A Photographer’s Journey Into Haiti’s Cholera Crisis

After Hurricane Matthew hit, a silent killer struck the fragile country—again.

Photograph by Andrea Bruce, National Geographic
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Rose Dena, 85, attempts to clean what is left of her home in the mountains of southern Haiti more than a month after Hurricane Matthew.
Photograph by Andrea Bruce, National Geographic

The same rains that were spreading cholera across southern Haiti were blocking Andrea Bruce from getting to the story.

The National Geographic photographer had arrived a few weeks after Hurricane Matthew struck the island in October to document a new surge of cholera cases spreading across some of the country’s most remote areas.

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Hurricane Matthew flooded rivers and villages, making it difficult to reach remote areas in the mountainous south. A river near the town of Moron was finally crossable after a couple days without rain, allowing residents from nearby remote villages to buy and sell goods.

When she found the roads to the hardest-hit areas too waterlogged to drive, she set out on foot. As she traveled, she watched the floodwaters sweep away a truck. Nine times during her trek, she had to wade through waist-high rivers with her camera over her head. Once, when a strong current dragged her downstream, two passersby had to grab her and pull her to safety.

When Bruce reached the mountainous epicenter of the cholera crisis, a town called Rendel, she found crumbled homes, some with just a door frame or a single piece of furniture left standing. Residents were scrapping together small shacks from the rubble.

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People displaced by Hurricane Matthew take refuge in a public school in Les Cayes, Haiti. Students who normally attend the school protested their presence, blocking intersections throughout the city, in an effort to resume classes.

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Structures that survived the hurricane, like this school, are now sheltering displaced people who saw their homes crumble in winds that reach 145 miles an hour. The storm killed at least a thousand people in the country.

“When I woke up [each day] the first thing I’d hear were the hammers of people trying to rebuild their homes,” she says. “That’s actually a great sound.”

Bruce, who has spent 15 years photographing conflict around the world, says the resilience she encountered in Haiti is unlike anything she’s ever seen. “When you ask what happened, they tell you their story in a calm, matter-of-fact way,” she says. “But every story is one of the most dramatic I’ve ever heard.”

How It Began

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Fritznel Xavier, 15, receives a rehydration IV at a CTC in Jeremie, one of the cities hardest hit by the cholera epidemic. His parents carried him six hours to the center that morning after he showed symptoms of the disease.

Hurricane Matthew battered Haiti with 145 mile an hour winds, halting the slow reconstruction that’s been under way since 2010’s devastating earthquake. Some 175,000 people were displaced in the immediate aftermath of Matthew, as homes, health clinics, and schools were toppled. From the rubble and murky water, a familiar enemy returned: cholera.

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June Volontiaire's daughter brought her to a health clinic in Dame Marie, Haiti, when she contracted cholera. The disease is now heavily present throughout the south, rising and falling with the rain that carries infected sewage down the rivers.

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It took two and a half hours by motorcyle to bring 19-year-old Wilken Pirus to the nearest Cholera Treatment Center (CTC).

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Cholera patients receive IVs in southern Haiti. A resurgence of cholera, which first appeared after the 2010 earthquake, has appeared across the areas hit by the hurricane.

The illness, which comes from contaminated food or drink, causes vomiting and severe diarrhea. Without treatment, victims become severely dehydrated and can eventually die. Since the hurricane, there have been more than 8,000 suspected new cases. Since the 2010 earthquake, some 800,000 people have been infected overall, and at least 10,000 killed.

The disease was brought to Haiti by the same people who came to help in the months after the 2010 quake. The source of the outbreak was traced back to Nepalese UN peacekeepers who’d disposed of their sewage in a river near their base. The waste contaminated water supplies and spread rapidly. Before that, the island nation hadn’t seen a case of cholera for 150 years.

“Haiti was the perfect storm for cholera,” says Sean Casey, director of emergency response at the International Medical Corps, who was in Haiti in 2011 when the disease first appeared. The country’s high population density and displacement, coupled with a general lack of sanitation, helped cholera spread quickly.

The More Things Change

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Clairvicia Conseillant bails water out of her home which was destroyed by Hurricane Matthew. The persistent rain has made it impossible to rebuild.

Six years later, says Bruce, a strong distrust of the UN still lingers in Haiti. Shooting in a coastal city after Matthew, she came across a statue of a Haitian with his fist in the air and a foot on a pile of skulls of cholera victims. Resting on top of the skulls was a UN peacekeeper’s helmet.

Today, Haiti’s cholera treatment centers are well-stocked, and health workers are delivering vaccines. Yet the “horror movie-esque” disease is still crippling communities, says Bruce. Clinics remain full of vomiting, feverish patients on wooden-slat beds.

That’s because the conditions that first allowed cholera to spread have not changed. In half of the clinics she visited, Bruce says she watched as bodily fluids from patients were mopped up, then taken outside and dumped on the ground 20 feet away. Every time it rains, she says, the waste washes into the river—and cholera spreads all over again.

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The Elise Adventure Morija Church was completely swept away during Hurricane Matthew. Residents still hold services under a tent on the church's foundation.

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Residents of Les Irois line up in front of the town hall to find jobs. Hurricane Matthew destroyed the farms, fishing boats and tools needed for most of the industries southern Haiti depends on.

Despite $13.5 billion donated for reconstruction, few permanent infrastructure projects have been built since 2011. When Casey returned to Haiti with the International Medical Corps after Hurricane Matthew, he found that not only had the country’s sanitation failed to improve, but that many of the facilities set up five years ago to treat the disease had been destroyed in the storm.

“We’re seeing this again today because we haven’t made investments in the infrastructure,” he says.

The Blame Game

Haiti’s cholera victims and their families have spent years pursuing a $40 billion redress lawsuit seeking compensation from the United Nations. Since the 2011 outbreak, the UN has been widely condemned for failing to acknowledge the relief workers’ responsibility in the outbreak. Among the critics are the UN’s own independent human-rights advisers.

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Haitians wash themselves and their clothes in a stream that flows from the mountains. Cholera, which spreads through infected water and poor sanitation, is rampant through southern Haiti.

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Bricthone Tabeline, 11, and Isadora Joseph, 10, study on the foundation of what was their home before Hurricane Matthew hit in October. Today, only the door frame remains and they live in a shack behind it.

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Barbara Bellevue, 16, and Sterline Bellevue, 14, take care of their sister's baby, born less than a week after the hurricane. Their home was destroyed in the storm, and now the nine family members live in a single shack.

The international organization, fearing liability for damages in this and future lawsuits, finally acknowledged its role this August. Yet shortly after the long-overdue acknowledgment, a U.S. court ruled that the UN has immunity from prosecution within the United States.

Earlier in 2016, a Yale study found that the UN could have screened its troops for cholera for just $2,000. Today, the Haitian government’s 10-year cholera-elimination plan will cost $2.2 billion.

Speaking at a UN Generally Assembly meeting on December 8, UN Secretary-General Ban Ki-moon issued the organization’s first official apology for not doing enough to halt the disease’s spread. But he stopped short of accepting responsibility. Instead, he pledged half of a $400 million UN cholera-response package to provide direct assistance to victims or families of victims of the disease.

"This has cast a shadow upon the relationship between the United Nations and the people of Haiti,” Ban said. “It is a blemish on the reputation of UN peacekeeping and [on] the organization worldwide."

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During sunrise, the son of a fisherman gathers rocks in front of his destroyed home. He then sells the rocks along the highway to people working in construction.