As the annual rainy season gathers over Haiti, bringing the risk of a renewed cholera epidemic that first struck in October 2011, growing numbers of health care professionals and relief workers are openly critical of the United Nations — which many believe brought the deadly disease to Haiti in the first place.
“The situation is worse than it was two years ago, “ says Duncan McLean, a health program manager for Doctors Without Borders, a voluntary organization that treated some 23,000 Haitians for cholera last year. “I’m very, very concerned about the state of cholera preparation in Haiti. The situation has become more dangerous than it was before.”
More than 656,000 people have been infected, and 8,090 died of water-borne cholera as of March 31, according to the Haitian health ministry, and according to McLean, who has visited Haiti numerous times since the emergency began, those totals are likely under-reported.
“To treat cholera primarily as a development issue is grand, but people are dying now.”
- Duncan McLean, Doctors Without Borders
And every rainy season, the number of cases spikes, as polluted water levels rise in a country that is already desperately short of safe drinking water and disinfectant supplies. New cases of cholera, which had been trending down, began to rise again starting last December.
Yet even as the risk of new infection grows, short-term medical treatment funds have been evaporating, and health care workers leaving, while the desperately poor Caribbean country still struggles to recover from the horrific earthquake of January 2010, which killed more than 158,000 people.
McLean and others put part of the blame for the shaky health situation on a $2.2 billion U.N. funding drive for a ten-year cholera eradication program, launched with considerable fanfare by Secretary General Ban Ki-moon last December, but which in financial terms has barely managed to get off the ground.
According to a U.N. spokesman, the world organization has allocated $23.5 million to the effort, which aims at creating safer water facilities, sanitation facilities and other forms of community hygiene to bring the disease, which had not appeared in Haiti in a century, under control. As of early May, only about $17.7 million has been committed to various programs.
“To treat cholera primarily as a development issue is grand,” says McLean, “but people are dying now.”
Short-term health care facilities—some of which Doctors Without Borders originally created, then handed over to the Haitian government—are without funding, their staffs unpaid and often untrained. Health care supplies that turn cholera into an easily treatable disease—antibiotics, intravenous fluids and strong disinfectants like chlorine bleach—are often nonexistent.
While the Haitian government’s lethargic role in the ongoing emergency is significant, foreign health care professionals are especially critical of the United Nations effort, which has numerous agencies on the ground, but according to those critics, is focused on other things than the health emergency.
“The system is dysfunctional at the U.N., they are unable to follow up on their own vows” says Rishi Rattan, a surgeon at the Tufts Medical Center in Boston. Rattan is also advocacy chair for Physicians For Haiti, a loose network of some 300 doctors, other health practitioners and community activists from the Boston area who focus on education and training for their Haitian counterparts in a scattering of overworked and under-funded Haitian hospitals.
By way of illustration, earlier this month Rattan’s organization issued a “report card” on the U.N.’s implementation of recommendations made by its own independent panel of experts in a May 2011 report on ways to combat epidemic.
According to the report card, U.N. Secretary General Ban promised a “prompt” follow-up to the recommendations, but “two years later, most recommendations are not implemented.”
The report card says only two of the expert panel’s seven major recommendations—on establishing a better surveillance and tracking system for cholera, and a pilot vaccination program have been implemented.
Physicians For Haiti gives the U.N. credit for “partially implementing” a program of training health care workers, getting some anti-cholera supplies to affected communities, and contributing “significantly” to the water, sanitation and hygiene effort. But the U.N. efforts have dwindled, along with their funding, and sewage plants the U.N. helped the government build, the report says, are “barely operational” as their funding dries up.
The expert recommendations that Physicians for Haiti say remain unfulfilled are also the most politically sensitive. They call for U.N. personnel from “cholera endemic areas,” to be dosed with vaccines and antibiotics to quell any latent infections before arrival in an emergency areas; for U.N. personnel operating in zones anywhere else in the world where cholera is endemic to get the same treatment, and for human waste at U.N. installations worldwide to be thoroughly sterilized before disposal.
That failing grade is especially resonant due to the widely held belief, backed up by significant medical findings, that the U.N. itself was the source of the devastating outbreak, through inadequate sanitary practices at a U.N. peacekeeping camp manned by Nepalese soldiers, whose homeland had experienced a recent outbreak.
A number of forensic studies have identified the DNA of cholera bacteria in the massive Haitian outbreak to be “virtually identical” with the South Asian strain in Nepal. At least one other significant study released last year, however, by researchers largely from the University of Maryland, claims that it also found additional DNA from a local cholera strain, though the virulent South Asian strain was an acknowledged mass killer.
So far, as the U.N. itself is concerned, the issue of whether its peacekeepers caused the outbreak remains unproven.
Even so, the world organization response to the expert recommendations could hardly be called prompt.
First, Ban created yet another task force made up not of medical experts, but largely of U.N. personnel – and including officials from the World Health Organization and UNICEF -- to study the document and decide further what to do.
The task force was composed, according to U.N. spokesman Martin Nesirky, of “senior staff from across the organization”—eight different departments in all, including the U.N.’s peacekeepers themselves, its legal and management departments, and relief agencies including the WHO and the U.N.’s Office for the Coordination of Humanitarian Affairs (OCHA).
The task force held its first meeting in June 2011, and reported back to Ban in December, 2012—a full 18 months later—at the same time as he announced his multibillion-dollar anti-cholera plan.
In the end, according to spokesman Nesirky, the U.N. officials endorsed only five of the seven recommendations of its independent experts, and “the various U.N. departments and agencies have been working to implement them” – a tacit admission that the work was not yet done.
Among other things, he asserted, the U.N. has added “additional waste water treatment systems” along with other filtering and chlorination equipment at all U.N. camps in the country.
No such additional measures were hinted at in the rest of the world, however; Nesirky said only that the U.N. “has clear standards for sanitation and waste water management in field missions,” and “actively inspects and reviews its sanitation and waste water management mechanisms to ensure that acceptable standards are maintained.”
But two recommendations in particular had been rejected: the notion of giving antibiotics, vaccinations and screening to U.N. peacekeepers and other emergency workers, in Haiti and elsewhere. According to Nesirky, “the use of antibiotics to prevent the spread of cholera has not been shown to be effective and may contribute to the emergence of antibiotic resistance.”
On the issue of vaccinating U.N. peacekeepers and other personnel, Nesirky says, the world organization “recommends” it but hasn’t made it mandatory—meaning that the world organization was reluctant to place the onus on the often relatively poor countries, like Nepal and Pakistan (another area where cholera is endemic), that often provide peacekeeping troops.
He added, “there is no evidence that such vaccination would have a wider public health benefit; the only benefit would be the protection of the vaccinated individual.”
From the viewpoint of the U.N.’s original expert panel and of Physicians for Haiti, however, that was exactly the point, as vaccinated U.N. workers would not have passed on cholera to the people they were there to help.
When asked by Fox News why the U.N. had not decided to vaccinate its peacekeepers, if only to avoid further accusations that they might be cholera carriers, the U.N. declined to provide an answer.
To Physicians for Haiti spokesman Rattan, the U.N. responses indicated “not a good-faith effort.”
“For the organizations that failed to take precautions in the first place to decide on their responses in secret meetings without full explanations is just putting the fox in the hen-house,” he declared.
“The U.N. pledges of money to improve the situation are paltry,” he added. “If the U.N. is not going to do more, we need a full and transparent discussion of why not.”
George Russell is editor-at-large of Fox News and can be found on Twitter @GeorgeRussell.