A year and a half ago, that last sentence would have been incendiary. Most foreigners assumed that cholera was part of the impoverished country's landscape, a result of the squalid living conditions that many Haitians found themselves in after the country’s massive 2010 earthquake. Suggesting otherwise was seen as an exercise in reckless scapegoating. But as the Associated Press correspondent in Port-au-Prince, it quickly became clear to me that there was more to the story. For one thing, the outbreak had first been noticed outside of the quake zone in the country's rice-growing heartland. More startlingly, no one had ever before recorded an outbreak of cholera in Haiti. Our resulting investigation in late 2010, along with those of Harvard microbiologists, a French-led team of epidemiologists and others would uncover a mountain of evidence pointing to the U.N. base as the source of the outbreak. Today Bill Clinton, the U.N. Special Envoy to Haiti, can casually link the peacekeepers to the epidemic. A summary of the facts to date can sit comfortably as the lead story in Sunday's New York Times.
But one key group still insists upon doubting the cholera’s source. The U.N. Stabilization Mission in Haiti, or MINUSTAH, has steadfastly refused to accept the evidence of its negligence. Aware of its nosediving popularity in Haiti eight years after it was installed, the U.N. has become increasingly defensive in the face of criticism there. The spokesman for United Nations Secretary-General Ban Ki-moon, Martin Nesirky, reiterated on Monday that “it was not possible to be conclusive about how cholera was introduced into Haiti … and, therefore, at this point, I don’t have any further comment.”
Nesirky ignores the overwhelming evidence implicating the U.N. soldiers: that the disease first appeared in the water next to their base, and that the bacterium was, in the words of a 2011 panel appointed under pressure by the U.N., a “perfect match” for cholera circulating 9,000 miles away in Nepal. But he is right that there will probably never be a smoking gun--a thermal video, one might imagine, of the index Vibrio cholerae microbe sloughing out of the base into the Artibonite River system. That is in large part because, as soon as the U.N. base was implicated, principal agencies including the U.N. World Health Organization and U.S. Centers for Disease Control and Prevention refused to investigate in the critical months when such evidence might have still been present. (Many major U.S. news outlets followed their lead, ignoring the story for weeks and then blasting the very idea of trying to pinpoint the epidemic's origin.)
The ever-clarifying picture of how cholera came to Haiti has clear implications for public health. A conversation about how to move troops and other large groups of people from one side of the world to the other without putting vulnerable populations at risk has already begun. The U.N. has quietly removed the Nepalese soldiers from their base, replaced by a Uruguayan contingent that dug a new path for the river farther away from its perimeter and stopped dumping its waste in overflowing pits across the street. It is also installing water treatment centers on 28 of its bases throughout Haiti, and taking measures to ensure water can no longer go out of U.N. camps, according to mission spokeswoman Sylvie Van Den Wildenberg.
But that alone is of little solace to the people still suffering cholera's wrath nearby. Many of the epidemic's first victims still live around the base in Meille, a collection of concrete, thatch and mud houses spread thin amongst the banana trees. Children splash around in the babbling river where the infection began, women washing and bathing on rocks in the sun. Jonas Fleury used to sell homemade liquor and food to the Nepalese soldiers. He was one of the first to be hospitalized, and his cousin was one of the first to die. “The U.N. polluted the river. I don't drink from it anymore,” he said, his eyes flashing with fury.
Meanwhile at least one group is pursuing redress by legal means. Following the lead of victims of negligence from Love Canal to BP's Deepwater Horizon, a team of lawyers has filed a petition for relief on behalf of 5,000 cholera victims. The action brought by the Institute for Justice and Democracy in Haiti, a longtime opponent of the peacekeepers, demands the U.N. pay reparations for “gross negligence, recklessness and deliberate indifference.” Their petition also calls for the U.N. to fund a national program for clean water, adequate sanitation and appropriate medical treatment. Some of those items are nice ideas to which the U.N. agencies have paid lip service, but they are currently under no obligation to implement any of them. Moreover, the U.N.'s forces are protected by a standard agreement shielding its troops from prosecution in the country where they are deployed. If the case proceeds, it could change the ways that soldiers and responders are moved, and conduct themselves, around the world. Such a goal would seem theoretical or even irrelevant to some. But not when it's your river.
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Jonathan M. Katz was the Associated Press correspondent in Haiti from 2007 to 2011. His forthcoming book about the earthquake and response, The Big Truck That Went By (Palgrave Macmillan), recently won the J. Anthony Lukas Work-in-Progress Award given by Columbia Journalism School and the Nieman Foundation for Journalism at Harvard.
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