by Elizabeth M. Campa, Water Sanitation and Hygiene Coordinator, CARE Haiti

Flood waters surround a water pump in Léogâne, Haiti. © 2012 CARE

"Haiti is the country with the highest risk of vulnerability to climate change in terms of potential floods and mudslides," according to the Climate Change Vulnerability Index. The index ranks nearly 200 nations and their vulnerability to climate change. The arrival of hurricane Sandy proved this tragic statistic true – once again.

Contrary to the effects causes by tropical storm Isaac, which hit Haiti in August and brought strong winds, this time communities were mostly affected by the massive quantities of rain. Assessments conducted on October 26 and 27 in the areas where CARE works (Léogane, Carrefour and Grande-Anse) showed the extent of the damages. In Léogane, located along the coastline, several villages were washed by massive flooding, leaving more than 300 families homeless and forced to seek refuge in schools and churches or with more fortunate neighbors.

The situation in Carrefour was even more devastating. Here, a region of over 450,000 inhabitants, most people are living in transitional shelters constructed after the devastating earthquake in 2010 (more than 1,100 of these shelters were built by CARE). Hurricane Sandy damaged more than 300 shelters and destroyed 200 latrines currently under construction.

Carrefour is also a region with very scarce access to potable water. People trying to reach water spring catchments can only do so by crossing a river that now is swollen. And to make a bad situation worse, many of the water kiosks (places where people are able to clean water for a small fee) have been closed, due to power shortages and the absence of operators, leaving the population no other choice than to use river water for drinking that has been contaminated by fecal matter due to lack of latrines in the area.

Grande-Anse, and its 12 communes, was most affected by Hurricane Sandy. Massive rainfalls washed away bridges and homes. An estimated 3,000 homes were destroyed or badly damaged, and more than 1,600 people displaced. Many areas are still completely cut off. The destruction has had a high impact on food security: 40-50 percent of crops are lost. The production was already expected to be low due to droughts and tropical storm Isaac, therefore placing this farming community at higher risk in terms of increasing levels of malnutrition.

Cholera is another pressing issue. Grande Anse has the highest cholera prevalence in the country. CARE’s immediate response consists of supporting cholera treatment centers through programs already in place in the area, repairing existing cholera treatment facilities, through our partner Médecins du Monde-France, as well as improving water sources. We’ll also focus on the distribution of aquatabs to purify water, tarpaulins and tents, hygiene and kitchen kits, and water containers as well as the promotion of hygiene in the area. In conjunction with the local water authority, DINEPA, CARE erected a water bladder containing 1,500 gallons of chlorinated water, and will continue to do so as needed, particularly in areas where cholera is likely to spread.
The lack of clean water and proper sanitation in Haiti is often simply overwhelming.

In my 12 years of experience working overseas in development and emergency programs, I find it unbelievable that Haiti experiences such low levels of access to water and sanitation, considering its close proximity to the U.S.A. Hurricane Sandy will not be the last storm that passes through Haiti. We will continue to see natural disasters destroying people’s lives and livelihoods and they will need our assistance. It is imperative that we invest in improving water and sanitation and disaster risk reduction, so people can protect themselves and be prepared for future disasters.

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A boy pushes a bike through a flooded street in Léogâne, Haiti. © 2012 CARE

The western regions of Grande Anse and Leogane, where CARE is currently active, were badly hit. According to initial CARE field assessments, more than 6,500 homes have been flooded, damaged or destroyed, with approximately 7,500 people having been displaced. However, a complete overview is sketchy at best as access to many areas, particularly in the Grande Anse, is difficult. The main route is inundated in places with a key bridge destroyed and other routes are impassable by vehicles. Boats and airplanes are currently the only means to transport relief items quickly. The Haitian National Emergency Center reports a total of 7,627 families (approximately 38,000 individuals) have been affected, with 44 deaths and 19 grave injuries.

CARE had been preparing for a possible emergency response in Grand Anse and Leogane these areas before the hurricane hit the country. The emergency team now is planning to support affected people with clean water as in many areas. Because water points have been damaged, the population dependent on river water for consumption, which is not only dangerous due to its dangerously high levels, but the risk of cholera.

CARE will assist in distributing aqua tabs to purify water, soap and jerry cans. In order to provide clean water, CARE’s water and sanitation team may also install water bladders as needed. CARE will also assess current project sites and cholera treatment centers to determine the level of repair required to reestablish access to potable water and sanitation facilities.

