Haiti Message on UN responsibility for importing cholera

HLLN Message to the UN and all decent peoples on the UN importing cholera to Haiti

The Meille River feeds into the Artibonite, Haiti’s longest river that fertilizes its breadbasket. At first the UN said its Nepalese contingent in Mirebalais, Haiti use seven septic tanks to contain their raw feces. These tanks were built in accordance with Environmental Protection Agency (EPA) standards, emptied every week by a subcontractor’s trucks, which then take their load to bury at an approved site that is ” 250 metres off the Meille River, which is more than 20 times the internationally required distance.

When an Al Jazeera video showed foul, leaking and unsecured UN septic tanks and the raw feces from the Nepalese base being leaked straight into the Meille River and further filmed UN subcontractor’s trucks dumping their load in an open pit draining virtually directly into the river, the UN then said the source of the cholera is not important. It declared the important thing is treating the injured. The UN tear-gassed and shot dead Haiti demonstrators accusing the UN of bringing to Haiti this communicable disease that was killing their children. The corporate media reported the UN side of the story, called the Haiti grievers “insurgents.” They said the mourners were demonstrating against the UN because they were looking to destabilize Haiti for political reasons and to influence the upcoming (sham) elections. Then, when world renowned experts pointed out the cholera strain in Haiti was South Asian, not Haitian, the UN proceeded to investigate itself and determined, yes it most likely brought cholera into vulnerable Haiti, but it is not to blame for the lives lost. Haitians disagree.
Demand a stop to the denials.

The UN is accountable for not controlling its own troops’ hygiene, for importing a communicable disease, for not controlling that communicable disease, for the damage done, the lives lost, the Haiti farmers and Artibonite breadbasket that’s been contaminated. The UN’s failure to properly dispose of its human fecal waste, is not a “state action” subject to state immunity. It’s a personal injury inflicted upon a vulnerable people the UN says its mandated to protect. The UN is paying itself almost $1 billion ($860million) dollars per year for said “protection.” The UN is not above the law, immune for violating international sanitary standards, nor for failing to control the spread of its own disease. —Ezili Dantò of HLLN

In a nutshell, the UN imported the deadly cholera disease to Haiti, but blames the fatal injury on the victim’s pre-existing conditions. (Blaming their injustice on their defenseless victims is not new for the UN forces in Haiti.)

Folks, Ezili’s HLLN needs your help. The UN literally dumped the deadly disease, through gross and perhaps even criminal negligence into Haiti’s waterways and tributaries. It has killed untold thousands of Haitians. But the UN expects immunity from responsibility and prosecution.

Haitians are the first Blacks to stop slavery and colonialism and thus we have no big imperialist nuclear power to throw at the five post World War II powers who have divided the world amongst themselves and sit, with veto power over the 192 countries at the UN. This UN Security Council, their Clinton/Farmer UN Special Envoys, their NGOs with the Obama Administration who took over Haiti’s airport and from the UN after the earthquake to “help” Haitians are killing Haitians, simply letting us die from their constant “help.”

The ugly, racist and interminable quiet genocide must end; the UN expectation of immunity for giving Haitians cholera must not stand. We Haitians, who have been working to save our own lives, are calling on those decent people of the world not involved in false benevolence, pimping poverty, structural racism or colonialism to stand in solidarity with us against UN immunity for this travesty it dumped into Haiti – this new and catastrophic earthquake- brought in by UN peacekeepers that is expected to infect 800,000 Haitians, that’s Rwanda genocide figures.

If might really doesn’t make right then the illegal, gross and perhaps criminal negligence of the UN in giving Haiti cholera will not be immune from prosecution and the reach of justice.

Since October 2010 when the UN-imported cholera outbreak was unleashed, we knew this new international and imported excrement would kill thousands upon thousands of innocent but super-exploited Haitians, destroy our Artibonite breadbasket further than Clinton’s Arkansa rice-dumping US policies, sweatshop/export economy and unfair trade already has. (See also, Haiti’s case against the UN for importing cholera epidemic by Ezili Dantò, written on Oct. 28, 2010. )

As early as Nov. 4, 2010, just weeks after the Oct. 19 Haiti cholera outbreak, John Mekalanos, a cholera expert and chairman of Harvard University’s microbiology department said this was a South Asian strain and most likely brought in by the Nepalese soldiers. The CDC likewise also said this was not a Haiti disease. But the mainstream media took a past. Stopped reporting the Haiti perspective, letting the UN “independently investigate” itself while Haiti’s people died unmercifully. No measures were taken to mobilize the UN’s massive resources or any of its tentacles to stop the contaminated UN carriers, throughout the country, from further infecting the poor Haitians. At one point the international “humanitarians” ordered 200,000 body bags to prepare for the dead they were expecting! That is, paid themselves monies for 200,000 body bags, but laid no monies down for installing not one inch of pipe for clean water or a sanitation system.

More than six-months after the cholera outbreak the UN is confirming it imported cholera to Haiti but obfuscating UN liability with their newly released UN report.

The UN, having examine itself is telling all and sundry it indeed brought the deadly disease to Haiti that has, on top of the apocalyptic earthquake trauma, made over 300,000 ill and killed untold thousands upon thousands of innocent Haitians. Cholera is expected to kill thousands more and make up to 800,000 more Haitians suffer sickness. But apparently the UN is not RESPONSIBLE to compensate and make whole for the damage done, the lives destroyed, for toxifying the country’s land, water system, food and the entire eco-system it has compromised, nor for the unspeakable indignity of having our people drink its imported fecal excrement on top of and along with the rest of the UN nightmares Haiti’s innocents have had to endured these last and interminable 7-years!

In no world except exploited and ravaged-by-“humanitarians-and-peacekeepers”-Haiti would the carriers of this deadly disease not have been immediately tested and quarantined. The damage this has exacerbated is UNIMAGINABLE.

The road to controlling a cholera epidemic has been paved by hundreds of previous outbreaks worldwide. Yet, in Haiti, there are vast gaps in the deployment of well-established control measures.” (Haiti: where aid failed.)

Do the world powers seriously believe that Haitians will accept this conclusion by the UN’s “independent” panel? As I wrote already, that’s like handing over a rapist kit and letting the rapists investigate themselves! (“The accused UN cannot investigate itself” – Ezili Dantò, Oct 30, 2010 interview with Yves Point Du Jour, and Haiti elections and Cholera , interview with Ezili Dantò of HLLN, Oct. 22, 2010, Gorilla Radio.)

The UN and their various “envoys” are not above the law. Yes, they’ve unilaterally usurped Haiti relief and reconstruction and the country’s civil functions, but indigenous Haitians know they are our jailers and executioners, not our rescuers. The powers responsible for bringing cholera and allowing its spread in Haiti will be held liable for whatever criminal consequences their false benevolence has secured and that can be duly determined by independent courts of law.

There are laws against gross negligence, wrongful death, false benevolence, massive infliction of pain and suffering, not to mention destroying Haiti’s water system, territory and environment, already burden with TOURISTAH (aka MINUSTAH) and foreign NGOs! (See the UN “independent panel” report ; “93% of the USAID funds come back to the US” ; It’s called “Tied Aid “; Avatar Haiti, part two.)

