Cholera ward in a health centre in Blantyre. Malawi has experienced a massive rise in cholera in the past year. Credit: Charles Mpaka/IPS

By Charles Mpaka
BLANTYRE, Jan 9 2023 (IPS)

On March 3, 2022, Malawi declared a cholera outbreak after a district hospital in the southern region reported a case. This was the first case in the 2021 to 2022 cholera season.

That single case was a warning for what would become Malawi’s worst cholera outbreak in decades.

For nearly a year now, cholera has gripped the country, with cases reported in all 29 districts and rising.

In an unprecedented occurrence, the cases rose sharply even through the summer months when cholera is least expected and the country least prepared for it.

As of January 4, 2023, up to 704 people were killed, and 21,000 cases were registered, government data shows. The case fatality rate stands at 3.4 percent, higher than the recommended rate of less than one percent.

Maziko Matemba, Executive Director for Health and Rights Education Programme (HREP), a local civil society organisation, says the situation is alarming and keeps the country in a “spiral of health crisis”.

“We started the year 2022 hoping to recover from the devastation of Covid-19. Then Tropical Storm Ana knocked us back in January. In March, cholera hit, and it hasn’t left for ten months, worsening as time passes. We have not had this kind of cholera outbreak for a long time,” Matemba tells IPS.

And there are growing fears that the disease could spread further now that the rainy season when it usually breaks out in Malawi, has begun.

Tropical Storm Ana has played a significant part in this outbreak, experts say. The rainstorm affected 16 districts, including Machinga, where the first cholera case was reported in March, and Nsanje, a flood-prone district and one of the first areas to report cholera cases in this outbreak.

A final situation report on the impact of the storm by the Department of Disaster Management Affairs found that over 53,000 latrines collapsed, while 337 boreholes, 206 water taps and eight gravity-fed water schemes were damaged in those 16 districts.

The department said this resulted in low sanitation coverage, limited access to safe water and poor hygienic practices, with some sites and communities reporting open defecation and contamination of the few available water sources.

The report said the situation increased the risk of cholera and other communicable diseases.

“As such, safe water supply, sanitation and hygiene services are immediately needed to address water, sanitation and hygiene issues. Furthermore, there is a need for rehabilitation of toilets to avoid infectious and waterborne diseases,” it said.

But Malawi has not fully recovered from this disaster since, Matemba says.

“So lack of recovery on water and sanitation infrastructure destroyed during that time have created good conditions for cholera to thrive. That comes into an existing frame of a weak prevention system. We usually take prevention rather casually,” he says.

Save Kumwenda, an environmental health expert, says alongside the water, sanitation and hygiene issues, there is also evidence of temperature and precipitation being influential in cholera outbreaks – with temperature driving epidemics and rainfall acting as a dispersal mechanism.

“Then there are also socio-economic conditions which are key drivers for outbreaks, as these increase pathogen exposure,” says Kumwenda, an associate professor at the Malawi University of Business and Applied Sciences (MUBAS).

He says the situation could worsen as the rainy season spreads the bacteria through contamination of water bodies and food.

The outbreak has hit the hardest Malawi’s two major cities of Lilongwe, the capital city, and Blantyre, the commercial city.

For instance, in the 7 days between December 29, 2022, and January 4, 2023, the country recorded 2,773 cases and 137 deaths. Out of these, Blantyre and Lilongwe contributed 47 percent of the new cases and 53 percent of the new deaths.

Kumwenda says this is the case because the two cities, struggling with solid waste management and aged sewer systems, have large peri-urban areas where residents depend on wells, boreholes and river water which is highly contaminated by faecal matter from toilets, broken septic tanks, broken sewer pipes and open defaecation.

He says most houses in these areas do not have adequate toilets, and many depend on sharing.

In addition, most of these households cannot afford to pay for water from waterboards for both drinking and domestic use. They, therefore, prioritise safe water for drinking only and unsafe water for other uses, which leads to contamination of foods and utensils and also contamination of the available safe water.

“The other reason for the high numbers of cholera cases in these cities is the high number of people who rely on piece works, and these rely on foods sold in markets where hygiene and sanitation conditions are compromised,” he says.

In response, the government has delayed by two weeks the opening of schools in the two cities and surrounding areas. Malawi opened the 2022 academic year on January 3.

Minister of Health Khumbize Kandodo Chiponda says in a statement that opening schools in the two cities would affect containment efforts for the outbreak, considering that cholera is passed from one person to another through contaminated food, water and inadequate sanitation facilities, a feature that exists in school settings.

“The converging of learners, especially in the nursery, primary and secondary schools, increases the chances of uncontrolled spread of the vibrio bacteria that causes cholera disease,” she says.

During the two weeks delay, the government will be conducting a thorough assessment and improving the water and sanitation situation in the schools in both cities.

For a national response, among other measures, the government says it will be opening more treatment centres in the cholera hotspots, employing more staff in the treatment centres, intensifying hygiene promotion and undertaking water quality assessments in targeted areas.

In November last year, Malawi rolled out the oral cholera vaccination reactive campaign targeting 2.9 million people aged one year and above.

Kumwenda says Malawi needed to act quickly to stop the outbreak before the onset of the rainy season as there was clear evidence of the impending emergency due to the rising of the cases through the hot months.

But for long-term control of the disease, Malawi needs to invest in research in order to come up with interventions based on evidence.

“This will ensure that we always invest in interventions which yield maximum benefits. We need to understand the main drivers of the epidemic and also identify reservoirs of the bacteria causing cholera. The knowledge of the reservoirs will help us to easily prevent the re-occurrence of the outbreak,” says Kumwenda, president of the Malawi Environmental Health Association, a group of environmental health experts.

IPS UN Bureau Report

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Tents set up at Alsabeen hospital in Sana'a Yemen for screening suspected cholera cases.

By Roshni Majumdar
UNITED NATIONS, Jul 27 2017 (IPS)

The directors of the UN Children’s Fund (UNICEF), World Food Programme (WFP) and World Health Organization (WHO) released a joint statement today shedding light on a deadly cholera epidemic engulfing war-torn Yemen.

More than 400,000 cases of cholera are suspected, and nearly 1,900 people have died from associated cases in the last three months alone.

The dire situation results from a culmination of factors, such as modern tactics of warfare that destroy water pipelines, as well as continuous bombing of schools and hospitals. More than 60 percent of the population remains uncertain of their next meal as famine looms.

Nearly 2 million children are suffering from malnutrition, and are easy targets of the water-borne disease. The report estimates that nearly 80 percent of all children need immediate humanitarian assistance.

Amid the lack of adequate international support, community leaders have stepped up to the task—more than 16,000 volunteers visit families from door-to-door to raise awareness about cholera, and assist them with information to protect themselves.

Many health-care workers, as many as 30,000, haven’t been paid in nearly 10 months. Still, that doesn’t keep them from their work.

Similarly, international organisations like UNICEF and WHO have set up nearly 1,000 diarrhoea treatment centers to provide key supplies, like food and medicine. They are also similarly assisting, with the help of the community, to rebuild the local infrastructure.

