Haiti Cholera Victims Welcome UN Recognizing Role in Outbreak

  • Posted on: 18 August 2016
  • By: Bryan Schaaf
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As one of the few countries in the world where sanitation had gotten worse over the past twenty years, Haiti was highly vulnerable to the cholera outbreak in 2010.  After years of obfuscation, the United Nations has finally admitted that the epidemic was imported by UN peacekeepers. That it has happened at all is testament to the efforts of Haitian civil society and the advocacy of organizations like the Institute of Democracy and Justice in Haiti.  The UN intends to release a response plan in two weeks.  More information from AFP follows. 

PORT-AU-PRINCE (AFP) - Victims' advocates hailed as vindication Thursday the United Nations' acknowledgment it played a role in a devastating cholera epidemic believed to have been imported by UN peacekeepers.  The epidemic has killed 10,000 people since it broke out in 2010 in the vicinity of a base housing UN peacekeepers, in a country that previously was considered cholera-free. "This is a major victory for the thousands of Haitians who have been marching for justice, writing to the UN and bringing the UN to court," said Mario Joseph, a Haitian human rights lawyer representing victims of the epidemic that began with an outbreak in October 2010. "It is high time for the UN to make this right and prove to the world that 'human rights for all' means for Haitians too."

Compounding the suffering, the epidemic began just months after a devastating earthquake killed more than 200,000 people on the impoverished island nation.  UN Secretary-General Ban Ki-moon's deputy spokesman Farhan Haq said in an email that a "significant new set of UN actions" will be developed to respond to the crisis following a critical report by a UN adviser.  "Over the past year, the UN has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera," Haq said.  The spokesman said the new response would be released publicly with the next two months, after it has been agreed with Haitian authorities and discussed with member states.

French epidemiologist Roland Piarroux has said the scope of the cholera epidemic is "unprecedented" in recent history. The first cases appeared on the banks of the Artibonite River, near a base where Nepalese members of the UN peacekeeping mission were staying in the central town of Mirebalais. As early as November 2010, Piarroux had concluded that the epidemic had been imported into the country.
Despite numerous scientific studies backing that conclusion, the United Nations had until now refused to acknowledge any responsibility in introducing the disease in the country, saying it was impossible to authoritatively determine the source of the epidemic. US courts have rejected complaints filed by families of cholera victims in New York, where the UN is headquartered, due to the world body's immunity. "The UN must follow this announcement with action, including issuing a public apology, establishing a plan to provide compensation to the victims who have lost so much, and ensuring that cholera is eliminated in Haiti through robust investment in water and sanitation infrastructure," said Beatrice Lindstrom, staff attorney at the Institute for Justice and Democracy in Haiti. "We will keep fighting until it does."



By Anastasia Moloney (Reuters) 

A U.S. federal appeals court has upheld the United Nations' immunity from a damage claim filed by human rights lawyers on behalf of thousands of Haitians killed or sickened by a cholera epidemic they blame on U.N. peacekeepers.  In a decision late on Thursday, the U.S. Second Circuit Court of Appeals in New York upheld a lower court's January 2015 dismissal of a lawsuit brought by lawyers seeking compensation and a public apology for 5,000 Haitian cholera victims.

"We have considered all of plaintiffs' arguments on appeal and find them to be without merit," the U.S. appellate judges concluded. Cholera, a water-borne disease, has killed more than 9,000 Haitians and infected over 770,000 since the outbreak began in 2010, U.N. figures show.

The court's decision came shortly after Farhan Haq, spokesman for U.N. Secretary-General Ban Ki-moon, admitted the U.N.'s possible involvement in the introduction of cholera to Haiti. "...over the past year the U.N. has become convinced it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera," he told reporters on Thursday.

Lawyers for the plaintiffs said the remarks were a breakthrough because it was the first time the U.N. had acknowledged any involvement in causing the cholera outbreak.  A 2011 study by the U.S. Centers for Disease Control and Prevention said U.N. peacekeepers from Nepal, where cholera is endemic, were the likely cause of the outbreak. The peacekeepers on mission in Haiti were stationed near a river and discharged raw sewage.

Brian Concannon, executive director of the Boston-based Institute for Justice and Democracy in Haiti (IJDH), the group that filed the lawsuit on behalf of cholera victims, said they had 90 days to decide whether to seek an appeal with the U.S. Supreme Court. "We will decide how to proceed based on whether the U.N.'s actions fulfill the cholera victims' rights to an effective remedy," Concannon said in a statement.

