© Parkin Parkin

Up in the hills of Port-au-Prince, I accompany a team from one of UNICEF’s partner organisations, Croix-Rouge française (CRF). The capital spreads from these high hills down to the blue ocean, down to Cité Soleil, Haiti’s famous slum. Here in the hills is where cholera resurged, in the slum of Martissant, one of the poorest and most gang-infested areas of the city. CRF delivers emergency responses to outbreaks. If someone arrives at a CTC or clinic and is thought to have cholera, a team is dispatched – ideally within 48 hours – to set up a ‘cordon sanitaire’, or sanitary barrier. Speed is an important weapon, both in the spread of cholera and in the fight against it. UNICEF and other agencies are excited about a new Google Drive system that enables them to get real-time updates on cholera cases all over the country, something that didn’t exist before. If they know cholera’s routes, they can block them more effectively.

Today’s team wears red vests and baseball caps. They resemble the men on Port-au-Prince street corners who are selling mobile phone minutes, but they carry chlorine sprays, not phone cards. Our target is a narrow street. We reach it though other narrow streets, where women are selling raw meat and cooked food. None of it is covered. The flies are landing freely, their feet likely contaminated with faeces.

In the National Plan to Eliminate Cholera, the country’s sanitation is described as “practically non-existent”. Port-au-Prince has only one operational waste treatment centre for a city of two to three million people. People who do have latrines have them emptied manually by an underclass of bayakou (men who jump, often naked, into the pits and shovel out their contents). Hardly any of that shit is disposed of at the treatment plant; instead, it ends up anywhere the bayakou can put it. It’s the same ‘anywhere’ where the majority of Haitians without latrines go to do their open defecation. It’s the anywhere where cholera thrives.

We park, finally, and the team gets ready. One man is the disinfector. He puts on a mask, apron and gloves and gets his spray can. There are three stages of disinfection and three strengths of chlorine solution: today will be A-strength (four spoonfuls of chlorine solution in 20 litres of water) and the whole house will be sprayed, along with the neighbours’ houses. Another team member has a clipboard and pen. To combat the speed of contamination, questions are as important as chlorine. How did you get cholera? Where have you travelled? Who have you met? Cholera is easily transmitted in food and water, but also at funerals and carnivals and street markets.

The questions are being asked of Gaelle*, just discharged from a CTC after three days. She leans against the dingy curtain in the dingy concrete house as if it is holding her up. I ask her how she got cholera: “I don’t know. We treat our water.” She and her sister Lourdes* say they buy Aquatabs, water disinfection tablets that are widely available for sale but seen as expensive, unless they are dispensed freely by NGOs. (Most people add chlorine to their water, though usually too much.) I ask Gaelle how cholera is transmitted: “With dirty hands or when the environment is dirty.” Finally, in my most patronising mode, I ask what she thinks cholera is. A small animal, a virus? “No,” she says with some pity for my stupidity. “It’s a microbe.”

When I interview Haitian officials, they talk about outreach and messaging. They mean hygiene posters and pamphlets and megaphones that instruct Haitians to wash their hands, treat their water, keep themselves clean. I don’t think this kind of top-down didactic approach works ordinarily: no one responds well to hectoring. It’s even less successful when the messages are so well known, says one NGO worker, “that if you start [a sentence about hygiene], it’s them who finish the sentence.” As cholera retreated, lassitude grew. “They know what to do,” says Olivier Lamothe, who works on emergency responses for UNICEF. “They say, ‘but I’ve always done that and there was no cholera’. There’s a reticence. We have to figure out how to adjust the message.”

Many residents of Port-au-Prince get their water from official water points monitored by the government. Others buy it from kiosks with names like Eau Miracle (slogan: “I drink Miracle Water; do you?”). There are so many of these kiosks, I don’t see how they can all be monitored. Even if they were, gangs in Martissant have been breaking into the mains and trucking water up the hills, where the pipes don’t reach, to sell it. Breaking into a water main is a great way to get it contaminated, and it’s probably the reason why cholera broke out again in Martissant in 2014. “The network is permeable,” says Gregory Bulit. It’s so bad, official talks are going to be set up with the gangs. If they must sell the pirated water, then at least let it be pirated and chlorinated.

I look at Gaelle’s latrine, a dirty concrete pit inside her house, and wonder how a spray of chlorine can make it safe. I wonder how even all the effort and programmes can make everything safe: every food seller offering fly-covered pigs’ trotters, every hug of a corpse at a funeral and the dirt underneath every child’s fingernails. It seems so daunting. And it will cost a fortune: the government costed the National Plan for the Elimination of Cholera at $2.2 billion, and a high-level conference on Haiti at the World Bank last year estimated that $310 million would be needed over the next three years, plus $70 million more to fix Port-au-Prince’s water supply.

The money is of course lacking. UNICEF, government, MSF, anyone – whenever I ask about funding, I hear the same three words: Ebola, Syria, Ukraine. Donors have forgotten Haiti. Their heads have been turned by other, more dramatic causes. Drama attracts money; water mains and pit latrines do not.