There is hope, and more than 99 percent who are now showing cholera-related symptoms have a good chance of surviving.

The two-year deadly conflict in Yemen between the Saudi-led Coalition (SLC) and Houthi rebels in one of the most poorest Arab countries has produced devastating results—one report in 2016, which was quickly withdrawn, estimated that nearly 60% of children died from attacks by the SLC.

The UN agency leaders, Anthony Lake (UNICEF), David Beasley (WFP) and Tedros Adhanom Ghebreyesus (WHO) urged the international community to “redouble its support for the people of Yemen,” following a trip to the country themselves.

Secretary-General Ban Ki-moon addresses the General Assembly during a briefing on the United Nations’ New Approach to Cholera in Haiti. Credit: UN Photo/Eskinder Debebe

By Tharanga Yakupitiyage
UNITED NATIONS, Dec 2 2016 (IPS)

For the first time, the United Nations issued a formal apology for their role in the cholera outbreak in Haiti and announced new steps to alleviate the ongoing health crisis.

Speaking to the members of the UN General Assembly, Secretary General Ban Ki-moon made an emotional statement, expressing his deep regret for the suffering and loss of life that resulted from the cholera epidemic.

“On behalf of the United Nations, I want to say very clearly: we apologise to the Haitian people. We simply did not do enough with regard to the cholera outbreak and its spread in Haiti. We are profoundly sorry for our role,” said Secretary General Ban Ki-moon Thursday.

Ban first delivered the apology, which was broadcast live on television in Haiti, in Creole, before switching to French and English.

The cholera outbreak, which occurred soon after the earthquake in 2010, killed nearly 10,000 and has to date infected close to 800,000, roughly one in twelve, Haitians.

Numerous reports including one by the U.S. Centres for Disease Control and Prevention pinpointed the appearance of the first cholera cases to the arrival of UN peacekeepers from Nepal.

Just one month before leaving office, Secretary General Ban Ki-moon noted that the cholera outbreak has created a “blemish” on the reputation of both UN peacekeeping and the organisation as a whole.

The UN first admitted its role in the cholera crisis in August when, during a briefing, spokesman Farhan Haq said that the that international organisation became “convinced that it needs to do much more regarding its own involvement in the initial outbreak.”

Desir Jean-Clair from Boucan Care, a cholera survivor whose mother died from cholera described the apology as a “victory.”

“We sent thousands of letters and were in the street to get this victory for them to say today that they were responsible,” he told The Institute for Justice & Democracy in Haiti. “They said that and we thank them. But it can’t end here. Because today there is still cholera in the whole country.”

While U.S. Senator Edward Markey, who had called for the apology, stated that it was “overdue” and is an “important first step for justice” for Haitians.

“The people of Haiti have long deserved more than just acknowledgment for the pain and sacrifice they have suffered in great part due to UN negligence,” said the top Democrat on the U.S. Senate Subcommittee on Africa and Global Health Policy.

Though it does represent a shift after over six years of denial of involvement or responsibility on the part of the UN, the apology stops short of explicitly acknowledging the responsibility of the UN in introducing cholera into Haiti.

“We now recognise that we had a role in this, but to go to the extent of taking full responsibility for all is a step that would not be possible for us to take,” said Deputy Secretary General Jan Eliasson during a briefing.

He noted the major reason for the limitation is to ensure the continuation of peacekeeping and humanitarian operations.

“We have to continue to do this work, There might be tragic mistakes in the future also, but we have to keep that long-term perspective,” he said.

The apology also comes after a U.S. appeals court upheld the UN’s immunity in August from a lawsuit filed on behalf of thousands of Haitian cholera victims.

Eliasson noted that the court decision helped protect key UN peacekeeping and humanitarian operations. It was therefore a “triggering” point for the apology and roadmap, he added.

“That is the reason we can now move forward to take this position of accepting moral responsibility and go to the extent that we express an apology…that is a way for us to send a message of support,” Eliasson stated.

However, words can only go so far, both Eliasson and Ban Ki-moon said.

“For the sake of the Haitian people, but also for the sake of the United Nations itself, we have a moral responsibility to act, and we have a collective responsibility to deliver,” Ban said.

In a report, the Secretary-General lays out a new two-track approach in order to reduce and end cholera transmission and long-term development of the country’s water, sanitation and health sectors respectively. Though work on track one is already underway, including the deployment of rapid response teams and vaccination programs, track two still is yet to be determined as consultations are ongoing.

Ban proposed a community approach for track two, working directly with the most affected Haitians. Though individual reparations could still be an element, Ban noted the difficulties to carry out such a program including the identification of deceased individuals and ensuring the provision of a meaningful fixed amount per cholera death.

The organisation has requested a total of $400 million over two years for the program, and has set up a voluntary funding system for both tracks. So far, an estimated $150 million has been received.

In order for the UN to achieve its ambitious program, it requires UN member states to make voluntary contributions.

“UN action requires member state action. Without your political will and financial support, we have only good intentions and words,” Ban said.

“With their history of suffering and hardships, the people of Haiti deserve this tangible expression of our solidarity,” he concluded.

Prof Grace Irimu shows IPS a drip feed bag and a copy of Kenya’s ‘Basic Paediatric Protocols’ as she explains the importance of intravenous treatment in saving the lives of young children affected by acute watery diarrhoea. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, May 23 2015 (IPS)

Acute watery diarrhoea is a major killer of young children but misunderstanding over the benefits of fluid treatment is preventing many Kenyan parents from resorting to this life-saving technique and threatening to reverse the strides that the country has made in child health.

The 2014 Kenya Demographic and Health Survey, released in April this year, reports that the country’s under-five mortality rate fell to 52 deaths per 1,000 live births in 2014, down from the 74 deaths in 2008-09, but still far from the 32 per 1,000 live births targeted under the Millennium Development Goals (MDGs).“Parents must … understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea” – Prof Grace Irimu, Associate Professor of Paediatrics, University of Nairobi

The primary treatment for acute watery diarrhoea is rehydration, administered intravenously in the most severe cases of very young children suffering from shock after losing excessively high quantities of body fluids. A fluid bolus – or rapid liquid dose – delivered directly through an intravenous drip allows a much faster delivery than oral rehydration.

However, notes nurse Esther Mayaka at the Jamii Clinic in Mathare, Nairobi, “parents of children brought to hospital with acute watery diarrhoea are refusing to have them put on [drip] fluid treatment and this is a major concern because diarrhoea is a leading killer among children and giving fluids is still the main solution.”

She told IPS that the ongoing rains and floods in many parts of the country “have created a comeback for diseases like cholera whose most telling sign is watery diarrhoea which needs to be managed with fluids.”

In February this year, Kenya’s Director of Medical Services, Dr Nicholas Muraguri, issued a cholera outbreak alert following an increase in cases of acute watery diarrhoea in several counties, including Homa Bay, Migori and Nairobi.

