the International Lawyers Bureau (BAI), based in Port-au-Prince,
and the Institute for Justice and Democracy (IJDH), based in
Boston, filed a complaint at the United Nations’ headquarters in
New York demanding reparations from the world body for starting
Haiti’s cholera epidemic, today the worst in the world (see
Haïti Liberté, Vol. 5, No. 17, 11/9/2011).
water-borne disease has sickened about 523,000 Haitians and
killed over 7,000. Those numbers will be spiking in the coming
weeks now that the rainy season has arrived.
suit requests UN financial compensation for 5,000 Haitians who
are cholera survivors or close family members of someone killed
by the disease. The petitioners also call on the UN to take
constructive action to prevent cholera’s spread and to formally
accept responsibility for importing cholera into Haiti.
now, the UN has not officially replied to the complaint, saying
it is still “being studied,” and continues to deny
responsibility. Just last week, the UN Secretary General’s
spokesman said that “it was not possible to be conclusive
about how cholera was introduced into Haiti.”
Dr. Evan Lyon disagrees. “There is no doubt” that UN
Nepalese troops brought cholera into Haiti when they returned
there in October 2010 from Nepal, where the disease is endemic,
he said. “From a micro-biologic and genetic point of view,
epidemiologically,... the strains in Haiti and Nepal are
identical. It’s like matching, in criminal forensics, a
blood sample or some other piece of tissue; you can tell where
it comes from.”
Lyon, who fought, as part of Partners in Health, on the
front-lines against the disease when it exploded in Haiti’s
Artibonite River basin, was speaking to a room-full of UN
diplomats and journalists at 777 UN Plaza in Manhattan on Apr. 9
in a conference organized by the Global Policy Forum, an
independent policy watchdog that monitors the UN’s work.
Speaking with him at the event were the BAI’s lead lawyer Mario
Joseph and Brian Concannon, Jr., the head of the IJDH.
were also joined by Abby Goldberg of the New Media Advocacy
Project (NMAP), who presented a beautifully crafted six-minute
video entitled “Fight the Outbreak: Cholera in Haiti & the
presentations were followed by a question and answer period
where the audience repeatedly asked who in the UN was refusing
to accept responsibility for the outbreak and why.
present here the abridged remarks of Dr. Lyon, who now teaches
medicine at the University of Chicago, and Mr. Joseph.
Cholera is really a 19th century problem. It’s not a
modern medical problem. It’s a solvable problem. Medicine has a
very small role to play actually in the control of the cholera
epidemic. It’s more an infrastructure, water and sanitation
problem than a medical problem.
Cholera was understood to be a water-borne illness before germs
were understand to cause illness. Before germ theory, in 1854, a
man named John Snow made a map of a cluster of cholera outbreaks
along Broad Street in London. He found a pump where most of
these cases were clustered. He took the handle off the pump, and
that’s assumed to be one of the first effective public health
interventions around infectious disease.
unfortunately we’re faced in Haiti with an epidemic which is
rampant, it’s not going anywhere, and it has now infected close
to 5% of the population. There are an estimated 500,000 cases in
a country of 9 million people. If that were the United States,
that would be 12.5 million people sick. That’s the city of New
Everyone in Haiti has been touched by the disease. It’s very
fast and very frightening. And again it’s not going anywhere.
prevent the illness with proper water and sanitation is really
the only option. Medicine can save lives, but to stop the
epidemic, there needs to be better infrastructure and better
capacity to provide safe clean water to people, and, of course,
is no municipal sewage system in the entire nation. Only half of
people have access to any improved water source in rural places.
That’s probably 25% of all people. So most people are living,
predictably, without any access to clean water...
2007, along with a team from NYU here in the city, some
colleagues in Haiti, and other partners in Washington, DC, we
did a study [on water]... in Port-de-Paix, a city of about
100,000 people in the north of Haiti. We spent several months
studying the problem, including a household survey and water
Haiti’s water supply has always had an underlying vulnerability,
and the world community understands this. In Port-de-Paix, in
the summer of 2007, people were living on nine liters of water a
day. International standards say, for survival, one should have
access to 20 liters a day. For health, it’s better to have 50
liters a day. Long term, these are households which are living
on nine liters a day or half of what’s estimated for basic
survival in refugee settings and displacement settings.
