A spreading cholera outbreak in rural Haiti is threatening to outpace aid groups as they step up efforts to keep the disease from reaching the densely populated camps of earthquake survivors in Port-au-Prince.
Health officials said at least 208 people had died and 2,674 others were infected in an outbreak mostly centred in the Artibonite region to the north of the capital.
But the number of cases in towns near Port-au-Prince is rising, and officials are worried the outbreak will reach the hundreds of thousands of Haitians left homeless by January's devastating quake and living in camps across the capital.
Reports were coming in of patients seeking treatment in clinics closer to Port-au-Prince because the St Nicholas hospital in the seaside city of St Marc is overcrowded, a spokeswoman for aid agency International Medical Corps said.
At least five people who travelled from the Artibonite region to Port-au-Prince on Saturday tested positive for cholera once they arrived in the capital, where they are being treated, she said. They are not considered to be the first cholera cases of Port-au-Prince because officials believe the people contracted the disease in Artibonite.
UN officials stressed that the five cases were "very quickly diagnosed and isolated". A spokeswoman told Reuters: "This is not a new location of infection."
Dr Estrella Serrano, World Vision's emergency response health and nutrition manager, said: "If the epidemic makes its way to Port-au-Prince, where children and families are living in unsanitary, overcrowded camps, the results could be disastrous."
One doctor in the capital reported that a six-year-old girl from Port-au-Prince's southern Carrefour district tested positive for cholera, although government health officials had not confirmed the case.
"The child was in very weak condition," Dr Willy Lafond Edwight told the Associated Press. "She couldn't stand up. She couldn't even talk … I guarantee that if you find one case, many more cases will appear."
Officials confirmed at least five cholera cases in Arcahaie, a town close to Port-au-Prince, and four cases in Limbe, a small northern municipality. Ten cases were reported in Gonaïves, the largest city in the Artibonite, according to Partners in Health, a US-based humanitarian group.
The sick included 50 inmates at a prison in Mirebalais, just north of Port-au-Prince, health ministry director Gabriel Thimothe said.
Experts also are investigating possible cases in Croix-des-Bouquets, a suburb of the capital that they think is a transfer point of the disease because it has a widely used bus station, said Paul Namphy with Haiti's national water agency.
"This is a very mobile country," he said. "It can spread like wildfire."
Cholera is a waterborne bacterial infection, and the water agency was nearly doubling the amount of chlorine in drinking water.
Aid groups are providing soap and water purification tablets and educating people in Port-au-Prince about the importance of washing hands.
The groups have also begun training more staff about cholera and where to direct people with symptoms. Cholera has not been seen in Haiti for decades, and many people do not know about the disease, which causes severe diarrhoea and vomiting and can lead to dehydration and death within hours.
Red Cross spokeswoman Julie Sell said teams would begin teaching people in refugee camps how to prevent cholera starting tomorrow – five days after the outbreak.
"We are taking this very seriously, but we also want to make sure that every one of our people has the information they need," she said.
The International Organisation for Migration is training staff and sending 64 workers out to camps tomorrow, spokeswoman Sabina Carlson said.