According to Prof Grace Irimu, Associate Professor of Paediatrics at the University of Nairobi, the reluctance to resort to drip fluid treatment has arisen due to misunderstanding generated by a Fluid Expansion As Supportive Therapy (FEAST) study in 2011 to establish whether the bolus technique was the best practice to use among children diagnosed with shock.

The FEAST study, which was conducted among children in Kenya, Tanzania and Uganda, found that fluid boluses increased 48-hour mortality in critically-ill children with poor blood circulation or shock in these resource-limited settings in Africa, but Irimu told IPS that the study excluded diarrhoea and only studied illnesses associated with fever, such malaria and sepsis.

“Parents must therefore understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea,” she said.

The Kenya Paediatric Association is also trying to set the record straight and, in a statement shared with IPS, the association reiterated that “diarrhoea complicated by severe dehydration is one of the biggest killers of children globally.”

According to the paediatrics association, the FEAST study excluded children with diarrhoea and dehydration because “the value of giving fluids in this group is well known. Giving appropriate fluid therapy is essential.”

Prof Irimu told IPS that the FEAST study had led to a revision of the ‘Basic Paediatric Protocols’, Kenya’s national guidelines for paediatric care, and clauses that address the treatment of diarrhoea were also revised.

Previously, a child diagnosed with shock as a result of diarrhoea would be given fluids in three cycles, every 15 minutes depending on the response. Now, the child receives the fluids in two cycles and if there is no response, health providers are advised to proceed to slower fluid administration where the child is given the amount that the body needs, depending on the level of dehydration.

Meanwhile, the country continues to make strides in dealing with HIV/AIDS – another critical health issue covered by the MDGs – among children. Studies show that the number of children with HIV aged between 18 months and 14 years fell from 184,000 in 2007 to 104,000 in 2012, according to the most recent Kenya Aids Indicator Survey.

However, Prof Joseph Karanja, a reproductive health and HIV/AIDs expert in Nairobi, says that the country can still do better because “through available antiretroviral drugs as a preventive measure among HIV positive mothers, HIV transmission to the infant can be reduced to as low as one percent.”

Dr Pauline Samia, a paediatric neurologist and a board member of the Kenya Paediatric Association, says that there is also a commitment to address conditions that challenge the management of HIV among children such as epilepsy.

“Though research in this area is limited, an estimated 6.7 percent of children with HIV also have epilepsy, with at least 50 percent of children with HIV having central nervous system problems such as delayed development, behavioural challenges and convulsions,” she observes.

Regarding progress in other MDGs, some progress has been made in reducing the prevalence of underweight children less than five years of age, one of the goals set for eradicating extreme hunger and poverty.

The 2014 Kenya Demographic and Health Survey reports that not only has childhood malnutrition declined significantly, from 35 percent in 2008 to the current 26 percent, but the prevalence of underweight children also decreased from 16 percent in 2008 to 11 percent in 2014.

On the front of improving maternal health, the survey says that while maternal mortality remains high at 488 deaths in every 100,000 live births, in the past five years more than three in five births (61 percent) took place in healthcare facilities, a marked improvement compared with the 43 percent in 2008.

Edited by Phil Harris   

Whether they like it or not, many Africans faced with the possibility of having to access water through prepaid meters have resorted to unprotected and often unclean sources of water because they cannot afford to pay. Credit: Jeffrey Moyo/IPS

By Jeffrey Moyo
HARARE, May 8 2015 (IPS)

While many countries appear to have met the U.N. Millennium Development Goal (MDG) of halving the proportion of people without sustainable access to safe drinking water, rights activists say that African countries which have taken to installing prepaid water meters have rendered a blow to many poor people, making it hard for them to access water.

“The goal to ensure that everyone has access to clean water here in Africa faces a drawback as a number of African countries have resorted to using prepaid water meters, which certainly bar the poor from accessing the precious liquid,” Claris Madhuku, director of the Platform for Youth Development, a Zimbabwean democracy lobby group, told IPS.

Prepaid water meters work in such a way that if a person cannot pay in advance, he or she will be unable to access water.Despite U.N. recognition that water is a human right, international financial institutions such as the World Bank argue that water should be allocated through market mechanisms to allow for full cost recovery from users

As a result, African rights activists like award-winning Terry Mutsvanga from Zimbabwe and other civil society organisations are against the idea of prepaid water meters.

“If one has to pay upfront before accessing water, then it would mean those in most need would be denied access,” Mutsvanga told IPS, adding that water is a global human right.

Mutsvanga was echoing the United Nations General Assembly which, in July 2010, emerged with a binding resolution on the human right to water and sanitation – but for Africa, the human right to water may be far from reality.

Laden with a population of approximately 1.1 billion, Africa’s 300 million people have no access to safe drinking water, according to the U.N. Environment Programme (UNEP).

Many rights activists on the continent attribute Africa’s mounting water challenges partly to the advent of prepaid water meters.

“We already have hundreds of millions of people without access to clean water, and imagine the severity of the water challenge if water prepaid meters would reach everyone on the continent,” Mutsvanga said.

Over the years, prepaid water meters have been widely used in African countries like Namibia, Nigeria, Swaziland and Tanzania, as well as South Africa, where the meters which were rolled out in 1999 are currently in low-income areas.

Zimbabwe is currently conducting a pilot project aimed at installing the prepaid water meters, in towns and cities to begin with. And the country’s impoverished urban dwellers like 51-year old Tinago Chikasha are in panic mode, fearing the worst may be coming their way.

“Local authorities are pressing ahead with the idea of prepaid water meters, but jobless people like me have no money to make prepayments for water while we already have unpaid water bills running into thousands of dollars, which local authorities say they will deduct through all future water prepayments, meaning we run into the danger of having dry water taps for as long as we owe local authorities,” Chikasha told IPS.

In non-African countries like the United Kingdom, prepaid water meters are no longer being used after they were declared illegal in 1998 for public health reasons.

They were also abandoned in South Africa at one stage following a massive cholera outbreak, but were reintroduced and have replaced previously free communal standpipes in rural townships.

Despite U.N. recognition that water is a human right, international financial institutions such as the World Bank argue that water should be allocated through market mechanisms to allow for full cost recovery from users, and civil society activists like Melusi Khumalo in South Africa blame capitalist tendencies for necessitating the advent of prepaid water meters.

“Prepaid water meters are a result of such negative policies by institutions like the World Bank and they [prepaid water meters] deny water access to those in most need,” Khumalo, who is affiliated to Parktown North Residents’ Association in Johannesburg, told IPS.

In Zimbabwe, Mfundo Mlilo, chief executive officer of Combined Harare Residents’ Association (CHRA), told IPS: “We are vehemently against the prepaid meter project because it will not solve the problems of water delivery, and these prepaid water meters will not lead to residents receiving adequate safe and clean water, while the same prepaid water meters will also not lead to increase in revenue flows as the City [of Harare] claims.”

Last month, Harare’s Town Clerk Tendai Mahachi was reported by Zimbabwe’s Weekend Post as saying: “With these meters we expect roughly to save about 20-30 percent of the current costs we are incurring.”

