Haiti's Cholera Outbreak Whodunit

Friday, 05 November 2010 14:51

MINUSTAH is under increasing scrutiny as investigators consider whether Haiti’s cholera outbreak may have begun at a base in Mirebalais, on a tributary of the Artibonite River, used by a Nepalese MINUSTAH contingent. “The U.S. Centers for Disease Control and Prevention found that the strain of cholera that has killed at least 442 people the past three weeks matches strains found in South Asia,” AP reported Wednesday. Other experts are certain that the disease – which has not been experienced in Haiti for many decades – must have had a foreign origin:

Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, said it is clear that the disease was imported to Haiti but that it is still not clear by whom or how. She said the epidemic will contain lessons for humanitarian relief work and disaster relief around the world.

"It has to be either peacekeepers or humanitarian relief workers, that's the bottom line," she said.

Some experts, such as Partners in Health founder, U.N. deputy special envoy, and award-winning doctor and humanitarian, Paul Farmer, urged continued investigation into the cause, despite UN reluctance. Farmer added that the decision not to investigate the diseases origins, “sounds like politics to me, not science.” AP also reports that

John Mekalanos, a cholera expert and chairman of Harvard University's microbiology department, said it is important to know exactly where and how the disease emerged because it is a novel, virulent strain previously unknown in the Western Hemisphere - and public health officials need to know how it spreads.

Interviewed by phone from Cambridge, Massachusetts, Mekalanos said evidence suggests Nepalese soldiers carried the disease when they arrived in early October following outbreaks in their homeland.

"The organism that is causing the disease is very uncharacteristic of (Haiti and the Caribbean), and is quite characteristic of the region from where the soldiers in the base came," said Mekalanos, a colleague of Farmer. "I don't see there is any way to avoid the conclusion that an unfortunate and presumably accidental introduction of the organism occurred."

Meanwhile, echoing Farmer’s statement that politics may be hindering efforts to contain the disease, Julie Turkewitz reports that the Haitian government may be slow in releasing information on new cholera cases because of the upcoming November 28 “elections”, even as Hurricane Tomas bears down on Haiti, threatening to “increase the cholera caseload ‘earlier and faster,’” Turkewitz quotes the Pan American Health Organization as warning.

MINUSTAH was defensive when questions were first raised as to whether the outbreak could have come from waste water at a site used by their Nepalese troops. Higher ups at the UN likewise seem to have been in no hurry to consider the possibility that MINUSTAH might be responsible for bringing cholera to Haiti. In an interview last week, Imogen Wall, the Head of Communications for the UN’s Office for the Coordination of Humanitarian Affairs, responded to the question “do we know sort of how the outbreak occurred and sort of what its sources are?” by calling it “appalling luck”. Appalling luck, perhaps, if human behavior had nothing to do with it, but appalling in other ways if it is due to negligence, carelessness, or preventable actions. A day after the interview, MINUSTAH announced it was indeed testing to see whether it might be responsible for the outbreak.

(Wall also highlights improved sanitation as key to avoiding spreading disease, but states that it is “a massive, massive long-term project.” Sanitation has indeed apparently been considered a “long-term project” ever since just after over a million people were displaced by the earthquake, despite warnings that poor sanitation could lead to disease outbreaks – and considered “long-term” even by large NGO’s that received tens of millions of U.S. taxpayer dollars specifically designated for sanitation, but have been slow to spend it.)

This latest MINUSTAH scandal should raise the question: why is MINUSTAH in Haiti? The UN often cites security needs as the rationale for annual extensions of MINUSTAH’s mission. Yet the complete lack of security threats and violence in the immediate aftermath of the quake – a time when foreign observers seemed most concerned that they would erupt – calls into question whether MINUSTAH’s presence is necessary, especially considering the many dark stains on its record, and frequent Protests against the Mission by Haitians. The UN Security Council has tasked MINUSTAH with assisting with logistics for this month’s elections, but the elections will be a sham if major political parties continue to be kept off the ballot for no justifiable reason.

Tags: hurricane season | minustah | sanitation | un