Since the outbreak, HLLN has attempted to find a commercial law firm with deep pockets who could help us bring this Haiti tort and wrongful death case to a proper court of law. To date, most of those we’ve approached have declined to take on the Clinton/UN/Farmer/USAID gang of “humanitarians” in Haiti “saving” us for our own good.

We know HLLN will file a case against the UN one way or the other on this. But we need the Ezili’s Haiti Network’s support and help. I am so very tired of hitting my head on steel doors that won’t open to help us Haitians and so I come to you, I open this search to you the Ezili Network for you constructive input. Ezili’s HLLN has no financial resources to take on this case but we are the best informed Haitians to defend Haiti with partners who do have the resources and respect for life and dignity of our people. So, write and call me directly if you’re willing to fight against the UN’s callous expectation of immunity and impunity and you are a partner in a law firm or have University connections to an entity with the staff, willingness to defend what’s just and deep pockets to take this on with Ezili’s HLLN as special co-counsel.

We hope to publish your various responses if they are on point and helpful in this case.

Men anpil chay pa lou! Time is of the essence for there ought not to be any general or broad UN immunity for this gross negligence, wrongful deaths, personal injuries, deliberate social and environmental destruction which are caused by the deliberate and illegal dumping of raw feces into a sovereign nation’s main and central water systems. The UN is not and should not be above the law, morally or legally.

The 32-page report, prepared by the so-called UN “independent panel” of medical experts at the behest of U.N. Secretary General Ban Ki-moon, took over six month to say what the CDC and several world renowned epidemiologists have already said just a few weeks after the outbreak. The UN report:

“clearly states that the source of the epidemic was most likely a camp for U.N. peacekeepers in Haiti, whose human waste was dumped by independent contractors into an unsecured pit that was susceptible to flooding in heavy rainfall. That conclusion, the report notes, mirrors “a commonly held belief in Haiti” virtually from the moment the outbreak began. But the report buries that central finding under a welter of circumstances that caused investigators to conclude that the outbreak, which is ongoing, “was not the fault of, or deliberate action of, a group or individual.” (U.N.-Sponsored Report on Haiti’s Cholera Outbreak Points to U.N. Itself as Culprit By George Russell, May 05, 2011| FoxNews.com .)

It seems to us Haitians that the UN “independent ” panel simply took over six months to find the language, the blatant conscience and daring, to package and feed Haitians some more raw feces, this absolute lie to swallow and make us sicker – namely that the Haiti cholera outbreak was caused by a “confluence of circumstances … and was not the fault of, or deliberate action of, a group or individual!”

At Ezili’s HLLN, we herein respond directly to the UN and say, “justice will be done even if new laws must be written or precedents made to cover and avenge Haiti’s people against these egregious and daily compounding UN injuries and injustices. The official UN denial of responsibility for importing cholera is a further UN excrement dumped on Haiti to swallow, untreated by international laws. The UN is not immune from prosecution under international conventions but obligated under the Status of Force Agreement with Haiti, for instance, to properly dispose its feces, address sanitary issues and control communicable diseases. This Haiti tort case shall be heard in courts on law. Justice will be done.”

Ezili Dantò of HLLN
May 6, 2011
www.erzilidanto.com/zili
email: erzilidanto@yahoo.com

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UPDATE:

Four spectacular US attorneys respond to Ezili HLLNs call to help bring justice to UN cholera victims

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BACKGROUND INFORMATION:

The accused UN cannot investigate itself” – Ezili Dantò, Oct 30, 2010 interview with Yves Point Du Jour.

Haiti elections and Cholera

Study bolsters UN source for Haiti’s cholera outbreak
May 9, 2011 (CIDRAP News) – http://bit.ly/is1YXW

-“The (cholera) virus had been eradicated in Haiti”, Haiti’s Health Ministry said.

-“…It is against this backdrop that many non-governmental agencies have launched fundraising appeals, even while their post-earthquake coffers remain filled.”(Haiti: where aid failed.)”

The UN’s Office for the Co-ordination of Humanitarian Affairs (OCHA) has repeatedly claimed that underfunding of its $174m cholera appeal, launched primarily to benefit private groups, is hampering the response – despite the fact that Haiti is the top-funded UN appeal for 2010. As nearly a million Haitians remain homeless in the face of a full-blown public health emergency, arguments that existing funds are tied up in longer-term programmes ring hollow…”(Haiti: where aid failed.)

In Haiti, the cholera outbreak will continue to claim lives for the foreseeable future. What is clear, though, is that the aid community at large has failed to prevent unnecessary deaths, in a population already so tragically affected by one catastrophe after another. (Haiti: where aid failed.)

Video:93% of the USAID funds come back to the US. 93%!

http://bit.ly/fyOpPy

It’s called “Tied Aid – 93% of the USAID funds come back to the US.
http://bit.ly/lUSEOV.

The U.N. cholera panel builds case against U.N. blue helmets, then clears them-By Colum Lynch

CDC Says Haiti’s Cholera Due to “One Event”

Haiti caught cholera from UN peacekeepers
http://bit.ly/ircIgC

Verdict: Haiti’s Cholera Outbreak Originated In U.N. Camp

– UN Panel Links Cholera to MINUSTAH Base; MINUSTAH Continues to Shift Blame
http://bit.ly/iubeeN

– Haiti’s cholera misery: 5,000 dead – and UN peacekeepers to blame
http://ind.pn/lJy6T4

The UN Faces Blame for a Cholera Outbreak in Haiti

– UN Final Report Pdf:
http://bit.ly/jNr63o

– Haiti’s case against the UN for importing cholera epidemic by Ezili Dantò
http://bit.ly/aaQpdT

http://bit.ly/c2GNZI
Is Haiti’s deadly cholera outbreak an imported disease?

– See also: Ezili Dantò on the election of Michel Martelly ; Beating back the elite’s rabid rage; Seismic shifts and Avatar Haiti

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Forwarded by Ezili’s Haitian Lawyers Leadership Network ********************************************************

Haiti caught cholera from UN peacekeepers

May 6, 2011, Debora MacKenzie, consultant | Source: New Scientist Blog

Cholera.jpg

(Image: Sipa Press/Rex Features)

Where did Haiti’s cholera come from? Most Haitians believe the bacteria that have so far sickened 286,000 of them – and killed 4870 – were brought in by United Nations peacekeeping troops from Nepal. And this certainly seemed likely, given where and when the disease broke out, and the fact that regions of Nepal were experiencing cholera outbreaks around the same time that the Nepalese left for Haiti.

Yet the UN mission in the country has consistently denied the allegation. It said natural cholera could have invaded Haiti from the sea, and refused to test its troops.

Now it turns out the Haitians were right. A blue-ribbon panel of scientists nominated by the UN to settle the matter has now reported that “the evidence overwhelmingly supports the conclusion” that someone contaminated Haiti’s Meye river with south Asian cholera.

Other scientists, and New Scientist, had already figured as much. But the new report places the issue beyond reasonable doubt. The team combined data on water flow with hospital records to show an “explosive” outbreak started on the Meye 150 metres downstream from the Nepalese base, on 17 October last year and spread through the Artibonite river system in three days – exactly matching the natural flow of water downstream. Nothing suggested it came in from the sea.

