01.05.12

A Call for U.N. Accountability for Cholera in Post-Earthquake Haiti

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In response to the second anniversary of Haiti’s January 12, 2010 earthquake, this post begins a four-part weekly series that will examine the implications of ongoing efforts to establish U.N. accountability for allegedly causing Haiti’s deadly cholera epidemic in the months following the events of January 12, 2010. This first post was authored by O’Neill Institute Research Associate, J.P. Shuster.

 On December 9, 2011, in conjunction with International Human Rights Day and the 63rd anniversary of the signing of the Universal Declaration of Human Rights, several thousand Haitians assembled outside a U.N. peacekeeping base in the city of St. Marc, located sixty miles north of Haiti’s capital of Port-au-Prince, emphatically chanting “human rights belong to Haitians too.” The U.N. peacekeeping mission, known by its acronym MINUSTAH, had arrived in Haiti in 2004 to calm political turmoil surrounding the ouster of Haiti’s former president, Jean-Bertrand Aristide. But the latest tumult arose from allegations that a Nepalese contingent of MINUSTAH had introduced a devastating strain of cholera into the Haitian population ten months after the earthquake by allowing human waste to flow from a poorly maintained septic tank at the battalion’s base in the town of Meille into a tributary of Haiti’s largest and most vital river, the Artibonite.

Prior to October 2010, Haiti had not documented a single case of cholera in over 100 years.[1] However, suddenly, scores of people living in the Mirebalais region down river from Meille began experiencing vomiting and diarrhea so catastrophic that many died within hours of presenting symptoms. Two thousand people died in the first thirty days alone. At present, Haiti’s Ministère de la Santé Publique et de la Population has reported that the water-born disease has already infected roughly 515,000 people – about five percent of Haiti’s total population – and killed nearly 7,000 people since it was detected last year.[2] Haiti, which is still very much dealing with the devastation of the 7.0 magnitude earthquake of January 2010, now also faces the largest active cholera epidemic in the world.[3]

 On November 3 of this past year, one of the organizers of the December 9 protest, the Bureau des Avocats Internationaux (BAI), along with its U.S. partner organization, the Institute for Justice and Democracy in Haiti (IJDH), filed a formal action against the U.N. with the Claims Unit of the Office of the United Nations Secretary-General in Haiti for inadvertently spreading the particular strain of cholera to Haiti.[4] The claim was filed on behalf of 5,000 victims of cholera, though the organizations contend they now have closer to 15,000 complaints on record. Among other claims, the BAI/IJDH complaint alleges that the U.N. failed to screen cholera-carrying Nepalese troops for the disease prior to deployment; that the U.N. failed to properly maintain its sanitation and waste disposal facilities at the Nepalese battalion camp; and furthermore, that the U.N. “willfully [delayed] investigation and [obscured] discovery of the outbreak’s source.”

 According to the organizations, such failures have amounted to negligence, gross negligence, recklessness, and deliberate indifference for the lives of Haitians. Specifically, the complaint asserts that restitution, in addition to compensation, should be made available to victims of the cholera epidemic in the amount of $50,000 U.S. for each person infected and $100,000 U.S. for the families of those who have died as a result of the epidemic. The request also includes financing for improvements in Haiti’s water and sanitation infrastructure. Meanwhile, Haitian lawyers with a newly created civic group, the Community Mobilization for Reparations of Cholera Victims, is hoping to forgo the U.N.’s internal claims procedure and file a civil action against MINUSTAH in the Haitian court system, and a Brazilian organization, the Faculdade de Direito de Santa Maria (FADISMA), has gone directly to the Inter-American Commission on Human Rights (IACHR) with a separate petition.

 In addition to the import of such legal actions to those directly affected, the lawsuits are monumental in several regards. First, the BAI/IJDH petition, in particular, represents one of the largest claims for relief ever brought against the U.N.[5] In fact, if entirely successful, the suit could require the U.N. to pay multiple billions of dollars.[6] Beyond the specific legal issues raised in the BAI/IJDH complaint, however, the lawsuits also call into question the standards to which the U.N. and other international agencies adhere for the prevention of and accountability for the international spread of disease. At present, the World Health Organization’s (WHO) International Health Regulations (IHR)(2005) guides WHO member countries on the development and maintenance of core capacities for preventing and responding to international outbreaks of disease.[7] However, personnel in the U.N.’s Department of Peacekeeping Operations (DPKO) comprise one of many international entities that operate according to their own health screening and response protocols. Additionally, the Status of Forces Agreement (SOFA) that directs each U.N. peacekeeping operation affords uniformed personnel immunity from criminal prosecution in the courts of host countries. Meanwhile, U.N. internal procedures entirely govern private action against its personnel.[8]  In fact, such lack of external oversight has allowed the U.N. to operate in Haiti since 2004 without ever setting up the Standing Claims Commission called for in its SOFA to respond to civil complaints like the BAI/IJDH petition.   

 Before exploring the prospects of securing compensation for Haiti’s cholera victims, as well as the applicability and utility of the IHR (2005) in improving the U.N.’s protocol for preventing and responding to the international spread of disease, it is helpful to consider the strength of the scientific and circumstantial evidence on which the legitimacy on the various complaints rests.

 As cholera continues to spread in Haiti at an alarming rate – the Government of Haiti reported 22,000 new infections this past October alone[9] – evidence of U.N. responsibility for the international spread of the disease continues to mount. According to the U.S. Centers for Disease Control (CDC), cholera outbreaks occur under two conditions. First, there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholerae organisms. Second, cholera must be present in the population. Scientific examinations carried out over the past year have confirmed the presence of both factors in Haiti after October 2010.

