overthrown by a 2004 coup after he attempted to disband Haiti’s feared and despised military. Aristide accused US President Bush of supporting the rebels. The US sent in marines again. Chief Justice Boniface Alexandre was appointed interim leader and he immediately asked the UN to intervene with an international peacekeeping force. Brazil leads the MINUSTAH (Mission des Nations Unies pour la stabilisation en Haïti) force with a mandate to “"to concentrate the use of its resources, including civilian police, towards increasing security and protection during the electoral period". In July 2005, MINUSTAH carried out a raid in a Port-au-Prince slum targeting a base of illegally armed rebels. Estimates of fatalities ranged from 5 to 80 but the incident served to harden resistance against the force.

Elections were finally held in February 2006, and the well-respected René Préval was elected president for a second term. But Preval is helpless to solve his country’s issues without external support. Yesterday, the president of the neighbouring Dominican Republic urged international help to solve the intractable problems of Haiti. On a visit to Washington, President Leonel Fernández urged President Bush to "help Haiti in any way you can." Asserting it "may have been a mistake" to disband the military, he said the police cannot handle the security challenges alone. Haiti remains one of the poorest countries in the world with about 80% of the population living in abject poverty.