In Leogane, especially in the areas of Saria and Bino, where 300 families lost their homes and all possessions, CARE is supporting other local organizations which have already response plans in place CARE has more than 40 trained staff, including social mobilizers, water and sanitation experts, as well as engineers that are available to assist organizations carrying out emergency assistance.

June 6, 2011
Stories and photos by Mildrède Béliard, CARE Haiti

On the road to Carrefour, nothing has changed. At the entrance to the town, you see the market where fruit and vegetable waste is rotting and where traders stand with their feet in water.>

You may not notice it but the town has been facing a resurgence of the cholera epidemic, which reappeared here just under two weeks ago. This morning, a 12 year old boy died. He was one of two people carried on the backs of other residents of the site to a Cholera Treatment Center (CTC). He did not make it. He was living near the camp Bel Air 3. He had been ill since the previous afternoon, but his mother refused to admit that he had cholera until camp residents, trained and sensitized by CARE, realized he was suffering from the disease.

In the car taking us to Lycée Louis Joseph Janvier, which houses more than 1,200 people, the cell phone of Naomie Marcelin, one of CARE's health promotion activities supervisors, does not stop ringing. She is told that three cases have been identified in a site that had not previously been affected by cholera.

"Last week we distributed aquatabs in sites where we work already. We have also offered HTH solutions (concentrated chlorine) to disinfect the tents where there is a risk of cholera," says Naomi. "During the week we plan to deliver oral rehydration salts (ORS) to households."

Naomie is dismayed about the death of the young boy . To avoid a similar situation, she plans to propose the installation of oral rehydration posts (ORP) on sites in remote areas. "The boy died of dehydration. If people had been able to rehydrate him before taking him to the CTC, he would have survived," she explains.

At Lycée Louis Joseph Janvier, CARE teams are ready! They have posters and leaflets to explain key practices to prevent the spread of the cholera epidemic to representatives of a number of other local camps.

Around 20 people are present. Some are members of mothers' or youth clubs created by CARE WASH and Health teams to serve as peer educators.

Brice Sodlon is a voodoo priest who performs at Lycée Louis Joseph Janvier: "It is essential to learn, especially if you are a leader in your community. My family lives in this camp. My friends live in this camp. It is a duty for me to learn how to protect them from this disease," said Brice. "CARE can't stop. CARE does not have the right to stop. If CARE had run this training at the start of the crisis at Grand'Anse, I am sure all these voodoo priests would not have been killed by the people who were accusing them of causing the disease," he says.

Like other participants at the training, Brice knows the essential actions to take to protect himself against cholera: wash hands regularly, treat drinking or cooking water, cook food well, wash fruit and vegetables thoroughly with chlorinated water, treat human waste. Simple actions that save lives.

The cholera outbreak, which had decreased a few months ago, returned in force two weeks ago, affecting areas in which it had not previously been seen. CARE has started training and awareness sessions in camps, and also plans to distribute hygiene kits, water purification tablets, oral rehydration salts and concentrated chlorine solutions.

On Saturday, May 4, CARE donated sanitation equipment – wheelbarrows, shovels, rakes, trash cans – to Carrefour City Hall, which had organized activities to mark International Environment Day. These materials will be used to clean camps and public areas to avoid the worst.

Béatrice Jean-Louis and Magdala Saint-Ange, CARE staff members, holding a training session on cholera prevention at Lycée Louis Joseph Janvier, an IDP camp housing approximately 1,200 people. The cholera outbreak hits Carrefour where more than a thousand people are hospitalized.

Brice Sodlon, a voodoo priest in Carrefour, participating in the training session

A CARE mother's club member showing to the group how to use purification tablets to clean water at the training session.

• Read more about CARE's work in Haiti
• CARE scales up activities to respond to resurgence of cholera
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Story and photo by Marie-Eve Bertrand, CARE Haiti
November 11, 2010

Yveline walks up to me with a nice smile, but I can tell she is reserved. As we walk into her parent's house, I notice that all of her family's belongings are stored on the table, on the higher cupboards or shelters.

"When Tomas approached, CARE staff brought a speakerphone to the community and told us to get prepared. We stored our things and, therefore, did not lose too much," Yveline says. "The rain and water filled the streets and our house." She shows me the mark on the wall, indicating the water level: three feet high.

