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The Cholera Plan Remains Totally Underfunded

UN Responds to Haiti’s Cholera Crisis by Sending Repackaged Aid

by ROGER ANNIS

December 18, 2012–In a short ceremony in New York City on Dec. 11, UN Secretary-General Ban Ki-Moon announced what appeared to be an important nod to international grassroots pressure to fund a universal treatment and prevention program for cholera in Haiti. He said that  $215 million from bilateral and multilateral donors and $23.5 million from the UN’s own coffers were being pledged to a plan by the governments of Haiti and the Dominican Republic to limit the spread of cholera and eventually eliminate the disease from the island that the two countries share.

However, on closer examination, it turns out that the $23.5 million is the only new money involved, amounting to a mere one percent of the $2.2 billion some estimate it will cost to eliminate cholera.

Also, Ban did not acknowledge that UN troops brought the disease to the Caribbean country, one of the key demands of a year-old suit by Haitian cholera victims. Evidence from numerous studies has established that Haiti’s cholera epidemic, currently the world’s worst, was caused by sewage from a garrison of Nepalese UN soldiers leaking into the headwaters of the country’s largest river, the Artibonite, in October 2010. To date, close to 8,000 have died and over 630,000 have been sickened.

The Secretary-General also announced that Dr. Paul Farmer, a co-founder of the global health agency Partners In Health (PIH), will serve as special advisor to his office on community-based medicine. Zanmi Lasante, PIH’s Haitian arm, is one of the country’s most important health care providers. Farmer already acts as the deputy to the UN’s special envoy to Haiti, former U.S. president Bill Clinton.

While some in global health and aid circles hailed Ban’s announcement, others were rightly circumspect, in view of the string of lofty pronouncements on cholera throughout 2012 that have produced little progress on the ground.

Behind the Figures

The Secretary-General’s announcement was in support of the “Call for Action for a Cholera-free Hispaniola” made  in January 2012 by the Presidents of Haiti and the Dominican Republic with support from the Pan American Health Organization (PAHO)/World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the United States Centers for Disease Control and Prevention.

That call led to the launch in Brazil on June 4 of the “Regional Coalition on Water and Sanitation for the Elimination of Cholera on the Island of Hispaniola.” The Coalition has expanded several times since then, always with plenty of fanfare.

The main focus of the UN’s cholera prevention efforts, Ban said, are construction of clean drinking water and sanitation systems in the two countries and increasing the use of oral vaccines. But his comments on the two paths of treatment focused on vaccination, not on clean water and sanitation systems which experts argue is the only lasting way to eliminate the disease.

Many news outlets headlined that Ban had announced a ten-year, $2.2 billion cholera plan for Haiti, but he gave no such figure. “Haiti will need almost $500 million over the next two years to carry out its national implementation plan,” he said.

The $2.2-billion and 10-year figures come from a UN “media backgrounder” for the Dec. 11 announcement. They appear nowhere in the WHO/PAHO report on the Dec. 11 announcement nor in the Regional Coalition’s page on the PAHO website. The larger plan and figures will undoubtedly be a centerpiece of Haitian government announcements on the third anniversary of the Jan. 12, 2010 earthquake.

“Far from launching an ambitious new initiative, the UN was merely repackaging a still-unfunded, year-old effort,” write former AP correspondent in Haiti Jonathan Katz and international aid blogger Tom Murphy in Foreign Policy on Dec. 18. Almost all of the bilateral and multilateral $215 million announced had been pledged already to Haiti but not yet delivered, they point out.

As for the $2.2 billion plan, it “is purely aspirational.” Unlike the 9,000-strong UN occupation force MINUSTAH which is budgeted to receive $677 million over the next year alone, “The (cholera) initiative is almost totally unfunded.”

Pressure on International Authorities

An article by Mark Weisbrot of the Center for Economic Policy Research (CEPR) published by Al Jazeera on Dec. 12 said that Ban’s announcement is a sign that organized political pressure on the world body can produce results for Haiti. But the UN’s announced plan is too slow, Weisbrot argues. Some 700 people have died since seasonal rains began in April 2012, including close to 200 since Hurricane Sandy caused widespread flooding on Oct. 23 and 24. “The necessary infrastructure work should begin immediately, not years from now,” he wrote.

Examples of pressure, Weisbrot explained, are the legal action against the UN brought by the Institute for Justice and Democracy in Haiti (IJDH) and the Office of International Lawyers (Bureau des avocats internationaux or BAI) on behalf of 5000 Haitian cholera victims in November 2011; editorials in the New York Times, Boston Globe, and other major newspapers; a July 2012 letter signed by 104 U.S. Democratic Congresspeople; and constant street protests in Haiti and its diaspora.

