Few post-disaster myths have a stronger hold on our imaginations than the specter of a follow-on epidemic. Some imagine a killer virus will spread through the sudden glut of dead bodies. Others merely go by the notion that when it rains--or shakes, or erupts, or burns--it pours. But we can all take a deep, healthy breath: It's not true. There don't tend to be spontaneous epidemics in the wake of natural disasters. As a World Health Organization team explained in a 2007 study published in the journal Emerging Infectious Diseases: "The risk for outbreaks after natural disasters is low."
But myths have their price. And nowhere has the price of this particular myth been higher than in Haiti.
You know about the Haiti earthquake of 2010, which observes its third anniversary this week. Though a mere 7.0 on the magnitude-moment scale, the location of the quake and the country's underlying poverty made it the deadliest single natural disaster ever recorded in the Western Hemisphere.
Billions of dollars were pledged for relief and reconstruction, and thousands of organizations rushed in to save lives. One of the responders' primary stated goals was to prevent the outbreak of disease, especially amid the poor sanitary conditions of sprawling postquake homeless camps. No less a luminary than Bill Clinton, the UN Special Envoy for Haiti, warned in early 2010 that diarrheal disease sparked by squalid conditions could prove a "second round of death."
In fact, there was a second catastrophic round of death in Haiti that year: an epidemic, no less. But that epidemic--a virulent outbreak of El Tor cholera--had nothing to do with the earthquake at all.
Most crucially of all, the strain spreading unchecked through Haiti's vulnerable population had never been seen in the country before. In fact, there had never been a confirmed case of cholera in Haiti before that outbreak, ever.
That's where the epidemic myth came in. Already expecting outbreak of disease after the earthquake, particularly in a place regarded as backwards and dirty, most journalists and responders shrugged off cholera as a natural product of the disaster. "It's what all of us worried about when we arrived in Haiti just hours after the quake," Brian Williams said as the outbreak was reported on NBC Nightly News. "Beyond the death toll, the inevitable spread of disease." That the supposedly "causal" earthquake had taken place a full 10 months before, this notion went largely unquestioned for months. The attitude made epidemiologists and aid workers less likely to seek out the source of what was in fact a particular infection not only new to Haiti, but the entire hemisphere. And it has since continued to provide cover for the United Nations as advocates press for reparations, and public health experts try to reform the peacekeeping system to prevent such a catastrophic error from happening again.
Jonathan M. Katz is the author of The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster (Palgrave Macmillan, January 2013). Follow him on Twitter.
Interesting article, I wish it include all the other economic and social disease problems with Haiti as well. My heart goes out to this small country. Aids and other diseases are climbing in this destroyed country. A lot of the help and money is being wasted do a lack of relief administrative structure and Haiti government administrative problems.
Interesting article. Claude de Ville was right when I first heard him present on the problems of hype almost two decades ago, and he remains correct.
However, much of the problem of "disaster mythology" is linked strongly to bad journalism.
Poor science isn't as likely to get far, or cause much damage, without the support, or perhaps I should say the complicity, of shoddy journalism and editing; the repeated post-earthquake comments of impending infectious disease spread from bodies.
Another area that warrants focus is false attribution of developmental disabilities to vaccinations.
Just as poor journalism can furthur victimize those negatively impacted by natural disasters, it can increase the chances of life-long disabilities and readily-preventable diseases because individuals elect not to be, or have their children vaccinated - children who can then acquire life-threatening, disabling diseases, or spread disease to others who are too young to receive certain vaccinations, or have medical contraindications to being vaccinated. Those of us who have seen a case of congenital rubella syndrome have little patience with those journalists who fail to properly interview those celebrities and othes who are the advocates of vaccine denialism and other bad science.
When working in Peru close to the start of the cholera outbreak in 1991, cases did not show up among the wealthy, and rarely impacted those with access to clean water and hygiene facilities. When it did, the infected were, with few exceptions, able to get to care early, with virtually no mortality risk. With good care the mortality rate for cholera can be held below 1%. That people die from cholera, and other vaccine-preventable diseases, in as many places as they do, reflects what value people and societies place, or fail to place, on human life.
The most terrifying words in the English language are: I'm from the government and I'm here to help.
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It would seem correct that the best advice for many would be to stay out. Let those who have been working in Haiti continue doing what they have done for decades. When I was there in 1982 the infrastructure was in place. Medical clinics were operational. Just give them the supplies to do more.