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Haiti needs elected leadership and answers on cholera Add to ...

The cholera epidemic in Haiti has unleashed a health disaster in a country already on its knees, adding a new urgency to Sunday's national elections. The Caribbean country of eight million needs a strong leader now more than ever to press donors to deliver the billions of dollars in aid pledged following last January's devastating earthquake, to educate Haitians about how to prevent the spread of cholera, and to press the United Nations Stabilization mission for answers.

Several global health experts think UN peacekeepers from Nepal may be the source of the cholera outbreak, which began on Oct. 19 in Saint-Marc, near the Artibonite River, where a base houses 454 soldiers from Nepal.

Did the UN mission manage to import a disease that had not been documented for years in Haiti? Why did the mission, set up to manage security after a coup ousted President Jean-Bertrand Aristide in 2004, not take more seriously citizens' complaints about unsanitary conditions and sewage being dumped into the Artibonite River from the base?

Epidemiologists now predict that there will be as many as 500,000 more cases in Haiti, and that it could spread to other parts of the region. Already, 1,344 people have died of cholera, and 23,377 have been hospitalized. Spread by contaminated fecal matter, the disease is normally preventable and treatable. But a lack of sanitation and clean drinking water in Haiti makes it more challenging to contain. Poor infrastructure and a shortage of resources also make it difficult to deliver medical assistance to patients in rural areas and urban slums, putting them at a much higher risk of dying.

The bacterial samples from Haitian patients match a strain endemic in southern Asia. While none of the Nepalese peacekeepers show symptoms, 75 per cent of people infected with cholera are asymptomatic, but can still pass on the disease for two weeks after being exposed. UN officials should test Nepalese soldiers for the disease, and launch an investigation into the origins of the outbreak.

Nepalese soldiers may have brought the novel strain of cholera to Haiti, according to John Mekalanos, a cholera specialist and chairman of Harvard University's microbiology department, who believes it is key to find out how the disease spread.

Haiti needs a decisive leader to calm its people. If Haitians turn against the blue helmets, as happened this week with a series of violent protests, the country's recovery will be set back. The UN owes it to Haiti to provide some accountability, and reassure people there will be no breaches in public health protocols.

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