UN Confronts Cholera in Haiti with New Initiative but Few Specifics
16 December 2012
The good news is pressure works, yes even in as stiflingly bureaucratic, politically unaccountable, and legally immune an organisation as the UN. The bad news is that anyone who cares about the victims of the cholera that has killed a minimum of 7,750 people and sickened more than 650,000 in Haiti, introduced by foreign troops wearing UN insignia, will need to prepare for a lot more heavy-lifting.
Our work has only just begun.
At a few minutes after 5pm New York time on December 11, UN Secretary General Ban Ki-Moon began reading a prepared text announcing a new initiative to invest in “prevention, treatment and education” to combat cholera in Haiti. Flanked by Haitian Prime Minister Laurent Lamothe and the Dominican Republic’s Health Minister Dr. Lorenzo Hildago he divulged that he had secured commitments for $215m in funding from bi-lateral and multilateral donors to which the UN would add $23.5m of its own funds.
That funding amounts to less than half what the UN and a coalition of forces, led by the Pan-American Health Organisation (PAHO), the Center for Disease Control (CDC), UNICEF, WHO and the Dominican and Haitian governments, say they need over the next two years ($517m), to fund the first stage of a much broader $2.27bn ten-year plan known as the Initiative for the Elimination of Cholera on the Island of Hispaniola.
First mooted in January 2012, and in refinement and development for a year since, the overall plan, which foresees substantial investment in water, sanitation and hygiene (WASH) facilities in Haiti as the best long-term buttress against cholera, will be formally launched by both governments next month. As such, the initiative announced on December 11, is not new, not original and above all, is not the UN’s.
As it stands, the UN’s announcement represents no more than pledges, whose sources have yet to be revealed, and whose cheques may not yet be banked. Even assuming they are, the sum raised to date covers little more than 10% of the total cost of the Cholera Initiative. It is a start, but a much more modest one than anticipated.
Given that, it is worth recalling that the international community’s collective track record on funding development projects and programmes to which it nominally “commits” is distinctly poor and nowhere more so than in Haiti. In the four years before the earthquake, Haiti actually received as little as 17% of the total funds pledged to its development by donors.
Whilst the UN Secretary General deserves some credit for finally demonstrating a personal interest in combating the cholera epidemic – he is reported to have been arm-twisting potential donors in his executive suite, while bending ears on the telephone – none of this would have happened without serious external pressure being applied to the UN.
Pressure, Resistance, but Change? “A Just Response Requires…”
Leading the way, along with the thousands of Haitians who have protested in the streets and outside UN troop compounds in Haiti, has been the Bureau des Avocats Internationaux (BAI) in Port-au-Prince and the Boston-based, Institute for Justice and Democracy in Haiti (IJDH).
More than a year ago, BAI and IJDH challenged the UN’s proclaimed legal impunity by filing a compensation claim for 5,000 sample victims, as well as an apology and major investment in water and sanitation facilities in a country with some of worst access to both.
“As our complaint explained, the UN has a legal obligation to control the cholera outbreak caused by its malfeasance,” insists Mario Joseph, BAI’s lead counsel in the claim. “We welcome the Secretary General’s Initiative as a positive step…..” said Brian Concannon, IJDH Director and co-counsel in the case. “But a just response requires allowing past victims of the UN cholera and their survivors their day in court, to seek justice for their loss of loved ones, income, property and educational opportunities.”
There is not the slightest hint that the UN is preparing to accept even limited liability or to make even the most minimal compensation to the Haitian victims of its own epidemic. Nor is there any evidence that the UN has or is preparing to change its woefully inadequate medical protocols and field support unit guidelines for troops.
It was these that permitted soldiers from Nepal, where cholera is endemic, to be posted to post-earthquake Haiti without testing or vaccination then install totally inadequate waste disposal plumbing at their base, leaking raw sewage into tributaries of the country’s most vital river system (see the Haiti Support Group’s Haiti Briefing No 70, April 2012).
However, there was one possible indication of change in Ban Ki-Moon’s announcement: the appointment of Dr. Paul Farmer, the renowned infectious disease and Haitian public health advocate as his Special Adviser on cholera in Haiti. While ‘Dokte Paul’ as he is known by his Haitian patients and staff adds inestimably to the UN’s credibility on the issue, his power to change things remains to be seen.
As Deputy UN Special Envoy for Haiti under Bill Clinton, Farmer argued throughout 2010-11 that the UN should not only thoroughly investigate and publish its findings on the origins of the cholera outbreak, but should adopt what became known as a “maximalist” approach in fighting the epidemic, including a mass, national vaccination program.
Whilst broadly well received by senior UN personnel in Haiti, the substance and import of that advice has been largely ignored or shelved in New York. Now, as he made clear in his announcement, a national cholera vaccination program is back on Ban Ki-Moon’s agenda, but like everything else in the UN’s Initiative to date, the timetable and funds for it are unspecified. For hundreds of thousands of Haitians, it is already two years too late.