The report concludes that sanitation at the Nepalese base was “not sufficient to prevent contamination”, to put it mildly. As the UN has insisted, the Nepalese who arrived in Haiti just before the cholera began were indeed given a clean bill of health before they left Nepal. But, the panel now adds, after the health checks and before the troops flew to Haiti they were given 10 days’ leave. There was cholera in Kathmandu at the time. Ah.

Then there’s the smoking gun. Previously all we knew was that the cholera in Haiti genetically matched strains from south Asia. But the International Vaccine Institute in Seoul, South Korea, sent the panel cholera samples from Nepal. The Haitian strain is a “perfect match” for one from 2009.

The scientists say the outbreak was not the “fault of, or deliberate action of, a group or individual”. But no one serious thinks this was deliberate. It’s arguably more worrying than that: this risk was entirely foreseeable, happened anyway – and the official response was denial.

In future, the panel says UN people from cholera-endemic countries should be screened and given antibiotics or vaccine before deploying, and all UN installations should treat their own faeces. Good idea. And of course, Haiti needs treated drinking water and sanitation, but we knew that.

The fight now, they conclude, is to stop cholera from becoming endemic in Haiti. Signs are not good. The rainy season has just started there. And at last report, cholera cases are starting to rise.

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U.N. Haiti cholera panel avoids blaming peacekeepers

A dead body is transported from the cholera pavilion at a general hospital Port-au-Prince November 21, 2010. REUTERS/Kena Betancur

A dead body is transported from the cholera pavilion at a general hospital Port-au-Prince November 21, 2010.
Credit: Reuters/Kena Betancur

PORT-AU-PRINCE | Thu May 5, 2011 12:18pm | Source: Reuters

PORT-AU-PRINCE (Reuters) – Experts charged by the United Nations with probing the cause of a deadly cholera epidemic in Haiti pointed on Wednesday to fecal contamination by a riverside U.N. peacekeepers’ camp as a likely cause, but a U.N. spokesman said that could not be seen as conclusive.

The four-member U.N.-appointed panel, named by U.N. chief Ban Ki-moon in January, carefully avoided apportioning any direct blame or responsibility to U.N. peacekeepers, citing “a confluence of circumstances” behind the epidemic.

The four experts from Latin America, the United States and India had been asked to investigate the source of the Haitian cholera outbreak, which has killed more than 4,800 people since October, although the death rate has slowed considerably.

The panel was set up following accusations by Haitians that Nepalese soldiers serving in the U.N. peacekeeping mission in Haiti, or MINUSTAH, were the source of cholera, through leakage from latrines at their camp at Mirebalais in central Haiti.

A widespread belief in Haiti that the disease came from the peacekeepers from Nepal, where cholera is endemic, sparked some anti-U.N. riots last year in the poor Caribbean nation.

A French scientist brought in by the Haitian government also backed this theory in a study he made on the cholera emergency that started 10 months after Haiti’s devastating January 2010 earthquake that killed more than 300,000 people.

In its report published Wednesday, the U.N.-appointed panel said the outbreak was caused by “bacteria introduced into Haiti as a result of human activity; more specifically by the contamination of the Meye Tributary System of the Artibonite River with a pathogenic strain of the current South Asian type Vibrio cholerae.”

Declaring this cholera strain was introduced “as a result of environmental contamination with feces,” the report faulted sanitation conditions at the Mirebalais MINUSTAH camp, saying they “were not sufficient to prevent fecal contamination of the Meye Tributary System of the Artibonite River.”

‘EXPLOSIVE SPREAD’

Explaining the epidemic’s “explosive spread” along the Artibonite River and throughout Haiti, the report said “simultaneous water and sanitation and healthcare system deficiencies” contributed to the spread. It noted Haitians used river water for washing, bathing, drinking and recreation.

Despite pointing an apparent finger at the U.N. peacekeepers’ camp, the U.N.-appointed panel did not directly blame them for starting the epidemic.

“The Independent Panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances as described above, and was not the fault of, or deliberate action of, a group or individual,” it said.

Repeating a longstanding U.N. position over the cholera in Haiti, a U.N. spokesman in New York said the report “does not present any conclusive scientific evidence linking the outbreak to the MINUSTAH peacekeepers or the Mirebalais camp”

“Anyone carrying the relevant strain of the disease in the area could have introduced the bacteria into the river,” Michel Bonnardeaux, a spokesman for the U.N. peacekeeping department, told Reuters.

While not apportioning blame, the expert panel recommended that U.N. peacekeepers and personnel traveling from cholera-endemic areas be screened for the disease and given antibiotics before departure for their mission country.

It also recommended that to prevent contamination of a local environment, U.N. installations worldwide should effectively treat their fecal waste using on-site systems.

There was no immediate reaction to the U.N. panel’s report from the government in Haiti, where President-elect Michel Martelly, a former singer, will take office on May 14.

The panel was chaired by Alejandro Cravioto, a Mexican who works at the International Center for Diarrhoeal Disease Research in Bangladesh.

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UN peacekeepers linked to Haiti’s cholera outbreak

Colum Lynch, New York, May 7, 2011, Source: The Sydney Morning Herald

A cholera outbreak in Haiti late last year that killed rampantly prompted mass unrest in Haiti's capital. REUTERS/Allison ShelleyA cholera outbreak in Haiti late last year that killed rampantly prompted mass unrest in Haiti’s capital. REUTERS/Allison Shelley

A UN panel investigating the source of Haiti’s 2010 cholera outbreak has turned up circumstantial evidence suggesting that UN peacekeepers may have introduced a lethal strain of the disease into the Haitian population, triggering an epidemic that has killed more than 4500 people and made 300,000 ill.

But the panel stopped short of blaming the blue-helmeted forces for causing the cholera outbreak, saying the elements contributing to the spread of the disease – including poor sanitation and a dysfunctional healthcare system – were so varied as to make it impossible to identify a specific culprit.

”The independent panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances … and was not the fault of, or deliberate action of, a group or individual,” the report said.

UN peacekeeping officials highlighted the inconclusive findings to underscore there was no hard evidence linking the UN peacekeeping mission to the cholera outbreak.

The UN will establish a taskforce to study the findings and recommendations, including a call for the screening of peacekeepers for cholera, said Martin Nesirky, the spokesman for Secretary- General Ban Ki-moon.

In October, the cholera bacterium appeared for the first time in Haiti in nearly a century, striking its first victims near a UN outpost in Mirebalais, a town on the Meye tributary of the Artibonite River. Cholera causes dehydrating diarrhoea that can kill children and adults in less than 12 hours.

Within days, the disease had spread throughout the river delta to the coast, infecting thousands of Haitians in towns along the river. It has since spread throughout the country and continues to claim lives.

Haitians and public health experts elsewhere suspected that UN peacekeepers contaminated the river. A Nepalese force arrived at Mirebalais between October 8 and October 24, the same period the first cholera deaths were recorded.

In December, Mr Ban commissioned an independent panel to ”investigate and seek to determine the source” of the cholera outbreak. The four-member team concluded that the cholera strain came from south Asia and that it was probably introduced by human activity around the UN base along the Meye tributary. The panel also cited a poorly constructed sewage system at the base, which allowed human faeces and other waste to flow into the tributary.

