Health officials raised the death toll of Haiti's cholera outbreak Thursday to 442, adding 105 new deaths in the last five days, and an incoming storm is threatening to make matters worse.
Tropical Storm Tomas is on a path toward the island of Hispaniola and is expected to strengthen into a hurricane and make landfall Friday, with possible winds of 74 mph and heavy rains.
The storm could worsen the sanitation situation and accelerate the spread of cholera, which is highly infectious and waterborne.
"If the storm hits Haiti, it’s obvious that[it] will make a difficult situation even worse," Jon Andrus, deputy director of the Pan American Health Organization said.
"The bad sanitary conditions in many areas, combined with what the hurricane poses as huge amounts of rain and possibly flooding, are very likely to accelerate the spread of infection."
The Haitian government has called for voluntary evacuation of the many tent camps in and around Port-au-Prince in preparation for the storm. The plan is to move people to schools, churches, and other structures, but the government has only identified 1,000 such emergency shelters. More than a million people have been living in the camps since the Jan. 12 earthquake leveled much of the city.
The cholera outbreak has also depleted stockpiles of medical and emergency supplies around the country, said U.N. humanitarian spokesperson Imogen Wall. Shipments of new supplies have been mobilized, but stock levels of everything from tarpaulins and rope to chlorine and rehydration salts are precariously low.
"We are very stretched because of the cholera outbreak, so we have big gaps," she said. "We know we don't have what we need to respond to the hurricane."
Meanwhile, questions continue to swirl in some Haitian communities about the origin of the cholera outbreak in the country.
New research conducted by the U.S. Centers for Disease Control and Prevention, in collaboration with the National Public Health Laboratory in Haiti, shows the strain of cholera spreading in Haiti is closely related to strains found in South Asia. The strain was traced through a process known as DNA fingerprinting, and the results have intensified speculation about the possible role of U.N. peacekeepers in the arrival of the disease.
In releasing the results of the DNA testing, officials warned against jumping to conclusions.
"Although these results indicate that the strain is non-Haitian, cholera strains may move between different areas due to global travel and trade," Minister of Health Dr. Alex Larsen said in a statement. "Therefore, we will never know the exact origin of the strain that is causing the epidemic in Haiti."
Cholera is not endemic to Haiti and this is the first confirmed outbreak in the country in decades, though health officials have been warning of the threat of waterborne illness since the earthquake.
Hundreds of Haitian demonstrators protested at a rural U.N. peacekeeping base last week, even before the results were revealed. The crowd demanded the soldiers from Nepal, where cholera is endemic, leave the base and the area, according to The Associated Press.
The U.N. base is built on a tributary to the Artibonite River that runs through the region where most of the cholera cases have occurred, but the U.N. has denied any connection between the base and the outbreak.
Vincenzo Pugliese, a spokesperson for the Haitian U.N. mission said in an e-mail: "It is too soon to determine precisely how cholera came to Haiti. From a medical point of view, there’s no solid evidence of any possible link between cholera and these particular soldiers."
The U.N. tested all the soldiers at the camp for cholera and found they are all healthy. Water was also tested in the camp and at several points between the camp and the river, Pugliese said, all with negative results.
The AP reported witnessing "questionable sanitation" at the base as recently as Sunday, which the U.N. has said is being remedied. Pugliese said any further investigation at the base by the Ministry of Health or another authority would be fully cooperated with, but that no such investigation is being carried out at this time.