The Cholera Epidemic in Haiti: A Study in U.N. Impunity

by Sasha Alyson

In October 2010, criminally sloppy sanitation at a U.N. camp led to a cholera outbreak in Haiti. Some 10,000 people died.

Any large institution will inevitably make mistakes, sometimes big ones. Our real insight comes from what it does next. Does it try to make things right? Or does it try only to protect itself? We need to learn from the U.N.’s response to the cholera epidemic.

For a decade, the U.N. has aggressively avoided taking responsibility for its actions. Because of its unique status as a world body, it has succeeded. It has followed the same playbook used by the tobacco, fossil-fuel, big soda, and other industries:

Stonewall.
Deny.
Lie.
Destroy the evidence.
Fog the issue.
Procrastinate.
Do as little as possible.
When you must do something, make sure that it actually benefits yourself.

Here’s a brief timeline.

1804: After thirteen years of struggle, a slave revolt in Saint-Domingue (now known as Haiti) wins independence for what had been a colony of France.

1825: France sends warships to Haiti to demand compensation for the “property” – including enslaved people – that the French lost due to the revolution. For much of that century, these payments and interest consumed 80% of Haiti’s tax base. The debt was not paid off until 1947.(1)

1915: The United States invades Haiti, beginning a 19-year occupation to protect U.S. interests. General Smedley Butler, one of the U.S. Marines in charge, later expresses regret for his thirty-three years as “a gangster for capitalism.”(2)

1934: The U.S. occupation ends, but the United States has continued to intervene and attempt to influence elections in Haiti.

June 2004: Following a coup in Haiti, the U.N. sends peacekeeping troops under the name MINUSTAH (U.N. Stabilization Mission in Haiti) to quell violence. Despite being resented by much of the population, they stay until 2017 at an annual cost of roughly half a billion dollars.

Jan. 2010: A catastrophic earthquake hits Haiti with its epicenter not far from the capital, Port-au-Prince. Aftershocks continue for two weeks. Estimates of the death toll range from 100,000 to 200,000. Millions are homeless.

Oct. 17, 2010: Cholera breaks out in Haiti, which had been free of the disease for a century, with the biggest case cluster near a MINUSTAH camp. Nearby villagers have long been complaining about the stench of untreated sewage from a dumping area near the camp. Cholera kills fast if untreated, and within a few weeks, the death toll passes a thousand.

Oct. 26, 2010: The MINUSTAH camp is quickly identified as a likely source of the outbreak. MINUSTAH issues a statement declaring that it discharges human waste into septic tanks, and follows sanitation procedures consistent with U.S. and international standards.

Oct. 27, 2010: Associated Press correspondent Jonathan M. Katz visits the MINUSTAH camp. He is initially stonewalled by the officer in charge. Once past that, he finds open sewage pits, a broken PVC pipe which “leaked a foul-smelling black liquid toward the river,” and soldiers who admit that the evening before, they had hastily repaired some pipes and scrubbed a drainage canal that led to the river. A family living near one of the open pits says that some nights, the stench was so bad they couldn’t sleep.(3)

Nov. 2010: Guidelines from WHO (the World Health Organization) and CDC (the U.S. Centers for Disease Control and Prevention), as well as common sense, say that facing a sudden outbreak of a lethal disease, you urgently need to identify the cause. But with mounting evidence that the U.N. is the cause, global health organizations, NGOs, diplomats, and the media all circle the wagons, trying to discourage any such investigation. The U.N., WHO, and the CDC all argue that finding the cause should not be a priority. A New York Times story quotes several officials who dismiss any investigation as playing “the blame game,” and cautioned that “it’s important to remember that the blame game for pandemics eventually involves everyone.”(4)

Nov.-Dec. 2010: Overwhelming evidence indicates that the outbreak was caused by U.N. troops, who had come from a region of Nepal where the same strain of cholera was prevalent, who were not tested for cholera before being sent to Haiti, who had arrived at the MINUSTAH camp shortly before the outbreak, and whose untreated sewage was flowing into the water that people downstream used for bathing and drinking. Nevertheless, a fogbank of theories begins to circulate: The bacteria had been carried in by ocean currents, or it had somehow grown in the soil, or this was related to a 1991 outbreak in Peru.

Dec. 17, 2010: Trying to move the issue to a back burner, the U.N. sets up an independent commission to study and then report on the source of the epidemic.

Jan. 2011: A memo written the previous July by a U.N. oversight official is leaked. The memo describes “a pervasive culture of secrecy, notably surrounding Mr. Ban [and] that he appeared more concerned with preventing news leaks than with releasing possible criminal evidence to prosecutors.”(5)

May 4, 2011: The U.N. commission issues its report, confirming strong evidence that the MINUSTAH camp was the likely source of the outbreak, but then it lists nine other factors, many related to sanitation, and offers its conclusion 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.” No one, of course, had ever suggested a “deliberate” effort to introduce cholera into Haiti, but by introducing this standard, the commission avoids assigning responsibility for criminal levels of carelessness. Nor, in its “confluence of circumstances,” does the commission mention the impact of two centuries of colonial-style looting by the West.(6)

2013-2016: Unable to get the U.N. to discuss compensation, cholera survivors and next-of-kin file two lawsuits in the United States. The U.S. Justice Department provides free lawyers to argue that the U.N. is immune from any liability for its actions. A U.S. appeals court eventually rules in the U.N.’s favor.