The panel also noted that UN medical records show no evidence that Nepalese peacekeepers showed signs of illness before or during the outbreak.

Peacekeepers from other countries, including a contingent of 60 Bangladeshi policemen posted at Mirebalais, were also deployed in the area.

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UN: Peacekeepers’ Work Killed Thousands in Haiti

Friday, May 6, 2011 01:47 PM | Source: newsmax.com

By: Martin Gould

Thousands of Haitians were killed and hundreds of thousands more sickened because of shoddy construction work U.N. peacemakers carried out in the wake of last year’s devastating earthquake, an official report has revealed. A total of 5,000 are believed dead and another 300,000 sickened by “an explosive cholera outbreak” resulting from bad drainage, Britain’s newspaper reports.

Haiti, U.N. report, earthquake
Haiti’s toll had just begun after the earthquake, as shoddy workmanship in the recovery led to more death and sickness, a U.N. report says. (Getty Images Photo)

With the rainy season about to start, officials believe another half million people will catch cholera.

The U.N. team from Nepal built septic tanks that drained directly into a tributary of the Artibonite river in central Haiti. Water from the river system is used for drinking, cooking, bathing, and washing clothes.

Despite its abject poverty, Haiti had been free of cholera for decades. The cholera strain matches one found in Nepal in 2009, the U.N. report says.

More than 300,000 Haitians died in the Jan. 12, 2010, earthquake and its aftershocks. The U.N. and other agencies have faced mounting criticism for poor handling of refugees since. Around 750,000 people are still living in squalid refugee camps.

The septic tanks at the Mirebalais Minustah refugee camp were not sufficient to stop human waste flowing straight into the river system. “There is no fence around the site, and children were observed playing and animals roaming in the area around the pit,” the U.N. report says.

Cholera bacteria spread from the mountainous region along the length of the Artibonite — the longest and most important river in Haiti — all the way to its delta. The river provided “optimal conditions” for the spread of the disease, especially as most Haitians had no immunity to the disease and hospitals were soon overwhelmed, the report said.

U.N. Secretary General, Ban Ki-moon said he would convene a task force to “study the findings and recommendations.”

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Verdict: Haiti’s Cholera Outbreak Originated In U.N. Camp

by Richard Knox | Source: NPR

A man walked by a Port-au-Prince wall in February covered with anti-U.N. graffiti that equates the organization with cholera.

THONY BELIZAIRE/AFP/Getty Images
A man walked by a Port-au-Prince wall in February covered with anti-U.N. graffiti that equates the organization with cholera.

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Suspicions that U.N. peacekeepers brought cholera to Haiti last fall are so incendiary in that beleagured nation that most health experts fighting the outbreak have refused to discuss it.

But an expert panel appointed by U.N. Secretary-General Ban Ki-Moon has concluded those suspicions are correct.

In a 32-page report released quietly on Wednesday, the four-person panel leaves no doubt that cholera spread quickly from a U.N. camp in the upper Artibonite River valley to waters used by tens of thousands of Haitians for bathing, washing and drinking.

So far, Haiti’s cholera epidemic has sickened nearly 300,000 people and killed 4,500 of them.

While the U.N. panel stops short of saying Nepalese peacekeepers carried cholera to Haiti, their report says preliminary genetic tests indicate “the strains isolated in Haiti and Nepal … were a perfect match.”

Reflecting the sensitive nature of their findings, the panel takes pains to say the explosive outbreak was due to a “confluence” of factors “and was not the fault of, or deliberate action of, a group or individual.”

Some of those factors are:

  • Widespread use of the Artibonite River and its tributaries for washing, bathing and drinking;
  • Lack of immunity to cholera in Haiti, where the disease hasn’t been seen for nearly a century;
  • Poor water and sanitation conditions in Haiti; and
  • An especially virulent type of cholera, with a toxin that causes more severe diarrhea.

While all of those things contributed, the experts don’t mince words in saying cholera was introduced into Haiti and spread from the U.N. camp where peacekeepers were quartered.

“The sanitation conditions at the [U.N. camp] were not sufficient to prevent contamination of the Meye Tributary System with human fecal waste,” the report says. The Meye River feeds into the Artibonite, Haiti’s longest river.

Sewage from the UN camp could have gotten into the river system in two ways — from a drainage canal running through the camp or from an open septic pit near the Meye River where a private contractor dumped sewage from the camp.

The experts say Hurricane Thomas last November and a flood in the region last summer played no role in spreading cholera.

The report says the U.N. should clean up its facilities around the world to make sure fecal wastes don’t contaminate the environment.

Beyond that, the group says all U.N. personnel mobilized for emergencies should be vaccinated against cholera, receive prophylactic antibiotics, or both. Personnel from areas where cholera is endemic should be screened for cholera before they go to countries where it isn’t a problem.

And the panel says authorities should look into using cholera vaccines to reduce spread of the disease once an outbreak has occurred – an idea that’s controversial among health experts.

Secretary-General Ban says he will appoint a task force to study the panel’s findings and “ensure prompt and appropriate follow-up.”

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MINUSTAH denies rumour that it spread cholera in Haiti

Oct. 26, 2010 | Source- Earth Times

Port-au-Prince – The UN Mission for the Stabilization of Haiti (MINUSTAH) denied Tuesday that it is at the origin of the ongoing outbreak of cholera in the Caribbean country.

“MINUSTAH is keen to shed light around rumours published by certain media that led to the belief that human refuse thrown into a river in Mirebalais by MINUSTAH would be at the origin of the cholera epidemic in Haiti,” the mission said in a statement.MINUSTAH said that it does have a Nepalese contingent in Mirebalais, which uses seven septic tanks. These tanks have, however, been built in accordance with the regulations of the Environmental Protection Agency (EPA), the mission said.

The septic tanks in question are emptied every week by a subcontractor’s trucks, which then take their load to a site which has “the authorization of the municipality of Mirebalais,” the statement stressed.”

It is 250 metres off the Meille river, which is more than 20 times the internationally required distance,” MINUSTAH said.

Some 259 people have died and more than 3,000 infections have been confirmed since cholera broke out a week ago in central Haiti.

The government and aid organizations in the impoverished country are working frantically to stop the disease from spreading, amid fears that cholera could reach overcrowded refugee camps still housing around 1 million people since the January 12 earthquake.

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Haiti: Cholera Affects Farming in Artibonite

by , May 20, 2011.

Source: The Argentina Independent

With the declaration of the epidemic, Haitian farmers lost a lot of money due to the difficulties of finding customers in an environment of fear linked to the cholera in the department of Artibonite.

Whilst the infected workers died, others were afraid to enter the rice plantations in the lakes fed by the Artibonite river. This was the river identified by the United Nations as the cause of diffusing the bacteria of the virus.

Places such as Grande Saline, Desdunes and Lestere, in the department of Artibonite, were affected by the cholera during harvest time.

Also, when the growers could sow the rice, they had problems with marketing as traders did not arrive. The cost of storing the unsold goods resulted in addition losses for the growers.