According to Mahachi, at least 300 000 households in the Zimbabwean capital are scheduled to have prepaid water meters installed, while all new housing projects will be obliged to install meters.

Meanwhile, with prepaid water meters set to rake in big money for some of Africa’s local authorities, there are those like Nathan Jamela, an urban dweller in Bulawayo, Zimbabwe’s second largest city, who fear the health consequences.

“We experienced the worst cholera outbreak in 2008, and we fear that if prepaid water meters are installed in every household here we will slide back to the crisis, with many people unable to afford to pay for water,” Jamela told IPS.

Edited by Phil Harris   

Lara Adama digs for water in a dried up river bed in Dumai, in Cameroon’s far north. There has been a nine-month drought in the region and recurrent cholera outbreaks. Credit: Monde Kingsley Nfor/IPS

By Monde Kingsley Nfor
DUMAI/YAOUDE, Cameroon, Aug 19 2014 (IPS)

Under a scorching sun, with temperatures soaring to over 40 degrees Celsius, Lara Adama’s family is forced to dig for water from a dried-out river bed in Dumai, in northern Cameroon. 

This is one of the rivers that used to flow into the shrinking Lake Chad but there is not much water here.

There has been a nine-month-long drought in the region and Adama tells IPS that her family “digs out the sand on this river bed to tap water.”

“We depend on this water for everything in the house,” Adama, a villager in Mokolo in Cameroon’s Far North Region, says.

A cholera outbreak has been declared in Adama’s village. But she and other community members have no choice but to get their water from this river.

The lone borehole in this village of about 1,500 people is out of use due to technical problems.

“Every family comes here to retrieve drinking water. Our animals too depend on this water source to survive. When we come after the animals have already polluted a hole, we simply dig another to avoid any health problems,” she says.

This region is threatened by extreme water shortages and climate variability. Barren soils constitute some 25 to 30 percent of the surface area of this region. Lake Chad is rapidly shrinking while Lake Fianga dried up completely in December 1984.

Gregor Binkert, World Bank country director for Cameroon, tells IPS that a water-related crisis is prevalent in the north and there is an increased need for protection from floods and drought, which are affecting people more regularly.

“Northern Cameroon is characterised by high poverty levels, and it is also highly vulnerable to natural disasters and climate shocks, including frequent droughts and floods,” Binkert explains.

The protracted droughts in Far North Region have triggered a sharp increase in cholera cases. The outbreak is mainly concentrated in the Mayo-Tsanaga region as all its six health districts have cases of the infectious disease. The current outbreak has already resulted in more than 200 deaths out of the 1,500 cholera cases reported here since June.

According Cameroon’s Minister of Public Health Andre Mama Fouda, “poor sanitation and limited access to good drinking water are the main causes of recurrent outbreak in the Far North. A majority of those infected with the disease are children under the age of five and women.”

Poor hygiene practices

“Cholera in this region is not only a water scarcity problem, it also aggravated by the poor hygienic practices that are deeply rooted in people’s culture. Water is scarce and considered as a very precious commodity, but handling it is quite unhygienic,” Félicité Tchibindat, the country representative for the United Nations Children’s Fund (UNICEF) Cameroon, tells IPS.

Cultural practices are still primitive in most villages and urban areas.

Northerners have a culture where people publicly share water jars, from which everyone drinks from.

“These practices and many others make them vulnerable to water vector diseases. [It is the] reason why cholera can easily spread to other communities. Cholera outbreaks are a result of inadequate water supplies, sanitation, food safety and hygiene practices,” Tchibindat says.

Open defecation is also common in the region. According Global Atlas of Helminth Infections, 50 to 75 percent of the rural population in Far North Cameroon defecate in the open, compared to 25 to 50 percent of people in urban areas.

Access to good drinking water and sanitation is also very limited. Two out of three people do not have access to proper sanitation and hygiene. While about 40 percent of the population has access to good drinking water, this figure is much lower in rural areas. In rural Cameroon only about 18 percent of people have access to improved drinking water sources, which are on average about over 30 minutes away.

Development challenges

Water sanitation and health (WASH) is vital for development, yet Far North Region has some of the most limited infrastructure in the entire nation, coupled with security challenges as the region is increasily throated by Nigeria’s extremist group Boko Haram.

Poverty is high in the region, UNICEF’s Tchibindat says. And the security issue in neighbouring countries has not helped Cameroon provide proper access to medical services here.

According to UNICEF, major challenges abound in Cameroon. There is a low capacity of coordination for WASH at all levels, and poor institutional leadership of sanitation issues. The decentralisation of the WASH sector means there is no proper support with inequitable distribution of human resources in regions.

“The government and many development partners have provided boreholes to communities and the region counts more than 1,000 boreholes today,” Parfait Ndeme from the Ministry of Mines, Water Resources and Energy says.

But about 30 percent of boreholes are non-functional and need repair, according to UNICEF.

Ndeme explains that, “the cost of providing potable water in the sahelian region might be three times more costly than down south. Distance is one major factor that influences cost and the arid climate in the region makes it difficult to have underground water all year round.”

A borehole in the northern region costs at least eight million Francs (about 16,300 dollars) compared to two million Francs (about 4,000 dollars) in other regions.

Health care challenges are prominent.

“The Far North has limited access development which also has a direct influence of the quality of health care,” Tchibindat says.

The unavailability of basic infrastructure and equipment in health centres makes it difficult to practice in isolated rural areas. Consequently, most rural health centre have a high rate of desertion by staff due to the low level of rural development, she adds.

Most of Cameroon’s health workers, about 59.75 percent, are concentrated in the richest regions; Centre, Littoral and West Region, serving about 42.14 percent of Cameroon’s 21 million people.

According to the World Health Organisation:

• 30.9 percent of health centres in Cameroon do not have a medical analysis laboratory.
• 83 percent of health centres do not have room for minor surgery.
• 45.7 percent of health centres have no access to electricity
• 70 percent of health centres have no tap water.

“Due to lack of equipment in hospitals, the treatment might only start after a couple of hours increasing the probability of it spreading,” Peter Tambe, a health expert based in Maroua, the capital of Far North Region, tells IPS.

“Report of new cholera cases are numerous in isolated villages and the present efforts by the government and development partners are not sufficient to treat and also monitor prevalence,” Tambe says.

Since the discovery of cholera in the region, the government and UNICEF and other partners have doubled their services to these localities to enforce health facilities and provide the population with basic hygiene aid, water treatment tablets and free treatment for patients, regardless of their nationality, along the border with Chad and Nigeria.

“Despite insecurity challenges facing this region, the government and its partners have embarked on information exchanges with Niger, Chad, and Nigeria to avoid further cross-border cases,” Public Health Minister Fouda tells IPS.