A previous January 2015 ruling on the cholera case by a U.S. court said that the U.N. can block lawsuits established by a 1946 international convention and is thus immune to such legal action. But lawyers for the plaintiffs have long argued that the U.N. is not entitled to immunity under the convention because it has failed to establish any kind of settlement process for the cholera victims, as required by the same convention.

"This outcome places the onus back on the U.N. to follow through on its commitments to respond justly to victims out of court if it does not want to be an organization that stands for impunity," Mario Joseph, a Haitian lawyer who heads the Bureau des Avocats Internationaux, IJDH's partner in Haiti, said in a statement.  Health experts say cholera, which had not been documented in Haiti in almost 100 years prior to the outbreak, will continue to kill and infect Haitians as long as they lack access to clean water and sanitation.

(Reporting by Anastasia Moloney, editing by Ros Russell.; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, corruption and climate change. Visit http://news.trust.org)

    New York Times
    Jonathan Katz

    For the first time since a cholera epidemic believed to be imported by United Nations peacekeepers began killing thousands of Haitians nearly six years ago, the office of Secretary General Ban Ki-moon has acknowledged that the United Nations played a role in the initial outbreak and that a “significant new set of U.N. actions” will be needed to respond to the crisis.

    The deputy spokesman for the secretary general, Farhan Haq, said in an email this week that “over the past year, the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera.” He added that a “new response will be presented publicly within the next two months, once it has been fully elaborated, agreed with the Haitian authorities and discussed with member states.”

    The statement comes on the heels of a confidential report sent to Mr. Ban by a longtime United Nations adviser on Aug. 8. Written by Philip Alston, a New York University law professor who serves as one of a few dozen experts, known as special rapporteurs, who advise the organization on human rights issues, the draft language stated plainly that the epidemic “would not have broken out but for the actions of the United Nations.”

    The secretary general’s acknowledgment, by contrast, stopped short of saying that the United Nations specifically caused the epidemic. Nor does it indicate a change in the organization’s legal position that it is absolutely immune from legal actions, including a federal lawsuit brought in the United States on behalf of cholera victims seeking billions in damages stemming from the Haiti crisis.

    But it represents a significant shift after more than five years of high-level denial of any involvement or responsibility of the United Nations in the outbreak, which has killed at least 10,000 people and sickened hundreds of thousands. Cholera victims suffer from dehydration caused by severe diarrhea or vomiting.

    Special rapporteurs’ reports are technically independent guidance, which the United Nations can accept or reject. United Nations officials have until the end of this week to respond to the report, which will then go through revisions, but the statement suggests a new receptivity to its criticism.

    In the 19-page report, obtained from an official who had access to it, Mr. Alston took issue with the United Nations’ public handling of the outbreak, which was first documented in mid-October 2010, shortly after people living along the Meille River began dying from the disease.

    The first victims lived near a base housing 454 United Nations peacekeepers freshly arrived from Nepal, where a cholera outbreak was underway, and waste from the base often leaked into the river. Numerous scientists have since argued that the base was the only plausible source of the outbreak — whose real death toll, one study found, could be much higher than the official numbers state — but United Nations officials have consistently insisted that its origins remain up for debate.

    Mr. Alston wrote that the United Nations’ Haiti cholera policy “is morally unconscionable, legally indefensible and politically self-defeating.” He added, “It is also entirely unnecessary.” The organization’s continuing denial and refusal to make reparations to the victims, he argued, “upholds a double standard according to which the U.N. insists that member states respect human rights, while rejecting any such responsibility for itself.”

    He said, “It provides highly combustible fuel for those who claim that U.N. peacekeeping operations trample on the rights of those being protected, and it undermines both the U.N.’s overall credibility and the integrity of the Office of the Secretary-General.”

    Mr. Alston went beyond criticizing the Department of Peacekeeping Operations to blame the entire United Nations system. “As the magnitude of the disaster became known, key international officials carefully avoided acknowledging that the outbreak had resulted from discharges from the camp,” he noted.

    His most severe criticism was reserved for the organization’s Office of Legal Affairs, whose advice, he wrote, “has been permitted to override all of the other considerations that militate so powerfully in favor of seeking a constructive and just solution.” Its interpretations, he said, have “trumped the rule of law.”

