By Danielle Randall-L’Estrange, a DAP Volunteer, based in Port au Prince, Haiti

Haiti is no stranger to natural disasters. It is currently braving Hurricane Matthew, it’s 22nd hurricane in 200 years. Also, as most will remember, Haiti was hit by a 7.0 magnitude earthquake in 2010 which killed hundreds of thousands of people and left close to 1.5 million people displaced.

The cholera endemic that followed the 2010 earthquake, however, was not a disaster of unavoidable, natural consequence. As has been widely studied and documented, the UN was responsible for the introduction of cholera in Haiti. Thus far the international community has not placed sufficient pressure on the U.N. to take full responsibility and the situation continues to worsen.

In early August, a UN special rapporteur on human rights, Philip Alston, sent a confidential report to UN Secretary General Ban Ki-moon addressing the UN’s responsibility for Haiti’s cholera outbreak. The confidential draft report, first reported on by the New York Times, was written under the proposed agenda item “Promotion and Protection of Human Rights” for the UN’s 71st General Assembly which recently came to a close in New York.

Alston’s conclusions outline in detail the UN’s responsibility for the outbreak and their failures to take accountability and implement effective remedies in the aftermath. In producing this report, Alston has helped to shed light on a public health disaster, left to fester, that those living in the shadows of its grim reality in Haiti already know all too well.

The Disease

Cholera is a disease that is contracted by consuming food or water contaminated with a bacterium called Vibrio cholerae. As a result of the severe diarrhoea and vomiting it causes, the disease can lead to a swift and painful death from complete dehydration if it is not caught in time. When caught in time, the disease is completely treatable.

The Outbreak and Endemic in Haiti

Since the outbreak in Haiti which occurred in late 2010, more than 770,000 people have contracted the disease and at least 10,000 have died. Scientific studies have stated that the mortality rate is almost certainly much higher than what has been reported.

Prior to 2010, no reports of the bacterial infection had ever been reported in Haiti.

In 2010, an outbreak of cholera in Nepal was underway. In October 2010, 454 peacekeepers arrived in Haiti from Nepal as part of the UN’s stabilisation mission (MINUSTAH). Within days of the troops’ arrival at their base in Mirebalais, central Haiti, local villagers were infected with cholera.

It was ultimately established that a large amount of infected faecal matter was dumped outside the designated septic pit by their contractor enlisted for waste management. This contaminated faecal matter entered first a local stream and then later, Haiti’s biggest river, the Artibonite. The UN’s own Panel in 2011 found that “the evidence overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Mèyé Tributary of the Artibonite River with a pathogenic strain of current South Asian type Vibrio cholerae as a result of human activity.” Crushingly, to add insult to injury, it has also been found in numerous studies that the UN troops who entered Haiti from Nepal could have been screened for the disease, and thus this public health disaster avoided, for as little as $2000.

The disease is now endemic in Haiti and current efforts targeted at eradication are ineffective. According to the UN’s own assessments in 2014, clinics were insufficiently stocked with vital oral rehydration salts, treatment centres outside the main cities were closing down as the funding organisations moved on to crises elsewhere and an increasing proportion of patients were dying after they reached hospitals. And all this despite the billions raised after the earthquake which have produced minimal outcomes — for example, see the ProPublica investigation of the American Red Cross.

Infection rates have been rising each year since 2014. From January-July 2016, 227 of the cases have resulted in death, a 32% increase from 2015.

A mere 24% of Haiti’s population have access to a toilet. Safe water continues to be inaccessible to many and sewage is largely untreated. Public health experts state that without efforts to tackle the country’s water and sanitation issues, the disease will continue to flourish. Dr Renaud Piarroux, a pediatrician who was one of the first to raise the alarm about Haiti’s outbreak, recently visited Haiti and wrote in a report that she found the prevalence of the disease and ongoing lack of infrastructure to reduce its spread alarming. She reported “that the current response is not up to the challenge is an understatement…neither local politicians nor the international community seem to have taken the measure of the seriousness of the situation.”