The problems in rice production affected 80,000 growers in the Artibonite region, 28,000 day labourers, 800,000 retailers and 400,000 owners, according to statistics provided by organisations which support rural industry.

This meant a decrease in the consumption of local rice, which is suffering from the import of foreign grains, and decreasing prices from the United States.

Before this situation, the United Nations Food and Agriculture Organisation began developing a campaign for food hygiene and cholera prevention. They are searching for the best way in which to communicate with the isolated communities.

The initiative aims to inform about practical food higiene in order to prevent illnesses linked to the lack of sanitary conditions. The FAO has also considered it important to reassure the rural and urban consumers about the quality of Haitian farm products.

The Haitian Minister for Health has affirmed that cholera caused the death of 4938 people between October 2010 and April 2011. In spite of being the poorest nation in American, the Caribbean country had eradicated the illness more than a century ago.

A group of investigators called together by the UN recognised that the origin of the epidemic is a stock of the virus from the South Asia. This stock contaminated the Artibonite river, close to the camp of the Nepalese soldiers sent to Haiti by the UN. The investigation also says that the camp lacks sufficient sanitary conditions.

Story courtesy of Agencia Púlsar, the news agency of AMARC-ALC.

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Experts: Did UN troops infect Haiti?

By JONATHAN M. KATZ

The Associated Press
Wednesday, November 3, 2010; 5:40 PM

Source: Washington Post

http://media3.washingtonpost.com/wp-srv/js/article_slideshow_v2.js

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The head of Nepal's mission in Haiti, Lt. Col. Krishna, second from left, and Prakash Neupane, deputy chief of the MINUSTAH engineering section, left, walks by pipes coming from latrines that lead to septic tanks that crosses a canal that leads to the Artibonite River at Nepal's U.N. base in Mirebalais, Haiti, Sunday Oct. 31, 2010. A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday, intensifying the scrutiny of a U.N. base that is home to recently arrived Nepalese peacekeepers, built on a tributary to the Artibonite River. (AP Photo/Ramon Espinosa)
The head of Nepal’s mission in Haiti, Lt. Col. Krishna, second from left, and Prakash Neupane, deputy chief of the MINUSTAH engineering section, left, walks by pipes coming from latrines that lead to septic tanks that crosses a canal that leads to the Artibonite River at Nepal’s U.N. base in Mirebalais, Haiti, Sunday Oct. 31, 2010. A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday, intensifying the scrutiny of a U.N. base that is home to recently arrived Nepalese peacekeepers, built on a tributary to the Artibonite River. (AP Photo/Ramon Espinosa) (Ramon Espinosa – AP)
The head of Nepal's mission in Haiti, Lt. Col. Krishna, center, and Prakash Neupane, deputy chief of the MINUSTAH engineering section, left, enter Nepal's U.N. base in Mirebalais, Haiti, Sunday Oct. 31, 2010. A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday, intensifying the scrutiny of a U.N. base that is home to recently arrived Nepalese peacekeepers, built on a tributary to the Artibonite River. (AP Photo/Ramon Espinosa)
The head of Nepal’s mission in Haiti, Lt. Col. Krishna, cente

The head of Nepal’s mission in Haiti, Lt. Col. Krishna, center, and Prakash Neupane, deputy chief of the MINUSTAH engineering section, left, enter Nepal’s U.N. base in Mirebalais, Haiti, Sunday Oct. 31, 2010. A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday, intensifying the scrutiny of a U.N. base that is home to recently arrived Nepalese peacekeepers, built on a tributary to the Artibonite River. (AP Photo/Ramon Espinosa) (Ramon Espinosa – AP)

A man walks with an umbrella by Nepal's U.N. base in Mirebalais, Haiti, Sunday Oct. 31, 2010. A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday, intensifying the scrutiny of a U.N. base that is home to recently arrived Nepalese peacekeepers, built on a tributary to the Artibonite River. (AP Photo/Ramon Espinosa)
A man walks with an umbrella by Nepal’s U.N. base in Mireb
alais, Haiti, Sunday Oct. 31, 2010. A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the U.S. Centers for Disease Control and Prevention said Monday, intensifying the scrutiny of a U.N. base that is home to recently arrived Nepalese peacekeepers, built on a tributary to the Artibonite River. (AP Photo/Ramon Espinosa) (Ramon Espinosa – AP)

//

PORT-AU-PRINCE, Haiti — Researchers should determine whether United Nations peacekeepers were the source of a deadly outbreak of cholera in Haiti, two public health experts, including a U.N. official, said Wednesday.

The U.S. Centers for Disease Control and Prevention found that the strain of cholera that has killed at least 442 people the past three weeks matches strains found in South Asia. The CDC, World Health Organization and United Nations say it’s not possible to pinpoint the source and investigating further would distract from efforts to fight the disease.

But leading experts on cholera and medicine consulted by The Associated Press challenged that position, saying it is both possible and necessary to track the source to prevent future deaths.

“That sounds like politics to me, not science,” Dr. Paul Farmer, a U.N. deputy special envoy to Haiti and a noted expert on poverty and medicine, said of the reluctance to delve further into what caused the outbreak. “Knowing where the point source is – or source, or sources – would seem to be a good enterprise in terms of public health.”

The suspicion that a Nepalese U.N. peacekeeping base on a tributary to the infected Artibonite River could have been a source of the infection fueled a protest last week during which hundreds of Haitians denounced the peacekeepers.

John Mekalanos, a cholera expert and chairman of Harvard University’s microbiology department, said it is important to know exactly where and how the disease emerged because it is a novel, virulent strain previously unknown in the Western Hemisphere – and public health officials need to know how it spreads.

Interviewed by phone from Cambridge, Massachusetts, Mekalanos said evidence suggests Nepalese soldiers carried the disease when they arrived in early October following outbreaks in their homeland.

“The organism that is causing the disease is very uncharacteristic of (Haiti and the Caribbean), and is quite characteristic of the region from where the soldiers in the base came,” said Mekalanos, a colleague of Farmer. “I don’t see there is any way to avoid the conclusion that an unfortunate and presumably accidental introduction of the organism occurred.”

Cholera, which had never before been documented in Haiti, has killed at least 442 people and hospitalized more than 6,742 with fever, diarrhea and vomiting since late October. It is now present in at least half of Haiti’s political regions, called departments.

Death occurs when patients go into shock from extreme dehydration. The epidemic has diverted resources needed for the expected strike of a hurricane this week, and could spread further if there is flooding.

Suspicions that the Nepalese base could have been a source of the infection intensified Monday after the CDC revealed the strain in Haiti matches those found in South Asia, including Nepal.

But nothing has been proven conclusively, and in the meantime the case remains politically charged and diplomatically sensitive. The United Nations has a 12,000-strong force in Haiti that has provided badly needed security in the country since 2004. But their presence is not universally welcomed, and some Haitian politicians have seized upon the cholera accusations, calling for a full-scale investigation and fomenting demonstrations.

Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, said it is clear that the disease was imported to Haiti but that it is still not clear by whom or how. She said the epidemic will contain lessons for humanitarian relief work and disaster relief around the world.

“It has to be either peacekeepers or humanitarian relief workers, that’s the bottom line,” she said.

Mekalanos said researchers might be more aggressive in finding the source of the infection if the case was less sensitive.