    Mr. Alston also argued in his report that, as The New York Times has reported, the United Nations’ cholera eradication program has failed. Infection rates have been rising every year in Haiti since 2014, as the organization struggles to raise the $2.27 billion it says is needed to eradicate the disease from member states. No major water or sanitation projects have been completed in Haiti; two pilot wastewater processing plants built there in the wake of the epidemic quickly closed because of a lack of donor funds.

    In a separate internal report released days ago after being withheld for nearly a year, United Nations auditors said a quarter of the sites run by the peacekeepers with the organization’s Stabilization Mission in Haiti, or Minustah, that they had visited were still discharging their waste into public canals as late as 2014, four years after the epidemic began.

    “Victims are living in fear because the disease is still out there,” Mario Joseph, a prominent Haitian human rights lawyer representing cholera victims, told demonstrators in Port-au-Prince last month. He added, “If the Nepalese contingent returns to defecate in the water again, they will get the disease again, only worse.”

    In 2011, when families of 5,000 Haitian cholera victims petitioned the United Nations for redress, its Office of Legal Affairs simply declared their claims “not receivable.” (Mr. Alston called that argument “wholly unconvincing in legal terms.”)

    Those families and others then sued the United Nations, including Mr. Ban and the former Minustah chief Edmond Mulet, in federal court in New York. (In November, Mr. Ban promoted Mr. Mulet to be his chief of staff.) The United Nations refused to appear in court, claiming diplomatic immunity under its charter, leaving Justice Department lawyers to defend it instead. That case is now pending a decision from the Second Circuit Court of Appeals in New York.

    The redress demanded by families of the 10,000 people killed and 800,000 affected would reach $40 billion, Mr. Alston wrote — and that figure does not take into account “those certain to die and be infected in the years ahead.”

    “Since this is almost five times the total annual budget for peacekeeping worldwide, it is a figure that is understandably seen as prohibitive and unrealistic,” he said. Still, he argued: “The figure of $40 billion should stand as a warning of the consequences that could follow if national courts become convinced that the abdication policy is not just unconscionable but also legally unjustified. The best way to avoid that happening is for the United Nations to offer an appropriate remedy.”

    Mr. Alston, who declined to comment for this article, will present the final report at the opening of the General Assembly in September, when presidents, prime ministers and monarchs from nearly every country gather at United Nations headquarters in New York.

    Mr. Haq said the secretary general’s office “wanted to take this opportunity to welcome this vital report,” which he added “will be a valuable contribution to the U.N. as we work towards a significant new set of U.N. actions.”

    Miami Herald



    United Nations Secretary General Ban Ki-moon Tuesday expressed “tremendous regret,” over the cholera outbreak in Haiti as part of his opening address to the United Nations General Assembly. “I feel tremendous regret and sorrow at the profound suffering of Haitians affected by cholera,” he said. “The time has come for a new approach to ease the plight and better their lives. This is our firm and enduring moral responsibility.” It was the first time since the cholera outbreak began in 2010 that Ban, who has four months left on his 10-year tenure as the head of the United Nations, mentioned the deadly epidemic in his annual address to the General Assembly.

    Ban, who spoke in French, also expressed regret over the “despicable” acts of sexual violence by some U.N. peacekeepers in Haiti and elsewhere around the globe where the global body is active. An internal report by the United Nations Office of Internal Oversight Services, released last year, found that troops commonly paid for sex. “A number of U.N. peacekeepers and other personnel have compounded the suffering of people already caught up in armed conflicts and also undermined the work done by so many around the world,” he said. “Protectors must never become predators.”

    Ban’s public acknowledgment of the U.N.’s “involvement in the initial outbreak” of Haiti’s 2010 cholera outbreak comes on the heels of a confidential report by a United Nations expert who blamed the organization’s actions for the water-borne disease’s appearance in Haiti months after the country was hit by a devastating earthquake. Several scientific studies have traced the outbreak to Nepalese soldiers stationed in an isolated rural base near the Meille River in Haiti. The river flows into the Artibonite Valley, where the first cholera deaths were found. The Nepalese soldiers were with the United Nations peacekeeping mission in Haiti, and had recently arrived from Nepal where a cholera outbreak was under way.

    Ban first publicly acknowledged the U.N.’s “moral responsibility” to help Haiti address the deadly epidemic in a 2014 Miami Herald interview. It was his strongest statement on the issue until last month when deputy spokesman Farhan Haq said the United Nations had “become convinced that it needs to do much more regarding its own involvement in the initial outbreak” of cholera. Haq said officials were putting together a “significant new set of U.N. actions,” to intensify the flight against cholera, and that the details would be announced within two months.

