UN ‘overwhelmingly’ linked to cholera epidemic in Haiti

Blog by Matt Barr

According to new report released by researchers at Yale University the United Nations inadvertently caused a deadly cholera outbreak in Haiti in October 2010 and has a legal and moral obligation to remedy this harm. This on-going cholera epidemic has killed more than 8,000 people and infected more than 650,000 in Haiti, a country still struggling with the aftereffects of the 2010 earthquake. Crucially, this conclusion directly contradicts recent statements by the UN Secretary General, Ban Ki-moon, that have claimed that the UN did not bring cholera to Haiti and therefore has no legal responsibilities for the. As such, the UN has refused to even consider claims by Haitians affected by the outbreak who are seeking compensation.

The 58 page report, ‘Peacekeeping without Accountability’, was published on 7 August and provides the first comprehensive analysis of the cause of the massive outbreak of cholera that followed the devastating earthquake in January 2010. In line with previous scientific investigations, the Yale report notes that “[s]cientific study of the origins of the cholera epidemic in Haiti overwhelmingly demonstrates that U.N. peacekeeping troops from Nepal introduced the disease into the country.” UN troops, known by the acronym MINUSTAH, have been in Haiti since early 2004.

Not only does the Yale report outline the overwhelming scientific evidence of origin but in doing so it also stress that the UN should therefore be held accountable for the outbreak, thus requiring it to remedy as best as is possible its consequences and prevent its further spread. This is something the organisation has steadfastly refused to do.

Earlier this year the UN invoked its immunity privileges against claims for compensation by 5,000 Haitians and according to The Economist “has staunchly refused to entertain the cholera claims in any venue”. Whilst this is not the first occasion on which the UN has invoked its immunity, it is nonetheless “a highly unusual move made more controversial by the extreme distress in Haiti to which it relates.

Dr Louise Ivers, who works in Haiti with Partners in Health, commented on this use of immunity, stating that, “Regardless of the merits of this argument, the United Nations has a moral, if not legal, obligation to help solve a crisis it inadvertently helped start.” Writing about the recent UN initiative to eliminate cholera in Haiti and the Dominican Republic, Dr Ivers commented that UN funding of this, and the Haitian government’s anti-cholera program, “could have a significant and immediate impact on stemming this epidemic” but then reports that instead the UN only “plans to contribute just 1 percent of the cost.”

In relation to this op-ed, as the New York Times pointed out that what makes these comments “especially striking” is that Dr Ivers’ “organization’s co-founder and chief strategist, Dr. Paul Farmer, served as the United Nations’ deputy special envoy for Haiti for the past three years and was appointed by Mr. Ban in December to lead the very anticholera initiative that she found lacking.”

Indeed, as detailed below, the $23.5 million the UN is providing towards the $2.2 billion cost of the initiative is contrasted by the on-going cost the UN is paying for MINUSTAH, budgeted last year for over $648 million, a cost that Dr Ivers notes “could more than fund the entire cholera elimination initiative for two years.”

In many ways, the cholera issue acts as a window into the wider issues at hand with the MINUSTAH mission in Haiti. Even before the cholera outbreak MINUSTAH was greatly resented by Haitians for its lack of accountability and violence, including the rape of a 14 year old boy, sexual abuse of young girls  and the killing of civilians in armed raids.

2010 Outbreak Background
Set against the backdrop of the social disaster that followed the 2010 earthquake [that has been outlined in a previous Peace News blog article], on October 22, 2010, ten months after January's seismic reverberations, cholera was confirmed to have appeared in Haiti for the first time in nearly a century. By the evening of October 25 the World Health Organisation had published Ministry of Health figures of 3,342 confirmed cases including 259 fatalities.

Haiti had remained unaffected by previous regional cholera outbreaks, including the one that began in Peru in the early 1990s. This prolonged interval in the absence of the disease, however, actually produced problems of a multidimensional nature such as the fact that without previous exposure the Haitian population lacked immunity to cholera, thus exacerbating its overall effect as compared to areas that had previous experience with the disease. In addition, the disease's long absence from Haiti, as medical epidemiologist Robert Quick has pointed out, resulted in the population being “immunologically naive”  in terms of both preventative measures and in identifying symptoms as they had no experience to draw upon in how to deal with it. Another factor working against the Haitian people emanating directly from the prolonged absence was that most Haitian health professionals also had no experience of dealing with the disease. Complicating this lack of experience further, as The Lancet reported, there was “also a less-visible factor”, namely the “brain drain that has robbed the country of most of its medical school graduates.”

