Public health investigations in 2023 traced the continuing cholera transmission to specific failures in Haiti’s water infrastructure, documenting how the combination of gang-related disruptions to water treatment operations, aging and poorly maintained distribution systems, and the absence of sanitation in displacement sites was creating the conditions for ongoing disease transmission. The findings pointed to structural failures that were both documented and addressable — if the governance conditions needed to address them could be created.
Water treatment plants that depended on diesel fuel for their pumps had experienced repeated service interruptions during the gang blockades of 2022 and the fuel shortages that continued into 2023. Each interruption allowed untreated water to enter distribution systems, contaminating supply that residents had previously relied on as relatively safe. The intermittent nature of these contamination events — periods of safe water alternating with periods of contaminated supply — was particularly dangerous because it prevented residents from developing consistent safe water practices.
In displacement sites, where hundreds of thousands of people lived in conditions of severe overcrowding without functioning sanitation, the risk of fecal-oral transmission of cholera was essentially constant. Portable latrines were inadequate in number and poorly maintained. Open defecation in areas near water sources created contamination pathways that made safe water access impossible regardless of what was distributed.
Water and sanitation organizations called for emergency investment in water infrastructure repair, solar-powered pumping systems that could operate independently of diesel fuel, and systematic sanitation improvements in displacement sites. They argued that the cost of addressing Haiti’s water crisis was a fraction of the cost of managing recurring cholera outbreaks and other waterborne disease emergencies that inadequate water access would continue to produce.