    Cholera has killed thousands in Haiti and sickened hundreds of thousands. A new vaccination campaign was recently launched in Haiti but critics say more is needed to prevent the disease’s spread in a country with almost non-existent sanitation in some areas. Last month, a U.S. federal court upheld the U.N.’s immunity, ruling in a class-action lawsuit brought by the Institute for Justice & Democracy in Haiti on behalf of victims that the world body cannot not be sued in U.S. courts.

    Brian Concannon Jr., head of Boston-based institute, said the organization will hold off on appealing the case to the Supreme Court until it learns details of the U.N.’s plans. “We are looking forward to hearing those details, but will keep the struggle for justice going until the U.N. respects the victims' rights,” Concannon said from Port-au-Prince, where a protest was planned Tuesday on behalf of cholera victims in front of the United Nations’ mission headquarters near the airport.

    To lead its latest cholera response, the global body has tapped Dr. David Nabarro, who coordinated the U.N.’s Ebola response. Nabarro quietly visited Haiti in August. The country has struggled to raised $2.2 billion as part of a 10-year cholera elimination plan Ban and the government of Haiti announced in 2012. So far only about 24 percent of the money has been raised. “The failure to fund more of the elimination plan does raise concerns about the U.N.’s ability to fund its significant measures now,” Concannon said. “But that effort suffers from a lack of leadership from the beginning. If the U.N. is serious this time, and makes this a global priority, it can raise the money.

    “I expect honesty will help,” Concannon said, noting that the U.N. has raised more than $7 billion for its peacekeeping operation in Haiti. “There was an inherent conflict in the U.N. trying to raise money for the epidemic on one hand, and minimizing it in the other to reduce its legal exposure.”

    Plastic-sheeted cots for men, women and children are crammed side by side in a former hangar. At the cholera treatment center in the Haitian city of Carrefour, the sick have no privacy. Djelile Pierre gingerly uses a syringe to feed her five-year-old daughter, who has been hospitalized there near the capital of Port-au-Prince for three days. "I didn't think she was going to survive," said the 24-year-old mother. "She's still very weak and refuses to eat anything."

    Whether from drinking unsafe, untreated water or eating contaminated food, the little girl contracted cholera, falling to the same fate as nearly 800,000 Haitians since the epidemic broke out in October 2010 near a base housing UN peacekeepers. Earlier this month, the United Nations finally admitted for the first time that it had played a role in the epidemic that has killed 10,000 people in the poorest country in the Americas. UN peacekeepers from Nepal, which was suffering a cholera outbreak, introduced the disease to the impoverished Caribbean nation, the UN acknowledged, while insisting the world body is legally immune to lawsuits. But on the ground in Haiti, medical teams are worried about the lack of funding.

    "After October, no one knows how to continue supporting a rapid response," said Jean Ludovic Metenier, deputy representative of the United Nations Children's Fund (UNICEF) in Haiti. The acute diarrheal disease can kill within hours if left untreated. Already, humanitarian organizations intervene only to prevent the spread of cholera, on a case-by-case basis. About 60 kilometers (35 miles) north of the capital, patients arriving at the hospital in Verrettes with acute diarrhea are interviewed by personnel from a French non-governmental organization, the Agency for Technical Cooperation and Development (ACTED), to determine how they contracted the disease. While reassuring relatives of a hospitalized youth, a team headed to their small home to cover its dirt walls with a chlorine solution one morning. "We are decontaminating the home of the patient and the toilets to kill the (cholera) bacteria to prevent the people sharing the facilities from being infected," said ACTED's Nadine Guerrier.

    In the tiny, rural village, the sanitation operation does not go unnoticed, and the humanitarian workers explain to the curious the hygiene guidelines for avoiding cholera. This urgent awareness campaign is currently the only action being taken to fight the epidemic.  "People have completely stopped working on health sanitation and potable water infrastructure," said Emilie Bernard, country director for ACTED Haiti. "So we are only putting a bandage on an open fracture."

    Six years after the start of the epidemic, about 72 percent of Haitians have no toilets at home and 42 percent lack access to safe drinking water, according to the UN. The situation is dire, with 500 new cases of cholera reported each week and Haiti facing its worst epidemic in recent history. "Since the beginning of the year, there have been 25,000 cases in the country," Metenier said. "In the Democratic Republic of Congo, a country with 10 times as many inhabitants, there were only 15,000 cases since January," he said.

