Health workers fear a surge of cholera cases in the shantytowns and muddy tent camps of Haiti's capital as suspected cases piled up and a laboratory confirmed a case originated in the overcrowded city.
Hundreds of people suffered the cholera symptoms of fever and diarrhoea in hospitals and shacks built along the putrid waste canals of slums like Cite Soleil and Martissant.
At least 73 cholera cases had been confirmed among people living in Port-au-Prince. Physicians with the aid group Doctors Without Borders reported seeing more than 200 city residents with severe symptoms at their facilities alone over the last three days.
High risk for spread of cholera
Following confirmation that a three-year-old boy from a tent camp near Cite Soleil had contracted the disease without leaving the capital, the Pan-American Health Organisation said the epidemic's spread from river towns in the countryside to the nation's primary urban centre was a dangerous development.
Damage to Port-au-Prince's already miserable pre-earthquake sanitation and drinking water systems make the city "ripe for the rapid spread of cholera," Dr Jon K. Andrus, the organization's deputy director, said.
Port-au-Prince is estimated to be home to between 2.5 million and 3 million people, about half of whom have been living in homeless encampments since the earthquake ravaged the capital in January 2010.
"We expect transmission to be extensive and we have to be prepared for it, there's no question," Andrus said. "We have to prepare for a large upsurge in numbers of cases and be prepared with supplies and human resources and everything that goes into a rapid response."
A confirmed case of cholera had never been seen in this Caribbean country before last month, when it suddenly killed several dozen people and spread across the agricultural heartland of the Artibonite Valley.
The US Centres for Disease Control and Prevention found that the strain is most similar to those found in South Asia, but no formal investigations have been done to learn how the disease arrived in Haiti.
Cholera death toll
It has killed more than 580 people and hospitalised more than 9,500, with confirmed cases across the entire northern two-thirds of the country. Dozens of cases are rumoured throughout the south.
Haiti's health ministry said the disease has become a threat to the entire nation of 10 million people.
"Now it is our duty as citizens to help solve this problem, which has gone from being an urgent humanitarian matter and gone to the level of national security," the ministry's executive director, Dr Gabriel Timothee, said.
The disease, primarily spread when infected faecal matter contaminates food or water, is preventable and treatable, mainly by rehydrating the sick with safe water or intravenous fluids and sometimes using basic antibiotics.
No access to clean water
Decades of failing and often regressing infrastructure - wracked by political upheaval, unbalanced foreign trade, a 1990s embargo and natural disasters - have left millions of Haitians without access to clean water, sanitation or medical care.
Haitian and foreign aid workers continued campaigns to tell people to wash their hands, cook food thoroughly and take other precautions against the spread of cholera. Treatment centres were being set up across the capital to handle the expected rising case load.
Health officials said that cholera will be part of the Haitian landscape for a long time, taking its place among the other challenges in one of the world's most difficult places to live.
"We have to think about and plan for the long term," Andrus said. "The bacteria have a foothold in the rivers and the water system, so it will be there for a number of years."
(Sapa, Jonathan M. Katz, November 2010)