Institute for Justice and Democracy in Haiti

Truth Out, Dying Season In

The Haiti Support Group

UN Cholera Response: Disdainful, Disingenuous and Deceitful

Has the UN’s intestinal worm turned? On an inspection of the solar energy capacity of the new teaching hospital in Mirebalais on arch 7, Bill Clinton, UN Special Envoy to Haiti, stated as fact what everyone except the United Nations itself has accepted for more than a year. UN troops – specifically a Nepalese Battalion based just a couple of miles away – were responsible for introducing cholera to Haiti in October 2010, causing what is now the world’s most potent current epidemic. 

The admission came in reply to a challenge from one of Haiti’s most active investigative journalists, Ansel Hertz. Just days before, in reporting an unprecedented trip to Haiti by the UN Security Council, Washington’s Ambassador to the UN, Susan Rice, had  referred to both the cholera epidemic and sexual abuse by UN troops in Haiti in the same sentence.

Rice called on the United Nations to “redouble its efforts to prevent any further incidents of this kind and to ensure that those responsible are held accountable.” The listing of the two charges on the same rap sheet implied the UN was responsible for cholera – without actually stating it. It was an ambiguity that might have been intentional given the growing frustration with the UN in Haiti.

Hertz asked Clinton if he agreed that those who introduced cholera to Haiti should be held responsible, citing the “multiple scientific studies” that pointed to the UN. Clinton’s answer was actually “no”, but in saying so, he stated what Rice had not, whilst making all the classic excuses about intention (none) and context (Haiti’s terrible water and sanitation provision).

“I don’t know that the person who introduced cholera into Haiti from the UN peacekeeping forces…was actually aware that he was carrying the virus…it came from his waste stream into the waterways of Haiti and into the bodies of Haitians. But what really caused it was that you don’t have a comprehensive sanitation system.”

Clinton went on. “I can’t recall ever until this cholera outbreak hit people even asking: ‘Did these people come from a place where they have a lot of cholera, malaria or you name it and…therefore, almost by accident, we could start an epidemic?’ It’s one question that I think will always be asked from now on. I feel terrible about what happened here…but I don’t think this was a deliberate callous disregard for the lives of the people of Haiti.”

It was the ultimate Clintonesque parry and a reaffirmation of the norm in Haiti for everyone and everything from the government to the international community. In short, the UN should not be held accountable, even though it was responsible, because no one whose job it was to consider the risk of causing an epidemic in the UN’s Departments of Field Support, Medical Services, or Environmental Engineering, had bothered to do so. As Jonathan Katz, the prize-winning reporter who did so much to uncover the UN’s responsibility, summarized on his blog as to accountability: “Maybe next time.” Meantime, in that old Clinton emotes ploy: He feels Haitians’ pain.

UN Denies, Haitians Die

If that’s the gospel according to UN Special Envoy to Haiti Bill Clinton, you would expect some version of that to also become the UN’s in due course. But don’t hold your breath. The one theme running through the UN’s disingenuous denials and deceit since cholera exploded with 129 deaths in 3,000 cases in just 48 hours during late October 2010, is that the evidence is, in their public relations team’s words, “inconclusive”.

In fact, the UN has done everything possible to ensure such evidence will never be available by failing to test the suspect troops, failing to use a proven technique to test the leaking sewage at their base, and thus, in such denial, failing to warn in a timely manner and causing scores of deaths. The UN has had one overriding modus operandi in this case from the beginning: knowing the facts will be incriminating – it has refused to search them out.

No one else – epidemiologists, public health experts, microbiologists – has any doubts about the cause and the culpability. In the year since the UN’s own expert panel published a report presenting evidence of UN fault, making compelling recommendations for change but declining to actually point the finger, the science has become conclusive. At the last count, nine separate independent research groups, using 12 different scientifically- validated methods, have all pointed in just one direction: Nepalese troops in a base known as NEPBATT 1 in Meille (Meye), near Mirebalais.

In particular, the most recent study compared full-genome sequencing of the vibrio cholerae found in Haiti with samples collected during a 2010 epidemic in the Kathmandu Valley. The samples bravely provided by the National Public Health  Laboratory in Kathmandu in a commitment to transparency, truth and life-preservation that puts the UN to shame. One cluster of samples demonstrated only a single DNA base pair difference (cholera has more than 4 million) between the two strains, a 99.9999% genetic similarity.

Despite what experts are now labelling ‘molecular proof,’ the UN has refused to take the Susan Rice or Bill Clinton hint – or kick – and come clean. In fact, quite the opposite, within 48 hours of Clinton’s remarks, Mariano Fernandez, the head of the UN in Haiti kicked back, hard. “We took the decision to not say a single word on cholera because there’s a legal claim. No single person from the UN should say anything about cholera.”