Another initial factor not related to the previous absence of the disease was that the first cases occurred outside of the capital, Port-au-Prince, where domestic and international health professionals were on their guard and working to avoid the outbreak of communicable diseases in the wake of the earthquake. The outbreak of cholera occurred in a rural area unaffected by the earthquake along the Artibonite River in central Haiti, north of the capital, which directly affected both the preparations and response times to the outbreak.

The short incubation period of two hours to five days enhances the potentially explosive pattern of outbreaks; cholera, if left untreated, can kill within hours. What is critical to reduce the impact of cholera and other waterborne diseases, the World Health Organisation (WHO) outline, is the provision of safe drinking water and sanitation. Although in up to 80% of cholera cases it can be successfully treated with oral rehydration salts, these salts are considered only as “an additional means to control cholera” that “should not replace conventional control measures”, those of safe drinking water and effective sanitation provisions.

Impact of Poverty

In July 2010, three months before the outbreak, UNICEF had reported that, “Sanitation is a major concern” meaning “potentially dire consequences for the spread of disease.” Even prior to the earthquake half of those living in Port-au-Prince had no latrines or other sanitation systems and a third lacked access to tap water; not only did Haiti have the worst water security in the hemisphere, but in 2002 it also ranked 147th out of 147 countries surveyed in the Water Poverty Index. In 2009, according to WHO figures, 45% of the Haitian population did not have access to potable water and 83% did not have access to sufficient sanitation services.

These conditions, and the aforementioned brain drain, are the direct result of Haiti’s poverty, a plight linked to its self-liberation from the bonds of slavery in 1804, the world’s only example of a country being born from a successful slave revolt, and the international isolation and intervention the country has faced ever since. [These themes are explored in two previous Peace News blog articles available here and here.]

Previous Scientific Links to the UN

In the July 2011 issue of the medical academic journal Emerging Infectious Diseases it was reported that a recent study's findings strongly suggested that it was contamination from the Artibonite river and one of its tributaries downstream from a MINUSTAH military camp that had triggered the epidemic. Indeed, the results of subsequent studies were consistent with this conclusion.

Indeed, as the New York Times reported following local and national protests and an Associated Press investigation, the UN Security General “empaneled a group of international experts to determine the disease’s source.” Whilst it was careful not to ascribe blame or fault, even the UN’s own report stated that evidence “overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meye Tributary of the Artibonite River with a pathogenic strain of current South Asian type Vibrio cholerae as a result of human activity.
This is to say, the Nepalese MINUSTAH contingent at the base there.

As with disasters following earthquakes, and other extreme natural events, disease outbreaks disproportionately impact upon the poor, a point made by Dr Paul Farmer and Dr Louise Ivers in a co-authored article regarding the cholera epidemic in Haiti: “If we know so much about cholera, its pathophysiology and epidemiology and treatment and prevention, how did it become the leading infectious killer of young adults in Haiti during the international humanitarian response - one of the largest in history - to the January 2010 earthquake? The short answer is that expectations are lowered for diseases that disproportionately afflict poor people.” Farmer and Ivers also contend that in assessing the root of this disproportionate affliction amongst the poor it is “not merely polemic to note that all diseases that affect primarily the poor are, by definition, neglected”.


As mentioned, even prior to the cholera outbreak the UN military presence in Haiti was, to say the least, highly contested by the majority of Haitians and controversial.

It was shortly after the February 2004 coup that disposed for the second time the democratically elected Aristide that the UN established the UN Stabilisation Mission to Haiti (MINUSTAH) under the mandate of UN Security Council resolution 1542 to ensure a “secure and stable environment”. Despite this supposed humanitarian mandate, as Dan Coughlin has reported, leaked US diplomatic cables in fact reveal the politicalisation of MINUSTAH, an acronym derived from its French name, and that the main driver behind this process was Washington. Indeed, these cables compelled Mark Weisbrot to write in the Guardian that “make no mistake about it: the UN occupation of Haiti is really a US occupation”.