Yveline is one of the 333 children that CARE sends to school here in Gonaïves. She has been in the project for six years and is really thankful for the help her family gets from CARE. She is smart and caring.

"My dream is to be a doctor because I want to help my community and other people who are disadvantaged. I know it is a lot of work, but thanks to CARE's generous donors, I have been able to concentrate on my studies," Yveline tells me. "My family supports me, and I know that one day I will do good work."

I asked her about cholera and the situation in Gonaïves. She tells me about what they have learned so far through CARE's prevention training."Cholera is an illness that is treatable and preventable. People need to wash their hands, disinfect their house if someone is sick and give them rehydration salts. And we need to make sure that we should not abandon those who are sick. They need help!"

She adds, "Cholera should not kill so many people. The problem is that we have little sanitation infrastructure, and now with Tomas' flooding it is even worse. We have very poor land management. We cut too many trees with no plans, and did not pay attention to our natural resources. Now, it is our infrastructure that is missing. We do not have enough gutters, and we do not care enough for our environment." "

When looking at her, you see that she does care for her neighbors. She is volunteering with CARE – attending meetings and training. She wants to make a difference in her world.

We walked outside of her parent's house, and jumped on stones to avoid stepping in the mud that covers their yard. The streets are filled with waste and mud. But, Yveline is off, helping spread information on how to prevent cholera.

Once she's gone, I can't help wonder how many out young Yvelines did not have the chance to go to school, live their dreams and build a better life for themselves and their communities.

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Story and photo by Marie-Eve Bertrand, CARE Haiti
November 11, 2010

The sun is shining, dogs are barking and the wind is blowing. This could be a normal day in Gonaïves. But it's not. Streets are empty, kids are not in school and mothers are concerned.

As I was with a community volunteers team, we were training women on how to purify the water they sell with bleach that CARE is providing them. A woman showed up. Wearing a mask, she was scared to approach me, scared to touch anyone.

Our team then visited an area called Descoteaux. This part of Gonaïves was flooded by Hurricane Tomas a few days ago. Now mud and garbage are covering streets. We stopped at Rosette Noël's house situated in a zone where CARE's volunteers and staff have distributed aid. A little girl is looking at us. Suddenly, another one joins her, then a grandma, a dad, two teenagers and a mom. Rosette is the mother of many kids she tells me. Her family includes her sister, her brother, and many siblings. I tried to get an exact figure. I don't think she knew.

Rosette tells me that when Tomas struck, they did not have enough time to gather their belongings. I could tell this was true by looking at the clothes and miscelleous household items drying on the brick wall between the houses.

"There was mud everywhere," she says. "We sought refuge with our neighbors. In this neighbourhood, we take care of one another. But what concerns me now is that my niece was sick yesterday. And now it is my sister. They are resting in bed, and we give them rehydration salts and clean them. We do what we hear on the radio messages." CARE's public information campaign via radio instructing Haitians on how best avoid and prevent cholera has reached at least 200,000 people to date. I am glad Rosette has hear them.

When I asked her why she was not taking them to the hospital, she turns her head. She is concerned about the fact that the hospitals are already over capacity and that the staff does have the ability to take care of her loved ones.

"We know that some people were left on the streets because they were sick. I don't want that to happen to my family. We can take care of them. I am afraid that they will get more sick in the hospital," Rosette explains. "Family is everything."

Her youngest looks at me. She is gorgeous and smiling. Her eyes are full of life and joy. I just wish I could do something to help them. But they know what to do.

"CARE helped us a lot. They came here to tell us how to protect ourselves before Tomas, and then after [explaines how to help]avoid being sick. We received soap bars and aquatabs," Rosette says.

As I leave the house, they wave goodbye to me. The grandma tells me to take good care and to stay healthy. These people are generous, and I am so proud I got to meet them.

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by Dr. Franck Geneus, CARE health manager in Haiti
November 10, 2010

The situation here in Artibonite is all but reassuring. You can feel the angriness rising slowly but surely. In Raboto, it was reported that the dead were being abandoned in the streets. Hospitals are already at capacity with patients infected with diarrhea. Others who are infected are being discharged or discouraged not to go to the hospital in the first place. The police have assigned a car that transports infected people both dead and alive. This car is not being disinfected.

Protests in the streets were reported by the press. The fear of illness is everywhere. The sick are not adequately being taken care of and are seen as pests. Babies have been abandoned. Those that have children in schools are thinking of keeping them at home.