“Behaviour Change” Prescribed for Haitians, as UN Exempts Itself
It was noticeable that Paul Farmer played no role in the UN announcement beyond his appearance in the hall. The only official sent out to field questions at the press stakeout area at UN headquarters on December 11 was Nigel Fisher, the UN’s Resident and Humanitarian Co-ordinator for Haiti. He repeated the UN mantra that he could not discuss the issues of liability or compensation because the matters were subjudice.
In effect, he was doing what every UN spokesman has done for the past year: using their own organization’s refusal to respond to the BAI/IJDH legal complaint, filed some 13 months ago now, to try and quash all discussion of the basic accountability and impunity issues it raises.
The two reporters who got in questions to Fisher, Barbara Plett of the BBC and Matthew Lee of Inner City Press, were both bang on target. Plett asked twice whether Fisher thought the UN had the “moral credibility” to be able to deal effectively with the remediation of cholera in Haiti, given its role in its cause. It’s a vital question and if you follow the money, or the relative lack of it, the answer is clear.
When Matthew Lee of Inner City Press asked Nigel Fisher if any of the funds would be compensating the victims, he differed and deflected, saying the funds would be spent on “all Haitians.” When Lee followed up by asking if the UN’s Department of Peacekeeping Operations (DKPO) had made any changes to its protocols or procedures to prevent the possibility of a reoccurance of this epidemic, Fisher said he could not speak for the DPKO.
HSG is certain that the answer, to date at least, is no; that despite the establishment of a UN task force more than 18 months ago to recommend such changes to ensure, in the Secretary General’s words, “prompt and appropriate follow-up”, nothing has happened. Whilst the Secretary General seeks funds to finance public health education programmes promoting what he terms “behaviour change” in Haiti, there has been nothing of the sort in New York.
As noted by Lee in his report, the man who can definitively answer any such questions, the head of DPKO, Herve Ladsous was present as Ban Ki-Moon launched his initiative. His spokesman stayed in the upstairs briefing room to monitor Fisher’s answers on UN television. DPKO has refused to answer any questions about its response to the cholera epidemic in Haiti for two years; the UN itself has refused to even release the names of the members of its task force.
UN Cholera Credibility Vacuum Could have Serious Consequences
One reason the UN has had to recruit its top man to the cause is that the UN’s leading paymasters, who also happen to be the leading bank-rollers of MINUSTAH – the UN’s troops in Haiti – and their annual $800m cost, are distinctly underwhelmed by the force’s performance, of which the introduction of cholera is just Exhibit A in the egregious behaviour column.
With more than a few UN diplomats expressing private if not public doubts about the configuration, leadership and emphasis of a force they have funded for more than eight years, some say they can be forgiven for being skeptical about paying to clear up the mess left behind by one contingent of that force, however much they may sympathise with the Haitian people.
That attitude is reflected in the chronic underfunding of some admirable although strictly limited cholera mitigation efforts by the UN in Haiti over the past two years. Of the $30m the UN requested for cholera treatment in Haiti in 2012, just 34% was actually secured. Inevitably, undeniably, it is Haitians, not the UN, who are paying the price.
The UN’s lack of moral credibility among big donors is one reason Ban Ki-Moon is said to have been focusing on “non-traditional donors” — defined as private, philanthropic and multi-lateral on December 11. None of the donors have been named, but the risks are obvious.
Private sector WASH solutions are at the very least more likely to downplay the principle and practice of a rights-based approach to water and sanitation, with investment less likely to be targeted at those most in need — the poorest and most marginalized. As the execution of any major investment in WASH infrastructure is passed onto the Haitian government, such risks are certain to increase if there are no serious guarantees, conditionalities or oversight.
Much of the potable water sold from trucks in Port-au-Prince today is stolen or “purchased” cheaply from DINEPA, Haiti’s WASH utility. More investment within the same structures and systems could simply reinforce these problems, while failing to bring prices down or extend availability.
Thus the pressure on all fronts must be maintained. To date the press, with major articles and Opinion-Editorial pieces on cholera in Haiti and the UN in newspapers like the New York Times, The Boston Globe, and the Miami Herald, have played a major role in raising the profile of the issue.
Leading advocacy, development and public health groups such as the Center for Policy Research (CEPR), the Haiti Advocacy Working Group (HAWG), Physicians for Haiti (P4H) and Partners in Health (PIH) have all published reports and papers, convened hearings, circulated letters and made trips to New York to apply pressure to both the UN Secretariat and representatives of its member states.
You can and should be part of this effort. The first step if you have not done so already is to sign the Avaaz Community petition calling on the UN to maintain and step up its commitment to effective action (click on this link to read and sign the petition). If you have already signed, please email, text or twitter all your friends, relatives and colleagues with the link. In the coming months, as the Cholera Initiative is executed we will be asking you to take further concrete steps to press for basic justice on cholera in Haiti and greater access to water and sanitation there. Haitians are relying on you.