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A cholera outbreak in Haiti has now reached the capital, Port-au-Prince, where five cases of the disease have been confirmed.
Health officials announced the confirmed cases on Saturday (00:00 GMT on Sunday), sparking fears that the disease could spread rapidly among hundreds of thousands of earthquake survivors sheltered in camps in the capital.
However the five cases, the first confirmed in the capital since the epidemic started, were people who had become infected in the main outbreak zone of Artibonite, north of Port-au-Prince, UN officials told Al Jazeera, citing the Haitian ministry of health.
They had subsequently travelled to the capital, where they fell ill and are now being treated.
The five are among more than 2,000 people who were infected in an outbreak mostly centered in the rural Artibonite region. At least 208 people have died in the outbreak, and officials have warned that the figure could rise.
Containing the disease
Al Jazeera's Sebastian Walker, reporting from the capital, said the confirmed cases in the capital represent a very significant development.
"It's really the news that everyone here has been fearing," he said.
"All of these victims are still alive but they have been confirmed sick with cholera. They have also all travelled back from that disease zone; they are not patients who contracted the disease here in the capital."
He said the main priority for health officials now is containing the disease.
"The main focus is on the IDP (internally displaced person) camps. You have 1.3 million people living in very squalid conditions, conditions in which health officials have told us are breeding grounds for disease - very poor levels of sanitation, almost no drinking water."
The first two cholera cases outside the Artibonite region were confirmed in Arcahaie, a town closer to the capital. Experts were also investigating possible cases in Croix-des-Bouquet, a suburb of the capital, and radio reports said there were two dozen cases of diarrhea, which can be a symptom of cholera, on Gonave Island across the Gulf of Gonave from the capital.
Medical facilities in the port city of Saint-Marc were overcrowded with patients suffering from dehydration and diarrhea - symptoms of cholera. The two suspected patients spotted at the National Hospital had come from Saint-Marc.
Our correspondent, who visited the area on Saturday, said he saw first-hand the "extreme nature" of cholera during a visit to Saint-Marc.
"There were in that hospital people dying every time we visited ... there were bodies piling up in the morgue," he said. "So certainly in that area...the situation is incredibly serious".
According to the UN, the Saint-Marc river has tested positive for cholera, Walker said, yet people are still drinking from it and using the river water to wash their dishes.
Aid groups and the government were rushing medical teams, medicine, clean water and water purification to the affected areas. The health ministry also declared a state of emergency in Artibonite.
'Very dangerous'
If the disease spreads into camps where those left homeless by the January 12 earthquake are sheltering, a public health crisis could be imminent. More than 250,000 people were killed in the earthquake and another 1.2 million left homeless.
"It will be very, very dangerous,'' Claude Surena, president of the Haitian Medical Association, said. "Port-au-Prince already has more than 2.4 million people, and the way they are living is dangerous enough already. Clearly a lot more needs to be done.''
This is the first time cholera has struck Haiti since 1960, according to the UN.
Officials have urged residents to take preventative action.
"One of the simplest things they can do is frequent handwashing. Personal hygiene. That does wonders," Jon Andrus, the deputy director of the Pan American Health Organization, said.
"Chlorine is being provided so to take advantage of those measures that will ensure that anything ingested whether it be water or food is properly prepared and that the source of the water is safe and adequately treated."
Andrus said the number of cases will continue to grow because Haitians do not have any built-up immunity to cholera.
"As we know from our experience, with situations of cholera where there is no infrastructure to deal with the crisis, it just gets much worse. We have to expect that and react to it."
Cholera is transmitted by water but also by food that has been in contact with unclean water contaminated by cholera bacteria. The disease is easily treatable by rehydration and antibiotics but can kill within hours if not treated.
PHOTO CAPTION
Tents are lined up at a camp set up in the Delmas 33 zone in Port-au-Prince September 29, 2010.
Al-Jazeera
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