2014: A quarter of the U.N. MINUSTAH sites in Haiti continued to discharge waste into public canals four years after the outbreak, according to a U.N. auditor’s report that was filed in 2015 and became public a year later.(7)

Aug. 2016: Philip Alston, a New York law professor and “special rapporteur” to the U.N., files a confidential report (subsequently leaked) charging that the U.N.’s failure to take responsibility was “morally unconscionable, legally indefensible and politically self-defeating.” Furthermore, he adds, it “upholds a double standard according to which the U.N. insists that member states respect human rights, while rejecting any such responsibility for itself.”(7)

Dec. 2016: Beginning his last month in office, Ban Ki-moon issues his first semblance of an apology, though still not admitting that the U.N. might have caused the outbreak: “We simply did not do enough with regard to the cholera outbreak and its spread in Haiti. We are profoundly sorry about our role.” He announced a $400 trust fund to combat cholera and to “provide material assistance and support” for those affected. However, it was his last month in office. Finding that money would be up to his successor.

March 2017: His successor, António Guterres, was busy with other things. After three months, the trust fund has only about $2 million. The U.N. strategy is described in a Boston Globe editorial: “Late last year, Secretary General Ban Ki-moon offered an apology for the U.N.’s role in bringing deadly cholera to Haiti…. Since then, there has been little more than silence.”

April 2018: Halfway through what was supposed to be a three-year term, the trust fund has raised $8.7 million, barely over 2% of what had been announced. Less than half of that has been spent.

April 2021: With an extended term and $10 million from USAID, the U.N. fund has received $22 million, still less than 6% of the level announced — also less than 5% of what the U.N. had been spending every year on MINUSTAH. Only two-thirds has been disbursed, and the U.N. has given 100% of that money to itself.(8) Many of its planned activities were delayed due to “socio-political instability in 2019,” and then most were cancelled in 2020 due to Covid-19.

I can find no details about what these activities were, or would have been, beyond their titles: “Technical assistance trainings for sustainable management of infrastructures” and “Preparation and development of a catalog, a project guide with financial estimates and feasibility constraints.”

The U.N. does, however, tell us how many Haitians benefitted from this work:

220,140 women and 201,529 men
Total” 421,669 beneficiaries.(9)


Notes and Sources

Top photo: The Artibonite River, Haiti’s longest river and the site of the initial outbreak. Public domain photo by USAID.

Many of these timeline facts are widely reported and easily confirmed. I have footnoted some that are of special interest.

1. Killing with Kindness: Haiti, International Aid, and NGOs, by Mark Schuller. Rutgers University Press, New Jersey, 2012. The author closely studied two Haitian women’s NGOs which were similar in many respects, but with one important difference: The first was more donor-driven and sought to please donors while serving “clients”; as one NGO director put it, “Essentially, we follow the money.” The second group focused on retaining autonomy and member participation. Schuller also provides an illuminating history of Haiti and the crippling debt imposed on it by France.

2. The Long Legacy of Occupation in Haiti, by Edwidge Danticat, The New Yorker, 28 July, 2015

3. The Big Truck That Went By: How the World Came to Save Haiti and Left behind a Disaster, by Jonathan M. Katz. Palgrave Macmillan, New York, 2013. Katz’s excellent book also helped me get an overview of what happened, and provided other sources for this timeline.

4. Cholera’s Second Fever: An Urge to Blame, by Donald G. McNeil Jr., New York Times, 21 Nov. 2010.

5. A Bloated U.N. Bureaucracy Causes Bewilderment, by Matthew Saltmarsh, New York Times, Jan. 5, 2011

6. Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti, May 2011.

7. U.N. Admits Role in Cholera Epidemic in Haiti, by Jonathan M. Katz, New York Times, 17 Aug. 2016. (This story covers both the continued discharges at MINUSTAH sites, and the Alston report.)

8. Trust Fund Factsheet, viewed on 3 April 2021. (Table from this page is shown below.) About 14,600,000 had been given by the U.N. to the U.N. organizations listed, but most had not yet been spent as of this report. The organizations are: UNDPO (U.N. Dept. of Peace Operations), UNDP (U.N. Development Programme), PAHO/WHO (Pan American Health Organisation and World Health Organisation; PAHO is a regional office of WHO), UNOPS (U.N. Office for Project Services), and UNICEF.

9. U.N. Haiti Cholera Response Multi-Partner Trust Fund, Project Narrative Report, 2019. This is the source of the project titles and beneficiary counts.

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