Cholera epidemic in Haiti

Shame on the UN for creating the deadly cholera epidemic that's killed 7,500 in Haiti

World View: Nepalese blue-beret troops brought the disease to the stricken country after the 2010 quake, but report implies the islanders are to blame

the Independent,

26 April, 2012

Haitians suffer more than most people in the world from poverty, disease, dictatorship, occupation and earthquakes. But for the past century, they have at least been free from cholera.

Not any more, thanks to the UN. The disease was carried to the island in 2010 by UN troops from Nepal, where cholera is endemic; and it first appeared near their camps. In the past two years, it has ravaged Haiti, killing 7,500 people and making 600,000 very ill. People are still dying in large numbers and it will probably be impossible to eradicate it from the fresh water supply on the island.

There is no doubt about the UN's culpability, though it is still trying to evade this and has not held anybody responsible for what happened. It is seeking to treat this man-made calamity as if it was a natural disaster that nobody could have foreseen or prevented. So far it has largely succeeded, because the outside world pays little attention to what goes on in Haiti, the poorest country in the Western hemisphere.

The last time the UN so fatally failed people it was meant to protect was in Srebrenica in 1995, when 8,373 Muslims were massacred by Serbian forces in Bosnia. On that occasion, it was a 400-strong Dutch unit of the UN protection force that failed to stop the massacre of defenceless people who wrongly supposed they would be all right in a "Safe Area" declared by the UN Security Council.

Srebrenica was denounced by the UN secretary general as the worst war crime in Europe since the Second World War. People still recognise the name, but how many people know that the UN presence in Haiti has led to a wholly predictable epidemic that has so far killed 7,568 Haitians, a toll that is still rising and which, sometime next year, will surpass that of Srebrenica?

The UN has yet to respond formally to the charge of starting the epidemic made against it by human rights organisations, or agree to pay compensation. It has sought to downplay the whole event, commissioning an expert report which has just been published and makes clear that the UN brought cholera to Haiti from Nepal, but claims "the source of the cholera in Haiti is no longer relevant to controlling the outbreak".

The UN study, entitled The Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti, is worth reading as an example of experts trying to tell a truth deeply damaging to those who commissioned the report. But at the same time, they rob their conclusions of impact by wrapping them in bureaucratic gobbledegook and claiming that nobody in the UN was at fault.

If anybody is to blame, the independent experts seem to think, it is the Haitians for being so vulnerable to the incoming bacteria brought by the infected Nepalese soldiers. Had the Haitians not used the rivers "for washing, bathing, drinking and recreation", all might have been well. Haitians lacked natural immunity, had inadequate sanitation, lacked effective medical facilities and should not have spread the illness by fleeing their villages when they were hit by the epidemic. Somehow, so the panel argues, this vulnerability of Haitians to the cholera means the outbreak "was not the fault of, or deliberate action of, a group or individual".

This is hypocrisy of a high order and the epidemic was certainly not an unhappy accident that nobody in the UN could have predicted.

The UN troops were sent to Haiti in the wake of the catastrophic earthquake in January 2010. Nepal was in the middle of a cholera outbreak, as was widely known. If troops came from Nepal, even after the most stringent screening, there was the likelihood that they would bring cholera with them. In practice, screening was very lax for soldiers on their way from Nepal to Haiti. Worse, in the 10 days before they departed, they were given 10-day passes to travel around the country, including the cholera-hit areas. They were not retested on their return.

The cholera epidemic in Haiti started downriver from the Nepalese soldiers' camps at Mirebalais, Hinche and Terre Rouge near a0 tributary of the Artibonite River, north of the capital Port-au-Prince, the first case being confirmed on 22 October 2010. Cholera normally spreads through water contaminated by faecal waste and there was little attempt to dispose of this safely. The independent report found that raw sewage from the Nepalese camp at Mirebalais ended up in tanks that were pumped out twice a week by an independent contractor into a truck. It continues: "The waste is then transported across the street and up a residential dirt road to a location at the top of a hill, where it is deposited in an open septic pit." A photo of the pit in the report shows it to be just a substantial hole in the ground. It is unfenced and children play around it. Another open cesspit nearby was used by the Nepalese soldiers for solid waste, with local residents commenting that "the area is susceptible to flooding and overflow into the tributary [of the Artibonite River] during rainfall".

There had been suggestions advantageous to the UN early on that the bacteria infecting Haiti might have come from the Gulf of Mexico or be a home-grown cholera strain previously present in Haiti that had mutated into a deadlier variety. The report knocks these ideas firmly on the head. It says that "study indicated that the Haitian strains were all identical and ... closely related to strains of Vibrio cholerae from the Indian sub-continent". It is quite distinct from those isolated in South America, Africa, Bahrain, Indonesia, Vietnam, Malaysia or Germany.

As with many official reports, the one on Haiti plays down its most damning findings in its executive summary and conclusions, but they are present in more direct language in the body of the report.

This leaves no doubt about the feckless disregard on the part of the UN commanders of the health risk posed by bringing Nepalese troops, some of whom were very likely to be cholera carriers, given that an epidemic was raging in their country, and allowing them to contaminate the water supply in Haiti. The excuse by the panel of experts that all might still have been well if Haiti had a better supply of fresh water and adequate sanitation is absurdly self-serving and hypocritical.

The UN's continuing evasion of responsibility for the Haitian outbreak, the biggest cholera epidemic anywhere in the world in recent years, has practical and fatal consequences for Haitians. It means the rest of the world is unaware of the seriousness of what has happened. The only way such an epidemic can be stopped is to improve Haiti's fresh water supply, sanitation, and health care. When the epidemic started, local medical centres did not even have a place where people could wash their hands. Haiti, where 400,000 people are still living in tents because their houses were destroyed by the earthquake two years ago, does not have any money to build such an infrastructure. When so many die because of incompetence, that incompetence becomes a crime. The UN should admit what it did, build this infrastructure, and pay reparations to its victims.