Yesterday, the UN “independent panel” released their long awaited report (PDF) on the origin of cholera in Haiti. Although the ultimate conclusion of the panel was that “the Haiti cholera outbreak was caused by the confluence of circumstances…and was not the fault of, or deliberate action of, a group or individual,” the report is a serious indictment of MINUSTAH, specifically the base in Mirebalais. The report finds that the cholera outbreak began in a tributary near the MINUSTAH base and that the “sanitation conditions at the Mirebalais MINUSTAH camp were not sufficient to prevent fecal contamination of the Meye Tributary System of the Artibonite River.” (Check out the picture of the sewage pit on page 22 of the report).
The report does find that cholera “strains isolated in Haiti and Nepal during 2009 were a perfect match”. The MINUSTAH troops at the base were from Nepal. And the disease was introduced “as a result of human activity.” But, as Colum Lynch asked today:
In the end, the panel echoed the U.N.’s talking points throughout the cholera crisis: that the battle to end the scourge should take priority over determining how it got there. “The source of cholera in Haiti is no longer relevant to controlling the outbreak,” he said. “What are needed at this time are measures to prevent the disease from becoming endemic,” the report concluded.
Surely, no one would quibble with that sentiment. But wasn’t the panel’s primary mission to do just that?
Although MINUSTAH has long maintained that the focus should be on treating the disease rather than finding the source, French epidemiologist Renaud Piarroux has argued for the importance of tracking the origin. Among the reasons given are:
if an investigation demonstrates, or even suspects, that problems in detecting asymptomatic carriage, handling sewage or preserving water resources may have resulted in such an epidemic, referred institutions would be compelled to modify their procedures so that such a disaster could never happen again. Thirdly, knowing the origin of the Haitian epidemic is essential for the future. If cholera started from a quiescent reservoir, its elimination will not be achieved in Haiti for many years, if ever. Alternatively, if importation is confirmed, hope of elimination still remains. Fourthly, and most importantly, researching and telling the truth is essential to restore trust between populations and humanitarian staff.
Fortunately, most news articles have looked beyond the conclusion of the report, and accurately noted that while the panel members refused to lay blame on MINUSTAH, the evidence in the report clearly does. Joe Lauria of the Wall Street Journal wrote:
The report plays down as a “hypothesis that soldiers deployed from a cholera-endemic country to the Mirebalais Minustah camp were the source of the cholera” which it said was “a commonly held belief in Haiti.”
But the report then describes in detail how the outbreak occurred because of contamination of the Artibonite River from the peacekeeping camp.
Most importantly, and one of the main reasons for trying to trace the origin, as Piarroux noted, is that the report has led to a series of recommendations that hopefully will prevent something like this from occurring again. The report suggests that UN personnel coming from cholera endemic regions should first be screened for the disease, that UN personnel should be given antibiotics or vaccines before deployment, and that UN bases should “treat fecal waste using on-site systems”.
MINUSTAH Attempts to Avoid Blame
The report also raises serious questions about MINUSTAH’s reaction in the first weeks of the cholera outbreak. On October 26, 2010 MINUSTAH issued a statement to “clarify rumors” about the origin of cholera. The statement said:
MINUSTAH is keen to shed light around rumours published by certain media that led to the belief that human refuse thrown into a river in Mirebalais by MINUSTAH would be at the origin of the cholera epidemic in Haiti
The statement continued, touting their sanitation system:
Seven septic tanks, built in a closed circuit, serve the military base and meet the construction standards of the Environmental Protection Agency (EPA).
And noting that “It is 250 meters from the Meille river, which represents more than 20 times the distance required at the international level.”
The recently released report, however, describes the waste pit, where fecal matter and other waste is deposited:
There is no fence around the site, and children were observed playing and animals roaming in the area around the pit. The southeast branch of Meye Tributary System is located a short walk down the hill from the pit, on the banks of which is located the solid waste disposal site for the MINUSTAH camp. Local residents reported trucks delivering waste to this disposal site and commented that the area is susceptible to flooding and overflow into the Tributary during rainfall.
Just two days later MINUSTAH issued another statement that reiterates the same points again. It also adds that they had undertook tests in the water and they were all negative, and that:
The engineers of Minustah have strongly emphasized that the water overflow near the latrines comes from a water disposal basin connected to a kitchen and a shower – that occasionally overflows after hard rains – and not from the latrines or from the sceptic tanks. This basin is located 3 meters away from the latrines. Passersby mistakenly believed that the proximity of soaked earth as far as the latrines was caused by the overflow of human waste.
Yet the report notes that:
The construction of the water pipes in the main toilet/showering area is haphazard, with significant potential for cross-contamination through leakage from broken pipes and poor pipe connections, especially from pipes that run over an open drainage ditch that runs throughout the camp and flows directly into the Meye Tributary System.
Other UN agencies were often no better, with OCHA spokesperson Imogen Wall calling the cholera outbreak “appalling luck.” But as was pointed out previously, the sanitation at the MINUSTAH base was “not sufficient to prevent fecal contamination of the Meye Tributary System” and the report was clear that cholera was introduced “as a result of human activity,” and not just “appalling luck.”
Also, rather than responding to the legitimate grievances of those protesting against MINUSTAH, the peacekeeping force blamed the protesters for being “politically motivated” and for sowing chaos before the election.
It is unfortunate that his pattern of deflecting blame and dishonesty about the sanitation at the base continues even after the UN report.