Fourteen of the 19 samples we tested were contaminated with
infectious material. People were spending 12% of household
income for water. Accessibility both physically and financially
were very low. There were vulnerabilities for women and others
collecting water. It was a really dramatic situation which has
yet to be remedied.
cholera strain, that is frequent in Southeast Asia, had a
documented outbreak in Nepal some months before October 2010.
Peacekeeping troops carrying that germ came to Haiti. There was
a basic breakdown in sanitation, and the germ was introduced
into the water system.
is no doubt, from a micro-biologic and genetic point of view,
epidemiologically, that the strains in Haiti and Nepal are
identical. It’s like matching, in criminal forensics, a blood
sample or some other piece of tissue; you can tell where it
comes from. And the germ that is now epidemic in Haiti, that is
causing the largest outbreak in the world, is identical to the
strain that is from Nepal, and we also know that the soldiers
moved from Nepal to Haiti. So that is, without any doubt, the
proximate cause of this outbreak.
Haiti’s poor water and sanitation systems, it blew up very
quickly... None of my colleagues or myself , none of us had ever
treated cholera until this outbreak. Very quickly it spread down
the river valley. I work with a group in St. Marc. We went from
no documented cases on Oct. 18, [2010,] to 18 documented cases
of diarrheal disease the next day, to 400 cases on the Oct. 20.
Mortality was around 9% in that first wave of the epidemic. We
didn’t have the means or the knowledge to deal with it on a
medical or community level. There have been major improvements,
and now mortality is closer to 1%. But that still is drastic
considering the size of the epidemic.
someone reaches medical care in time, there’s very low
mortality. Interventions are quite simple: hydration with oral
fluids, salt water, and sugar. If that fails or isn’t possible,
intravenous hydration is needed, which is a little harder
logistically, but not rocket science. It’s very doable.
Antibiotics may play a role, but even that’s unclear.
is a vaccine available. There is currently not enough vaccine in
the world to treat this epidemic. Should the world decide to
invest in it at the level needed, there are some vaccine trials
that may start soon. They have been hampered by a variety of
world was really not ready for this epidemic. Certainly, Haiti
was not ready for it.
epidemic will be around for at least a decade. Best estimates
are that, even with improvements to water and sanitation, even
with an adequate response for treatment, and what’s available
for prevention, the epidemic will last for some time.
of the reasons for that is because there is no immunity. Haiti
has not seen cholera in many generations. Haiti was largely
spared from the global pandemics that were lead killers in the
19th century. But now, with this large, fast moving
epidemic, in a context where there is no immunity, people have
not been exposed to the germ, so noone is protected. The vaccine
would help jumpstart that process and allow people some limited
protection based on exposure.
there were investment in water and sanitation, it would change
generations of lives in Haiti. Although there aren’t great
statistics in Haiti, there are 15 to 20 thousand deaths from
diarrheal illness in Haiti each year, most of that among
children. It’s estimated that 16% of under 5 mortality is from
could, as a world community, invest in water and sanitation, we
could change the primary dynamic of this epidemic. There would
be side-benefits for generations, literally. We would save,
potentially, tens of thousands of lives per year if there were
meaningful water improvements...
Medical people are not the answer to this problem. Public
health, sanitation and infrastructure are the answer.
filed a complaint with the UN on behalf of 5,000 victims of
cholera in November, 2011. The cholera victims ask the UN to
provide three things. First, the clean water and sanitation
infrastructure necessary to control the epidemic. Second,
compensation for the victims, many of whom lost everything they
had, or were forced from poverty into starvation by the loss of
the family wage earner. Third, the victims want an apology to
the people of Haiti for the reckless introduction of cholera
into our country.
filed the complaint with the MINUSTAH claims commission in Haiti
and the UN General Secretariat in New York. We received a
response acknowledging UN receipt of the complaint in December,
but have not heard anything else from the UN.
