The Price for Sanitation in Haiti

The smell of diesel and petrol fumes bog the wet air as the engines thraw and thunk and the fleet two wheelers whip up the mud and rubble through chance gaps of road and pavement. I am in Haiti and the rain is against them, but what isn’t? My western features pull their faces up, round and through but why wouldn’t they? Just another out of place blan. The dignity has been chipped away for a very long time and a little bit of scepticism greets any westerner who pitches up like a preacher, teacher or Sunday speaker just to tangle up the ropes a little more and to change what? Not much generally.

I grip the back of a motorbike heading back up the crumbling route to Gougeon, just outside
Petion-Ville in Port au Prince. The clouds have really opened up as the rim of a cyclone brushes past the island. The roads which somehow manage to squeeze through a consistent stream of traffic, including regular fistfuls of UN vehicles, are in a state unimaginable for any functioning capital city. In their stamped vehicles and casual cream gear the then UN staff appear united in perturbance as the water pours over the roads. As the downpour continues the troops look on, gun-hoe and loaded, just in case any civil unrest brakes out as everyone races for shelter.

With all the excitement as I wind through the capital, it is easy to forget that for most people here the rain brings down a heave of other problems with it. While the precarious housing of 400 000 people in camps feel the pressure of the flash flood, and the fragile landscape gives way to landslides, the rain now spreads cholera; a virus which has become endemic in Haiti.

In April 2012 I visited Haiti with the intention of bettering my understanding of the cholera epidemic and the country itself. One thing I realised when I was there was that you need to spend a lot longer than a month and a half there to really break the seams of the place.

I had been reading about the country for a while after picking up an account of the megalomaniac dictator, Francois Duvalier. The book entitled “Papa Doc” by Bernard Diederich and Al Burt led to an interest in a country which I previously knew little about apart from the fact that it had recently experienced a devastating earthquake. The earthquake in 2010 killed an estimate of 316 000 people and for a brief period brought the country under the gaze of the western media. The death count of the earthquake alone would be more than the total population of Newcastle upon Tyne, the city I was born. It was hard to imagine but during that period in 2010 you saw coverage of what looked like the world caving in.

In January 2012 I went to a round-the-table discussion at the Bar Council offices in London led by Mario Joseph, the managing lawyer of the BAI (The Bureau Des Avocats Internationaux) which represents the otherwise unrepresented victims of human rights violations in Haiti. The meeting concerned the cholera outbreak that hit Haiti in October 2010 and which I knew nothing about at the time. The outbreak had begun in the area surrounding the Artibonite river, the largest river in Haiti and the integral source of the country’s water supply.Since the outbreak began in October over two years ago it has now killed around 8000 and affected 620,000 making it the worst case in recent history. Mario Joseph was in the process of travelling to speak to lawyers around the globe about the situation and to engender support in his fight to hold the UN accountable for the outbreak.

On November 2011 the BAI and the IJDH (Institute for Justice & Democracy in Haiti) submitted a claim for relief against the UN and its subsidiary, the United Nations Stabilization Mission in Haiti (“MINUSTAH”). The claim was for over 5000 victims of cholera in Haiti, and was still awaiting response 8 months on when I was there.

MINUSTAH is the UN stabilization mission in Haiti set up there in 2004 during a coup d’etat. Haiti is the only country to be occupied by the UN without being at war or posing a global threat. Before the cholera outbreak there was already a great deal of animosity towards them from the Haitian people. In the 2005 protests that took place in Cite Soleil in which people demanded the return of their President, Jean-Bertrand Aristide, there was a raid that left a number of civilians including woman and children dead. The UN stated that all shots were in self-defence but no UN peacekeepers received bullet wounds. This incident led to growing resentment amongst the population who wanted the UN out of the country. While I was in Haiti I was told of other incidents of violence, sexual assault and human rights violations reported against UN troops. The only instance which I am aware of where UN troops faced charges for violations was in 2012 when two troops from Pakistan were sent home and imprisoned for raping a 14 year old Haitian boy. Three troops were arrested after a video was leaked onto YouTube in September 2011 and only two were imprisoned. They received 1 year.

Among the large number of MINUSTAH troops, gathered from a number of countries there is a camp of Nepalese who are situated on the Meille river, a tributary 60 km north of Porte Prince that leads into the Artibonite. Cholera is endemic in Nepal whilst prior to the current outbreak there had been no reported cases in Haiti for more than a century. There was a known outbreak of cholera in Kathmandu valley where the troops had been training before entering Haiti. People began getting sick just after a new contingent arrived at the camp and it was later found that a sewage pipeline had been illegally pumping the troop’s human waste into the river. The pattern that then followed of those downstream from the camp falling ill was an indication of the source.

A number of facilities including The Welcome Trust Sanger Institute in Cambridge, The Harvard Cholera Group and The International Vaccine Institute in Seoul, Korea linked the strain of cholera found in Haiti to a strain found in South Asia. U.S. Centers for Disease Control and Prevention also released a report in July 2011 entitled “Understanding the Cholera Epidemic, Haiti” which points out the correlation between the arrival of the Nepalese troops and the reports of Haitians falling victims to the disease.

