After three years cholera-free, Haiti officials reported two confirmed cases of the disease in October 2022. Five months later, the United Nations Office for the Coordination of Humanitarian Affairs suspects the disease has spread to over 33,600 residents—most of whom are children under age five.

Haiti’s Department of Epidemiology, Laboratories, and Research (DELR) reported over 2,400 confirmed cases and over 29,700 hospitalized cases on Feb. 28. The DELR has shared that 594 people have died from Cholera in Haiti and that it has spread to Dominican Republic where there are now 88 confirmed cases.

Nearly 20% of the confirmed cases are children aged one to four and 16% of cases are children aged five to nine. Some physicians suspect the newest spread of the disease is due to a lack of immunity among young children and increased risk to bacteria from unsafe living conditions due to ongoing social and political strife. Haiti health experts have reported a lack of access to affected areas and limited fuel distribution that has inhibited basic water and sanitation services. There is also a growing global cholera crisis that has increased demand for supplies like the oral vaccine.

Cholera is a bacterial disease typically spread through contaminated water or food. Symptoms include diarrhea, vomiting, dehydration, and sometimes fever. The disease was first introduced to the country in 2010 by U.N Peacekeepers responding to the catastrophic earthquake. The Center for Disease Control reported over 820,000 cases and nearly 10,000 deaths at the time.

The earlier outbreak put a heavy toll on the Haitian people, given how the disease was brought to them and how quickly thousands died from the disease. Dr. Wilfrid Cadet, Chief Medical Advisor at Health Equity International, said the messaging around the importance of hand washing, water treatments and general sanitation has been more well-received in 2023.

“As a society, we have remembered what happened,” Cadet said. “During the first outbreak, there was denial and rejection…we haven’t seen that in the new outbreak. Instead, there is more social mobilization and solidarity.”

Cadet said that cases peaked in November of 2022 and have steadily declined, although thousands are still presumed to have been affected already. The medical advisor said that the current social and economic strain on the country exacerbates unsanitary and unsustainable living conditions. In November, Health Equity International reported that the price of food in Haiti had increased to 63% due to inflation, putting almost half the country’s inhabitants at “acute food insecurity.”

Potable water and medical supplies, like oral treatments, are also needed to stop the spread, as well as more health professionals in areas where there is limited access to care.

Dr. Marie Deschamps, Deputy Director of Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), said that patients with confirmed cases of cholera in 2022 knew their water wasn’t potable but drank it anyway because “they had no choice.”

“It is unbelievable that in 2023 so many people do not have access to clean water,” she said. “This is unacceptable; this is something that they need to consider where someone can at least have access to clean water and not have to drink contaminated water.”

Deschamps, who works in Haiti, said health officials are working to decrease the stigma around the disease. The physician told Direct Relief that residents are more informed now than they were in 2011, so they try to seek treatment when they see potential signs of cholera.

The disease causes dehydration, which can be fatal if not properly treated. Fluids and nutrients are needed to overcome cholera, usually through oral or intravenous methods.

But medical professionals say treating the new wave of cholera has proven difficult. Transportation barriers across major roadways have been blocked, forcing healthcare institutions to deliver medical supplies by helicopter. Conor Shapiro, President and CEO of Health Equity International, says the helicopter deliveries have limited the number of supplies transported each day.

“Given the security challenges out of Port-au-Prince, we’ve been (transporting) medical supplies by helicopter with the UN to people in the south,” he said. “So over 2 million people in the south of Haiti are cut off completely from Port au Prince by road because of the security situation.”

In December, the State Department put Haiti under travel advisory “Level Four: Do Not Travel.” The U.S. Embassy released a statement on Feb. 5 that the travel restrictions are still in effect due to kidnapping, crime and civil unrest, citing that armed robbery, carjackings and violent crime were common. Fewer nonprofits and nongovernmental organizations are active in the country since 2011, and Haiti’s government does not have the resources or support to fight the humanitarian crisis on its own.

Shapiro said Health Equity International prioritized prevention and treatment methods during Haiti’s “horrific” cholera outbreak in 2010. The nonprofit has increased access to potable water, supported treatment centers and supplies at hospitals, and used community health workers to teach preventative methods.

“We’re in unprecedented times in terms of security in Haiti,” Shapiro said.  

Since Oct. 2022, Direct Relief has shipped more than 61 tons of medical aid to Haiti, including cholera treatment kits, to health organizations working in the country.