The United Nations’ Role in Haiti Cholera Outbreak

LATIN AMERICA AND THE CARIBBEAN, UNITED NATIONS, HEALTH, 26 Nov 2012

Lauren Carasik – Al Jazeera

Just over two years have passed since the cholera epidemic started its deadly march in Haiti, exacting a staggering toll. The most recent statistics from “Partners in Health” indicate that cholera has left 600,885 sick and taken 7,568 lives, with 76,981 new cases diagnosed in 2012.

As details emerged about the origin of the cholera epidemic, a disease not seen in Haiti in almost a century prior to the outbreak, it became clear that the UN stabilisation force, known by its French acronym, MINUSTAH, was to blame.

Yet, as we approach the one-year mark since human rights groups filed a claim against the UN for bringing cholera to Haiti, the UN has failed to respond to the charges levelled against it.

Advocates are seeking reparations for victims, as well as investments in Haiti’s water, sanitary and health infrastructure – measures necessary to end the epidemic as the impoverished country lacks resources to undertake them without assistance.

Outbreak of cholera 

The evidence of UN culpability is clear. Among the UN troops deployed to Haiti in the aftermath of the devastating earthquake in January 2010 was a contingent from Nepal that was housed in the Mirebalais MINUSTAH camp, near a tributary of the Artibonite River that served to propagate the infection.

At the time the Nepalese soldiers were being trained prior to deployment, Nepal was experiencing a well-known cholera outbreak. Although many Nepalese showed the classic symptoms of cholera, approximately half of those infected were asymptomatic.

Despite what was known about the disease process in Nepal, routine health screening for soldiers whose deployment was imminent included testing of stool only when clinically indicated by symptoms. The lax screening procedures were further evident when, after the initial health screening, soldiers were given 10-day passes to travel around Nepal prior to deployment, including travel to cholera-infected areas without a subsequent health re-check.

In November 2010, French epidemiologist Renaud Piarroux concluded that someone in the MINUSTAH camp was responsible for introducing the infection into Haiti. In response to blistering criticism for its role in the cholera outbreak, the United Nations convened an independent panel to investigate the source of the outbreak and issue a public report of its findings.

According to the report, cholera was spread due to a confluence of circumstances, including environmental, economic, socio-political and immunological factors. Yet none of these factors should have come as a surprise in the poorest country in the Western hemisphere, and advocates warned of the possibility of an outbreak of cholera.

The report offered recommendations to prevent such a calamity in future, including that: Troops mobilised for emergency response should receive prophylactic treatment or screening or both; the United Nations should treat its own waste rather than subcontracting waste disposal; and that the United Nations forces should provide health training and resources for rehydration.

Knowing the conditions in Haiti and the risk for the spread of cholera they present, the UN should have taken heightened precautions to ensure that its peacekeepers were in good health. Moreover, the UN should have outlined strict sanitation guidelines, ensuring that the vulnerable local community would be protected from any further threats to life.

The suggestions of the independent panel regarding future safeguards speak to the fact that such precautions are viable and should have been in place prior to the deployment of the Nepalese troops instead of being implemented as an afterthought.

Providing assistance

Haiti has still not recovered from other natural disasters, including the earthquake and more recently the ravages of Hurricane Isaac. In the wake of 51 deaths and untold damage attributed to Hurricane Sandy, those coordinating humanitarian relief expressed concern that the resultant flooding will cause a spike in waterborne diseases, including cholera. Almost 400,000 Haitians still residing in internally displaced persons camps are especially vulnerable.

For many of the catastrophes that have plagued Haiti, there is no easily identifiable violator and no clear remedy. However, in the introduction of cholera and the suffering it has engendered, malfeasance on the part of the United Nations is beyond dispute. Even UN special Envoy to Haiti Bill Clinton admitted that the UN was the proximate cause of the epidemic.

The United Nations voted recently to extend the MINUSTAH mission, albeit with a substantial troop drawdown. This is a step in the right direction, as MINUSTAH’s presence in Haiti since 2004 has generated significant opposition – MINUSTAH stands accused of multiple other transgressions since 2004.

In numerous instances, MINUSTAH troops have been accused of sexual misconduct, including Uruguayan soldiers caught on video assaulting a young Haitian man, misbehaviour by Pakistani soldiers and the repatriation of more than one hundred Sri Lankan troops accused of “illicit liaisons”. MINUSTAH troops were also accused of unprovoked brutality, violence and deaths resulting from incursions into desperately poor Cite Soleil.

In her comments about renewing the MINUSTAH mission, US Ambassador to the UN, Susan Rice, opined that “The Mission has helped provide a more secure and stable environment in Haiti, strengthened the country’s institutions, protected civilians and safeguarded human rights”.

As the UN has decreased its MINUSTAH expenditures in Haiti, it can remedy the cholera tragedy by providing reparations to Haitians harmed by the epidemic, and by investing money in the development of a sanitation and health infrastructure that would forestall this type of crisis in future.

Among the services listed by the UN in reauthorising the MINUSTAH mission was its assistance in supporting institutions that uphold the rule of law. As human rights lawyer Mario Joseph noted, “To be a credible advocate for rule of law, however, the UN must demonstrate by example and be accountable for the cholera epidemic it caused.” Despite serious threats against Mario Joseph and other human rights advocates that have caused international alarm, the UN has remained silent.

The UN must model accountability by taking responsibility for the cholera epidemic by paying reparations to victims and investing in both immediate and long-term measures to remediate the conditions that make Haiti a hospitable vector for the continued transmission of cholera.

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Lauren Carasik is Director of the International Human Rights Clinic at Western New England University School of Law.

Go to Original – aljazeera.com

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