By SIMON ROMERO
PORT-AU-PRINCE, Haiti — As hundreds of thousands of people displaced by last month’s earthquake put down stakes in the squalid tent camps of this wrecked city, the authorities are struggling to address the worsening problem of human waste. Public health officials warn that waste accumulation is creating conditions for major disease outbreaks, including cholera, which could further stress the ravaged health system.
Some American and Haitian public health specialists here consider the diseases stemming from the buildup of human waste in the camps as possibly the most pressing health threat in the city. Doctors are already seeing a spike in illnesses like typhoid and shigellosis, which arise from contaminated food or water.
“We’re witnessing the setup for the spread of severe diarrheal illnesses in a place where the health system has collapsed and without a functioning sewage system to begin with,” said Ian Greenwald, chief medical officer for a Duke University team of doctors working here this month.
The problem has become impossible to overlook in many districts of Port-au-Prince, with the stench of decomposing bodies replaced by that of excrement. Children in some camps that are still lacking latrines and portable toilets play in open areas scattered with the waste. The light rains here this week caused some donated latrines in the camps to overflow, illustrating how the problem would grow more acute as the rainy season intensified in the months ahead.
“Haiti’s pigs live better lives than we do,” said Dora Nadege, 28, as she wandered back to her tent camp in Place St.-Pierre from a ravine on the camp’s edge, where its hundreds of inhabitants relieve themselves throughout the day in the open air. “When the rains come, we’ll be lucky not to drown in our own excrement,” said Ms. Nadege, a mother of four, who sold bread on the street before the earthquake.
Aid groups are trying to address the problem by distributing more than 10,000 latrines and portable toilets, and employing dozens of new desludging trucks to empty the toilets. But these solutions seem to be a stopgap measure, at best.
“It’s a drop in the ocean of what’s needed,” said Jessica Barry, a spokeswoman for the International Committee of the Red Cross, which is distributing latrines with special sludge pumps. “You can have 100,000 latrines, but you need a way to remove the excrement.”
With the number of people displaced here by the earthquake estimated at 700,000, emptying the latrines from one location creates a new problem when the waste is disposed in another. Haiti, a nation of 10 million, does not have a single sewage treatment plant. Trucks often simply take the waste to the Troutier trash dump near the slums of Cité Soleil on this city’s edge.
The trucks empty into pits filled with medical waste like intravenous bags and garbage. Smoke billows from burning piles of trash. One truck from a private company, Sanco, with its motto “Fighting for a Clean Environment” emblazoned on its side, did not bother to go to a pit, dumping its cargo of human waste on the open ground.
A squatter community of a dozen families, including some new arrivals whose homes were destroyed in the earthquake, tries to eke out its survival by scavenging in this setting.
“There’s food to be found here, and sometimes wood to cook with,” said Mackinson Charles, 14, who wandered around the pools of waste with his brother, Mickenson, 12, as dusk fell here one day this week. Four other boys accompanied them, including two who were barefoot. “This is where we live,” Mackinson said.
The human waste problem was daunting even before the earthquake. Lacking a municipal sewage system, many families here employ a socially scorned class of nocturnal latrine cleaners known in Creole as the “bayakou.” They descend into latrines to clean excrement with their hands, before transporting it in carts to improvised disposal sites.
The current problem is part of a politically delicate debate over the future of the camps themselves. Even as many of those living in the camps dig in, building wooden shacks instead of resigning themselves to living in tents or under sheets, some here are calling for the camps to be broken up.
“We need to acknowledge that the sanitation problems cannot be solved in the current camp structure, and that what’s needed is to resettle people in cities outside Port-au-Prince,” said Peter Haas, executive director of A.I.D.G., an American nonprofit group that does development work in Haiti.
Viva Rio, a Brazilian nongovernmental group, has begun operating a project in the Kai Nou slum in this city’s central commercial district that turns human excrement into a biogas used as fuel for cooking and electricity.
“This crisis can trigger innovation for Haiti, allowing us to move beyond the desperation you see now,” said Volmir Fachini, the director of the project, which the group hopes to emulate in a sprawling tent camp of about 3,500 families adjacent to Kai Nou. “The solutions to the waste problem are within our grasp.”
Still, disease specialists fear that the scale of the problem could soon overwhelm such projects.
Robert Redfield, a co-founder of the Institute of Human Virology at the University of Maryland, cited the example of a 1994 outbreak of cholera in refugee camps in Congo among the hundreds of thousands who fled Rwanda at the time.
“The real culprit right now is the flies, which become vectors by taking fecal waste from one place to another,” said Dr. Redfield, who got sick himself with salmonella typhi while working in Haiti this month. “This means you can control what you eat and still get something,” he said. “The arrival of the rains could make malaria and dengue more problematic as well.”
Some families seeking shelter have nowhere else to turn. “This is my life now, my family’s life,” said Sindia Michel, 33, who moved to the Troutier trash dump after her shack collapsed in the earthquake. She scavenged for firewood with one of her five children near the pits of excrement.
“I do what it takes to endure,” she said.
Potential health problems are staggering.
TB will surge with the start of Haiti’s rainy season and the fact that TB infected people are living with the masses of people made homeless by the quake.
Cholera is a real danger as water supplied become contaminated with human waste.
Tetanus has already become an ever-present threat as those infected seek hemoglobin to atop the diseases terrible symptoms that can see muscles become so tense as to break bones, jaws lock and people suffer fits. We need a huge drive to inject people with the anti-tetanus drug. We also need a vast quantity of hemoglobin to deal with those infected.
There are no Tetanus injections in Haiti at this time. They require refrigeration .
The most frightening aspect of the tetanus threat is the fact that diagnosis is difficult until the onset of the most dangerous symptoms.
It is a terrible way to die.