Do No Harm

When a 7.0 magnitude earthquake struck Haiti more than three years ago, killing an estimated 100,000 to 200,000 people and destroying around 250,000 residences, the international community was quick to respond to overwhelming public health and humanitarian needs. Countries around the world provided life-saving supplies, equipment, logistics support and other resources to address immediate challenges and the international community committed to a long-term engagement to “build back better”.

Ten months after the earthquake, Haiti was dealt a second devastating blow – an outbreak of cholera. The ongoing cholera outbreak, one of the worst cholera outbreaks in recent history according to the CDC, has killed more than 8,000 Haitians and sickened thousands more.  Outbreaks of cholera and other infectious diseases can be common following natural disasters but preventive measures focusing on sanitation and water management and mass vaccination campaigns can significantly reduce the risk of infection and subsequent outbreak.

With a completely debilitated health system, Haiti has relied on global public health institutions, primarily the UN, WHO, the CDC, and major international NGOs, to treat thousands of cholera patients and lead efforts to curb the epidemic.

But what does a country like Haiti do when those charged with protecting the health and wellbeing of vulnerable populations around the world bring disease to your door?

The suspected source of the outbreak was the Artibonite River near a UN military base housing peacekeepers from Nepal with documented sanitation and waste management deficiencies. Scientific analysis later showed that the highly virulent strain responsible for the cholera outbreak, previously unknown in Haiti, matched strains found in South Asia.

At the time, the UN denied any connection to the outbreak and other international public health entities such as the WHO and the CDC stated that they were chiefly concerned with controlling the outbreak, not investigating the source since the origin of the strain may never be known. Under immense pressure, the UN appointed a panel to investigate with the final report citing significant evidence that the UN military base was responsible yet indicated that a confluence of ‘other factors’ make it difficult to make a final determination on the source of the outbreak.

The UN and the larger international public health community’s obfuscation is troubling. While the UN presence in Haiti has been politically sensitive given other scandals involving UN peacekeeping troops, its lack of leadership in confronting this public health emergency has served to further delegitimize the UN’s role in addressing international challenges. Even more troubling is the WHO’s lack of leadership. As the international body focused exclusively on the protection and promotion of health and wellbeing around the world, the WHO should have leveraged its technical resources to manage this international public health crisis.

Earlier last week, the Institute for Justice and Democracy in Haiti filed a lawsuit against the UN on behalf of cholera victims in a New York court, challenging the UN’s immunity from lawsuits arising out of damages done in the course of activities. While lawyers hash out legal questions over jurisdiction and limits of UN immunity, a larger arises: If the UN bears “moral responsibility” for the outbreak as the Haitian Prime Minister Laurent Lamothe has stated, who will hold the UN and our global public health institutions accountable?




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