    The teams battling the epidemic are dismayed that the troubling Haitian sanitary crisis has not drawn more attention from the international community. "Cholera can be eliminated if one has the means," Metenier emphasized. "Ebola, which had roughly the same number of fatalities, mobilized $1.5 billion. The cholera epidemic in Haiti since 2010 has only drawn $300 million."

    On the ground, the lack of money has terrible repercussions. "We receive treatments to care for 10 patients a day," said Mirlene Lorcy, supervisor at the treatment center in Carrefour. But by mid-morning one day, 12 patients were already on beds in the hangar. "We take care of all the sick who come on their own, but if they arrive by ambulance, we send them somewhere else," she said.

    Lorcy said she was not sure where the sick were transported. But she noted that the Carrefour facility, due to a lack of money, has cut its staff in half since July. In early August, French epidemiologist Renaud Piarroux reported more than 21,000 cholera cases and 200 deaths occurred from January to June. He predicted that with the rainy season lasting through November or even into December, cholera could "easily" kill up to 500 people this year, 200 more than died two years ago


    PORT AU PRINCE, Haiti -- A sanitation initiative in southeastern Haiti has shown encouraging results, with a major reduction in the number of water-borne infections for local residents, according to the United Nations Children’s Fund (UNICEF).  “Five localities in this region have been declared open defecation free (ODF), which marks progress in the prevention of cholera and other water-borne diseases in the area,” said Marc Vincent, the UNICEF representative in the country. “In the area of sanitation we have come a long way and there is still a long way to go,” he added. “For UNICEF, we are active in 120 communities and, in total, more than 20,000 people in the country now benefit from living in an ODF environment – this is a substantive change and it inspires hope.” 

    The five localities – Nan Merlien, Fatima, Rada and three other communities in the country’s southeast – have been taking part in the UN-backed Community-Led Total Sanitation (CLTS) campaign as part of the Total Sanitation Campaign, which supports the Haitian authorities´ national plan against cholera through the promotion of zero open defecation and increased access to water and sanitation facilities in schools and health centres.  The CLTS campaign supports local communities in addressing access to water, rehabilitating water systems and ensuring chlorination to combat contamination. At the same time, the initiative is also supporting communities to build toilets and to reduce the contamination of water through open defecation. CLTS has already been implemented in 67 other localities and, as a result, 1,000 self-built household toilets have been constructed and 2,000 more are in progress. Six communities have been certified as ODF and 16 are in process.  A community worker in the Haitian South-East department, Harry Richner, underlined that the effort to convince local residents to change their habits required persistence as many had hoped that others would construct the required latrines. 

    “I have been engaged in this fight for a long time, and with the combined efforts of several partners we were able to end this practice in the area,” he said. “Thanks to the local CLTS committee of nine adults and two children who helped me do the work, we were able to meet the challenge.” One of the local committee members in the locality of Fatima Rada, 12-year-old Anephta Pierre-Louis, highlighted the important role that children have to play in the campaign.  “I deal with monitoring in the committee – when a family leaves its toilet dirty, I ask them nicely to clean it so as to avoid catching diseases, “she said. “But I also educate children like me, in my neighborhood and at school: I ask them not to defecate on the ground and to wash their hands after leaving the toilet.” 

    The UNICEF country representative noted that such steps provide an inspirational example for others to follow.  “When you talk to people in the communities and see how proud they are of having built themselves their own toilets, and how proud they are of protecting their families and children by their own means – when you see that it gives you hope, hope to go further and beyond,” Vincent said. “Because what we want and have to do is totally eliminate cholera.” UN Secretary-General Ban Ki-moon launched in 2014 with the Haitian government the Total Sanitation Campaign, which is one of the long-term key pillars to the cholera response in Haiti. This response has also other key components such as the emergency response and the epidemiological surveillance. According to UNICEF, the provision of clean drinking water, the use of safe sanitation infrastructure and good hygiene practices are crucial elements to advance the prevention of cholera and other water-borne diseases in Haiti. However, despite progress made in fighting cholera in Haiti, UNICEF states much remains to be done and the engagement of the full international community, donors and partners is urgently needed. Currently, according to the country’s national agency for water supply and sanitation – the Direction Nationale de l’Eau Potable et de l’Assainissement – only 28 percent of the Haitian population has access to adequate sanitation and 42 percent does not have adequate access to safe drinking water.


