Since the earthquake of January 12, 2010 that devastated Haiti and resulted in more than 230,000 deaths, thousands of volunteers have traveled to that country to assist in the relief effort. Virtually all reports, whether they originate from the media, the Haitian government, organizations and agencies such as the Red Cross, WHO/PAHO, UNICEF, CDC, and OXFAM point out the high risk of disease due to lack of safe drinking water and unsanitary living conditions particularly for the victims left homeless by the earthquake.

Millions of Haitians have migrated to “makeshift tent cities” around Port-au-Prince, where they are crammed together without adequate sanitation and safe drinking water. The deposition of human waste upon the ground surface greatly increases the likelihood of contamination of water and food. Under such conditions there is a highly elevated risk of typhoid fever, cholera, dysentery, and other transmissible diseases. Before the earthquake, PAHO had estimated that an unusually high percentage of deaths in Haiti were related to waterborne disease. That risk is now greatly exacerbated.

Repair of the community water and sewer systems, which did not provide universal coverage and were not in good condition before the earthquake, will require a considerable investment of money and effort and will take time. Therefore, emergency measures are being taken in the interim by the relief entities and volunteers to help reduce the threat of waterborne disease. Bottled water has been flown in but this measure is costly and the supply is rapidly depleted. A number of self contained mobile water treatment plants have been flown in and set up in high need areas, such as temporary hospitals, schools, and community centers. They are providing safe drinking water but their output is limited and the water still needs to be transported to the site of use, mostly in hand carried containers.

To enable Haitians to purify water at the level of use, many providers of relief are utilizing the low cost, rapid, and efficient method of assuring safe drinking water that was jointly proven by the CDC and PAHO in demonstration projects around the world in the early 1990s. This consists of providing households with a chemical disinfectant and a container specifically designed to facilitate disinfection and prevent recontamination of the water during its storage and use and of course training them in its use. Various tablet forms of chlorine compounds have been and continue to be donated to the Haitian relief efforts by a number of chemical manufacturers in the United States, Canada, and Europe as well as by relief entities themselves. Some of these tablets also contain a flocculating agent to clarify the water as well as to render it free of pathogens.

Many Haitians are familiar with the concept of water disinfection at the household level since it was introduced earlier in Haiti by PAHO and UNICEF to help ameliorate the highest rate of childhood mortality in the Western hemisphere. It has been estimated that the majority of childhood deaths in Haiti are related to waterborne disease.

As part of the relief effort health agents and community health workers are being trained in the methodology of disinfection of water supplies at the local level. Mobile doctors are distributing these tablets as they go into the countryside.

The abject poverty in Haiti greatly complicates relief efforts as well as long term goals to improve water and sanitary conditions. It is important that measures taken to prevent the spread of waterborne disease during the recovery period be practical, effective, and efficient. The volunteers and providers of relief are to be commended for all they are doing. It is equally important that long term efforts also be practical and affordable. Chlorination of drinking water has been proven time after time as the most cost effective measure that can be taken to prevent waterborne disease during the aftermath of a natural disaster.

(Fred Reiff, P.E., is a former official of the Pan American Health Organization/World Health Organization and a member of the Water Quality & Health Council.)

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