“I think that it is an attempt to maybe do the politically right thing and leave some agencies a way out of this embarrassment. But they should understand that … there is a bigger picture here,” he said. “It’s a threat to the whole region.”

He also cast doubt on U.N. military tests released this week that showed no sign of cholera. The tests were taken from leaking water and an underground waste container at the base a week after the epidemic was first noted and processed at a lab in the neighboring Dominican Republic, U.N. spokesman Vincenzo Pugliese said.

Mekalanos said that it is extremely difficult to accurately isolate cholera in environmental samples and that false negatives are common.

The Nepalese troops were not tested for cholera before their deployment if they did not present symptoms. But health officials say 75 percent of people infected with cholera bacteria do not show symptoms and can still pass on the disease for weeks.

A spokesman for the World Health Organization said finding the cause of the outbreak is “not important right now.”

“Right now, there is no active investigation. I can’t say one way or another (if there will be). It is not something we are thinking about at the moment. What we are thinking about is the public health response in Haiti,” said spokesman Gregory Hartl.

The Harvard experts said more conclusive evidence would be available following closer examinations of the genetic material in the strain.

CDC spokeswoman Kathryn Harben said in an e-mail that the center will make the full genomic DNA sequence available when it is confirmed.

“At some point in the future, when many different analyses of the strain are complete, it may be possible to identify the origin of the strain causing the outbreak in Haiti,” she said.

Farmer, who co-founded the medical organization Partners in Health that is a leading responder in the epidemic, said there is no reason to wait.

“The idea that we’d never know is not very likely,” he said. “There’s got to be a way to know the truth without pointing fingers.”

*****

November 1, 2010

Cholera in Haiti Matches Strains Seen in South Asia, U.S. Says

PORT-AU-PRINCE, Haiti (AP) — A cholera outbreak that has killed more than 300 people in Haiti matches strains commonly found in South Asia, the United States Centers for Disease Control and Prevention said Monday.

Researchers identified the strain by analyzing DNA patterns that can be compared with those from other regions of the world, according to Dr. Christopher Braden, a C.D.C. epidemiologist.

The finding does not identify the source, nor does it explain how cholera — a disease never confirmed to have existed in Haitisuddenly erupted in the vulnerable country’s rural center. But it eliminates some possibilities, including any connection to a 1990s South American outbreak.

The finding also intensifies the scrutiny of a United Nations base built on a tributary to the Artibonite River. Cholera has been detected in the waterway, and most of the cases have been among people who live downriver and drank from the Artibonite.

Speculation among Haitians has increasingly focused on the base and troops there from Nepal, where cholera is endemic and which saw outbreaks this summer before the current contingent of troops arrived in Haiti. Most people infected by the microbe never develop symptoms but can still pass on the disease.

On Friday, hundreds of demonstrators waving tree branches and carrying anti-United Nations banners walked from the central plateau city of Mirebalais several miles to the gates of the base. “Like it or not, they must go,” they chanted.

The United Nations has defended its sanitation practices and denied that the base could be a source of the infection. A spokesman said the agency was looking into the matter on Monday following the C.D.C.’s announcement.

In the coming weeks, additional laboratory testing, including whole genome DNA sequencing, will be conducted, but investigating officials note that such testing may never fully explain how cholera was introduced into Haiti.

“Our primary focus here is to save lives and control the spread of disease,” said Dr. Jordan Tappero, the epidemiologist who is leading the C.D.C.’s cholera response team in the country. “We realize that it’s also important to understand how infectious agents move to new countries. However, we may never know the actual origin of this cholera strain.”

**************

Source: Unpublished Mission Report by Renaud Piarroux, November 7-27, 2010 (in French).

Translation from French to English by R. R. Frerichs with assistance of iGoogle, Jan. 1, 2011; translation correction, Jan. 24, 2011.

Comments by Ralph R. Frerichs are posted below at the end of this mission report.

Mission report on the cholera epidemic in Haiti

Professor Renaud Piarroux, Source : UCLA.edu/Dept of Epidemiology –Ralph R. Frerichs

1. Mission activities

The mission took place from 7 to 27 November 2010. Its objectives were to analyze the functioning of the epidemic and to develop a system of epidemiological information to monitor the epidemic on a daily basis in order to adapt control activities. During the stay, numerous meetings were organized and discussions were held with technical managers and policy makers, especially with the President of the Republic of Haiti, the health minister and his team (Director General of Health, chief of staff, members of the National Commission for the fight against cholera). Meanwhile, all the stakeholders involved in the sectors of health (officials of the Ministry of Health, those responsible for health care facilities, doctors at the WHO, MSF and Epicentre) and access to drinking water (CAMEP DINEPA, UNICEF) have been met, often repeatedly. Field visits were conducted at the University Hospital and near Cite Soleil in Port-au-Prince, in the cities of Hinche, Mirebalais, Saint Marc, Gonaives, Plaisance, Cap Haitien, Saint Michel de l’Atalaye . This was to better understand the circumstances of the contamination of people and evaluate the care of patients. The results of the investigations described below were discussed with the ambassador of France and the first counselor of the embassy, with the Haitian authorities (President of the Republic, Minister of Public Health and Population) and with the Special Representative of Secretary General Kofi Annan and key UN officials in Haiti. The end of the mission was specifically devoted to the establishment of an epidemiological information system to report daily and position on a map cases and deaths in each municipality of the country. Finally, three conferences were held for university students to the French Institute in Haiti, and to the Haitian Medical Association.

2. Circumstances of onset of the epidemic.

The first confirmed case of cholera showed symptoms of cholera starting on Thursday, October 14 (see bacteriological results attached [not enclosed]). This case is a 20 year old man living near the village of Meille Mirebalais in the Central Department. The Cuban medical team of the hospital in Mirebalais, who we met at the hospital, has confirmed the occurrence of an abnormal number of cases of watery diarrhea (suspected cholera) during the 41st epidemiological week (from October 11 to 17) and more particularly from 16 October (see table attached to the investigative report done by the team of health department of the Centre [not enclosed]). Physicians who reported the first confirmed cases stated they were patients from Meille. After a few days, the epidemic has spread to the town of Mirebalais, a few miles away. At Mirebalais, the epidemic initially affected people living along the Artibonite River then spread gradually to other wards. This spread within Mirebalais was facilitated since the city is undergoing major work to its water supply network and many people are required to obtain water directly from the Artibonite River. Neighboring towns (not downstream of Mirebalais) have been affected several days or even weeks later (see casebook provided by Cuban doctors [not enclosed]).