    Miami Herald

    by Jacqueline Charles

    In early August of 2014, the Ebola virus was rapidly spreading through small towns in three West African nations, and doctors were losing the fight to control the outbreak.  David Nabarro, a British physician with more than 30 years of public health experience, had just been appointed coordinator of the United Nations’ Ebola effort. As he worked with the African governments and tried to galvanize international support from a variety of financial sources, Nabarro couldn’t escape the worrying questions from donors. “Do you know what you’re doing? Do you have a strategy that’s sensible that we can buy into? Do you have the confidence of the national governments?” Nabarro — who ended up raising $3.5 billion to fight Ebola — recalled more than one donor asking him. “There was a question mark always over whether or not we had a strategy that made sense, whether or not we knew what we were up to.” Nabarro, 67, is once more fielding the same kinds of questions. Only this time, his fight isn’t Ebola — which earlier this year was declared under control by the World Health Organization — it’s Haiti’s deadly cholera outbreak. Known for his organized mind, results-oriented style and willingness to take personal risks to achieve the task at hand, Nabarro is known as the go-to guy who helps the United Nations respond to “really tricky situations,” as he put it. He was tapped last month by U.N. Secretary General Ban Ki-moon to oversee the response to cholera, which has killed 9,393 and sickened 790,840 as of Aug. 20, according to Haiti’s Ministry of Health. The high profile appointment comes as the United Nations finally admits that it played a role in Haiti’s October 2010 cholera outbreak. Ban for the first time publicly expressed “tremendous regret and sorrow at the profound suffering of Haitians affected by cholera” during his opening speech at the U.N. General Assembly earlier this month.

    The acknowledgments follow years of litigation on behalf of cholera victims. Scientific studies traced the outbreak to Nepalese soldiers stationed near a river in the rural town of Mirebalais after the devastating Jan. 12, 2010, earthquake. And a U.N. expert recently issued a confidential report blaming the organization for the water-borne disease. Pledging to intensify the fight against cholera, Ban has announced that he will propose a support package in the coming months. And Ban is looking to Nabarro, a one-time World Health Organization functionary now vying for the top job, to do for cholera what he did for Ebola: galvanize governments and raise money. “I have no illusions about this. It’s going to be tough,” Nabarro told the Miami Herald. “But I am not scared by it.”

    Nabarro said the proposal would have an initial price tag of $360 million to $400 million — about half of which will be used to address the immediate cholera crisis and the longer term issues of water and sanitation and the rest as part of a material assistance package for victims and families affected by the disease. Dr. Renaud Piarroux, a French physician who has studied cholera in Haiti since its arrival, said the forthcoming plan will be different from the 10-year, $2.2 billion cholera elimination plan Ban and Haitian authorities announced in December 2012. That plan, which did not target cholera but instead focused on improving access to latrines and health, among other issues, is only 24 percent funded so far, the United Nations said.  “Basically, that plan said, ‘We will get rid of cholera by making Haiti a rich country,’” said Piarroux, who participated in the preparation of the new plan. “It was not targeting cholera, so we didn’t find any money to do any of that and it was very expensive.”

    Under the new strategy, Nabarro will help Haiti go after smaller chunks of funding, and cholera will be tackled in the field, Piarroux said. Adults will be vaccinated, more rapid response teams will be dispatched within 24 to 48 hours of an infection, and the infrastructure will be improved in places where cholera is rooted. “We can eliminate cholera,” he said. Still, Piarroux wonders whether the international community, already suffering from Haiti fatigue, is committed to helping Haiti rid itself the disease. Last week, Haiti’s interim President Joceleme Privert, addressing world leaders at the U.N. General Assembly, said his struggling nation needs more than words. “We hope that the urgent appeal of the secretary-general for the implementation of a program to substantially reinforce the fight against cholera and provide assistance to victims and their families will be heard and fully meet the expectations of the Haitian people,” Privert said. “The resurgence of cholera cases in recent months is today one of the most acute challenges in Haiti. It illustrates the significant deterioration in the humanitarian situation.”

    Unlike the Ebola epidemic, which killed about 11,000 and sickened 28,000 and dominated international headlines, cholera has largely been ignored. Funding drastically decreased a year ago, forcing local non-governmental organizations in Haiti to cut rapid response teams by a third, which Nabarro learned when he made an unannounced trip to Haiti in August to investigate the epidemic.  “[They] were saying we can do better,” he said. “They really are not able to get to all of the people within 24 hours or even 48 hours; sometimes it takes even longer.” Rapid response, experts say, is key to catching the disease before it becomes fatal. The rains in May and June worsened the problem, triggering a 30 percent spike in cholera cases. After his Haiti visit, Nabarro managed to get the United Nations to borrow about $10 million internally, money he has agreed to repay from fund-raising.

