When a disaster strikes, aid agencies tend to focus on food, shelter and healthcare. Water and sanitation is often neglected, even though the lack of clean water and decent sewage systems can wreak havoc on healthcare. In Haiti, for instance, cholera has now become the overwhelming health problem, and 3000 people are estimated to have died from a disease that is entirely treatable.
Now, the disease has spilled over into the neighbouring Dominican Republic, and this week, three cases were reported in New York (people who had attended a wedding in the Dominican Republic).
But public health experts predicted months ago that when basic infrastructure breaks down as spectacularly as it did after the earthquake a year ago, outbreaks of waterborne diseases like cholera are inevitable. Given this knowledge, how did cholera run riot?
One Haitian blogger points to the utter failure of the Haitian government to provide its people with clean water long before the earthquake hit:
"Instead of policies or plans to invest in water treatment facilities, we have been witnessing an erosion of the few water pipes we had in the capital and the other major metropolitan areas. There is not a single waste management facility in Haiti. Overall, the politics of water in Haiti has been a complete failure, and today we are paying a dear price for it."
Recently, aid agency Médecins Sans Frontières (Doctors Without Borders) made a scathing attack on the humanitarian aid response to Haiti. MSF's international president Unni Karunakara wrote in an opinion piece that agencies given funds to provide chlorinated water and improve sanitation took little action for months, which contributed enormously to the rapid spread of cholera after the initial outbreak.
Karunakara is particularly suspicious of the trend to cluster the provision of aid. In theory, this should harmonise the provision of similar types of aid. In reality, he says, it seems to mean awkwardly forcing together organisations of differing capabilities and experience.
"Instead of providing the technical support that many NGOs could benefit from," he says, "these clusters, at best, seem capable of only passing basic information and delivering few concrete results during a fast-moving emergency."
This urgently required technical knowledge could come from a new grassroots organisation called Plumbers Without Borders. The organisation, which is currently looking for expert plumbers, engineers, electricians, and carpenters, aims to provide the know-how for agencies that are trying to respond to emergencies in water and sanitation.