A South Asian strain of cholera contaminated a river where Haitians drink, wash, bath and swim, causing an outbreak that killed over 4,000 people in the past year, a UN-appointed panel reported late on Wednesday.
But the four scientific experts refrained from blaming UN peacekeepers, particularly those from Nepal who had been accused of poor sanitation at their base near Mirebalais, the town where the epidemic first began. Instead their report said the outbreak was a result of a "confluence of circumstances."
In one of its few readable sentences, the report stated:
The evidence overwhelmingly supports the conclusion that the source of the Haiti cholera outbreak was due to contamination of the Meye Tributary of the Artibonite River with a pathogenic strain of current South Asian type Vibrio cholerae as a result of human activity.
At the same time, the panel said "genetic typing data on the Nepal strains of Vibrio cholerae" was recently made available to the independent panel from an institute in Korea but said the "genome sequences of the Nepal strains are still in the process of being completed." However, it said the sanitation conditions at the Mirebalais UN peacekeeping camp "were not sufficient to prevent contamination of the Meye Tributary System with human fecal waste."
So if UN Secretary-General Ban Ki-moon, who appointed the panel, expected a "yes" or "no" reply to whether the peacekeepers brought the debilitating disease to Haiti. He did not get it. Neither did Haitians awaiting the report.
Best answerThe United Nations said tests on its troops have proved negative but Ban said that an independent panel was necessary to provide the "best answer science can provide." The UN mission, known as MINUSTAH, went to Haiti in 2004 and was there during the devastating earthquake on January 12, 2010.
Last November protestors stoned a UN patrol and shouted accusations at the peacekeepers.
The rainy season is just beginning in Haiti, boosting the number of cases of cholera, which is waterborne and often spreads through sewage. In the three weeks prior to the rains, the Partners In Health cholera center in Mirebalais, saw 500 cases but the weather doubled this number. "Since the rainy season began in the last two weeks, we've seen 1,000 cases," said David Walton, who runs the center.
Among a list of recommendations from the panel was the need for UN personnel and other emergency responders traveling from cholera endemic areas to "either receive a prophylactic dose of appropriate antibiotics before departure or be screened with a sensitive method to confirm absence of asymptomatic carriage of Vibrio cholerae, or both."
Another was for the UN to treat "fecal waste using on-site systems that inactivate pathogens before disposal. "
Cholera treatment inadequateDespite all the health assistance groups that flooded into Haiti after the earthquake, the report said cholera patients were often treated in poor medical facilities that were unable to stop the spread of the disease to other patients or health workers.
And it said that the Artibonite River's canal system and delta provided "optimal conditions" for spreading cholera in the Caribbean nation already suffering from poor water and sanitation and a lack of immunity to the disease.
The panel, which operated independently from the United Nations, had access to all UN records, reports, facilities and staff, the organization said. The chair is Alejandro Cravioto, a Mexican at the International Center for Diarrhoeal Disease Research in Bangladesh. The other members are Claudio Lanata of the Instituto de Investigacion Nutritional in Peru, Daniele Lantagne of Harvard University and Balakrish Nair of the National Institute of Cholera and Enteric Diseases in India.