Studies – and Editorials – Pile Up Pointing to UN Responsibility for Cholera in Haiti

August 13, 2013

(This post was revised on August 14, 2013 to add additional references to cholera studies suggested by reader feedback.)

Yet another study [PDF] has determined that the U.N. is responsible for having caused Haiti’s deadly, ongoing cholera epidemic. The new report written by Rosalyn Chan MD, MPH, Tassity Johnson, Charanya Krishnaswami, Samuel Oliker-Friedland, and Celso Perez Carballo and published by the Yale Law School and the Yale School of Public Health, in collaboration with the Haitian Environmental Law Association (Association Hatïenne de Droit de L’Environment), concludes that “The United Nations inadvertently caused a deadly cholera epidemic in Haiti, and has legal and moral obligations to remedy this harm.”

According to the press release accompanying the 58-page report [PDF], the results “directly contradic[t] recent statements by the U.N. Secretary-General that the organization did not bring cholera to Haiti, and has no legal responsibilities for the epidemic or its consequences.”

“The U.N.’s ongoing unwillingness to hold itself accountable to victims violates its obligations under international law,” Johnson said in the release.

A Washington Post editorial on Sunday once again called on the U.N. to take responsibility for the cholera outbreak, and on the international community to put up the funds needed to implement the cholera eradication plan designed by the Haitian and Dominican governments, the U.N., the Pan American Health Organization, and the Centers for Disease Control and Prevention:

IT IS now all but certain that Haiti’s cholera epidemic, which has killed more than 8,000 people and sickened more than 600,000, is directly traceable to a battalion of U.N. peacekeepers who arrived in the country after the 2010 earthquake.

A report from researchers at the Yale School of Public Health and Yale Law School details the convincing epidemiological evidence, as well as the United Nations’ stubborn disavowal of responsibility. Initially, a panel of independent experts enlisted by the United Nations said that the evidence pointing to the peacekeepers was mainly circumstantial. Now the experts have reversed themselves, saying that the Nepalese peacekeepers were “most likely” the cause of the epidemic. Still, the United Nations refuses to accept legal, financial or moral responsibility.

Haiti needs sewage treatment plants and municipal water facilities, as well as an effective primary health-care system accessible to people in rural areas as well as towns. Through UNICEF and the Pan American Health Organization, the United Nations should redouble its efforts to establish modern infrastructure in a country where 90 percent of the population lacks running water.

That’s not just part of the United Nations’ mission. It’s a matter of accountability and responsibility.

The Yale study is at least the tenth such report to emerge with evidence pointing to U.N. culpability. As former AP Haiti correspondent Jonathan Katz (one of the first reporters to document the reckless sewage disposal practices at the Mirebalais MINUSTAH camp) reminded us, as early as November 1, 2010, the CDC had announced “results of laboratory testing showing that the cholera strain linked to the current outbreak in Haiti is most similar to cholera strains found in South Asia.” Others studies have included those published by:

  • Microbiology and Immunology (July 2013, by the authors of the original U.N. independent study – see below): “the preponderance of the evidence and the weight of the circumstantial evidence does lead to the conclusion that personnel associated with the Mirebalais MINUSTAH [The U.N. Mission in Haiti] facility were the most likely source of introduction of cholera into Haiti.”
  • mBio (American Society for Microbiology) (July 2013): “We have found no evidence that environmental strains have played a role in the evolution of the outbreak strain,” “Our results were consistent with previous findings that show that the Haiti cholera outbreak is clonal and that Nepalese isolates are the closest relatives to the Haiti strain identified to date…”
  • Clinical Microbiology and Infection (June 2012): “The evidence that the Nepalese UN peacekeeping troops brought cholera to Haiti appears particularly strong, based on background events and published epidemiologic and molecular-genetic investigations.”
  • The Lancet [PDF] (March 2012): “…the onset of cholera in Haiti was not the result of climatic factors and was not the direct consequence of the January 2010 earthquake. All of the scienti?c evidence shows that cholera was brought by a contingent of soldiers travelling from a country experiencing a cholera epidemic.”
  • The American Journal of Tropical Medicine and Hygiene (January 2012): “The Haitian strain of cholera was analyzed initially to be of South Asian origin, later confirmed to be identical to the circulating Nepali strain and identified to have most likely been inadvertently introduced into the Meye river tributary system in Mirebalais as the result of faulty sanitation practices in the base camp of United Nations peacekeepers.”
  • mBio (August 2011): “This molecular phylogeny reinforces the previous epidemiological investigation that pointed towards United Nations peacekeepers from Nepal as the source of the Haitian cholera epidemic.”
  • Emerging Infectious Diseases (CDC) (July 2011): “Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic,” “We…believe that symptomatic cases occurred inside the MINUSTAH camp.”
  • The United Nations Independent Panel of Experts [PDF] (May 2011): “the 2010 Haiti cholera outbreak was caused by bacteria introduced into Haiti as a result of human activity; more specifically by the contamination of the Meye Tributary System of the  Artibonite River with a pathogenic strain of the current South Asian type Vibrio cholerae.” 
  • The New England Journal of Medicine (January 2011): “The V. cholerae strain responsible for the expanding cholera epidemic in Haiti is nearly identical to so-called variant seventh-pandemic El Tor O1 strains that are predominant in South Asia, including Bangladesh. …our data strongly suggest that the Haitian epidemic began with introduction of a V. cholerae strain into Haiti by human activity from a distant geographic source.”

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