The warning was given on 18 October by the Cuban medical cooperation, the day when an investigation mission conducted by the Department of Health team visited the Centre (see full report attached [not enclosed]). The first cases received and the first deaths at the hospital in Mirebalais came from the same hamlet Meille. All had presented an array of profuse watery diarrhea and severe dehydration. We obtained the results of bacteriological tests that were performed on Mielle’s patients and sent to the national laboratory in Port-au-Prince. Of six patients who became ill between 14 and 19 October 2010, five had a positive analysis for Vibrio cholerae O1 El Tor Ogawa. The oldest positive sample corresponded to a patient who got sick on October 14. The investigation conducted by the health department team of the Centre indicated that the first patients obtained their drinking water from a tributary of the Artibonite River flowing just below the base of MINUSTAH [United Nations Stabilization Mission in Haiti]. We went to this place. There the surveyed people reported that a nauseating liquid poured from pipes from the base at the time the outbreak occurred. These pipes were no longer present during the investigation because, according to residents, they were removed by the military shortly after the declaration of the cholera epidemic. The presence of a pipe from a septic tank in the MINUSTAH camp and pouring a dark liquid in the river had also been noted by the team of the Department of Epidemiology Centre during the initial investigation conducted from October 19, as well as by doctors who passed by MINUSTAH (this was explained to me during an interview organized by UN officials). The doctors told me that the MINUSTAH samples taken on October 21 at the latrines and these pipes have proved negative for Vibrio cholera, but it is impossible to know if the septic tank and/or the pipes had been disinfected before taking the samples (the outbreak began a week ago and the investigative report of Team Central Department shows that the epidemiological team was already investigating around the base and educating the population). Unfortunately, I could not find the methodology of the environmental analysis that was carried out or study the full results. Moreover, doctors said MINUSTAH, although the battalion in question had recently arrived from Kathmandu city (some soldiers arrived on October 8, others 12), while in the throes of an epidemic of cholera, no soldier of the camp had submitted a diarrhea sample and no environmental sample had yielded positive results. We must take this evidence with caution because, by October 21, it is difficult to imagine that the officers and caregivers of camp MINUSTAH were unaware of the suspicion of cholera (even though a fact-finding mission was engaged in the village below for several days), especially if an epidemic was underway within the camp. In this case, it cannot be ruled out that steps were taken to remove feces and erase traces of an epidemic of cholera among the soldiers. This first investigation team also visited the prison at Mirebalais where suspected cases of cholera had been reported. Sick prisoners were not hospitalized but four of them died at the Lascahobas hospital in Mirebalais. Regarding prisoners, these patients had not direct contacts with people outside and the only risk factor found was that the water in the prison was drawn from the same River involved in contamination of the village of Meille, but a little downstream. To conclude on this point, we wish to emphasize that our field investigation, including interrogation of the medical team at the hospital in Mirebalais, the investigation a few weeks earlier by the team’s medical department of the Centre and analytical results obtained from the laboratory of Port-au-Prince, all confirm that the cholera epidemic of Mirebalais began during the 41st week of 2010 (probably on October 14 and certainly before October 19) in the village of Meille, located below Camp MINUSTAH. The origin of the first cases and contamination of prisoners from the prison of Mirebalais leave no doubt on the role played by the affluent of the Artibonite River flowing below the camp in the first case of contamination. Finally, the report writing and the interviewing of Meille residents confirm that the pipes, now removed, had been installed to discharge sewage into the river from the camp. During the interview I had with the doctors who had been sent on October 21 by MINUSTAH, the presence of these pipes was indirectly confirmed, since these doctors indicated that environmental sampling (which proved negative) was performed at the outlet of these pipes. During the interview with the representative of the Secretary General of the UN and the General Staff of MINUSTAH, we investigated whether an alternative explanation, although unlikely, could be advanced to explain the sudden onset of this epidemic of cholera. No other hypothesis could be found to explain the start of an epidemic of cholera in this village of Meille, a village untouched by the earthquake earlier this year and located dozens of miles from the coast, but by the indicated camp.

3. Evolution of the epidemic

The occurrence of epidemic Meille/Mirebalais during the 41st week, even though it had quickly gained a certain extent, is not sufficient to explain the event which took place October 19 in the six communes [an administrative area coverring several towns and villages] watered by the Artibonite River and its delta, located down river dozens of miles from Mirebalais. Yet this event, the massive contamination of the Artibonite River throughout its delta, which has given its explosive nature of the epidemic, is unique in the recent history of cholera, and led to the devastation seen in the following days. After following the Artibonite river from the city of Mirebalais to its mouth, we went to the Health Management of the Artibonite Department, located in Gonaives [the Capital of the Artibonite Department] , and interviewed the director of the Department of Epidemiology and service. The Artibonite Departmental recorded its first alert on Tuesday, October 19. That day, three students at a school in Bocozelles had just died when they were in the classroom, exhibiting symptoms that included severe acute diarrhea with dehydration and vomiting. The same day the coordinator of the health center in Dessalines/Lesters reported cases of diarrhea and vomiting at the hospital Claire Heureuse Dessalines and deaths of people in the community, again with diarrhea and vomiting. On 20 October, epidemic alerts simultaneously affect the Hospital of St. Nicolas de Saint Marc, the health center Drouin Grande Saline, the health center Desdunes, hospital Pierre Payen de Saint Marc, the hospital Dumarsais Estimé de Verettes, Medical Center Charles Colimon de Petite Rivière de l’Artibonite, the Albert Schweitzer Hospital in the town of Deschapelles (near Verettes) and the health center of Desarmes de Verette. The same day a suspect case was hospitalized in Gonaives (health center Eben-Ezer); this patient actually came from Villard, a locality in the town of Dessalines. That day 514 patients were hospitalized, all living in the lower Artibonite, near the riverbed or delta, well downstream of Mirebalais. Forty-one of them died in hospital, while 31 additional deaths were recorded in the community. The next two days, nearly 2,000 additional cases were hospitalized and at least 120 new deaths were recorded in six communes in Lower Artibonite and the neighboring communities that had welcomed those who fled before the outbreak of sudden deaths. By Friday, October 22 at noon, there were 4,470 cholera cases and 195 deaths in 21 different communes occupying a territory of about thirty miles radius around the delta of the Artibonite. The expansion of cholera cases between 16 and 22 October has been displayed on maps and is presented in the Appendix. The simultaneous nature of the contamination of a large number of people, with common living or working in the delta of the Artibonite, can be explained by a person-to-person transmission exclusively. Even within an urban area, cholera is spread for weeks in all areas at risk. To illustrate this point we can provide the epidemiological curve of dozens of outbreaks recorded in recent years in the Comoros, Guinea, Guinea Bissau and the Democratic Republic of Congo. Moreover, the severity of the symptoms presented by patients first seen on October 19 cannot be explained by massive contamination with inocula exceeding one million of Vibrio cholerae and probably more. This massive and widespread contamination throughout the Artibonite Delta may have been caused by a spill all at once into the river by a tremendous amount of feces from a large number of patients. In the days that followed, the health teams find the movement of groups of inhabitants of the lower Artibonite bringing with them the disease to other municipalities, particularly in St. Michel de l’Attalaye and Gonaives. The deathly epidemic provoked a panic that made people flee to their home places. Because cholera was unknown in Haiti, their relatives did not protect themselves from the contamination, and within a few days, all these new foci were experiencing outbreaks. After a few days, transmission began to slow, but continued though.

