A cholera epidemic sweeping across Haiti has killed more than 800 people, hospitalized 12,000 and put an estimated 200,000 at risk, the United Nations said on Friday, as it appealed for $163 million in donor aid.

The first outbreak of the disease, which is contracted through contaminated water and causes severe diarrhoea and vomiting, was reported in the lower Artibonite region, north of capital Port-au- Prince on October 22.

As the epidemic found its way to Port-au-Prince — a shattered city of rubble and tents where more than 1.5 million homeless Haitians are forced to live in unsanitary and overcrowded conditions — hospitals are struggling to cope. Doctors in the earthquake-shattered country on Friday expressed concerns that they would soon have to treat cholera patients in unhygienic conditions.

“It’s a really worrying situation for us at the moment,” a doctor from Medecins Sans Frontieres (Doctors Without Borders, MSF) said. “All hospitals in Port-au-Prince are overflowing with patients and we’re seeing seven times the total amount of cases we had three days ago.”

At a medical centre in Cite Soleil, a slum in the north of the capital, MSF recorded 216 cases of cholera on Thursday, nearly 10 times as many as earlier this week.

“If the number of cases continues to increase at the same rate, then we’re going to have to adopt some drastic measures to be able to treat people,” the MSF doctor said. “We’re going to have to use public spaces and even streets.” The UN anticipates that up to 200,000 people will show symptoms of cholera, ranging from cases of mild diarrhoea to severe dehydration.

The number was calculated based on experiences in other countries as well as estimates by the World Health Organization and the US Centres for Disease Control and Prevention. Of the over $163 million the UN is seeking in donor funding, $89 million would be used for sanitation and hygiene.

“Cases are expected to appear in a burst of epidemics that will happen suddenly in different parts of the country,” the UN Office for the Coordination of Humanitarian Affairs (OCHA) said in statement. “Epidemiologists anticipate that the outbreak will continue to spread throughout the country and resources will need to be mobilized for at least six months,” according to OCHA.

Cholera symptoms typically develop between one to five days after drinking water contaminated by the faeces of people infected with the cholera bacteria. The infection progresses rapidly, and without adequate replacement of fluid and salt the patient may go into shock and die of dehydration.

According to Partners in Health, Haiti has not had a documented case of cholera since the 1960s. But conditions were ripe for an epidemic even before the January 12 earthquake because of an unsafe water supply system, which was further weakened over the years by a series of hurricanes, followed by floods and mudslides.

The Haitian government estimates that 222,750 people — or 2 per cent of the country’s population — died in the earthquake and at least 300,572 were injured. An estimated 1-2 million Haitians are still living in temporary settlements, which could continue for months or even years until transitional shelters are built, the UN has said.

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