Cholera outbreak in Haiti: what responsibilities for the UN?

A key step in the fight against cholera: spraying chlorinated solution, Haiti, 2017 ©Solidarités International

January 2010, cholera devastates Haiti and makes thousands of deaths. The medical specialist Renaud Piarroux, mandated by the French ambassador to Haiti to help the Haitian Ministry of Health to fight against this epidemic, leaves in November of that same year. However, going back to the sources and causes of cholera, Dr. Piarroux makes a surprising and scandalous discovery. The United Nations will do everything to hide the truth and discredit its conclusions.

It is the chronological account of the events that preceded and followed this discovery that he narrates step by step in his book “Cholera. Haiti 2010-2018, the story of a disaster“. A sort of police investigation that will reveal a scandal humanitarian, scientific and political.

Haiti, an unprecedented epidemic: phase 1, the investigation

Let us recall in the preamble that the cholera is characterized by intense and fast dehydration, through diarrhea and vomiting, which leads to a fatal rise in the viscosity of the blood, hence its nickname “blue death”.

Dr. Piarroux immediately notes the exceptional rapidity of expansion of the epidemic in a country where it had never appeared before. His first step will be to look in the field, where the first cases occurred to trace the path of the epidemic. Soon they are located near the river Mielle, northeast of Port-au-Prince, river near which more than 10 000 suspected cases appeared in a week.

River… located near a camp of Nepalese peacekeepers whose, says Dr. Piarroux, “sanitary facilities are managed in violation of basic hygiene rules and in disregard of the surrounding population” including an uncontrolled spill of content septic tanks. (NB: the peacekeepers have been present since 2004 to contribute to the political stability of the country and not only since the earthquake).

The obvious conclusion is that of the accumulation of Vibrio Cholerae in these pits, which presupposes the existence of an epidemic among these Blue Helmets because it takes a vast number of microbes to cause such an outbreak.

Dr. Piarroux immediately got in touch with René Mulet, Minustah’s chief as Special Representative of the Secretary-General of the United Nations, then with President René Préval.

Haiti, an unprecedented epidemic: phase 2, refusal of evidence and misinformation

November 2010, full electoral period… Charges fraud, dams, humanitarian aid can no longer reach Port-au-Prince, the deads accumulate. It was only when he came back to Paris that Dr. Piarroux discover the existence of an investigation conducted before his arrival by an Haitian health department assisted by epidemiologists, dating the beginning of the epidemic to October 14 and mentioning “an open pit” near the camp as well as spill pipes that, journalists will notice on October 27, the soldiers are busy replacing.

Later on, Dr. Piarroux becomes convinced that the information delivered to the public has been knowingly truncated or skewed, or even falsified: the medical records of the camp do not mention the smallest diarrhea, not the least digestive problem… While more than 400 soldiers arrived after 10 days off in a Nepal hit by cholera! But Dr. Piarroux could not question the Minustah’s soldiers. And no authorization to enter the camp was issued to the journalists. The presence of cases in the encampment can never be proven… nor denied. The question of earthworks so promptly executed by the soldiers arises also.

Moreover, in a communiqué of October 22nd, the Minustah locates the first cases appeared… far from camp, the river and the river that it joins. And the first cases, rightly indicated on the PAHO (Pan-American Health Organization) map of October 22nd, will disappear from the following maps, both those of PAHO and those of OCHA. The date of the occurrence of the epidemic is also shifted.

A series of theses will follow to explain the origin of this Vibrio Cholerae because it has been well identified as being Asian: global warming conjugated to the earthquake, marine currents, aquatic tank mixing marine and fluvial waters, introduction by the water contained in basalt boats from Asia…

One of those theses is precisely supported by the experts of the “independent panel” chosen by the UN to shed light on this epidemic after the reactions raised, in some media and at Médecins Sans Frontières (MSF) in particular, by the report of Dr. Piarroux.

It is only in 2010 that the genetic code of isolates collected in Haiti can be compared to that of Nepalese isolates: the result is without appeal, the strains are identical.

Shocked that no responsibility is implicated, Dr. Piarroux does everything to take legal action. The complaint against the UN in a New York court is dismissed. No compensation is paid to the families of the victims.

Specific centers must be set up against the epidemic: the cholera treatment centers (CTC), 2017, Haiti ©Solidarités International

Haiti, an unprecedented epidemic: phase 3, from hopes to disillusion

Unfortunately, at the end of 2012, cholera is endemic. The UN says in 2013 it is undertaking “significant investments” in Haiti, in terms of infrastructure, to fight against cholera. Investments that will not materialize then.

In 2015, a new epidemic breaks out. Then, after Hurricane Matthew in 2016, the Melina Foundation and Bill and Melinda Gates fund a major vaccination campaign. Fortunately, the epidemic will be curbed, but Dr Piarroux regrets that this campaign has had very questionable experimental aspects. He continues to strive to fight as effectively as possible.

Between 2010 and 2016, “nearly 800,000 people were affected, and more than 9,000 Haitians died”. These figures appear in the first mea culpa finally pronounced by Ban Ki-moon in December 2016, with the announcement of a real action plan. Hope is born of an efficient struggle. Alas disappointment again, in 2018, only half of the promised 20 million is reached, many countries stepping back, such as President Trump discarding himself by arguing the responsibility of the UN.

Thinking back over the past 8 years, what is most striking to Dr. Piarroux is “the lack of respect for the dignity of everyone”; the Nepali soldiers vis-à-vis the surrounding population, all the ones who have been lied to,  the victims who claim justice and  a community to whom the promised help has not been brought.

How many deaths could have been avoided if the truth had been unveiled immediately?

It was in tribute to the victims that Dr. Piarroux first decided to take some distance. But he is still fighting so that UN and big powers do not give up the fight before any risk of cholera epidemic is eradicated from Haiti.

Find the summary of Renaud Piarroux’s book: here.

By Sylvie Rosset

What is cholera, and how to fight it?

Cholera is an acute diarrheal infection caused by the ingestion of food or water contaminated with the bacillus Vibrio cholerae. Cholera remains a global threat to public health and an indicator of a lack of equity and inadequate social development. There is an estimation of 3 to 4 million cholera cases each year, and 21,000 to 143,000 deaths from the disease worldwide.

Hand washing training in a school by the NGO Solidarités International ©Solidarités International

It is an easy disease to treat. The majority of affected individuals can be cured by prompt administration of Oral Rehydration Salts (ORS). The WHO / UNICEF SRO standard bag is to be dissolved in 1 liter of drinking water. Up to 6 liters of ORS may be needed to treat moderate dehydration in an adult patient on the first day. Affected people must go to the Cholera Treatment Center (CTC) to be slowly rehydrated. This center is composed of a “triage zone” where the level of severity of the symptoms is evaluated. Then you have to go through the point of disinfection that any center has where the patient has to wash his hands and feet with a 0.5% chlorine solution. In the center, patients do medical tests to verify that it is a case of cholera. The danger is not to be taken care of in time because the disease causes severe dehydration, sometimes in just a few hours.

The houses of patients who have been declared sick and who are suspected of having cholera must then be chlorinated. The surrounding houses must also be sanitized so that the disease does not reach them. Often the major challenge is finally to rehabilitate the water networks because in most case the spread of the epidemic has been favored by a total lack of maintenance of the pipes and the water management system of a city.

To learn more about the treatment of cholera in Haiti, watch Season 3 of the Solidarités International web series “De vos propres yeux“(english subtitles available).