World

How the U.S. and U.N. Set the Stage for a Major Cholera Outbreak in Haiti

The failure to acknowledge the source of the outbreak and eradicate it has left the country vulnerable to the new uptick in infections.

Photo Credit: arindambanerjee / Shutterstock.com

Scientists say the warming of the ocean due to human-made climate change has intensified mega-storms like Hurricane Matthew, which recently tore through the Caribbean and parts of the United States, killing more than 1,000 people in Haiti alone, according to some estimates.

Now, with 1.4 million Haitians in need of emergency assistance, Haiti is bracing for another human-made disaster: a resurgence of its cholera outbreak, which dates to the aftermath of the catastrophic 2010 earthquake.

It took six years for the United Nations to publicly acknowledge what the scientific community has long known: the cholera epidemic was introduced to Haiti by U.N. peacekeepers, originating at one of the global organization’s camps in the upper Artibonite River valley, and from there, spreading through the country’s crumbling water system. The global failure to swiftly acknowledge the source of the outbreak and take aggressive action to eradicate it, has left the country vulnerable to the new uptick in infections.

The Pan American Health Organization (PAHO) said last week that it expects “an important upsurge in cholera cases in Haiti after Hurricane Matthew, given the context of flooding and the storm’s impact on water and sanitation infrastructure.”

“Water and sanitary conditions are expected to worsen due to the effects of Hurricane Matthew,” said Ciro Ugarte, the head of PAHO’s Program on Health Emergencies. “Efforts were already being directed to control the current epidemic of cholera and the high levels of vector-borne and water-borne diseases, but there is a limited capacity to respond to those challenges.”

Dominique Legros, cholera expert for the World Health Organization, told reporters Tuesday that there have been roughly 200 new cases after Hurricane Matthew. “It is more than usual. I know it is a sharp increase compared to [the] usual figures,” he said.

While cholera is preventable and easily treated under the right conditions, it has torn a devastating path through Haiti. Since October 2010, there have been more than 790,000 reported cases, and more than 9,300 people have been killed by the disease, according to PAHO. At its worst point in 2011, the epidemic was infecting 6,766 people every week. While cases continue, they have declined significantly, from 300,000 in 2011 to roughly 36,000 in 2015.

An expert panel convened by U.N. Secretary-General Ban Ki-Moon concluded in a 2011 report that cholera spread from a U.N. peacekeepers camp in the upper Artibonite River valley to the Meye Tributary system, which is used by “tens of thousands” of people for “washing, bathing, drinking and recreation.” Poor sanitation infrastructure caused human waste to contaminate the river system, leading to Haiti’s first cholera case in more than 100 years.

Numerous other scientific studies also pointed toward the role of the peacekeepers. Julianna LeMieux, senior fellow in molecular biology at the American Council on Science and Health, recently wrote, “The scientific community has known for years that the U.N. brought cholera to Haiti.”

Yet it was not until six years after the U.N. report came out—in August 2016—that the global institution made a nod to responsibility for its role in spreading the outbreak in Haiti, with spokesperson Farhan Haq proclaiming that "the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera."

This statement fell short of a full apology for the years that the U.N. spent denying its role in introducing the outbreak. Meanwhile, the U.N. continues to fight legal efforts by Haitian victims to win restitution, claiming immunity from a complaint filed on behalf of 5,000 victims of cholera. According to the Institute for Justice and Democracy in Haiti, the victims are demanding that the United Nations, "Install a national water and sanitation system that will control the epidemic; compensate individual victims of cholera for their losses; and issue a public apology from the United Nations for its wrongful acts."

Dan Beeton, international communications director for the Center for Economic and Policy Research, told AlterNet that the new wave of cholera infections could have been avoided “had there been a serious effort to eradicate cholera. What we’ve seen since the epidemic started six years ago is a focus on treatment during the rainy season when infections go up, but during the dry season people back off, so the epidemic remains.”

In a prescient warning, CEPR researchers Jake Johnston and Keane Bhatt wrote in 2011 that “health interventions launched to fight cholera have been hobbled by the initial missteps made in the wake of the epidemic. The international community underestimated the virulence of the outbreak; the U.N. initially denied responsibility for its introduction; and there was hesitation in investigating the circumstances surrounding its appearance.”

Meanwhile, international dollars have poured into organizations like the Red Cross and Clinton Foundation, despite evidence of gross mismanagement. At the same time, the U.N.-backed National Plan for the Elimination of Cholera in Haiti, 2013-2022, remains woefully under-funded, with the medium-term plan only 22 percent pledged and under 11 percent disbursed.

Some U.S. lawmakers are directing criticism toward the U.N., with 158 members of Congress who wrote a letter to John Kerry in June calling on the State Department to “immediately and unreservedly exercise its leadership to ensure that the United Nations take concrete steps to eliminate the cholera epidemic introduced to Haiti in 2010 by waste from a U.N. peacekeeper camp, and to comply with its legal and moral obligations to provide cholera victims with access to an effective remedy.”

However, this finger-pointing deflects from the central role that the U.S. played in setting the stage for the post-earthquake crisis, by undermining efforts to improve the country’s public water infrastructure. A paper published 2013 by the journal of the National Institutes of Health found that “Haiti has the lowest rates of access to improved water and sanitation infrastructure in the western hemisphere. This situation was likely exacerbated by the earthquake in 2010 and also contributed to the rapid spread of the cholera epidemic that started later that same year.”

The U.S. government bears responsibility for keeping Haiti's water system in a state of disrepair. According to a report released in 2008 by Partners In Health, Zanmi Lasante, the Center for Human Rights and Global Justice and the Robert F. Kennedy Memorial Center, the U.S. government clandestinely undermined a $54 million loan granted in 1998 by the Inter-American Development Bank to the Haitian government to improve its outdated water system. According to the report, the U.S. was motivated by the desire to destabilize Haiti’s elected government under then-President Jean-Bertrand Aristide.

However, the report notes that the root causes date back further. "Continual requirements to pay its debilitating debts—which date back to its early days of independence, when Haiti was essentially forced to purchase its freedom from the French for an exorbitant sum, and which has further amassed during two centuries of political turmoil, foreign occupation, and corruption—have left the Haitian government unable to funnel its limited resources into social infrastructure programs like water and sanitation systems, with catastrophic effects on the health and well-being of the Haitian people," the report states.

Sarah Lazare is a staff writer for AlterNet. A former staff writer for Common Dreams, she coedited the book About Face: Military Resisters Turn Against War. Follow her on Twitter at @sarahlazare.

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