The ironies here are profound. In making his admission, Bill Clinton used the legal phrase of the lawyers working for IJDH in Boston and BAI in Port-au-Prince in filing a claim against the organisation he represents (see inset article). Clinton stated: “It was the proximate cause of cholera, that is, he [the Nepalese soldier] was carrying the cholera strain.” Yet now the UN is using the fact that it has failed to respond in substance to the IJDH/BAI claim (presumably because it is unable to come up with any persuasive arguments to counter it) as an excuse to try and close the case down. The UN’s silence, must now, it insists, be everyone else’s.

Haitians and their advocates have refused to be silenced. There is no doubt that Clinton’s admission and Rice’s admonition owe as much to public as to political pressure. Every tool in the box has been applied, from mass demonstrations to lawsuits, from email deluges to conferences. Similarly, every possible agent has been recruited, from lawyers to epidemiologists, microbiologists to health promoters, diplomats to grassroots activists.

Put the facts under the microscope, and you see every virulent pathogen known to international agencies: gross negligence, in defiance of every health and human rights standard that the UN is charged with enforcing; denial, defiance and cover-up, which has demonstrably increased the death toll; and an arrogance and hubris that are wrapped in a cocoon of legal immunity. In essence, the UN can do no wrong, whilst vigorously defending its right to get away with causing massive harm.

The Numbers, the Negligence  

First – the numbers. Up to March 1, 2012, 7,040 Haitians are dead, with 530,953 sickened by cholera. That toll will soar again with the onset of the rainy season in May. And no one believes these figures are accurate. Despite the best efforts of the Haitian Health Ministry and its partners, many Haitians are dying unrecorded, miles from cholera treatment centres, in hamlets where no one even knows what the disease is, let alone why they are dying from it.

Introduced into a ‘cholera-naïve’ country with no immunity, into the perfect transmission mechanism, the headwaters of the country’s largest river system, into a nation that ranked 147 out of 147 on the world’s Water Poverty Index before the January 2010 earthquake and has endured the worst levels of sanitation in the world since, this particularly virulent strain of cholera has enjoyed near perfect conditions in which to spread.

In July 2011, the height of the rainy season, one Haitian succumbed to cholera every minute. With death rates that have been as high as 7% of those infected (the global benchmark is 1%), cholera is now endemic to Haiti, nearly one hundred years after the last known case. Compensation and restitution to the hundreds of thousands of Haitians killed or harmed to date, plus investment in water and sanitation systems to prevent a re-occurrence could run into the billions. The UN’s liability here, if it can be established legally as well as morally, is astronomic.

Second – the negligence. No one is accusing the UN of deliberately infecting Haiti with cholera, as Bill Clinton insinuates. The question is not whether they foresaw this, but rather whether they should have. Did they take reasonable precautions on a reasonable assessment of the risk? What is at issue here is simple: was there negligence, or worse, gross criminal negligence, recklessness and deliberate indifference? Did the UN do everything possible to prevent the introduction of cholera at a time when Haiti’s vulnerability to such was widely understood, even by the UN? Having failed to keep cholera out, did the UN respond adequately, make full redress, in a timely manner?

Anything but, it turns out.

Pre-deployment protocols published in the Medical Support Manual for UN Peacekeeping do not even require the testing of troops for cholera, let alone its treatment, if they show no signs of the illness or are, in medical terms, asymptomatic. As the UN’s own report by its panel of experts indelicately puts it: “A medical examination was completed before they departed Kathmandu. The examination only included microbiological testing of stools when clinically indicated.”

What the UN experts do not say in their report is how particularly inadequate all this was – for them such standards do not even seem to rise to the definition of a protocol – for this disease, in this circumstance. Many cholera carriers, up to 75% in Nepal, show no symptoms. Just what that meant in this case was revealed by the Nepalese army’s chief medical officer, Brigadier General Dr. Kishore Rana, who, in December 2010, confirmed that the UN “protocol” had been followed but that none of his troops required testing, despite a major cholera epidemic in the Kathmandu Valley in the summer of 2010.

Blackwater Backflow: A Stink

But the negligence that followed once the Nepalese troops were deployed at NEPBATT 1 in Meille, was even worse. “Frankly the place was a sanitation clusterfuck,” blogs Jonathan Katz, the reporter who got onto the base on October 27, 2010, the day after the UN had issued a press release denying its base could be the source. “The cholera could have come from anywhere there. It stank.”

Katz highlighted three probable sources. The first was an overflowing septic tank with broken pipes spewing liquid black water waste (sewage) onto the ground “which dribbled down to the river where people were bathing.” The second was leaking pipes crossing a drainage ditch that ran down to the river. The UN claimed these pipes carried grey water waste (wash water), but even after supposed remedial action three months later the UN’s expert investigators concluded that the piping system was so haphazard there was “significant potential for crosscontamination.”

