July 23, 2014
Last week, United Nations Secretary General Ban Ki-moon travelled to Haiti to raise awareness of the ongoing cholera epidemic that scientific studies have continually shown the U.N. troops in Haiti to be responsible for introducing. In an interview before his trip, Ban told Jacqueline Charles of the Miami Herald that the U.N. and international community had a “moral responsibility” to help Haiti eradicate the disease, already the world’s worst cholera epidemic having killed over 8,500 and sickened more than 700,000. Also last week, the U.N. quietly posted a document online (PDF) which provides information on its follow up to the Independent Panel of Expert’s recommendations, made in May 2011. The U.N. convened the panel in the aftermath of cholera’s introduction to study how it was introduced, how it can be stopped and efforts to prevent future epidemics.
In Haiti, during remarks at a church service in Las Palmas, the Secretary General told those present that, “I know that the epidemic has caused much anger and fear. I know that the disease continues to affect an unacceptable number of people.” Ban later ensured the Haitian people that, “You can count on me and the United Nations to do our part.”
But the visit by the Secretary General also put the spotlight on the U.N.’s own efforts to evade responsibility for cholera’s introduction, the subject of multiple lawsuits. “It is an insult to all Haitians for the Secretary-General to come to Haiti for a photo-op when he refuses to take responsibility for the thousands of Haitians killed and the hundreds of thousands sickened by the UN cholera epidemic,” said Mario Joseph, Managing Attorney of the Bureau des Avocats Internationaux (BAI) and one of the leading lawyers working to hold the U.N. accountable for cholera’s introduction to Haiti.
In December 2012, Ban pledged to “use every opportunity” to raise funds for an ambitious $2.2 billion ten-year cholera eradication plan. Yet over a year-and-a-half later, the plan remains woefully underfunded. According to the U.N. Office of the Secretary General’s Coordinator for Cholera Response in Haiti, at the current rate of disbursement, it “would take more than 40 years to fund the water, sanitation and hygiene” sectors of the elimination plan. Even the $485 million needed for the critical first two years of the plan, now nearing its end, is only 40 percent funded.
As part of the Secretary General’s trip, Ban launched a “Total Sanitation Campaign.” While it was presented as another new effort, according to the Office of the Secretary General’s Coordinator for Cholera Response in Haiti, it “is part of the sanitation component of the overall elimination plan.” Further, the U.N. itself has committed just 1 percent of the funds needed for the eradication plan. Meanwhile, since the earthquake, the U.N. troops that introduced cholera have cost the international community well over the $2.2 billion needed to fully fund the plan.
The Independent Panel’s Recommendations
In October 2010, the U.N. appointed an independent panel of scientific experts to study the introduction of cholera to Haiti. The panel concluded that it occurred as “a result of human activity,” and likely began in a river near a U.N. troop base, but that the “outbreak was caused by the confluence of circumstances” and that no single party should be blamed. Two years later, after additional scientific research was published, the authors followed up with a report that determined the U.N. was the “most likely” source.
As part of the Independent Panel’s original report, the author’s offered seven recommendations for the U.N.: using prophylactic antibiotics or screening U.N. personnel deployed from cholera endemic regions, use of antibiotics or the cholera vaccine when deploying personnel to locations with concurrent epidemics, improving on-site treatment of fecal waste at U.N. installations, taking the lead in improving case management, prioritizing programs to provide piped drinking water and sanitation, investigating the potential of cholera vaccines and increasing the use of advanced microbial techniques to improve surveillance and detection of cholera.
Upon the report’s release in May 2011, Ban announced that he would convene another task force to review the report and “ensure prompt and appropriate follow-up.” The Task Force was made up of senior U.N. officials from various agencies, including personnel from the UN Haiti team. However there has been little information as to what has been implemented in the intervening three-years, at least until a nine-page fact sheet was posted online last week by the U.N.
The U.N. has adopted some of the recommendations, but did not accept others. The U.N. has supported vaccination campaigns as well as increased use of advanced microbial techniques, as per the panel’s recommendations. The U.N. has also changed policies on the treatment of waste water at their bases around the world, noting that “All [U.N.] missions have provided action plans to ensure that all their wastewater facilities meet the minimum required standards set by the Organization’s Environmental Policy,” and that actions include “improvements to and better monitoring of existing facilities, installation of independent wastewater treatment plants, and inspection and closer supervision of contractors involved in wastewater disposal.”
The U.N. cites its work supporting the national elimination plan in response to the recommendations that it invest in water and sanitation infrastructure. But as described above, the lack of financial resources and the U.N.’s own role in the disease’s introduction have prevented a more robust response on this front.
A Second, Secretive Panel of Experts
“Overall, it does seem like progress is being made,” says Dr. Rishi Rattan, Chair of the Advocacy Committee for Physicians for Haiti. In a report he authored last year, Dr. Rattan evaluated the U.N.’s response to the independent panel’s recommendations, concluding that of the seven recommendations “the UN has not implemented three and only partially implemented two others.” The recently released fact sheet provides a glimpse into the rationale behind the lack of implementation and the role of a secretive second task force that was convened after the panel of experts presented its report.
While the formation of the Task Force was announced publicly at the time, little has been revealed about its actions. Though the Task Force was meant to implement the independent panel’s recommendations, in reality it had little contact with the panel members. In their follow up report (PDF) last year, the original panel members wrote that:
The Task Force did submit one request for additional information from the Independent Panel, which was answered. To date, no further contact has been initiated, and no results from the Task Force released.
Despite this, the U.N. decided against following recommendations one and two, which concerned the use of antibiotics, screening and vaccinations of U.N. personnel deployed from cholera endemic regions or into areas with cholera outbreaks. The U.N. cited the work of the Task Force, determining that there is a lack of scientific evidence to support the panel’s recommendations. While the Task Force’s original stated goal was to ensure “appropriate follow up,” the fact sheet provides an alternative explanation, describing the Task Force as being formed to “review the recommendations,” of the Independent Panel.
According to Dr. Rattan, while the U.N. may be “technically correct,” he added that there “is a lack of evidence to support either position.” For Dr. Rattan the bigger issue is the lack of transparency around this Task Force and how it has reached their decisions. Given that the U.N. itself selected the panel members because of their unique expertise on cholera-related issues, any decision in the opposite direction should be well documented.
“When a topic is controversial, complete transparency is ideal and when disagreements arise, each party goes back to the lab, conducts more tests, and presents all data. This is not what is happening here,” says Dr. Rattan. Even if the most likely outcome would be to agree with the U.N. interpretation, “the fact they are not doing it leaves a very bad taste in the mouth,” he adds.
While the fact that the U.N. has, after three years, publicly released a status update is welcome, says Beatrice Lindstrom of the Institute for Justice and Democracy in Haiti, “it doesn’t provide nearly enough information to explain why their internal experts’ views should trump the findings of the panel of independent experts they appointed in 2011.”
A request for further information on the makeup of the U.N. Task Force, and any documentation of its work was not answered by the U.N. cholera team. Members of the Independent Panel, contacted by e-mail, declined to comment.