Edited by: Nalisha Adams

The writer can be contacted at nformonde@gmail.com

A medical centre at the Bandama checkpoint in Kenema to test people in transit for symptoms of Ebola. Credit: Mohamed Fofanah/IPS

By Mohamed Fofanah
KENEMA, Sierra Leone, Jul 12 2014 (IPS)

Adikali Kamara is a 36-year-old student nurse working in the government hospital in Kenema, a sprawling town on the fringe of the Sierra Leone’s Gola tropical rain forest.

On June 19, he began feeling unwell, complaining of fever and a headache, and went to a chemist near where he lived to buy anti-malaria drugs and antibiotics to treat typhoid fever. “I thought that my symptoms indicated either malaria or typhoid because these are the most common ailments suffered by everybody here,” said Kamara.

However his condition did not change and two days later he decided to seek proper treatment at the hospital. That was when the doctors discovered he was suffering from Ebola, a disease that causes fever, vomiting, bleeding and diarrhoea and kills up to 90 percent of those infected.

Kamara was admitted immediately and just seven days later he was discharged after receiving supportive treatment.“People are vehemently denying that Ebola exists despite the massive awareness raising that is going on, and those that do believe the illness exists are so afraid that they do not come to the hospital or bring their relatives when they are sick. That is how Ebola spreads in the community” – Michael Vandi, Public Health Education Officer for Sierra Leone’s Eastern Province

Kamara is one the fortunate 51 persons in Sierra Leone who have survived the current Ebola scourge that is also ravaging two other West African neighbours – Guinea and Liberia. So far, 99 have died in Sierra Leone and a further 315 men, women and children have tested positive.

The Public Health Education Officer for Sierra Leone’s Eastern Province, Michael Vandi, who is based in the Kenema hospital which houses the country’s only Supportive Treatment Centre and testing laboratory for Ebola, said that the country is far from winning the fight against the disease, blaming people’s fear and denial of the disease.

Vandi said that “people are vehemently denying that Ebola exists despite the massive awareness raising that is going on, and those that do believe the illness exists are so afraid that they do not come to the hospital or bring their relatives when they are sick. That is how Ebola spreads in the community before we are aware of cases.”

According to Vandi, people are accusing doctors of administering lethal injections to the Ebola patients or removing vital organs for sale in European markets. He said that some even claim that people are being deliberately infected with the virus to reduce the population.

As a result, doctors and nurses in the hospitals have been attacked and many nurses are not wearing their uniforms on the way to work for fear of being attacked in the streets.

“Patients who were admitted – both male and female – are abandoning the hospitals,” said Vandi. “They are now going to pharmacies or being treated by quack doctors or nurses in their homes. This is worrisome because the signs and symptoms of Ebola mimic the prevalent malaria and typhoid fever in the country and, before they know what they are dealing with, it will be too late.”

The Senior Human Rights Officer who heads the Human Rights Commission’s Office in the Eastern Province, Hassan Yarjah, blames the government’s Ebola awareness raising strategy for fanning mistrust and disbelief among people.

He pointed out that the eastern part of the country, in which almost all cases of Ebola have so far been identified, is an opposition stronghold. “What the central government is doing, which I think is wrong, is sending people to these communities that the people cannot identify with; they are parliamentarians, they are ministers, they are executives from the ruling All People’s Congress party and this is a country where everything is polarised,” he said.

According to Yarjah, people in the country’s Eastern Province are saying that “because a census is scheduled for September, the politicians want to scare people away from this part of the country so that their number will dwindle; then, when they delimit the boundaries for constituency seats, this will mean less representatives for the opposition in parliament in the next election.”

“I think government should use the local structures, like the paramount chiefs, the medical personnel on the ground, and the local councils,” Yarjah told IPS.

Meanwhile, the government has announced a ban on regular trade fairs in Kailahun, one of the districts in Eastern Province worst hit by Ebola. There has also been an executive order for placing medical personnel at a number of checkpoints on roads from the Eastern Province to check people for Ebola-related symptoms.

“This has affected our agriculture,” complained Lamin Musa, a farmer from Kailahun. “We cannot sell our produce now at the trade fairs and this had heaped more hardship on our poor people. Even bush meat, which had been a lucrative trade for us, has been banned. It is difficult for us to understand all the suffering we have to undergo because of Ebola.”

Whatever the misgivings, misconceptions and accusations, the virus is thriving, in part due to dysfunctional medical systems and weak disaster management structures in Sierra Leone and its neighbours.

At the beginning of July, the World Health Organization (WHO) held an emergency meeting in Accra, Ghana, with health ministers from 12 West African countries to discuss and propose suggestions to combat the outbreak of Ebola virus that has hit the three West African countries.

The ministers adopted a common inter-country strategy calling for accelerated response to the Ebola outbreak in West Africa. The strategy stressed the need for regional, sub-regional and national leadership, coordinated actions by all stakeholders, enhanced cross border collaboration and the involvement of communities.

For his part, Kamara is optimistic. “I was able to beat this disease and any of you out there can,” he said. “You have to believe that Ebola is real, set aside prejudice and go to the hospital early if you experience the symptoms.”

The problem is that while Ebola may be a killer, a potentially greater threat to Sierra Leoneans and West Africans in general lies in less spectacular diseases. During the current outbreak of Ebola, other diseases are quietly taking their toll. Malaria is still rampant, and there is concern that cholera, which usually attacks during this period of the rains, will resurface to claim more lives.

A demonstrator holds up an anti-U.N. poster during an October 2010 protest outside a MINUSTAH base in Port-au-Prince. Credit: Ansel Herz/IPS

By Thalif Deen and Patrick Saint-Pre
UNITED NATIONS/PORT-AU-PRINCE, Oct 31 2013 (IPS)

Some 2,400 kilometres from New York City, where victims of Haiti’s cholera epidemic are suing the United Nations in a U.S. federal court, the disease continues to burn through the populace with no end in sight.

In a single week between Oct. 19 and Oct. 26, the Pan-American Health Organisation reported 1,512 new cases and 31 deaths. New cases are reported in all 10 departments."It is clear that damage has been caused, the negligence of the U.N. is proven and it must assume its responsibilities." -- Mario Joseph of BAI

At the Cholera Treatment Centre run by Médecins Sans Frontières/Doctors Without Borders in Delmas 33, a commune in Port-au-Prince Arrondissement, nurse Viola Augustine says the clinic is so packed it cannot accept new patients.

“The centre has already handled over 20,000 cases of cholera since it opened. At the moment, the centre is full and we cannot take in the increase of patients due to the rainy season,” she told IPS. “We are forced, in this case, to transfer patients to other treatment centres when they are brought here.”

The spread of cholera in Haiti, which has killed more than 8,300 and infected over 680,000 people since October 2010, has been blamed on Nepali peacekeepers who are part of the 9,500‑strong U.N. Stabilisation Mission in Haiti (MINUSTAH).

The United Nations has refused demands for compensation. Earlier this month, an advocacy group filed a lawsuit seeking reparations from the world body on behalf of the cholera victims.

Felicia Paul, 45, lives in Saint-Marc, about 100 kms northwest of the capital. She caught cholera in 2010, and survived it though extensive treatment with saline IV bags.