Another pressure point on the UN is that cholera has killed nearly 400 people in the Dominican Republic, endangering its tourism industry, which brings in over $4 billion annually. Dominican officials want “to dispel the idea that visitors could be in danger of contracting cholera,” wrote Ezra Fieser on Infosurhoy.com last year. She quotes the Dominican Health Minister as saying, “We as a nation must fight to save our economy, which is basically tourism.”

Weisbrot points to looming funding cut-offs for cholera treatment. PIH, for example, says that its U.S. funding for cholera treatment will run out in February. “In 2012, the UN requested just $30m for cholera treatment, yet only 34% of this has been raised,” he writes. “There were 205 cholera treatment units and 61 cholera treatment centres in Haiti in August 2011; by June 2012, these had fallen to 38 and 17, respectively.”

The cholera shortfall is consistent with a broader funding shortfall for post-earthquake reconstruction in Haiti. Of $5.3 billion pledged by governments to help Haiti to date, just $2.8 billion (53%) has been disbursed.

Other Reactions to the Plan

A joint statement issued by the IJDH and BAI cautiously welcomed Ban’s announcement, calling its promise of clean water delivery systems “one of the key remedies sought” in their legal action launched in November 2011.

“We are pleased that the UN is finally taking steps consistent with its legal obligations,” said Mario Joseph, lead counsel for the petitioners and Managing Attorney of the BAI. “But more resources are needed, and there needs to be more urgency. In the two years it took to launch this initiative… over 7,700 Haitians have died. Haitians will continue to die from UN cholera until clean water and sanitation is actually installed.”

In an interview with the Canadian Broadcasting Corporation’s radio program As It Happens on Dec. 12, IJDH staff attorney Beatrice Lindstrom explained that the cholera legal action has four main goals: assistance in establishing clean water and sanitation systems in Haiti; a fair hearing before international law for the victims of cholera; compensation to the families of the victims; and an apology for the reckless conduct of the UN Mission to Stabilize Haiti (MINUSTAH) in allowing the cholera bacteria to enter the country via its soldiers and failing to act quickly to prevent its spread.

“The United Nations is good at launching appeals for aid,” wrote Mark Doyle, veteran BBC reporter in Haiti, after the Dec. 11 announcement. “It is less good at admitting its own faults.”

Cholera’s Ongoing Threat

Joining the UN Secretary-General for the Dec. 11 announcement were Haiti Prime Minister Laurent Lamothe and Dominican Health Minister Lorenzo Wilfredo Hidalgo.

Lamothe spoke for four minutes, thanking governments and agencies assisting with cholera response and saying that his government has a two-year $600 million project to fight cholera. “We have to work together to bridge the remaining gap,” he said, implying that the $238.5 million announced would go towards his government’s goal.

To date, officials of the government of President Michel Martelly, including Lamothe,  have not uttered a word about the cholera lawsuit against the UN.

According to the most recent data from the World Bank, only 69% of Haitians have access to “improved drinking water” and just 17% have access to “improved sanitation”, defined in the plan as “flush toilets, septic tanks, ventilated improved pit latrines or composting toilets.” Among the poorest 20%, only 1% has access to improved water and more than 90% “practice open air defecation.”

At a press briefing following Ban’s announcement, UN Humanitarian Coordinator for Haiti Nigel Fisher would not comment on whether the MINUSTAH occupation force is to blame for bringing cholera to Haiti. Repeating statements he has made throughout 2012, he said the issue “is with the legal office and as a staff member I am not authorized to say anything about the legal process at this time.”

PAHO director Mirta Roses Periago told the briefing that it is not necessarily advisable to screen every UN soldier for diseases before they are deployed on international missions. But she said PAHO has advised the Secretary-General “to have special provisions for people coming from endemic areas and being sure that there is no outbreak going on at the time that people are being deployed.”

She said that the main problem for cholera in Haiti is poor sanitation and water infrastructure, noting that about 100 cases of cholera are imported to the United States each year without causing an epidemic. UN officials have used variations of that argument to deny culpability ever since the epidemic’s outbreak. 

How you can help

More than 7,500 people around the world have signed an online petition on Avaaz initiated by film director Oliver Stone demanding more and faster UN assistance for clean water infrastructure in Haiti. It is still collecting signatures.

Ongoing information about Haiti after the 2010 earthquake is published by the CEPR on its invaluable Haiti Relief and Reconstruction Watch blog. More recently, the Just Foreign Policy organization that Mark Weisbrot also co-directs has begun to publish the informative and innovative ‘Haiti Cholera Counter’ web page feature. You can place the feature on any website.

You can contribute financially to the IJDH and BAI or volunteer your time to assist their work.

Watch for events around the world to mark the third anniversary of Haiti’s earthquake, including screenings, followed by panel discussions, of Michele Mitchell’s 2012 documentary film, “Haiti: Where Did The Money Go?” and seminars in London, England. Full event listings can be found on the website of the Canada Haiti Action Network.

Roger Annis is a coordinator of the Canada Haiti Action Network and resides in Vancouver, Canada.