The number of new cholera cases have increased to 15 per day up from 3-5 cases before the hurricane struck. In the Hospital of Marmelade, over 200 cases have been reported since the beginning of the epidemic on October 20. Dead bodies are not being properly disposed of. Support staff are reluctant to come into contact with them because they don't have appropriate protective outfits.

CARE is supporting communities where we have our presence by providing early detection and management of cases; medically assisting rehydration; and conducting proper evacuation of cases. CARE's main focus is in helping facilities use proper hygiene and sanitation. CARE was approached by the Ministry of Education, for example, to clean a school which was flooded near a cemetery where bodies were wrongly disposed of. The cases are increasing and it wouldn't be a surprise if we see a boom in the epidemic in the coming days.

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by Marie-Eve Bertrand, CARE Haiti Emergency Team

09:00, Nov. 6, 2010

Saturday was a busy day for CARE's team. I spent the day with CARE teams on their field visit to Léogâne. When we arrived in the downtown area, I was shocked by the level and the strength of water in the streets. The Rouyonne River had overflowed. Once again. And it has washed away a substantial part of downtown.

People are walking in the knee-deep water filled with garbage, human waste, bugs, and what else...

Women and men were cleaning their houses or shelters, removing the mud and trying to make it look clean. Truth is, I am concerned that a broomstick is not enough to sanitize a place that was filled with filthy water.

Yet, amazingly, not everyone we met was in despair. Indy, a young women living with her mom, was cleaning their little brick house. Her mom was telling me it was enough, it had to stop. She was cleaning her clothes as Indy was removing the muddy water from the one room they use as a kitchen, living room, dining room and bed room. Indy was smiling to me, and I asked her if she was upset. She said, "No ... What would it change?"

(Indy cleaning her house in Léogâne after Hurricane Tomas flooded the town. Photo: Marie-Eve Bertrand/CARE)

I stopped to visit the family living in CARE's first temporary shelter. I remember meeting her this summer, as she was just about to move in. It would have been great to meet her in a better situation. She lost everything but her family in January. This time, their belongings were pilled up, the mattress was wet, the walls were dirty, and her ti-moun (child) was hungry.

She looked at the sky and said: "This is an act of God, what else can I say? But it's enough. I want fresh food for my kids, I don't want them to be sick. There are very few latrines here. People do their things in bags and throw them in the canal. It was always like that. Now the canal is overflowing."

(Read more about CARE's work helping survivors have a sturdy roof over their heads and a strong foundation to rebuild their lives. Photo: Marie-Eve Bertrand/CARE)

Yes, it is. And I saw those bags floating around. Filled with human waste. While kids were playing around ...

Cholera, of course, is on the mind of everyone, including the CARE staff. Sunday, our CARE team distributed help to 9500 beneficiaries in Léôgane. We gave them aquatabs, Hygiene kits or BP5 (high energy biscuits) based on their needs. The response is done in partnerships with the other NGO's on the ground.

In Bino Lester, a grandma walked up to me. Her crops had flooded. She was frustrated. Enough, she said. This has to stop. Even the strong people of Haiti have their limits.

Tomorrow, I head to Gonaïves, where a CARE team will continue distributions and raise awareness of health risks such as cholera. The flooding was quite serious there. I might see another smile like Indy's. But given the triple-dose of disaster in Haiti these days, it would not surprise me if I did not.

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by Marie-Eve Bertrand, CARE Haiti Emergency Team

06:00, Nov. 5, 2010

I woke up to dark grey clouds. There is no sun in Port-au-Prince today. It was pretty quiet first thing this morning as the storm was 'stopped' by the mountains, but then suddenly, it was as if someone opened the tap. It is loud now... very loud! The rain sounds as if you're standing next to a waterfall. For a moment I thought we would be okay. Now I am really concerned about our staff and friends living in camps or shelters. You don't want to be outside at this time...

Yesterday the staff and people in our neighbourhood were getting ready for the storm - packing up food, water supplies. I was at the market yesterday and you could tell that people were nervous. Everyone was filling up their baskets, talking loud, moving fast ...

Usually the market it's pretty relaxed, but yesterday everything changed. People were in the streets, the traffic was heavier much sooner as everyone tried to get home to their families, and the businesses closed much earlier.

People were asking: "Why this? Why us? Why again?"

The rain is getting harder. The wind hasn't picked up yet, but if this gets worse, I can only imagine how bad it will be for the people in the camps.

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