UN and Haiti signed an agreement called the Status of Forces
Agreement, or SOFA, that regulates the rights and
responsibilities of UN peacekeepers in Haiti. The Haiti SOFAs,
like SOFAs for all UN missions, has a provision giving the UN
protection against the jurisdiction of Haitian courts. But the
SOFA also requires the UN to set up an alternative mechanism,
called the Standing Claims Commission, to settle claims against
it. MINUSTAH has not set up a standing claims commission in
Haiti, or, to our knowledge, anywhere else in the world in over
60 years of peacekeeping.
is a developing legal doctrine that "immunity cannot mean
impunity." If an international organization with an immunity
agreement does not provide a fair mechanism for responding to
claims against it, courts will decline to enforce the immunity
provision. Right now we are asking the UN to provide our clients
with their day in court. If the UN does not do so, we will ask a
national court to do so. Currently we are researching avenues
for justice in Haitian, U.S. and European courts.
Haiti's cholera epidemic is a perfect illustration of the
dangers of impunity. Only an organization with no fear of
consequences would have acted so recklessly with a disease as
dangerous as cholera. As you have heard from Evan and seen on
the NMAP video, the introduction of cholera into my country was
not an accident, but the result of a series of decisions made
with no regard for the safety of people in Haiti. The UN made a
decision not to test peacekeepers coming from a cholera zone,
even though it had, itself, warned of Haiti's vulnerability to
cholera. The UN then made a decision not to safely dispose of
the wastes at the Mirebalais base. It is important to note that
the waste disposal problem in Mirebalais was not an isolated
incident, but part of a pattern of poor waste disposal at
MINUSTAH bases throughout Haiti.
UN's defense in this case, that "a confluence of factors"
caused the bacteria the UN introduced to turn into an epidemic,
would only be used as a defense for an institution with no fear
of being brought to court. The UN was fully aware of these
factors before it decided to not test its peacekeepers or safely
dispose of their wastes. As a result, that excuse would be
rejected in both the Continental law system and the English law
system. Under both, knowledge of a dangerous condition is a
reason for being more careful, not an excuse for being reckless.
UN's impunity problem in Haiti started before cholera. In its
seven years, the mission and its personnel have been involved in
many serious incidents of malfeasance, including widespread
sexual assault, individual murders and large-scale killings.
Each time MINUSTAH resists attempts to hold it accountable, and
so the cycle is repeated.
now we are expecting that the UN will take responsibility and
provide the cholera victims a fair hearing. There are several
encouraging signs since we filed the lawsuit. In January several
UN agencies joined a "call to action" that conceded that
the only way to effectively control the epidemic was
comprehensive water and sanitation. Last month UN Special Envoy
to Haiti Bill Clinton conceded that UN troops were the "proximate
cause" of the cholera epidemic. That is a little like
someone saying that the sky is blue, except in the context of
repeated UN denial, it was an important step forward. Also last
month, the Representatives of Pakistan and France displayed the
leadership needed for a just response to the cholera epidemic,
by urging the UN to take responsibility for cholera.
progress has not led, as far as we know, to any concrete plans
for stopping the cholera's killing in Haiti, or a financing plan
for the necessary infrastructure. So it is necessary for more
organization to play a leadership role and stand up for the
people of Haiti.
the cholera outbreak started in Haiti, we did not think of
filing a lawsuit, because we assumed that with such clear
liability and such great harm, that the UN would respond in a
responsible manner. But when the UN experts report came out in
May 2011, we knew we had to act. The report conceded the facts
showing the UN responsible, but somehow came to a conclusion
that it had no responsibility for its action. We knew then that
the UN's impunity addiction would keep it from treating cholera
victims fairly, so we acted.
One place that the UN can start looking for money to
save lives in Haiti is the budget of MINUSTAH, currently at over
$800 million per year or $2.4 million every day. MINUSTAH has
had one in ten UN peacekeepers, for seven years, in a country
that has not had a recognized war in my lifetime, and does not
pose a threat to other countries. Shortening MINUSTAH's presence
by just one year would, by some estimates, pay for the entire
water and sanitation infrastructure Haiti needs to control
cholera. That would save over 70,000 lives over a decade.