    Ralph R. Frerichs, the author of a book, “Deadly River, Cholera and Cover-up in Post-Earthquake Haiti,” that chronicles cholera’s rise in Haiti, said the United Nations needs to solve the problem. “There is a very simple premise: The U.N. brought it and they should get rid of it. They can get rid of it by planning,” he said. This is not the first time the U.N. has put someone in charge of raising money for Haiti’s cholera crisis. Pedro Medrano Rojas, a retired Chilean diplomat, served as senior coordinator for the cholera effort. He left at the end of his 18-month tenure last year disappointed by the international community’s failure to “acknowledge the fact that we have in Haiti the largest epidemic in the western hemisphere.” Nabarro said this time will be different because Haitians and donors seem ready to help. “There is a real outpouring of gratitude for the secretary-general to be willing to speak out about it in the way that he has. There is almost a collective relief,” Nabarro said. “There is a collective sense that ‘This happened as a result of us trying to help a country, and it’s really unfortunate. But we have to do something about it.’ I like to feel that over the last six years, there has been reflection and a recognition on the part of many of our members that … the people of Haiti are still affected by cholera and there is still a sense of injustice.”

    But the checks from donors haven’t started rolling in yet. “I’m starting a dialogue with them, starting to share our thinking with them so that they become partners with us in this effort,” Nabarro said. “They really understand the challenges;, they know a disease like cholera is difficult to get under control in a country like Haiti with such low levels of sanitation. They know we’re really keen to deal with all of the different dimensions. They know that we want to do it in a sensible way that’s fair.” And though Nabarro hopes to make time to campaign for the post as head of the World Health Organization, his main focus is Haiti’s cholera epidemic. Tackling it falls under his other job as special adviser to Ban for the 2030 agenda for sustainable development goals. “It’s really hard to get long-term social and economic development in an environment where sanitation is so non-existent,” he said. “Access to decent toilets and the capacity to practice your bodily functions in private is importation for so many reasons. At the heart of it is human dignity, what being a human is all about."


    The United Nations is seeking $400 million to address the outbreak of cholera in Haiti, but the world body denied that the request is an acknowledgement of responsibility for bringing the disease to the country. The United Nations requested $400 million (368 million euros) from its 193 member states on Monday to respond to the cholera outbreak in Haiti following Hurricane Matthew.

    The category 4 hurricane struck Haiti three weeks ago and caused widespread destruction, particularly in the southwest region of the country. Hundreds of Haitians died after the hurricane, and more than 1 million people require assistance. On top of the demand for aid, cholera has resurfaced once again. Officials have already counted hundreds of cases, with the number of afflicted expected to rise. The UN has proposed a two-part plan to tackle the disease.

    The first part, requiring an estimated $200 million, would bring rapid response teams to areas of new cholera outbreaks in Haiti. It would also fund cholera vaccines and provide investment in clean water and sanitation systems. Many Haitians lack access to such systems.

    The second part of the plan involves direct compensation to families who were affected by cholera since the disease spread in Haiti in 2010. One hundred million dollars would be spent on communities with cholera infections, and the remaining $100 million would go towards families of those who died in the cholera outbreak.

    Assistance has been slow for many Haitians since the hurricane struck, which has prompted protests and the looting of aid supplies and vehicles. A previous appeal from the UN for $120 million (110€ million) to help Haiti drew in only 12 percent of the funds needed. Nabarro said it has "proved to be very hard indeed to get any traction" from member states on providing donations. The United Nations is accused of exposing Haiti to cholera in its response to the 2010 earthquake, which killed more than 200,000 people. UN peacekeepers from Nepal, a country with its own cholera outbreak at the time, dumped infected sewage into Haiti's largest river and primary water source after the earthquake. Soon the country recorded hundreds of thousands of infections and more than 9,300 deaths due to the waterborne disease.

    Victims of the outbreak brought a class-action lawsuit against the UN in a United States court. The UN claimed immunity against prosecution, which was upheld in court. The UN has not accepted legal responsibility for causing the outbreak, and has denied allegations it should assume responsibility for the sudden spread of cholera in the country. UN Secretary-General Ban Ki-Moon, who steps down from his position after two five-year terms, said in August that the UN has a "moral responsibility" to help cholera victims and families.