“I was infected with cholera for 12 days,” Paul told IPS. “My two daughters caught it while they were taking care of me. MINUSTAH brought cholera so we ask that they compensate me. We always drank water out of the river and it never made us ill. But that water has been contaminated due the spillage of the peacekeeper’s feces into the river.

“I still feel the effects of the disease,” she added. “It blurs my vision and weakens me every day.”

A former senior U.N. official from Nepal told IPS he strongly supports compensation.

“As a Nepali who lived in and loved Haiti, I feel special empathy for the victims of the cholera epidemic,” said former U.N. Assistant Secretary-General Kul Gautam.

In a way, he said, even the Nepali peacekeepers are victims of the kind of poverty and poor governance that afflicts both Nepal and Haiti. The two nations are categorised by the United Nations as among the 49 least developed countries (LDCs), described as the poorest of the world’s poor.

None dispute that the lack of clean water and sanitation in Haiti has been a key driver of the epidemic.

“I wish a creative solution could be found whereby the Haitian victims would get some modest amount of financial support on humanitarian grounds, without the U.N. having to give up its diplomatic immunity,” Gautam said.

“For this to happen, some enlightened governments and foundations would need to offer help, not as a matter of legal obligation, but as a matter of humanitarian consideration,” said Gautam, a former deputy executive director of the U.N. children’s agency UNICEF.

Mario Joseph has been the director of Bureau des Avocats Internationaux (BAI) since its inception in 1995. BAI, together with the Institute for Justice and Democracy in Haiti, is leading the lawsuit.

“The trial is proceeding normally like any other trial,” he told IPS. “We’ve taken the first steps with the U.N. to bring them to take responsibility. To submit our claim, we sent the case to [Secretary-General] Ban Ki-moon, but unfortunately, the U.N. said it was protected by immunity.

“The U.N. experts have clearly established that it was the Nepalese peacekeepers who brought cholera to Haiti. It is clear that damage has been caused, the negligence of the U.N. is proven and it must assume its responsibilities.

“An organisation like the U.N. should not exercise a policy of double standard for evaluating itself vis-à-vis its member states. Haiti is a founding member of the U.N. In this sense the organisation must assume its responsibility concerning the cholera it brought into the country,” he said.

U.N. Spokesperson Martin Nesirky says the U.N. remains committed to do all it can to help the people of Haiti overcome the cholera epidemic.

“The United Nations is working on the ground with the government and people of Haiti both to provide immediate and practical assistance to those affected, and to put in place better infrastructure and services for all,” he told a press briefing this month.

Kanak Dixit, a veteran Nepali journalist and a civil rights activist, told IPS the fact that the epidemic has been traced to likely contamination of water sourced to the Nepali peacekeeping battalion is a matter of great consternation.

Nepal is heading into elections on Nov. 19, and the news has not received much attention there, nor has there been public discussion on the matter, he said.

“It would be extremely sad if it were true that a poor country in one hemisphere has been involved in the spread of the epidemic in an equally poor country in another part of the globe,” said Dixit, founder of the news magazine Himal SouthAsian.

He said it should be the collective duty of the United Nations to support the Haitian people in battling the epidemic, and supporting the victims’ families, rather than take a legalistic and hands‑off approach.

“Nepalis would understand the need to respond to the epidemic with humanitarian ethos and organisational efficiency,” Dixit said.

Nurse Augustine agrees. “For a disease like cholera that has led to so many victims, I think the United Nations should compensate those who have suffered because the illness is truly horrible.

“Talking about cholera and living with it are two different things,” she said. “Living with cholera is really frustrating.”

A man crosses a bridge over one of Cité Soleil’s waste canals that lead to the Port-au-Prince harbor. Credit: HGW/Marc Schindler Saint Val

By Correspondents
PORT-AU-PRINCE, Jul 26 2013 (Haiti Grassroots Watch)

Lack of financing for a 10-year eradication plan means that cholera will likely be endemic to Haiti for years to come.

Cholera spreads via contaminated food, water and fecal matter. One of the essential parts of the government’s 2.2-billion-dollar National Plan for the Elimination of Cholera in Haiti is financing for sanitation systems nationwide.“Haiti is the only country in the entire world whose sanitation coverage decreased in the last decade.” -- Dr. Rishi Rattan of Physicians for Haiti

The majority of Haitians – about eight million out of the country’s 10 million people – do not have access to a hygienic sanitation system. They defecate in the open, in fields, in ravines and on riverbanks. The capital region produces over 900 tonnes of human excreta every day, according to the United Nations Office for Project Services (UNOPS).

“Haiti is the only country in the entire world whose sanitation coverage decreased in the last decade,” noted Dr. Rishi Rattan, a member of Physicians for Haiti, an association of U.S.-based doctors and health professionals.

“Before the cholera outbreak or the earthquake, diarrhea was the number one killer of children under five and the second leading cause of all death in Haiti. Given that cholera is a water-borne illness that relies upon lack of access to clean water, it is highly likely that cholera will become endemic in Haiti without full funding of Haiti’s cholera elimination plan by entities such as the United Nations,” Rattan told Haiti Grassroots Watch (HGW) in an email.

Cholera, brought to Haiti in October 2010 by soldiers from the United Nations Stabilisation Mission in Haiti (MINUSTAH), quickly spread throughout the country. Almost 3,000 are infected each month. To date, over 600,000 people have been infected and at least 8,190 have died.

The death rate is on the rise in the countryside, due in part to the lack of cholera treatment centres. At the epidemic’s peak, there were 285. Today, there are only 28. Once financing ran out, most humanitarian agencies abandoned the country.

Worse, one of the two large waste treatment facilities built following the earthquake recently went out of service.

The cholera-excrement connection

Written with help from the Pan-American Health Organisation (PAHO), the U.S. government and UNICEF, the cholera elimination plan targets human excrement. The sanitation budget alone tops 467 million dollars.

“According to our figures, less than 30 percent of the population has access to what we might call basic sanitation,” Edwige Petit, head of sanitation for the government’s National Agency of Water and Sanitation (DINEPA), told HGW. “In neighbouring countries, 92 to 98 percent have basic sanitation.”

By DINEPA’s count, about half of households in the countryside, and 10 to 20 percent in the cities, lack access to a proper toilet or latrine. In Cité Soleil, a slum that is part of the capital region, some use any open patch of ground available.

“When our children have to take a poop, we put them on a little bowl,” explained resident Wisly Bellevue. “We put a little water in there. Once they are done, we throw it into an empty lot.”

Big institutions with septic systems are serviced by “desludging” trucks. In 2010 and 2011, for example, humanitarian agencies emptied the thousands of portable toilets in the refugee camps for the 1.3 million people made homeless by the 2010 earthquake.

Those who cannot pay for that service often hire a more economical one: the men called “bayakou” in Haiti, who empty latrines and septic systems by hand. The bayakou work at night. Most dump their cargo in rivers, canals and ravines.

