Cholera in Haiti shows U.N. must change its ways

The United Nations has accepted responsibility for the cholera epidemic that sickened at least 370,000 people in Haiti like the ones at this treatment center.
The United Nations has accepted responsibility for the cholera epidemic that sickened at least 370,000 people in Haiti like the ones at this treatment center. AP

Finally, the truth about the Haiti cholera outbreak is unarguable. U.N. peacekeeping soldiers from Nepal brought cholera to Haiti, a country they pledged to protect from strife and disorder. They arrived in October 2010 at a time of weak U.N. management, both in dealing with sanitation and water issues and in monitoring for infectious diseases.

This shoddy management resulted in leaking pipes at the soldiers’ base near Mirebalais, allowing feces and urine to flow into a nearby stream. The waterway was regular used by Haitians to wash clothes and gather water for drinking and other household uses.

Although cholera was never before recorded in Haiti, a few cases appeared in October 2010 shortly after the arrival of the soldiers from Nepal. But this flow from leaking sewer pipes was not enough to start the greatest cholera epidemic in modern times.

That took much more.

U.N. officials had contracted with a vendor to move waste from the camp to two hilltop pits, one for solid garbage and the other for liquid waste, including fecal matter. During the first few days in the camp, the soldiers from Nepal developed symptoms of the disease, including constant diarrhea.

When their cholera-ridden waste was taken to the hillside pit, the driver found it was full. He called his U.N.-contracted employer, who told him to dump the load, which he did — right into the stream. The fecal-contaminated water flowed north to the Artibonite River, then northeast to the Caribbean coast, passing through Haiti’s rich agricultural valley.

As people drank the water, cholera exploded in community after community, eventually making its way throughout the country.

The U.N.’s poor sanitary conditions were noted by reporters who first visited the camp a week after the epidemic began. A month later, the sanitary problems were again observed in U.N.-managed bases in Haiti by a U.N.-sponsored environmental health assessment team.

In February 2011, a group of four experts commissioned by the United Nations observed similar sanitation problems in and around the camp, although some improvements had been made.

The most recent review — done by the U.N.’s own Office of Internal Oversight Services covering July 2012 thru June 2014 — inspected all U.N. peacekeeping bases in Haiti. It found so many sanitary problems that the waste management score was deemed “unsatisfactory.”

While all this was taking place, U.N. officials were denying responsibility for bringing cholera to Haiti, altering maps to hide their tracks, and engaging in all kinds of cover-up activities.

When we, as epidemiologists, investigate disease outbreaks, we always look for the source. We use this information to recommend policy or procedural changes to prevent future outbreaks. Since the United Nations refused to admit what happened, or even acknowledge the source, it made it much more difficult to effectively respond to the lethal epidemic.

Now that the U.N. has finally acknowledged that it was involved in the onset of the epidemic, which has taken 10,000 lives, it must accept the scientific facts surrounding the source and early spread of the epidemic and own up to its role.

The next step is to implement three urgently needed policy changes for all of its peacekeeping missions.

▪ Troops brought from one country to another should be tested, vaccinated or treated for common infectious diseases. This is done with troops from wealthier countries. and should be done by the U.N. too.

▪ Inbound troops should be observed for a set time period — similar to a quarantine but not so restrictive — to look for signs of various diseases.

▪ Most important, human waste should be decontaminated within each camp with a local and reliable wastewater treatment plant. If a gastrointestinal disease outbreak does occur, at least the infected matter will not find its way into the drinking water of indigenous communities.

This is the least the United Nations can do wherever it stations peacekeepers to ensure that its soldiers never repeat the catastrophe in Haiti.

Dr. Ralph R. Frerichs is professor emeritus of epidemiology at UCLA. He has recently authored, in close collaboration with Dr. Renaud Piarroux, “Deadly River — Cholera and Cover-up in Post-earthquake Haiti.” (Cornell University Press, 2016). Dr. Piarroux, a French epidemiologist commissioned by the Haitian government to investigate the cholera epidemic, is professor at Aix Marseille University, and heads the Laboratory of Parasitology and Mycology at the La Timone academic hospital in Marseille, France.