The third was a shovel-dug landfill site, an unlined, unfenced, uncovered dumppit into which a contracted waste disposal company, Sanco Enterprises SA, deposited the contents of the bases’ septic tanks when called. This was just 820 feet – down a steep slope – from Boukan Kanni, the Meille River tributary of Haiti’s largest river, the Artibonite. Locals reported that both the on-base septic tank and the landfill site frequently overflowed into the stream, in which they had to bathe, drink and wash.

But it was the UN Military Police unit collecting samples of the waste stream trickling towards the river that provided the first instalment of the cover-up Jonathan Katz would now chronicle. Not only was the press release the UN had put out just hours before false – it claimed the base had sealed septic tanks that were emptied weekly and dumped in a landfill site a safe distance from the river – but they could not possibly know the base was not the source of the cholera until they had tested. The samples were only now being collected in blue-capped specimen jars by UN blue-caps who were, in Katz’s words, “clearly horrified”.

What happened next was classic spin. The UN said none of its Nepalese troops had shown signs of cholera. Yet again, even now, the troops were not tested. On October 30, under press interrogation, UN Spokesman, Vincenzo Pugliese confirmed that they had not been tested. It was not a message his boss Alain Le Roy, UN Under Secretary for Peacekeeping Operations, chose to hear or repeat in New York. Nearly seven weeks later he claimed to the press, “all the soldiers had tested negative for the strain.”

Some days later the results of UN ‘tests’ on the environmental samples were released. Predictably, they were negative; predictably, they had not gone to a recognized specialist lab; predictably, they were carried out by a medical facility under long-term, lucrative contract to the UN. Specialists immediately noted that the cholera bacterium is hard to isolate and that the UN did not appear to have large enough samples to do so effectively from environmental specimens. They also stated the obvious, whatever the inadequacy of the testing: a negative actually proves nothing.

Impunity plus Impermeability

Why are UN controls so lax, so lacking? Try immunity. Just as the UN enjoys legal immunity as a non-state actor (see inset article), so it claims exemptions from the surveillance and response obligations that the International Health Regulations (2005) of the World Health Organisation (WHO) impose on everyone else for the essential global control of infectious disease. No WHO standards, no effective standards at all, for the UN, it seems.

Added to that immunity, impermeability to the best lobbying efforts of some of the most qualified public health advocates for Haiti. Take Dr Rishi Rattan, chair of the Advocacy Subcommittee of Physicians for Haiti, an NGO with a long track record. He has allowed Haiti Briefing to quote from his notes on extended efforts to engage as recently as this March with the Department of Field Support in the Department of Peace Keeping Operations (DPKO) in New York. According to the UN itself, they are the only UN unit allowed to comment on cholera in Haiti.

“Despite multiple NGO and UN staff trying to contact multiple different people on our behalf, and our contacting them over two to three weeks by fax, email, phone and mail, we never received a response… so we tried to just show up but were denied access because we did not have a meeting scheduled.” Welcome to the United Nations.

Like so many working on health in Haiti, Dr Rattan has only one priority – Haitians and their vulnerability to the spike in cholera infection and death that the approaching rainy season will bring. “Anyone in the UN who will talk off the record gives you the same spin: how hurt the UN is by these accusations, how the UN is in Haiti to help, how they are investigating,” he observes. In other words, it is still all about the UN and its staff, the culprits, not about Haiti or Haitians, the victims.

“MINUSTAH’s response to the disaster it caused demonstrates its inability to follow its own mandates to tie security to development, help build basic social services, coordinate with the government on humanitarian assistance and address the needs of disaster-affected people,” Dr Rattan concludes in his final brief. In other words, the cholera chronicle is just the clearest evidence to date that the UN’s MINUSTAH troops are the problem, not the solution (see Haiti Briefing No 68).

In response to the crazy suggestion that MINUSTAH should take charge of the large scale water and sanitation projects now being proposed for Haiti, Dr Rattan says that being unable to build or maintain the most basic sanitation facilities in its own bases is not the only way in which the UN has already manifestly failed. The number of Haitians with access to clean water demonstrably decreased in each of the first four years MINUSTAH was deployed in Haiti.

Worst of all, the UN’s failure to tighten its own medical standards and procedures – discussions continue on implementing the UN experts’ year-old recommendations – means that no one is safe from the UN, its infections and its impunity, even now. “Given the UN’s inaction in fixing their protocols, based on current scientific evidence, it’s not if, but when this sort of epidemic will happen again and not just in Haiti,” says Dr Rattan. “It could be any vulnerable nation in which the UN is deployed, or any water-borne infection, not just cholera. Frankly, it’s inexcusable and inhuman.”

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