 As the BAI/IJDH complaint explains, French epidemiologist, Dr. Renaud Piarroux, investigated the MINUSTAH camp at the requests of the governments of Haiti and France and confirmed the presence of a septic tank pouring waste into the river.[10] The CDC also concluded that the cholera in Haiti originated from a single source and, furthermore, that the particular strain in Haiti matched similar strains recently isolated in South Asia.[11] A team of scientific researchers at Harvard confirmed the “nearly identical relationship” between Haiti’s strain of cholera and the predominant strains in South Asia through comparison of entire genome sequences.[12]

 The BAI/IJDH complaint also notes that circumstantial factors strongly suggest that cholera-carrying Nepalese peacekeepers spread the disease to Haiti. Nepal is the third largest peacekeeping contingent in MINUSTAH, deploying new peacekeepers every six months. Importantly, cholera is endemic in Nepal, and approximately seventy-five percent of carriers do not show active symptoms. At the same time, under current U.N. protocol, no uniformed personnel undergo laboratory testing for infectious diseases, including cholera, unless they present active symptoms. Additionally, shortly before the outbreak in Haiti, a surge in cholera infections was reported in the Kathmandu valley where Nepalese peacekeepers train for three months before departing to Haiti.

 In May of 2011, an independent panel of experts that U.N. Secretary-General Ban Ki Moon had appointed two months into the epidemic concluded that “the evidence overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meille Tributary of the Artibonite River with a pathogen strain of current South Asian type Vibrio cholerae as a result of human activity.”[13] Despite that finding, as well as the wide agreement that the Nepalese peacekeeping contingent likely caused the outbreak of cholera in Haiti, the U.N. has refused to acknowledge responsibility or even respond to the BAI/IJDH complaint beyond confirming receipt of the claim.[14]

 With U.N. Peacekeeping Operations deploying 121,787 personnel from 114 countries to man sixteen peacekeeping missions around the world,[15] Haiti’s ongoing cholera epidemic should serve as a jarring call for improved prevention and accountability mechanisms for U.N. peacekeeping missions. Aside from the U.N.’s potential culpability in Haiti, such poor pre-deployment standards and lack of response accountability continue to pose the threat of transporting disease to the many institutionally weakened countries in which the U.N. operates. Most immediately, as the second anniversary of Haiti’s January 12 earthquake nears, MINUSTAH should create the Standing Claims Commission called for in its SOFA and respond openly to complaints in order to remain faithful to its entrusted duty of protecting and promoting the human rights of Haitians. Otherwise, further evasion of accountability to Haiti’s cholera victims will also allow the U.N. to avoid making critical improvements in the U.N.’s standards for preventing and responding to the international spread of disease.


[1] Mark Doyle, Haiti’s Cholera Row with UN Rumbles On, BBC News, Dec. 14, 2011, available at, http://www.bbc.co.uk/news/world-latin-america-16180250.

[2] Nancie George, Haiti’s Cholera Victims Seek Justice From UN, Infectious Disease Special Edition, vol. 1 (Dec. 2011).

[3] Dennis Sadowski, After One Year, Haiti’s Cholera Epidemic Has Become the World’s Largest, Catholic News Service, Oct. 19, 2011, available at, http://cnsblog.wordpress.com/2011/10/19/after-one-year-haiti%E2%80%99s-cholera-epidemic-has-become-the-world%E2%80%99s-largest/.

[4] Pet. for Relief, filed with, Chief, Claims Unit, Office of the United Nations Secretary-General, Nov. 3, 2011. Available at, http://ijdh.org/archives/22916.

[5] Susana Ferreira, Cholera Fallout: Can Haitians Sue the U.N. for the Epidemic?, Time, Dec. 13, 2011, available at http://www.time.com/time/world/article/0,8599,2101763,00.html.

[6] Mark Doyle, supra note 1.

[7] World Health Organization, International Health Regulations (2005), 2nd ed., available at, http://www.who.int/ihr/en/.

[8] See, P.B., The UN in Haiti: Damned If You Do, The Economist, Nov. 10, 2011, available at, http://www.economist.com/blogs/americasview/2011/11/un-haiti?page=1.

[9] Anastasia Moloney, Cholera Killing Hundreds a Month in Haiti, AlertNet (Thomson Reuters Foundation Service), Nov. 23, 2011, available at, http://www.trust.org/alertnet/news/cholera-killing-hundreds-a-month-in-haiti.

[10] See, Renaud Piarroux, et al., Understanding the Cholera Epidemic, Haiti, 17:7 Emerging Infectious Diseases J.1161, available at, http://wwwnc.cdc.gov/eid/article/17/7/11-0059_article.htm#suggestedcitation.

[11] Centers for Disease Control, Press Release: Laboratory Test Results of Cholera Outbreak Strain in Haiti Announced, Nov. 1, 2010, available at, http://www.cdc.gov/media/pressrel/2010/r101101.html.

[12] See, Chen-Shan Chin, et al., The Origin of the Haitian Cholera Outbreak Strain, 364 N.E. J. Med. 33-42.

[13] See, Alejando Cravioto, et al., Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti, May 2011, available at, http://www.scribd.com/doc/54653594/UN-Cholera-Report-Final.

[14] See, George, supra note 2.

[15] U.N. Peacekeeping Operations Fact Sheet: 31 October 2011, available at, http://www.un.org/en/peacekeeping/resources/statistics/factsheet_archive.shtml.

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