Cholera can be carried by people who show no symptoms and all it took was for one Nepali solider to act as an incubator for the strain which was passed to other troops at the camp and subsequently contaminated the waste from the camp which was then dumped in the river. The evidence is clear now and was pretty clear in 2011 but the UN have been incredibly resistant to admitting their fault, pushing the blame towards Haiti and specifically the country’s inability to control the disease when it emerged.

Cholera is a virulent water transmitted disease that causes rapid dehydration of the body with uncontrollable acute diarrhoea usually accompanied by vomiting. In severe cases someone can lose around a litre of body fluid every hour. It can be relatively easy to cure if symptoms are spotted early and the body is rehydrated using Oral Rehydration Salts or clean water with a mix of salt and sugar. People in Haiti did not know what it was at first and in a country with extremely poor infrastructure for sanitation the disease spread rapidly.

I spoke to Nicole Roman from PDL, a Haitian based rural development program which works to promote and strengthen peasant organisations for social change. They have strong relationships with local grass-root organisations across Haiti, mainly working farmers. She stated that:

“At first it was very difficult because no-one knew what it was. Those who had it were being stigmatised including those at the health centres.”

PDL began getting phone calls one evening in October when people started to get sick. Before the epidemic PDL were already active in educating people in various areas on healthcare and sanitation. This saved a significant amount of lives as they had a number of trained people who could be told what to do over the phone before anyone could reach them.

They organised Clorox and IV serums, asking the leaders of one of the big NGOs to go and collect the materials.

“We decided to take off in a caravan in all of the areas and do two types of intervention. We took the serums to the leaders of the local organisations and gave them the effective remedies to distribute. This was not our area as we deal in sustainable projects but we had to intervene.”

PDL were the first organisation to go into the affected areas which says something about the numerous foreign NGOs in the country at the time.

The places where PDL had been and given the training needed to cope with the situation were comparatively less affected when the disease hit.

“All very simple things; the Clorox and how to use it, how to make the hydration drink. To clean the surfaces and their hands. You show them how to do it and it help them feel confident.”

Even things like mangos were an issue as many people go to the toilet under the mango trees so it was important to make sure they washed the mangos before eating them.

The importance of organisations like PDL is massively overlooked in Haiti and the work they do is undermined by the bigger NGOs. Cantave Jean Baptiste, the director of PDL spoke to me about the problems this causes in rural communities

“Many do not take time to understand the local community. They start to impose their way they think things should be done which does not work. We come from another world. But in their mind we are from those who exploit them. We are from those who are in charge of their poverty so they will be careful in dealing with use. So you must first build confidence and they should see you different from those blancs, those thieves. You will not inject awareness in these people; you will promote awareness, progressively.”

I visited a number of areas affected by cholera and there were few obvious signs that cholera had recently been so devastating and that cases were still continuing to arise. Many Haitians see the event as a splash in the pan which seems understandable when they have experienced so much tragedy. The struggle to live leaves little if no time to even attempt to protest when doing so seems pointless anyway. The people managed to elect Aristide through their own will, only to watch him become corrupted by power and see their hopes crushed. This was followed by an earthquake that completely shattered their already unstable society. Thereafter, the cholera epidemic was just another setback.

Mario Joseph with the BAI and the support of the IJDH sought out to seek justice for those affected, something which I didn’t see anyone else attempting to do. He pulled individuals in the Artibonite areas to go and gather victims directly affected by the cholera and with the overwhelming evidence stacked up against the UN it seemed that there was a good chance that those who had medical proof of having contracted the disease would receive some compensation for their avoidable trauma.

Speaking to two different groups in Saint-Marc and Saut-d’Eau there was still a lot of hope in receiving compensation, although they had seen little evidence of it. Both groups had been meeting up every Sunday for about three months and consisted of people from a number of different neighbourhoods in the areas. In Saint-Marc many were embarrassed to come to the meetings because they were ridiculed in their communities. One man I met, who had survived after contracting the decease soon after it appeared, said to me;

“On the way to one of these meetings I had an accident and nearly broke my arm. The people in the neighbourhood mock us. They say we are like cars without lights. But I believe that one day we will get justice.”

Many had spent what they had on treatment and ensuring a proper burial for their relatives who passed away. One woman I spoke to who had lost her stepfather and nearly lost her son said that she was still unable to use the rice plantation she owned as she had rented it out, with all the produce in order to survive and pay for treatment. Although there was doubt in the minds of those I spoke to, they held unto hope, perhaps because they had lost so much. This was the case with another woman I had spoken to who said:

“What can we do? Even I did everything I could to support my daughter but she died. I have faith. If I didn’t have faith I would’ve died.”

There was an understanding amongst those I met that the disease may have been caused by the MINUSTAH. However, no one really new for sure as they had not heard anything confirming the true source. Some understood it to be an airborne virus. Devastatingly, some ran to their voodoo doctors to seek help and died from failed treatment. NGOs like World Vision and American Red Cross had visited some of the areas, giving out aqua tabs and advice about how to avoid contracting cholera. Whilst this was necessary, many Haitians were still left confused as to how the outbreak began and about whether it was the river water that was the root of the disease. They were told that this wasn’t an act of God and that they deserved compensation from those responsible for their losses. There were lawyers working on their behalf so they kept the faith. A few were simply grateful that they were still alive but carried on coming to the meetings because they gave each other strength.