Philip Alston’s Report

Mr Alston, one of the many experts or “special rapporteurs” for the UN, sent his draft confidential report to UN Secretary General Ki-moon on August 8th. In this report he detailed that the overwhelming amount of published scientific evidence which establishes that the UN troops caused the outbreak in Haiti has eliminated the sustainability of their current policy of denial, a policy reliant on an earlier claim of scientific uncertainty. He also states that the undisclosed internal legal opinion which the UN currently rely on to claim immunity has been deemed deeply flawed by the overwhelming majority of expert commentators who have analysed the circumstances at hand.

The report follows a letter sent earlier this year by Alston and four other UN special rapporteurs to Ki-moon in which they indicated that the UN’s denial of their responsibility for Haiti’s cholera outbreak amounted to stripping the Haitian population of their right to justice.

Alston asserts that the cholera outbreak “would not have broken out but for the actions of the United Nations” and thus finds that the UN’s Haiti cholera policy is “morally unconscionable, legally indefensible and politically self-defeating.” Their position “upholds a double standard according to which the U.N. insists that member states respect human rights, while rejecting any such responsibility for itself.” He delves into a keen legal analysis to pick apart each element of their claim of immunity and also states that “research has provided as clear a demonstration of responsibility as is scientifically possible”.

Alston concludes that a new policy is urgently needed, and that this should start with an acceptance of responsibility and apology in the name of the Secretary-General. He states it must also include a compensation package for victims, in order for the UN to honour their “commitment to the rule of law, and upholding the integrity of the peacekeeping system”.

The UN’s Efforts to Date

In 2012, the UN announced a $US2.27 billion, 10-year program to assist in the eradication of cholera for both Haiti and the Dominican Republic, which are neighbouring countries on the island of Hispaniola. The funds required for this program have still not been raised (a meagre $307 million as of November 2015) and thus far the UN have not completed any large-scale water and sanitation projects in Haiti, which are crucial to the eradication of the disease.

In 2014, the UN Secretary General’s envoy for the cholera outbreak Pedro Medrano Rojas blamed the poor progress on donor fatigue and stated “[h]ad we had the resources it would have been different…It’s not expensive. No one should be dying from cholera”.

Accountability

As Alston details in his report, the UN have employed a number of strategies to sidestep the question of who is responsible for the outbreak. One such example is that the Investigative Panel set up by the UN in 2011 explicitly to “investigate and seek to determine the source” of the outbreak subsequently stated in their conclusion that the source was “no longer relevant for controlling the outbreak”.

Another example, as Alston identifies, is the UN’s attempt at muddying the facts by merging the fact that cholera would not be in Haiti but for the UN’s actions with the country’s vulnerability: the 2011 Panel concluded that the dumping of feces alone “could not have been the source of such an outbreak without simultaneous water and sanitation and health care system deficiencies.” Dr Paul S. Keim, a microbial geneticist whose laboratory matched the Nepalese and Haitian cholera strains, said of the disaster “it was like throwing a lighted match into a gasoline-filled room”. Drawing on this analogy, the UN’s strategy of deflecting responsibility on to the pre-existing conditions in Haiti is as absurd a statement as someone who has thrown a lit match into a room certainly known to be filled with gasoline, and then stating that they are not the cause of the inevitable explosion.

The UN not only denied responsibility and thus delayed actions in the crucial first few weeks, but also failed to clean up their act once the outbreak was rampant. In another internal UN report released last month, the UN’s own auditors found that of the sites they visited which were run by UN “peacekeepers” in Haiti, a quarter of them were still discharging waste into public canals in 2014, four years after the outbreak occurred.

Farhan Haq, UN deputy spokesman, said in a statement recently that a UN-appointed panel have already investigated the UN’s involvement in the outbreak and concluded that a local contractor failed to properly sanitise the waste at the UN base. Haq also said that “over the past year, 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”.

Despite these numerous internal findings and admissions of the UN’s responsibility for the outbreak of cholera in Haiti, and expert reports as explicitly damning as Alston’s, the UN’s ongoing claim in response to lawsuits is that they have diplomatic immunity under a 1946 convention. Effectively, they assert that they cannot be made to answer claims in regards to their responsibility for the outbreak because they are entirely immune from the litigation process.

