15240231 - port-au-prince - august 26: a haitian unidentified kid chewing a pouch packet of water on a hot afternoon, in port-au-prince, haiti on august 26, 2010.


Synopsis: Haiti was struck by a devastating cholera epidemic a few months after a disastrous earthquake hit. Eventually the UN and its peacekeeping groups were blamed for causing the outbreak, making a bad situation much worse. Experts discuss how it happened and lessons for future disaster recovery.

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  • Dr. Ralph Frerichs, Professor Emeritus of Epidemiology, UCLA and author, Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti

Link for more information:

16-35 Haitian Cholera Coverup

Nancy Benson: In January 2010, a devastating earthquake wracked the island nation of Haiti. Then a few months later, the world watched as cholera clawed through Haiti’s already vulnerable shores and ravaged the population. But what we never heard was why the epidemic happened in the first place. Why did it take so long for authorities to react? And what lessons have we learned from it moving forward?

Dr. Ralph Frerichs: What happened is that there was a series of steps that came up that the UN skillfully saw that rather than bringing this thing to a head, you want to put it off for another day. So this idea of off-putting any kind of conclusion was important.

Benson: That’s Dr. Ralph Frerichs, professor emeritus of epidemiology at UCLA and author of Deadly River: Cholera and Cover-Up in Post-Earthquake Haiti.

Frerichs: The choler epidemic came very quickly. People believe that maybe 11-12,000 or so deaths have occurred in this country of about 10 million people.

Benson: Cholera is a bacterial disease believed to be caused by ingesting fecal contaminated water. And you’d think Haiti would be prime ground for it. Reportedly, only 12 percent of Haitians had access to piped and treated water in 2008, and only 17 percent had access even to pit latrines. Despite this, the country was able to remain cholera-free for more than a century.

Frerichs: Haiti was not a spot that was widely visited by agents that bring cholera. You didn’t have a lot of people coming there to engage in trade from other countries. So it was pretty well isolated. And this isolation certainly hurts them economically, but it helped them in terms of avoiding some of these diseases that were evident in other parts of the world.

Benson: So what was different after the earthquake that could have brought cholera to Haiti? The United Nations itself became a suspect when two journalists visited a UN base next to the Antimonite River, the largest river in Haiti.

Frerichs: They saw what looked like leaking pipes coming out of latrines at the edge of the base. They did notice that there was a truck that picked up waste from the base and takes it up to a hillside spot that was adjacent to the base.

Benson: A group of Nepalese soldiers were stationed at that base. And the strain of cholera found in Haiti matched that of south Asian strains commonly found in Nepal.

Frerichs: It was very clear from that it was the Nepalese peacekeepers and their camp that started this epidemic. First leaking some of the sewage into the nearby streams where villagers living around the base became infected, but then a day or two later all of a sudden there was a huge amount, a huge amount of fecal matter that got into the river.

Benson: A report from an epidemiologist named Renaud Piarroux supported the findings of the journalists. Frerichs says this forced the UN to launch its own investigation.

Frerichs: The UN until that time had been able to say, well, these are just rumors. These journalists write this kind of stuff. You can’t trust the journalists. That kind of thing. But now all of a sudden you also had an esteemed French epidemiologist come in and he and his report was saying the same thing, but based on an epidemiological investigation. So this unnerved the UN a bit and Secretary General Ban Ki-moon came forward and he said, well, we’re going to do an independent investigation and find out what really happened. And they then got four individuals to participate in this. They were appointed by the UN in order to investigate the UN. So it was not a group that was predisposed to think that maybe humans had brought this to the country.

Benson: Despite this conflict of interest, the panel still traced the source of the outbreak to the UN base. Frerichs says they rejected one of two prevailing theories on how cholera is spread — the one that might have exonerated the UN.

Frerichs: There’s two theories the nationally and how cholera originates and how it spreads. One is the environmental theory that says that yes you have all these vibrio cholerae out there, these water loving agents out there in estuaries off the coast. But periodically there’s something called genomic recombination, it’s the recombining of elements and different neighboring vibrio cholera, and what results from that recombination is a super organism that is pathogenic.

Benson: But Frerichs says the United Nations sat in the crosshairs of the other theory for the explosion of the disease in Haiti.

Frerichs: And another theory is that this pathogenic type of vibrio cholera needs to have humans involved. It has to have what’s called human amplification, meaning that it goes from one human, then it contaminates maybe the nearby environment or food supplies or what not, gets into another human, that human in turn has severe diarrhea or vomiting and spreads it on to other humans.  

Benson: The United Nations has spent $140 million on its efforts to eliminate cholera from Haiti. However, that’s only a fraction of the estimated $2 billion necessary for an effective eradication program. According to Frerichs, this program would include public health measures and proper water sanitation.

Frerichs: You can strengthen the Haitian people by vaccinating all of them, for example. That’s one strategy. The other is that well, it’s a poor country and it doesn’t have safe water, doesn’t dispose of its fecal matter in a proper way, and so what you can do is you can invest grandly in the country and make sure they have safe water, safe toilets, but it turns out that the rest of the world wasn’t quite so willing to give to Haiti and they managed only to acquire about 17 -18 percent of that money.

Benson: More than 1000 Haitians have sued the United Nations, claiming they should take responsibility for failing to screen the Nepalese peacekeepers. Frerichs says the whole episode is a tragic lesson for the international community. When help is sent to the scene of a natural disaster, it can end up causing harm to the people they are sent to protect.

Frerichs: There’s a lot to be said here about coming up with better procedures to make sure that peacekeepers, when they come in, don’t bring foreign diseases. The other thing is if there is some accident, if somebody does bring in diseases you jump on it right away. You get on it right away, you don’t put it off, you jump on it right away, and you become responsible for it. But the UN wouldn’t say that they were responsible. Instead the UN in a series of different steps, tried to cover it up. Oh, it wasn’t us, it wasn’t this, it wasn’t that. They tried to change maps. They tried to point this panel that was not a representative panel of experts, they tried to do a number of different things to obscure what it is that happened. So people started losing faith in the UN.

Benson: Frerichs says the international community needs to step up and make good.

Frerichs: There’s great need for the cholera elimination program. It won’t help the people with their water. It won’t help them with their sewage and such, but it will bring them back to a place they were before cholera showed up in the country.

Benson: But that may also be too little, too late. Frerichs says lessons can be learned and preventive steps taken right away, if epidemiologists can track down the source of disease.

Frerichs: And you can’t wait too long because the footprints, the evidentiary footprints start getting a little bit dimmer and you’re unable then to say exactly what it is that happened.

Benson: You can find out more about Dr. Ralph Frerichs and the cholera coverup in Haiti through his website, deadlyriver.com.

Our writer this week is Michael Wu.

Our production director is Sean Waldron.

I’m Nancy Benson.

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