The rural communes of the mountainous areas mainly north of the Artibonite Delta have been hit very quickly. Populations of these municipalities were working in paddy fields and travelling on roads in the Artibonite and fled when they were faced with the deadly outbreak of 19, 20 and 21 October. Unfortunately, these communities are particularly underserved in health facilities and access to drinking water. This resulted in the successive occurrence of small epidemics, affecting one village after another, not spectacular regarding the numbers of patients counted, but extremely deadly. We thus made in the commune of Saint Michel de l’Attalaye, we had identified as particularly affected by the health information system in place during the mission. There, we found a lack of resources and inadequate organization of care for patients with suspected cholera. The doctor we interviewed acknowledged that he was not able to medically staff the unit for the treatment of cholera during the night, leading to the death of some patients for lack of renewal of their infusion (a cholera patient requires an average of 8 liters of infusion fluids in the first 24 hours of rehydration). The camp was not provided with chlorinated water at the inlet and outlet taps, and due to lack of staff, families were accompanying the patients to ensure the essential acts of nursing. In addition, due to lack of transportation, patients most often were arriving by foot from the affected villages and many died en route. In total, less than a month after the beginning of the epidemic in the county, more than one inhabitant in 1000 died of cholera, most often before reaching the hospital in Saint Michel (70% of deaths in the community). This situation is representative of all rural communes located between the north coast and the plains of the Artibonite and appears to extend to rural communes of the department’s central and northern department of the West. It will expand, but more gradually, to departments in the South. Some areas of the major coastal cities of North and Northwest, and the Cité Soleil neighborhood on the outskirts of Port-au-Prince have experienced, and still experience for certain cities, major outbreaks. This is particularly affected socially disadvantaged neighborhoods, with a very high population density. These neighborhoods are further located on floodplains, sometimes built on old landfills, and have drinking water which is especially vulnerable. The water provision is sometimes provided by wells, but more often they are reservoirs in homes filled by tanker trucks. Until the arrival of the epidemic, the water was not chlorinated but only used reverse osmosis, a technique that produces sterile water, but does not prevent its subsequent contamination. Field investigations in Cité Soleil and Cap Haitien have revealed the vulnerability of private reservoirs from contamination by dirty buckets. Besides this contamination associated with the ingestion of water, is added poor management of excreta, especially near Fougerolles in Cap Haitien. Access to care, however, is much easier than in rural areas and these areas are particularly vulnerable to cholera, which currently provides the largest number of patients seen in cholera treatment centers.

In other urban areas, particularly the vast majority of neighborhoods in Port-au-Prince, only a few cases are already identified. There the situation is properly controlled and healthcare facilities are able to cope. It should be noted that most emergency camps established after the earthquake of January 2010 are in this situation. Cholera has made its appearance, but without causing the damage anticipated by many humanitarian actors. In fact, the inhabitants of these camps have access to water and sanitary facilities often better than in the surrounding slums and are subject to specific epidemiological surveillance in place since the earthquake with the support of the US Centers for Disease Control. The probability of a major outbreak in the camps and in the neighborhoods of Port-au-Prince outside flood zones is low and will remain so unless major social unrest impedes the current treatment of cholera in Port-au- Prince. There will be no additional disaster if the response continues to gain momentum as we have seen in recent days and if the surveillance is used to select areas for priority action.

Conclusion and Recommendations

In conclusion, the fact-finding mission conducted last three weeks has revealed the severe and unusual nature of this epidemic, with the origin no doubt being imported. It started around the camp of MINUSTAH and was spread explosively due to massive contamination of the water in the Artibonite River and one of its tributaries with feces of patients with cholera. After the first wave of deadly cases along the Artibonite River and the neighboring rural communes, the situation appears to be stabilizing and mortality tends to decrease. For conduct in the weeks and months ahead we have several recommendations:
– continue to support the Haitian authorities in managing the epidemic, especially by strengthening their technical department of epidemiology:
– optimize control by accelerating the decision loop between the collection of field information and the implementation of control measures which are increasingly targeted;
– create a judicial inquiry into the origins and development of the epidemic, because even if the epidemiological investigation leaves no doubt about what happened, it is not formatted to establish the responsibilities of the various parties;
– review procedures at the earliest that might have prevented this biological catastrophe, particularly those relating to medical surveillance of troops involved in UN missions and those relating to sanitation (latrines, excreta) in camps housing those troops.

Comments by Ralph R. Frerichs on: “Mission report on the cholera epidemic in Haiti”

The epidemiologist who wrote this report, Professor Renaud Piarroux, is with the Université de la Méditerranée in Marseille, south of France, and the teaching Hospital of Assistance Publique-Hôpitaux de Marseille, located in the city. He is an acknowledged expert on cholera. According to the details described in Part 2 of the above report, the first confirmed case of cholera had onset of symptoms on Thursday, October 14, 2010 and was located near the village of Meille by the city of Mirebalais, close to the United Nations base. The replacement UN peacekeeping troops were reported to have come from Nepal between October 8 and 15, 2010 (note: Dr. Piarroux wrote that “…some soldiers arrived on October 8, others 12). Hence, taking into account an incubation period of 2-3 days, the two events (i.e., arrival of troops and onset time of initial case) were closely related in both place and time.

Dr. Piarroux also reported on a group of prisoners who died of suspected cholera, who had no contact with persons in the surrounding community. He stated, “…water in the prison was drawn from the same location at the Artibonite River involved in contamination of the village of Meille, but a little downstream.” The mechanism of the initial water contamination is purported to have been a pipe that came from “… a septic tank in the [UN] camp and pouring a dark liquid in the river.” Professor Piarroux concluded, “No other hypothesis could be found to explain the start of an epidemic of cholera in this village of Meille…”

While Dr. John Snow’s cholera investigations occurred nearly 156 years earlier, his report on London’s Broad Street Pump Outbreak in 1854 is not unlike that which was written by Professor Piarroux, although the latter features more modern scientific details. The Piarroux report as noted elsewhere on this web site was met by scepticism by various international officials, and was dismissed by some who questioned the value of “origin studies,” citing curious justifying notions such as “avoiding the blame game.” Yet following weeks of deliberations, the Secretary General of the United Nations finally decided in late December, 2010 to establish a panel of experts to review the Piarroux report and determine what might have started the Haiti cholera epidemic.

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2 thoughts on “Haiti Message on UN responsibility for importing cholera

  1. Ezili, it is my belief that we are all ancestors returned, and that you are the glorious ancestor returned to cradle justice with an unwavering sense of libation-dignity. For your tireless goodness of heart, for your spirituality that dances alive the seed in the rain-soaked mud, our BLACK_THANKS. Obama’s appointment of clinton and bush to oversee Haiti’s “recovery” tells one all that there is about him – the “whiteness” of the house. The US, is to say the least, the UN. It has supervised, with an unremitting, planned technical efficiency of capitalism, the oppression and repression of Haiti right from its foundation as the greatest dare for and the best unique example of Black freedom.

    The bottle-neck within which Haiti is intentionally impaled and strangled by the US and it’s UN amounts to genocide. The euro-americans have never been able to forgive Haiti for doing the impossible – defeat their so-called military genius napoleon and have a maternal hug of independence. Haiti is the best example for the yeast of freedom rising, and it will continue to rise. It will.

    Like

  2. Ezili,

    I applaud you for taking this on. It is a travesty of injustice that must not be covered-up nor white-washed.

    I will be thinking hard who will be able to help financially and where the court of justice ought to held.

    In solidarity, Lee Vanderheiden

    Like

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