Three years after it occurred, Haiti's cholera epidemic is still in the news.
I have already discussed how the disease was introduced by Nepalese peacekeepers serving in the United Nations Stabilisation Mission in Haiti (MINUSTAH). An epidemiologist sent to the country by the French ambassador raised this possibility shortly after the cholera outbreak began. His report, quickly swept under the carpet by the French Foreign Ministry to avoid causing problems for the UN, was nevertheless leaked to the press. Under public pressure, Secretary-General Ban Ki Moon decided to assign the case to an independent panel of experts, who confirmed what their French colleague, Dr Renaud Piarroux, had discovered and what the region's Haitian doctors already knew: the epidemic had clearly broken out along the Artibonite River downstream from the spot where the Nepalese base camp discharged its wastewater. Serological identification of the microbe responsible for the epidemic left little doubt about its Asian source. Meanwhile, a group of victims had filed a lawsuit against the UN for negligence. The victims blamed the UN for not screening soldiers coming from a cholera-endemic area and for failing to take precautions when discharging sewage into a body of water.
Experts also emphasised that the country's prevailing hygienic conditions contributed to the spread of the disease. One need only look at the Dominican Republic on the other side of the island as evidence: it has remained almost completely unscathed by cholera. Yet the secretary-general did not defend the organisation by invoking the shared responsibility of the UN and the Haitian government; instead, he pointed to the legal immunity agreement signed with the government that protects UN staff from lawsuits. In view of the epidemic's 5,000 victims, this is a pitiful argument that will do nothing to enhance the United Nations' prestige.
This evasion, as appalling as it is, should not obscure the main point, i.e. the conditions under which the cholera germ initially spread. As is customary, MINUSTAH had hired a local company to manage waste treatment and disposal at its military base. Breaking all rules, this company had installed sewer pipes directly connecting the septic tanks to the river without treating the waste, thus pouring faecal matter into the water used by the downstream population. The majority shareholder of Sanco Haiti, the disreputable company that benefited from a generous subcontracting agreement with MINUSTAH, is Elisabeth Delatour Préval, wife of the then-president of Haiti. Not one official body has taken an interest in this aspect of the case. Even more serious than the diplomatic immunity claimed by Ban Ki Moon, this political immunity has seemed to pass unnoticed by the outside world even though it is representative of the country's system of government - as if lost amid the many woes assailing the Haitian people. Haitian intellectuals never fail to accuse post-earthquake reconstruction aid of abuses and adverse effects and it is hard not to agree with them on many points. This is particularly true of the latest film by Raoul Peck, "Mortelle assistance" (Deadly Aid), which focuses on the humiliating way Haitians have been kept out of decision-making concerning their own future. As important as they are to express, these partial truths evade another, no less important reality - the failure of Haitian elites and the large responsibility they bear for the situation in their country.
Cholera, a metaphor par excellence for the diseases besetting Haitian society, will never find a cure through accusations hurled at international aid.
To cite this content :
Rony Brauman, The plague and cholera, 10 September 2013, URL : http://msf-crash.org/index.php/en/blog/medicine-and-public-health/plague-and-cholera
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