Most recently, a decision delivered by a Court of Appeal in New York on August 18th upheld their claim of immunity against such litigation in a case brought on behalf of 5,000 cholera victims. These claimants now have 90 days to decide if they want to appeal this decision found in favour of the UN to the U.S. Supreme Court. Brian Concannon, who has worked tirelessly for years as the executive director of the Institute for Justice and Democracy in Haiti to bring the UN to account for their actions, said in regards to this next appeal avenue “[w]e will decide how to proceed based on whether the U.N.’s actions fulfill the cholera victims’ rights to an effective remedy”.

Where to now?

Despite the latest court decision upholding their immunity, Farhan Haq has stated that “the United Nations has a moral responsibility to the victims”. In light of their involvement in the outbreak of the disease, the UN has promised that “a significantly new set of U.N. actions” will be presented publicly within the next two months and that the package would provide “material assistance” to the victims. “This is a major victory for the thousands of Haitians who have been marching for justice, writing to the UN and bringing the UN to court,” said Mario Joseph, a Haitian lawyer from the firm leading the case representing 5,000 of the epidemic’s victims.  “It is high time for the UN to make this right and prove to the world that “human rights for all” means for Haitians too,” he said.

The UN has not as yet been willing to say whether reparations are being considered. And as Beatrice Lindstrom of the Institute for Justice & Democracy in Haiti (IJDH) said, in order to truly test the intentions behind the UN’s words, “[they] must follow this announcement with action, including issuing a public apology, establishing a plan to provide compensation to the victims who have lost so much, and ensuring that cholera is eliminated in Haiti through robust investment in water and sanitation infrastructure. We will keep fighting until it does.”

One major problem in providing this compensation, and as Alston suspects one of the main deterrents for UN action to date, is the sheer cost of the damage done. The reparations demanded by the families of the 10,000 killed and more than 700,000 affected would reach $40 billion, and this figure does not even take into account “those certain to die and be infected in the years ahead”, Alston wrote. “Since this is almost five times the total annual budget for peacekeeping worldwide, it is a figure that is understandably seen as prohibitive and unrealistic,” he continued. For this very reason it is equally in the best interests of the UN, as it is for the Haitian population, that effective and feasible remedies are developed in a settlement context, rather than continuing the litigation process.

In regards to the impacts that Alston’s report may have, Special Rapporteurs technically provide independent guidance and thus the UN can choose to accept or reject their advice. The final version of Alston’s report was due to be presented as part of the 71st Session of the UN’s General Assembly which came to a close on September 24th. Haiti’s President Privert took to the podium as part of the General Assembly proceedings and stated that “[w]e want to hope that the Secretary-General’s urgent appeal for a substantially reinforced battle plan against cholera and to aid the victims and their near ones will be heard and fully meet the expectations of the Haitian people.”

And when the UN announces its new package, if nothing more concrete or effective than the current dismal efforts are offered – what then? How will States continue to invest resources and trust in such an organisation which on the one hand has such enormous breadth in scope and impact in the aftermath of a disaster, and on the other hand due to this same reach and impact can wreak havoc in the vulnerable environment into which it has been deployed, without consequence?

Such a lack of meaningful action by the UN may lead to quite a tenuous risk-reward ratio when assessing whether their on-the-ground assistance or interventions are welcome or “worth it”. States may indeed be wise to rely more on internal resources and structures to provide the relief that they can, lining up international funds with local implementing partners. Such a shift would be in line with one of the main outcomes at the first ever World Humanitarian Summit held in May, titled “The Grand Bargain,” which included a promise to increase funding to local and national agencies from less than 2 percent now to 25 percent by 2020.

At the date of writing of this article, Tuesday 4th October 2016, Hurricane Matthew maintains its Category 4 status as it continues to head north across the country and pick up momentum from an already alarming maximum sustained wind speed of 145mph. Fears are already spreading that Matthew and its aftermath may lead to the further spread of the disease in some communities.

Given the UN’s recent promise to establish a new plan for cholera in Haiti after receiving Alston’s report, time will tell as to whether the alarm on the subject has been raised loud enough to incite the media attention and public scrutiny required to coax the UN into action.