In the wake of the January 2010 earthquake that devastated poverty stricken Haiti, it was hit with a second disaster that October with an outbreak of a lethal strain of cholera that has never been seen in the Western Hemisphere. The source of the outbreak was easily and quickly traced to a UN peacekeepers from Nepal how were housed near the where the first cases occurred.
News reporters found improper sewerage drainage at the UN camp was leading to waste ending up in the river. There was an cholera outbreak in Nepal shortly before the troops were deployed and as none of them showed cholera symptoms during the pre-deployment medical, no follow-up tests for the disease were done (cholera can be carried asymptomatically). The spread of the disease also followed the waterway, along rivers downstream of the camp.
The genetic big-guns of whole genome sequencing were used to determine exactly what strain of cholera was causing the epidemic. The strains causing the disease in Haiti were shown to be identical clones, suggesting a single infectious source. Comparing DNA at specific genetic islands showed the Haiti strain was in the same subgroup as strains found in Eastern Asia, but not in the Americas. The Haiti bacteria were shown to be in the same subgroup as bacteria from Nepal and Bangladesh and most closely related to the Nepalese bacteria.
Haiti had previously been cholera free. The same strain has been responsible for outbreaks in Mexico and Cuba three years later. It was the careless peacekeepers who spilled infected raw sewage into the local river that caused the deaths of over 9,000 and sickened hundreds of thousands. The death toll could be even higher according to a report by Médecins Sans Frontières (Doctors Without Borders) that was published in a CDC journal in March, 2016.
a rapid assessment of cholera-related deaths, conducted by active case finding in Artibonite Department in November 2010, estimated that 87% of deaths were not recorded in the hospital records (10). These findings raised the possibility that a substantial number of cases and deaths across the country were not reported during the first wave of the epidemic, a prospect supported by subsequent assertions that the existing surveillance systems at the onset of the epidemic were unable to fully capture the amount and type of data needed to monitor the rapid evolution of the epidemic (6,11). If true, this assertion would imply that the public health consequences of this epidemic were underestimated and would raise questions about ways to improve the implementation and accuracy of cholera surveillance during epidemics so that these vital data are rapidly available to help first responders implement the most effective public health interventions possible.
Over the last six years the United Nations has refused to acknowledge their responsibility in the catastrophe and invoked immunity in US courts, until a report by a team of epidemiologists from Yale was leaked.
In a study published in the open-access research website PLOS, the team from Yale’s school of public health and law school looked at a variety of interventions that could have been used to counteract any infection before the UN peacekeepers were brought from Nepal to Haiti. By its reckoning, the epidemic could have been prevented for less than $2,000 – a tiny drop of the $2.2bn that estimates suggest must be spent over the next decade before the disease is eradicated.
Administering a basic screening test using rectal swabs together with antibiotics and vaccination could have reduced the probability of an outbreak by 98%, the epidemiologists concluded.
Today, the UN finally admitted to its responsibility for the epidemic.
For the first time since a cholera epidemic believed to be imported by United Nations peacekeepers began killing thousands of Haitians nearly six years ago, the office of Secretary General Ban Ki-moon has acknowledged that the United Nations played a role in the initial outbreak and that a “significant new set of U.N. actions” will be needed to respond to the crisis.
The deputy spokesman for the secretary general, Farhan Haq, said in an email this week that “over the past year, the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera.” He added that a “new response will be presented publicly within the next two months, once it has been fully elaborated, agreed with the Haitian authorities and discussed with member states.”
The statement comes on the heels of a confidential report sent to Mr. Ban by a longtime United Nations adviser on Aug. 8. Written by Philip Alston, a New York University law professor who serves as one of a few dozen experts, known as special rapporteurs, who advise the organization on human rights issues, the draft language stated plainly that the epidemic “would not have broken out but for the actions of the United Nations.”
The secretary general’s acknowledgment, by contrast, stopped short of saying that the United Nations specifically caused the epidemic. Nor does it indicate a change in the organization’s legal position that it is absolutely immune from legal actions, including a federal lawsuit brought in the United States on behalf of cholera victims seeking billions in damages stemming from the Haiti crisis.
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