Ange, a producer of a public radio station in L’Estere, an area located north of the Saint Marc, told me that the situation was confusing for people who, like so many Haitians, used the river water for everything from bathing to drinking,

“My family used the river water to wash and clean but never got sick. Everything that comes in life you see as a lesson. If the water is dirty then we should clean it. I believe there is a God and if you make someone suffer then you will pay surely. We are not in a position to accuse or want to accuse anyone.”

Many who I spoke to believed that what became of them was Gods intention, a fatalism evident in the phrase “god willing I survived” which I encountered frequently . I will never forget a taxi driver who, after asking me the regular formalities (name, country, wife etc.) told me that he had lost his girlfriend in the earthquake when a building they were both in at the time collapsed around them.

“I am blessed that God wanted me to survive.”

This is the conclusion for many for the trauma they face, that it is God’s will, God’s test to them. Unfortunately it causes many to give up the fight before it has begun. Admittedly their luck seems slight and the attitude of their neighbours towards those in Saint-Marc by their neighbours seems, at least in part, justified.

In February 2012 Susan Rice, U.S. Permanent Representative to the UN, released a statement after a visit to Haiti. After acknowledging the challenges being faced and the numerous roles that the UN are undertaking in order to improve the situation she said,
“The cholera epidemic and allegations of sexual exploitation and abuse by some mission personnel have badly eroded support for MINUSTAH and undermine its work. We are deeply troubled by these allegations, and expect the United Nations to redouble its efforts to prevent any further incidents of this kind and to ensure that those responsible are held accountable.”

This was then followed by a statement from Bill Clinton in March 2012 which acknowledged that a MINUSTAH troop was the “proximate” cause of the cholera outbreak but shifted the blame towards the poor state of the countries sanitary system. Bill Clinton was avoiding the point somewhat as the UN was fully aware of the situation in the country prior to the outbreak and should have ensured that compulsory screening of the Nepalese soldiers took place. Nonetheless, it appeared that the UN was coming under pressure to take responsibility.

In December 2012 Secretary-General Ban Ki-moon of the UN announced a new initiative that would help eliminate cholera in Haiti and the Dominican Republic,

“The main focus is on the extension of clean drinking water and sanitation systems – but we are also determined to save lives now through the use of an oral cholera vaccine.”

A fund of $500 million is quoted for the program. Donor funds of $215 million are already in existence along with $23.5 million pledged by the UN itself in addition to the $118 million already spent on the cholera response by the UN. With Dr Paul Farmer lending expertise to the project as its Special Advisor we should hopefully see vast improvement made to the worst sanitation system in the Western Hemisphere and end to cholera in Haiti. But what about the 7,750 people who have died and the 620000 infected? It seems that there is to be an attempt to clean-up the mess without ever acknowledging the casualties.

After 15 months of waiting, the question of compensation was still hanging when, on the 21st February 2013 Secretary-General Ban Ki moon’s spokesman finally announced that the UN would not take responsibility for the outbreak and that the compensation claim was “not receivable”. According to an act established in 1946 the UN is able to enjoy absolute immunity, unless it chooses otherwise, when exercising its peacekeeping role in a member state.

If compensation was granted to victims it would amount to a crippling sum given the number of those affected. There is an incontrovertible need to improve water and sanitation facilities and if the UN can achieve this it can only be a positive thing. However, it has taken 15 months for the UN to give a response to the claim made by the BAI and the IJDH. Meanwhile, the numbers of victims have been steadily increasing and the unavailing hope from those waiting to be compensated for their losses has remained unabated. The loss of friends, family members,the costs of treatment, funerals and priceless loss of dignity, were all caused by a previously non-existent threat. The fact is even those who contracted cholera and survived had to go through the terror of an incredibly aggressive virus which is difficult to fully recover from.

It took cholera for many to see that they should improve their sanitation at home and for the UN to address the need to improve infrastructure as a priority.. It twists the nerves to see Haiti left to fall apart right up to the point where it is perpetually shaking at the knees about to come crashing down upon the floor like some crumpled puppet. (We may occasionally see the lips of the mouth move to the tune of major disasters and corrupt governments otherwise they are left slack without the chance needed to begin feeding itself.

This has clearly not quashed the efforts of those working on the case, seen clearly from a statement made by Beatrice Lindstrom, human rights lawyer for the IJDH, to the Innercity Press expressing their determination,
“this does not mark the end… We will proceed. We are preparing a domestic lawsuit and we’ll file.”
I believe that the UN should at least compensate for the deaths of those lost and I believe that they should formally admit responsibility. The bureaucracy surrounding the action of admitting responsibility is something that I personally cannot really appreciate although I understand that the legalities of the issue make it relevant where the UN are concerned. I am an individual in a State which is a member of the United Nations and it is disturbing that they are able to wave immunity when it is clear that the human rights of the Haitians has been violated by those whose role it is to protect the populations of it’s member states.