Outlining this politicalisation, Coughlin cites an October 1, 2008 cable in which the then US ambassador Janet Sanderson insisted that MINUSTAH has been “an indispensable tool in realizing core USG [US Government] policy interests in Haiti.” In keeping with realising these core policy interests Sanderson continued by stating that MINUSTAH was establishing “domestic security and political stability” which she wrote was necessary to prevent the resurgence of “populist and anti-market economy political forces” and an “exodus of seaborne migrants.

It is worth noting that such “populist and anti-market economy political forces” that the US feared were precisely the issues and platform on which Aristide ran for president in both 1990 and 2000 and upon which he was overwhelmingly elected. As such, MINUSTAH was, and is, being used to undermine popular political actions that had an overwhelming democratic mandate.

The particular importance of MINUSTAH over a US entity carrying out this end of preventing the re-emergence of popular political forces in Haiti was twofold; a lack of US resources due to other military commitments, and the cost of such a mission. “In the current context of our military commitments elsewhere, the U.S. alone could not replace this mission,” Sanderson concluded in the October 1, 2008 cable.

On the issue of cost, a February 2006 US General Accounting Office report estimated “that it would cost the United States about twice as much as the United Nations... to conduct a peacekeeping operation similar to... MINUSTAH.” The GAO report also stated that the not only would it cost twice as much but that a “U.S. operation in Haiti of the same size and duration would cost an estimated $876 million, far exceeding the U.S. contribution for MINUSTAH of $116 million.

Perhaps most startling, however, is that despite the enormous economic cost, MINUSTAH has failed to meet the mandate for which it was created, that of protecting the population and stabilising the country.

In the assessment of one US Embassy official comment on MINUSTAH's achievements in a January 4, 2006 cable “there has been no tangible UN contribution to improving the human rights situation” in Haiti.” The US embassy was not alone in coming to this determination, indeed the opening paragraph of a July 28, 2005 Amnesty International report expresses a similar conclusion regarding the role of MINUSTAH in helping to 'improve' the human rights situation in Haiti: “Haitians remain mired in a human rights crisis despite the presence of a UN peacekeeping force, the Stabilization Mission in Haiti (MINUSTAH). In fact, little tangible progress has been made to protect human rights since the interim government took office in early March 2004 and in the year since MINUSTAH arrived in the country. Violent crime, confrontations between armed groups and gangs, and unlawful use of force by police continue to claim the lives of civilians on a daily basis.

Indeed, both The Lancet and FAIR have also reported that not only did it fail to combat the violence it was sent to lessen and prevent, but MINUSTAH actually contributed to the violence and death of civilians following Aristide’s removal in a coup.

Leaked diplomatic cables have also revealed the brutal extent and scale of MINUSTAH activities in Haiti.

A January 19, 2006 cable written by then US Chargé d’Affaires Timothy M. Carney outlined that as a result of MINUSTAH forays in late 2005, “Civilian casualties in Cité Soleil... [rose] from 100 wounded in October to between 170 and 205 in December”. Carney also stressed that half of these civilian causalities were women and children.

On another occasion, in a July 6, 2005 night-time raid, a cable reveals that Cité Soleil was surrounded and sealed off by 1,440 MINUSTAH troops who fired 22,000 rounds of ammunition causing dozens of casualties in just one seven-hour period. Three days prior to the writing of this diplomatic cable Amnesty International had on January 16 called for the UN “to make public its findings” of an internal review after MINUSTAH officials admitted that an internal investigation had concluded that during this MINUSTAH operation in Cité Soleil a number of unarmed civilians may have been killed.

The Status of Forces Agreement under which MINUSTAH personnel operate grants immunity from prosecution in civil and criminal courts. Despite there being a provision in this agreement that provides for an outside commission to hear Haitians’ complaints and demands for redress, no such body has never been set up. Consequently, MINUSTAH troops are essentially free to do as they please. “For the most part,” reports The Economist, “Minustah is subject only to the regulation of its own good intentions.

In addition to all these, and numerous other problems, considering the economic context of the country in which it is operating in the cost of MINUSTAH is prohibitive; the estimated figures of $428 million outlined in the February 2006 US General Accounting Office report for the cost of maintaining MINUSTAH was for its first fourteen months, whilst a 2007 article in the Los Angeles Times reported that the “mission's annual price tag now tops $500 million” and critically reports that this is “the equivalent of Haiti's entire budget.” The expenditure for MINUSTAH operations in 2008-9 was over $574 million and the apportionment for 2009-10 was over $611 million with 2011-12 costing over $793 million.(1) The latest UN approved budget for MINUSTAH's peacekeeping operations for 2013-2014 is over $609 million.