Before the cholera epidemic, even the trucks used to dump the feces mixed with urine into the ravines that drain into the Caribbean Sea.

Advances and challenges

DINEPA and its partners have made considerable advances in sanitation since 2010. With assistance from the Spanish government, UNICEF and others, DINEPA built two treatment centres for the capital region, and hopes to build 22 others for a total budget of 159 million dollars.

To date, however, only three have begun to be built: near St. Marc, in Les Cayes in the south, and in Limonade in the north.

The impressive Morne à Cabri waste treatment centre, costing about 2.5 million dollars and inaugurated in September 2011, “has the capacity to treat 500 cubic metres of excreta per day, which is the equivalent of what 500,000 produce,” according to DINEPA.

But there is already a problem.

Today, the centre is closed down. The gates are locked. Lack of financing is one reason. The fees paid by excreta trucking companies don’t generate enough revenue.

Also, after the humanitarian agencies stopped managing the refugee camps – they pulled out once funding ended – deliveries from the portable toilets became problematic.

“We went from having latrine matter being made up of 10 to 20 percent trash, to 70 to 80 percent,” Petit explained. “The treatment centre was not built to handle trash. It was built to handle water and fecal matter. The pools collapsed, blocked with trash.”

Even though it is struggling financially, DINEPA is determined to get things working again.

“We are going to use government equipment. If we can get 40,000 or 50,000 dollars, we will be able to clean it,” she said.

Of course, the other treatment centre is working, but two challenges remain: convincing the bayakou and others to deliver their loads, and the financing issue. For, even if the excreta is delivered, bayakou will not be able to pay.

Another part of the plan is an education campaign aimed at combating “poor defecation and hygiene practices”. According to Petit, many rural families don’t even bother building latrines any longer.

“Over the past 30 years, a certain mentality has developed, where people know that it’s quite possible somebody else [like a foreign agency] will give them toilets,” Petit explained.

Rather than giving out free toilets and latrines, DINEPA hopes to set up a 120-million-dollar fund that will allow families to borrow the money necessary to do their own construction.

Anti-cholera plan up a creek?

But many aspects of the cholera elimination plan are on hold. Haiti requires 2.2 billion dollars, and a plan for the neighbouring Dominican Republic needs an additional 77 million dollars. For the years 2013 and 2014 alone, Haiti needs 443.7 million dollars.

The World Bank, PAHO and UNICEF recently promised 29 million dollars, and U.N. agencies just offered another 2.5 million dollars. But, as of May 31, the pledges remain around 210 million dollars, less than half of what is needed.

“[The U.N.] has decreased the amount of money they initially pledged and it has yet to actually be disbursed,” said Dr. Rattan. “This is crippling the Haitian government’s ability to implement their life-saving cholera elimination plan.”

In Cité Soleil, Michelène Milfort knows very well that there will be no plan implemented any time soon. She lives in a tent. Her camp has 38 deteriorating temporary shelters, tents and shacks and only three SOIL latrines to take care of their needs. Before SOIL’s help, they used a nearby empty lot.

John Abniel Poliné is a neighbour.

“Some people have no regular place to take care of their needs. Sometimes a person has to use a little plastic bag, that he then throws into a canal,” he admitted. “It is not always the fault of the individual. You need to understand that if the person had a place to go, he would not be forced to that extreme.”

Poliné said he wonders about the priorities of the Haitian government and of international actors, especially MINUSTAH.

“They just keep giving MINUSTAH thousands of dollars, while the people of Cité Soleil live in subhuman conditions,” he said.

MINUSTAH’s 2012-2013 budget is 638 million dollars, over 200 million more than what is needed by the Haiti and the Dominican Republic for the first two years of their cholera elimination plans.

Haiti Grassroots Watch is a partnership of AlterPresse, the Society of the Animation of Social Communication (SAKS), the Network of Women Community Radio Broadcasters (REFRAKA), community radio stations from the Association of Haitian Community Media and students from the Journalism Laboratory at the State University of Haiti.

Residents of Saint Marc, in the Artibonite region of Haiti, wear masks to protect themselves against cholera. Credit: UN Photo/Sophia Paris

By Thalif Deen
UNITED NATIONS, Feb 22 2013 (IPS)

The United Nations has come under heavy political fire for its decision to deny compensation for thousands of victims of cholera in Haiti – a deadly disease spread by U.N. peacekeepers in the troubled Caribbean nation.

“The decision is really outrageous,” Michael Ratner of the Centre for Constitutional Rights, told IPS.

“Can it be where we live in a world where people under the U.N.s authority can cause a major epidemic and the U.N. claims its sympathetic, but will not lift a finger to compensate people of its wrongs?” he asked.If this were a private corporation that could be sued in a U.S. court, there is little doubt that it would end up paying hundreds of millions, if not billions in damages.

Ratner said the U.N.’s claims were the very definition of crocodile tears.

“When it comes to Haitians, it seems that no one cares. I believe that the secretary general (Ban Ki-moon) could have lifted any claimed immunity of the United Nations or its officials, but apparently he chose not to.”

Justice here is now delayed, “but ultimately I believe the Haitian people will prevail,” said Ratner, who also teaches international human rights litigation at Columbia University.

The United Nations could also face legal action internationally – perhaps going as far as the International Court of Justice (ICJ) in the Hague – despite its legal immunity as a protective shield.

Asked if the dispute could go to the ICJ, Mark Weisbrot, co-director of the Washington-based Center for Economic and Policy Research (CEPR), told IPS, “Well, that is another possibility.”

But it has to be kept in mind, he pointed out, that the United Nations is not just an independent actor here.

“Its actions in Haiti, like its deployment to Haiti, are determined by the United States and its allies in this situation (since there isn’t any group of nations opposing them),” he said. So, the responsibility is really with the “international community” who brought these troops to Haiti.

“If they wanted to clean up the mess they made, they could do it. And they will, if there is enough political pressure,” he added.

The ICJ, which is a judicial organ of the United Nations, primarily resolves disputes between and among U.N. member states.

On Thursday, U.N. spokesman Martin Nesirky told reporters that the representatives of cholera victims have been advised that their “claims are not receivable pursuant to Section 29 of the Convention on the Privileges and Immunities.”

Under this Section, the United Nations is required to make provisions for “appropriate modes of settlement” of private law disputes to which the world body is a party, or disputes involving a U.N. official who enjoys diplomatic immunity.

Nesirky also said he was not in a position to provide any details.

“It’s not the United Nations’ practice to discuss in public the details of, and the response to, claims filed against the organisation,” he told reporters.

The spread of cholera in Haiti, which has killed more than 7,500 and infected over 500,000 people since October 2010, has been sourced to the Nepali contingent of peacekeepers with the 9,500-strong U.N. Stabilisation Mission in Haiti (MINUSTAH).

Ban conveyed the U.N. decision to Haitian President Michel Martelly early this week.

The families of the next of kin sought a minimum of about 100,000 dollars for each Haitian killed in the cholera epidemic.

Last December, the United Nations launched a two-billion-dollar humanitarian appeal to fight the epidemic.