    Nearly a month after UN officials announced the idea of a $400 million package to deal with cholera in Haiti, almost no donors have agreed to pay for it. UN peacekeepers imported the disease from Nepal to the Caribbean nation in October 2010. Cholera has since killed 9,100 Haitians and the UN has only recently started to acknowledge its responsibility.  The idea of a package of "material assistance" for victims and survivors was floated by UN Secretary-General Ban Ki-moon after the publication of a searing report on the crisis by a human rights advisor. Philip Alston, a professor of Law at New York University and the UN’s special rapporteur on extreme poverty and human rights, called the organisation’s years of denials that it brought cholera to Haiti "a disgrace”. However the aid package itself is not off to a promising start: "It is really hard to advance this plan for material assistance without having some certainty that there will be money," said Ban’s Haiti cholera point man David Nabarro. "At the same time it is hard to have certainty that there will be money without clarity on what the actual material assistance might look like."

    After Alston’s report was leaked to The New York Times in August, Ban’s office for the first time conceded that the UN had a "moral responsibility" to provide "material assistance" in response to the cholera outbreak, but stopped short of admitting responsibility or apologising. Citing existing mechanisms for the UN to settle claims of negligence while maintaining its immunity, Alston said the "new policy remains critically incomplete" without a formal confession and apology. Ban is losing time to make amends before he leaves the job at the end of the year.  "Ban's failings in Haiti are one of the worst stains on his legacy, and the clock is running down on his chance to make it right," said Beatrice Lindstrom, staff attorney at IJDH, a legal group that has filed claims on behalf of cholera victims. "Ban must issue a public apology to the people of Haiti, and follow through on his promise of a ‘new response’ with real action."

    Alston wrote in his report, "the lamentably self-serving legal contortions devised to escape any form of legal responsibility still remain in place… Unless the new process also involves a reconsideration in this regard, the [UN’s] ability to salvage its moral, let alone its legal, credibility and authority will be gravely undermined." The office of the secretary-general did not respond when asked if Ban would apologise and take legal responsibility in a speech to the General Assembly on 1 December. Nabarro, appointed to oversee cholera relief operations in Haiti, says the terms and breakdown of funding of the “material assistance” plan are still being determined. Nabarro, who headed the UN’s Ebola response in West Africa, has met extensively with member states, but says the overall response to multiple Haiti appeals is lacklustre. Hurricane Matthew, which struck on 4 October, has increased humanitarian needs and sparked a rise in cholera cases.

    As of late October, UN member states have pledged to contribute just 18 percent of a $2.1 billion national plan to eliminate cholera up until 2022; the more general 2016 Humanitarian Response Plan for Haiti is only 33 percent funded; and a $119.9 million flash appeal in the aftermath of Hurricane Matthew, which Nabarro says is currently the most pressing need, is also less than half funded.

    The new package is expected to be split into two $200 million "tracks" – one aimed at eradicating cholera and funding sanitation improvements, and another to provide what has been termed "material assistance" for victims or communities, though the specifics are still hazy (Nabarro said he did not want to raise expectations in Haiti by offering hypothetical details). UN officials have taken pains to avoid characterising this tranche of funding as compensation – something critics and lawyers for victims say only adds another layer to the UN’s convoluted handling of its legal position on the crisis. Nabarro said that just one member state had agreed to earmark donations towards material assistance specifically. Other donors are more willing to fund the overall cholera response, or track one, but appear to be steering clear of the more politicised second tranche. "There’s quite a lot of pressure on us officials to have a concept for the material support package... with sufficient clarity for us to engage with member states so that they can decide how they want to deal with it," Nabarro said in an interview with IRIN.

    One scenario, Nabarro surmised, could be to fund the material assistance through assessed contributions (UN member states’ obligatory dues). But some countries have balked at that, concerned they could be on the hook for other serious negligence attributed to the UN. Critics, including Alston, say that fear is either misguided or, should such claims exist, is something the UN needs to bring out into the open. "This is the moment of truth for the UN's leadership, but it's also a moment of truth for the UN's member states," said Lindstrom of IJDH, which filed claims with the UN on behalf of 5,000  cholera victims, as well as a class action lawsuit against the UN in the US federal court. "If they're not ultimately willing to step forward and invest in a just response, then the promise of a more accountable UN rings hollow." In August, a US federal appeals court upheld that the UN was not subject to lawsuits in the US. Lindstrom said that this week an extension had been granted allowing the plaintiffs in the case until 17 January to file with the US Supreme Court. In the meantime, she said they would continue pressuring the UN to act on its own.


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