In addition to the Pakistani MINUSTAH soldiers who raped a 14 year old boy a video was leaked, the authenticity of which has been confirmed, in late 2011 of Uruguayan MINUSTAH troops raping an 18 year old man. These incidents of rape come against a backdrop of sexual abuse by MINUSTAH personnel; in December 2007 more than 100 MINUSTAH personnel from Sri Lanka were deported under charges of sexual abuse of under-age girls.

This followed a 2006 investigation by the BBC that uncovered allegations of sexual abuse of children by MINUSTAH soldiers; “I spoke to a 14-year-old girl who told of the peacekeeper who offered her jelly, sweets and a few dollars for sex with her and her friend - a child of just 11 years.” In response, Sarah Martin of Refugees International told the BBC, “To prey upon the very populations that you are sent to protect is one of the worst forms of violation and betrayal that there is.” In similar sentiments, in December 2007 the Los Angeles Times reported that whilst Haiti “has endured occupation repeatedly over the centuries, each time suffering instances of statutory rape and economically coerced sexual relations” on these most recent of occasions under the auspices of the UN “the troops had been sent to protect the country's people.

It is sadly ironic then, to say the least, that following the 2010 earthquake and the destruction of many homes in Haiti’s capital, MINUSTAH were tasked to police the massive ten cities that sprang up all across the city with the UN launching “a new operation to combat rape and gender violence in Haiti”. The scale of sexual violence against women in the post-earthquake environment that MINUSTAH was supposed to be combatting was later reported on by Amnesty International in harrowing detail a year after the earthquake.


Signalling the on-going nature of the epidemic, Dr Louise Ivers pointed out in her New York Times op-ed that three-and-a-half years after the outbreak the disease still has a strong hold in Haiti and has in fact been resurgent rather than diminishing at times; “There were 11,220 cases nationwide during the month of December — significantly more than the 8,205 cases seen during December 2011. Our clinic in St. Marc treated more people with the infection last month than in the previous eight months combined.” As such, the cholera issue is not simply a historic one, an aftershock of the earthquake, but is instead currently an entrenched killer in Haiti.

As the title of the Yale report, Peacekeeping without Accountability, suggest the use of UN immunity both in relation to the origin of the cholera outbreak in Haiti and MINUSTAH’s wider activities in the country has effectively allowed the politicised entity to act with impunity and at great cost to the people of Haiti. As such, the cholera issue should be seen as a window into the wider issues at hand with the MINUSTAH mission in Haiti and the, primarily American, interests it is serving in the country at the expense of both Haitian lives and political capacity building.

As The Nation wrote in simple elegance as concluding remarks to an article in September 2011, “The UN needs to end its occupation of Haiti.


A number of excellent articles about Haiti based on leaked US documents appeared both in Haïti Liberté and The Nation:

WikiLeaks Haiti: Cable Depicts Fraudulent Haiti Election

WikiLeaks Haiti: US Cables Paint Portrait of Brutal, Ineffectual and Polluting UN Force

WikiLeaked Cables Reveal: After Quake, a “Gold Rush” for Haiti Contracts

WikiLeaked U.S. Embassy Cables Portray Senator Youri Latortue 1/2

WikiLeaked U.S. Embassy Cables Portray Senator Youri Latortue 2/2

The short documentary, Baseball in the time of Cholera, from the perspective of one young Haitian is a beautiful film and is available to watch here (YouTube) and here (Vimeo). The trailer is available here.


(1) UN General Assembly (2010a) Overview of the financing of the United Nations peacekeeping operations: budget performance for the period from 1 July 2008 to 30 June 2009 and budget for the period from 1 July 2010 to 30 June 2011, A/64/643, February 1, 2010; the actual figures are $574,401,700 and $611,751,200 respectively. UN General Assembly (2010b) Administrative and budgetary aspects of the financing of the United Nations peacekeeping operations, A/C.5/65/19, July 22, 2011; the exact figure in the document is given as $793,517,100

Topics: Haiti