Phyllis Bennis, director of the New Internationalism Project at the Institute for Policy Studies and author of several books on the United Nations, told IPS, “The apparently unprecedented effort to hold the U.N. institutionally accountable for the consequences of its negligence should focus on holding accountable the powerful countries – in Haiti.”

She singled out France and the United States – “whose decisions determine U.N. actions, as well as the entire list of wealthy countries who pledge funds to support peacekeeping activities, but who routinely fail to meet their promised amounts”.

Weisbrot told IPS the United Nations is not supposed to be immune from this legal action under their own rules but they are pretending to be. This is not unprecedented, he said, in that U.N. troops have committed abuse in other countries without being held accountable for it.

“One thing that is perhaps unprecedented here is that the U.N. troops don’t really have a legitimate reason for being in Haiti in the first place,” he added.

Weisbrot said there was no peacekeeping agreement for them to help enforce, or post-conflict situation.

“They were brought to Haiti in 2004 to support a coup that was engineered by the United States and its allies, against a democratic government. So that is unprecedented,” he said.

Weisbrot also said the scientific and forensic evidence that U.N. troops brought cholera to Haiti is far beyond the standard of reasonable doubt required in the U.S. criminal justice system, let alone the less exacting standard of preponderance of the evidence in a civil suit.

He said it included studies by independent scientists, articles published by the New England Journal of Medicine, the U.S. Centers for Disease Control and Prevention, and even the U.N.’s own research.

“If this were a private corporation that could be sued in a U.S. court, there is little doubt that it would end up paying hundreds of millions, if not billions in damages,” he said.

The U.N.’s denial, he said, represents a failure not only of the U.N. system, which is abused by the rich countries, but a moral failure by the U.S. and its allies, who sent those troops to Haiti without proper safeguards and against the will of the Haitian people.

Bennis said the tragedy of the cholera outbreak in Haiti reflects two separate trajectories, both of which are rooted in international power imbalances.

Haiti’s endemic poverty results from a centuries-old legacy of colonialism, slavery, U.S.-backed dictatorship, and most recently a ruthless profit-driven globalisation that has left its people impoverished and the country without a sufficient infrastructure even to provide clean water and sewage treatment.

“The failures of the U.N.’s peacekeeping system are rooted in the dominance of major powers over UN operations, in which rich countries make the decisions while poor countries provide the troops – usually without adequate preparation, training, or, as we saw in Haiti, even decent facilities,” said Bennis, author of ‘Calling the Shots: How Washington Dominates Today’s UN’.

An infected child resting on the floor of the Doin medical centre near Saint Marc, a town in the Artibonite Region, where UNICEF has worked to contain the cholera outbreak. Credit: UN Photo/UNICEF/Marco Dormino

By Ethan Freedman
WASHINGTON, Jul 20 2012 (IPS)

U.S. legislators are appealing to the United Nations to take a greater role in addressing Haiti’s cholera outbreak, now in its third year and which has has left thousands dead.

In a letter addressed to U.S. Permanent Representative to the United Nations Susan Rice, 104 U.S. members of Congress urged Rice to help step up U.N. concern over the outbreak.

“It is imperative for the U.N. to now act decisively to control the cholera epidemic,” Representative John Conyers, Jr. wrote. “A failure to act will not only lead to countless more deaths … and will pose a permanent public health threat.”

The cholera outbreak has been linked in analyses to Nepali peacekeepers stationed in Haiti in 2010. A 2011 study by the New England Journal of Medicine concluded that the cholera strand introduced into Haiti — Vibrio cholerae — matched a strain that was found in a South Asian source identified in 2002 and 2008.

The 2010 outbreak was the first time that a case of cholera was reported in Haiti for nearly a century, according to the U.S. Centres for Disease Control and Prevention.

In March, former president Bill Clinton, now a U.N. special envoy to Haiti, stated that a U.N. peacekeeper was the “proximate cause” of the outbreak.

The U.N. offered no formal comment to IPS regarding the outbreak.

The letter from U.S. representatives was welcomed by the Haiti rights group Institute for Justice & Democracy in Haiti (IJDH), based in Boston, Massachusetts. The group is currently suing the U.N. on behalf of 5,000 cholera victms, for up to 100,000 dollars per death, and 50,000 per infected person.

“Congress’ call to action reflects a growing consensus that the U.N. has a moral and legal responsibility to address Haiti’s cholera epidemic, and that it must do so urgently before more lives are lost,” Brian Concannon Jr., director of the IJDH, said in a statement.

The U.N. has never accepted full responsibility for the outbreak, however, finding in a 2011 report that a “confluence of circumstances” caused the outbreak and that the epidemic was “not the fault of, or deliberate action of, a group or individual”.

According to some, the continued denial can be put down to the U.N. trying to save face. “It’s an embarrassment for them,” Daniel Beeton, director of international communications at the Center for Economic and Policy Research, a progressive think tank based here, told IPS. “It’s the opposite of their mission.”

According to the Pan American Health Organisation (PAHO), an arm of the World Health Organisation (WHO), more than 7,000 people have died from cholera in Haiti since the start of the outbreak in 2010.

Jon Kim Andrus, deputy director of PAHO, said that in addition to the death tolls, the Haitian government had reported a total of more than 520,000 cases of cholera.

The influx of cholera in Haiti has had adverse effects on the country beyond just health concerns, according to the WHO.

“In addition to human suffering caused by cholera, cholera outbreaks cause panic, disrupt the social and economic structure and can impede development in the affected communities,” the WHO has said.

The WHO cites the experience of Peru, which experienced a cholera outbreak in 1991. It ultimately cost the country 770 million dollars due to “food trade embargoes and adverse effects on tourism”.

Cholera, which induces diarrhea and vomiting in the victim that potentially lead to extreme dehydration, is impacting an economy that already has an unemployment rate of 40 percent, according to the Central Intelligence Agency World Factbook.

In response to the outbreak and humanitarian crises in Haiti, the U.N. requested 864 million dollars for stabalisation efforts, in 2010. The current budget for the U.N. Stabilization Mission in Haiti (MINUSTAH) is 793 million dollars.

According to the U.S. Agency for International Development (USAID), the government has already distributed more than 73 million dollars in aid to Haiti in response to the cholera outbreak.

Cholera has also been spreading across the Caribbean. Cuba now has 170 confirmed cases of the disease, though it has not yet been definitively linked to the outbreak in Haiti. However, the Cuban Health Ministry has said that the last reported outbreak of cholera in the country, before this year, was shortly after the 1959 Cuban Revolution.

Haiti has had additional problems previously with U.N. peacekeepers, notably over claims of sexual assault and excessive violence.

In March, the U.N. discharged three members of the Pakistani Formed Police Unit, who were serving with MINUSTAH, after they were accused of sexually assaulting a 14 year-old boy.

U.N. peacekeeping troops were also accused of pinning down and sexually assaulting an 18-year-old Haitian man in 2011, an event that was reportedly captured on a cell phone video.