People watch the passing waters of a swollen River Grise in Port au Prince. Hurricane Matthew passed over Haiti today, with heavy rains and winds. While the capital Port au Prince was mostly spared from the full strength of the class 4 hurricane, the western cities of Les Cayes and Jeremie received the full force sustaining wind and water damage across wide areas.In the Wake of Hurricane Matthew, Haiti’s Cholera Epidemic Could Get Much Worse Alanna Shaikh, MPH October 11, 2016 By: Alanna Shaikh, MPH on October 11, 2016Post-hurricane conditions are ideal incubators for cholera. And so far, thirteen people have died of cholera in Haiti since Hurricane Matthew made landfall. Unless authorities and the international community move swiftly to stem another outbreak, many more people could soon be afflicted with the disease.Cholera is a bacterial disease, spread through contaminated food and water. It causes severe vomiting and diarrhea, and it kills through dehydration. It has been devastating in Haiti – more than 10,000 people have died of cholera since the 2010 earthquake. Haiti is particularly vulnerable to cholera because of limited access to clean water and lack of sanitary toilet facilities. In 2009 – before the earthquake, only half the country’s population had access to a clean water source, and only 1 in 5 had access to an improved toilet. The earthquake damaged even those limited facilities, and the consumption of water contaminated with cholera bacteria became nearly impossible to avoid.Haiti is now facing very similar conditions. According to UNICEF before Hurricane Matthew, “28 percent of the population had access to proper sanitation facilities and 58 percent has access to clean drinking water.” The hurricane, like an earthquake, will have damaged those facilities. In 2010, the county was starting from a clean slate; there had never been a recorded outbreak of cholera. It spread from a single source – a UN peacekeeper camp near a river. In 2016, cholera is already endemic in Haiti. With limited access to good sanitation, it could spread from a thousand sources.If a cholera epidemic in Haiti is to be avoided, there will need to be a short-term response and a long-term response. In the short-term, it will be all about epidemiological surveillance and chlorine. Any case of cholera will need to be identified and tracked as the patient receives treatment based on rehydration. All drinking and washing water supplies will need to be consistently treated with chlorine tablets to kill cholera bacteria.In the long-run, Haiti needs water and sanitation facilities that provide clean water and hygienic places to dispose of human waste. Urban areas need drinking water systems that everyone can access. Rural areas need safe wells. Everyone needs toilets. As long as there are people who are forced to defecate in open spaces, the risk of cholera remains.At this writing, CNN is reporting that Haiti faces an “uptick” in confirmed cholera cases in the country’s Southwest peninsula, specifically the Sud, Grand’Anse, and Nippes districts. The next 24-48 hours will be the tipping point; patients will be rapidly identified and treated – and effective sanitation will then keep the bacteria from spreading – or the cholera epidemic is about to get a whole lot worse.Cholera didn’t arrive with the hurricane; it arrived with UN Peacekeepers in 2010, a second disaster to compound the impact of a massive earthquake. Haiti is now at risk for a second cholera epidemic. It will require coordinated effort from humanitarian responders, the government of Haiti, and the people affected by the hurricane to keep that from happening.