UN Rejects Recommendations to Change Medical Protocols

UN Rejects Recommendations to Change Medical Protocols
May 24, 2013 Andy Taylor
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UN Refusal to Protect Public Means it Could All Happen Again

More than two years after the UN Secretary General Ban Ki-Moon publicly promised to ensure “prompt and appropriate follow-up” on the seven recommendations made by a panel of experts he appointed to investigate the causes of the cholera epidemic in Haiti, the UN Task Force appointed to do so has effectively declined to implement the first three. All three were crucial changes to UN medical protocols and sanitation procedures designed to prevent another cholera epidemic being spread by UN troops.

“This just confirms the depth of the denial at the UN,” a furious Dr Rishi Rattan, Chair of Advocacy of leading NGO, Physicians for Haiti (P4H), told Haiti Briefing. “What happened in Haiti could happen again because the UN has refused to make basic, science-based protocol changes. Put simply, the UN is refusing to ensure the protection of the public they serve.”

The news leaked out of the UN’s headquarters in New York within hours of the publication of Protecting Peacekeepers and their Public, a Report Card by P4H, designed to highlight the lack of progress in implementing the UN Experts’ recommendations. Even in the face of a UN press blackout on the issue, P4H’s update turned out to be depressingly accurate.

It now seems clear that sometime earlier this year, the UN’s failure to act was formalised. It also seems clear that the central remit of the UN Task Force was not how to enact the recommendations but whether to do so at all.

“When we drafted the Report Card we knew they were not acting on the best advice of some of the world’s leading cholera experts — experts who had gone to Haiti to investigate the cause and context of this devastating epidemic. The Report Card was designed to draw attention to the absence of any of the action the Secretary General promised in his statement about ‘prompt and appropriate follow-up’ two years ago,” says Dr Rattan.

“Now our sources have revealed that the UN has no intention of acting and the anonymous members of this Task Force, whose credentials are entirely unknown beyond their UN affiliation, have finalized their decisions in an unpublished report. Giving us no insight into the reasoning or rationale for these decisions is, frankly, despicable.”

In their first recommendation, the UN Experts advocated that all UN personnel travelling from cholera endemic areas should “either receive a prophylactic dose of appropriate antibiotics before departure or be screened with a sensitive method to confirm the absence of asymptomatic carriage of vibrio cholerae or both.”

The UN Experts’ specific, stated aim was to avoid what happened in Haiti: “To prevent introduction of cholera into non-endemic countries.” The UN Task Force has, in the words of our source, “chosen not to endorse the recommendation.”

The second UN Experts’ recommendation, that all UN personnel should receive “prophylactic antibiotics, be immunized against cholera with currently available oral vaccines, or both,” has been partly endorsed by the UN Task Force but in a meaningless manner.

Oral vaccination of personnel is now “a recommendation” to troop-contributing nations, but not “a requirement.” This means that it will have no effective force because the UN’s Medical Support Manual (MSM) will not be updated to enforce any change. This conforms to a pattern in the MSM.

“Everything is viewed through the prism of protection of UN personnel, nothing through the necessity of protecting the populations they serve among,” says one health expert. “As such, this mirrors the UN’s rejection of the Haitian victims’ compensation claim. “We” and “our” rights are first and final for the UN; “others” are not even considered.”

Finally, recommendation three: “That United Nations installations worldwide should treat faecal waste using on-site systems that inactivate pathogens before disposal.” Although there is limited evidence of action on this, particularly in Haiti, it appears to be piecemeal, partial and particular.

Once again, on-site treatment has not been made a requirement or rule, with no changes in the written Environmental Policy for UN Field Missions that would make it meaningful, mandatory and above all global – crucial in an organisation that operates worldwide and only runs on written regulations.

All three recommendations highlighted here would cost almost nothing in the context of the UN Department of Peacekeeping’s $7.33bn annual budget. As the P4H Report Card points out, adding a little more than half a litre of household bleach – costing just pennies or cents — would be sufficient to neutralise all pathogens, including any vibrio cholerae, in the UN’s 2500-litre black water waste tanks. Public health advocates in Haiti have offered supplies of bleach to UN bases, only to have them refused.

In recent weeks, HSG has been part of delegations to the UN to raise awareness of the urgent need for these basic precautions. In March, we were part of a group that lobbied eight members of the UN Security Council in New York. In April, HSG posed specific questions to UN Under Secretary General, Ameerah Haq, head of the Department of Field Support (DFS) when she gave a talk in Washington DC about reforms in DFS, without even mentioning the UN Experts’ recommendations.

Ms Haq did not seem to understand the complete inadequacy of UN medical protocols that only require pre-deployment screening and treatment for cholera if an individual shows signs of the disease when up to 75% of cholera carriers can be asymptomatic. She stated that she would “have to ask her medical colleagues” if there would be any changes in UN protocols in response to the Experts’ recommendations.

Well now we know – and so does she. There have not been any changes, nor will there be. That perhaps explains Ms Haq’s failure to respond to a follow-up letter from HSG. And if that leaves you as worried as leading public health experts about the possibility of another UN-spawned cholera epidemic, you should be.

In March, it was announced that UN peacekeepers from 23 nations were being trained in Nepal, the source of Haiti’s cholera. Asked what measures had been taken to prevent them becoming unwitting carriers of cholera to their deployments worldwide, the UN’s Department of Peacekeeping refused to say. Take it from us: that means none.


“Now our sources have revealed that the UN has no intention of acting and the anonymous members of this Task Force, whose credentials are entirely unknown beyond their UN affiliation, have finalized their decisions in an unpublished report. Giving us no insight into the reasoning or rationale for these decisions is, frankly, despicable.”


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