Rishi Rattan, Physicians for Haiti
Before October 2010, there had been no reported cases of cholera in Haiti for half a century. As of January 2012, the Ministère de la Santé Publique et de la Population (MSPP), Haiti’s Ministry of Health, reported that the cholera epidemic had claimed over 7,000 lives. Over half a million cases have been documented. Lack of infrastructure combined with a median attack rate of 5 percent, and currently as high as 32% in some regions, prevent recording of all cases, leading to underreporting. From Haiti, cholera has spread to the Dominican Republic, Venezuela, Florida, and Massachusetts. Despite an overall decrease in incidence, the epidemic is projected to continue until two thousand
Since the birth of epidemiology during an English cholera epidemic in 1854, a foundation of control and prevention is identification and removal of the source. Taken as a whole, research published in peer-reviewed journals and findings of the independent panel commissioned by the United Nations (UN) indicate that the Mission des Nations Unies pour la stabilisation en Haïti (MINUSTAH) camp near Meille (also spelled Meye) was the source of cholera in Haiti. This was due to inadequate sanitation and waste disposal infrastructure causing fecal contamination of waterways. The MINUSTAH camp introduced cholera into Boukan Kanni, a waterway that feeds into the Meille Tributary System, which empties into the largest river in Haiti, the Artibonite.
From 28 July 2010 to 14 August 2010, there was a cholera epidemic in Nepal. On 23 September, an epidemic began in the capital, Kathmandu. Nepali soldiers were training in Kathmandu for 3 months prior to their arrival in Haiti in 2 waves, the first on 8 October, with soldiers arriving in Meille on 9 October, 12 October, and 16 October.10
The second wave arrived 24 October. Asymptomatic carriers unknowingly shed the bacterium in their stool and are more numerous than symptomatic patients, especially in areas like Nepal where cholera is endemic. Brig Gen Dr Kishore Rana, chief medical officer of the Nepalese Army, responsible for clearing recruits prior to UN deployment, confirmed that they followed UN protocol by not testing for asymptomatic carriage. Two days after his statement, UN Under-Secretary-General for Peacekeeping Operations, Alain Le Roy declared that “all soldiers had tested negative for the strain.” MINUSTAH spokesperson Vincenzo Pugliese admitted almost 3 weeks later that no Nepali soldiers were tested for cholera during their medical clearance.
Locals observed waste flowing from the MINUSTAH camp directly into the Meille Tributary System from broken pipes. This was confirmed by visiting epidemiologists and the UNcommissioned investigative panel. Further, the private waste disposal company contracted by the UN mission, SANCO Enterprises SA (http://www.sancohaiti.com), used open, unprotected septic tanks at the top of a hill near an adjacent waterway. According to residents, these often overflowed into the river during rainfall. Of MINUSTAH, SANCO, and the local government, no group has taken responsibility for overseeing the maintenance of these off-site tanks. However, Pugliese stated that on-site sanitation infrastructure was built to US Environmental Protection Agency standards and disposal sites were checked by MINUSTAH’s environmental compliance unit to ensure they adhered to international standards.