Picture this: soldiers from a foreign army are stationed near the headwaters of the Mississippi River. Sewage running from their base has long polluted the waterway, but the authorities never paid attention. One day a new rotation of soldiers arrives, carrying a deadly bacteria never before seen in the U. S. It enters the water. People get sick, then die. The infection spreads from St. Louis to Memphis to New Orleans, explodes along the Gulf Coast, and from there to every state in the union. Overwhelmed health responders watch in horror as family after family succumbs. Within a year, five percent of Americans have fallen seriously ill and thousands have died. The president tells a terrified and exhausted nation that it will cost more than the annual national budget to control the disease. Yet no court can hold the soldiers accountable for negligence, or even get them to acknowledge their role in causing the outbreak. “It doesn't matter,” an army spokesman says.
Such a nightmare is happening right now in Haiti. Cholera erupted on the shores of the country's most important river in the fall of 2010, downstream from a base that housed U.N. soldiers from Nepal. The disease has sickened half a million people and killed at least 7,000. As health officials and bureaucrats bicker over the best response, the disease is surging again with the spring rains. Haitians are left struggling to deal with the unending epidemic, caused by the very soldiers dispatched to protect them.
A year and a half ago, that last sentence would have been incendiary. Most foreigners assumed that cholera was part of the impoverished country's landscape, a result of the squalid living conditions that many Haitians found themselves in after the country’s massive 2010 earthquake. Suggesting otherwise was seen as an exercise in reckless scapegoating. But as the Associated Press correspondent in Port-au-Prince, I quickly realized that there was more to the story. For one thing, the outbreak had first been noticed outside of the quake zone in the country's rice-growing heartland. More startlingly, no one had ever before recorded an outbreak of cholera in Haiti. Our resulting investigation in late 2010, along with those of Harvard microbiologists, a French-led team of epidemiologists, and others would uncover a mountain of evidence pointing to the U.N. base as the source of the outbreak. Today Bill Clinton, the U.N. Special Envoy to Haiti, can casually link the peacekeepers to the epidemic. A summary of the facts to date can sit comfortably as the lead story in Sunday's New York Times.
But one key group still insists upon doubting the cholera’s source. The U.N. Stabilization Mission in Haiti, or MINUSTAH, has steadfastly refused to accept the evidence of its negligence. Aware of its nosediving popularity in Haiti eight years after it was installed, the U.N. has become increasingly defensive in the face of criticism there. The spokesman for United Nations Secretary-General Ban Ki-moon, Martin Nesirky, reiterated on Monday that “it was not possible to be conclusive about how cholera was introduced into Haiti … and therefore, at this point, I don’t have any further comment.”
Nesirky ignores the overwhelming evidence implicating the U.N. soldiers: that the disease first appeared in the water next to their base, and that the bacterium was, in the words of a 2011 panel appointed under pressure by the U.N., a “perfect match” for cholera circulating 9,000 miles away in Nepal. But he is right that there will probably never be a smoking gun--a thermal video, one might imagine, of the index Vibrio cholerae microbe sloughing out of the base into the Artibonite River system. That is in large part because, as soon as the U.N. base was implicated, principal agencies including the U.N. World Health Organization and U.S. Centers for Disease Control and Prevention refused to investigate during the critical months when such evidence might have still been present. (Many major U.S. news outlets followed their lead, ignoring the story for weeks and then blasting the very idea of trying to pinpoint the epidemic's origin.)
The ever-clarifying picture of how cholera came to Haiti has clear implications for public health. A conversation about how to move troops and other large groups of people from one side of the world to the other without putting vulnerable populations at risk has already begun. The U.N. has quietly removed the Nepalese soldiers from their base, replaced by a Uruguayan contingent that dug a new path for the river farther away from its perimeter and stopped dumping its waste in overflowing pits across the street. It is also installing water-treatment centers on 28 of its bases throughout Haiti, and taking measures to ensure water can no longer go out of U.N. camps, according to mission spokeswoman Sylvie van den Wildenberg.
But that alone is of little solace to the people still suffering cholera's wrath nearby. Many of the epidemic's first victims still live around the base in Meille, a collection of concrete, thatch, and mud houses spread thin amongst the banana trees. Children splash around in the babbling river where the infection began, women washing and bathing on rocks in the sun. Jonas Fleury used to sell homemade liquor and food to the Nepalese soldiers. He was one of the first to be hospitalized, and his cousin was one of the first to die. “The U.N. polluted the river. I don't drink from it anymore,” he said, his eyes flashing with fury.
In another time and place, Fleury might have a responsive government, or a forum in which to demand accountability from the organization that ruined his neighborhood, killed his relatives, and changed his way of life. But he does not. That leaves the question to others: What should happen when the people who respond to one set of crises are responsible for creating another? How do peacekeepers intend to promote the rule of law in a country where they are now widely seen as having acted with impunity? By trying to slam the door on inquiry about the origin of the epidemic, they took the debate out of the hands of health authorities and handed it to many of Haiti's less savory political actors, who have gladly stoked a nation's anger for their own ends.
Meanwhile at least one group is pursuing redress by legal means. Following the lead of victims of negligence from Love Canal to BP's Deepwater Horizon, a team of lawyers has filed a petition for relief on behalf of 5,000 cholera victims. The action brought by the Institute for Justice and Democracy in Haiti, a longtime opponent of the peacekeepers, demands that the UN pay reparations for “gross negligence, recklessness, and deliberate indifference.” Their petition also calls for the UN to fund a national program for clean water, adequate sanitation, and appropriate medical treatment. Some of those items are nice ideas to which the UN agencies have paid lip service, but they are currently under no obligation to implement any of them. Moreover, the UN's forces are protected by a standard agreement shielding its troops from prosecution in the country where they are deployed. If the case proceeds, it could change the ways that soldiers and responders are moved, and conduct themselves, around the world. Such a goal would seem theoretical or even irrelevant to some. But not when it's your river.