Updated November 17, 2016
Haiti: Cholera, the United Nations, and Hurricane Matthew
Hurricane Matthew hit Haiti on October 4, 2016, causing
The Spread of Cholera in Haiti
widespread damage and flooding and leaving 1.4 million
MINUSTAH was established in 2004 to help restore and
people in need of immediate assistance. Observers are
maintain order after the collapse of former President Jean-
concerned that the country might experience a surge in
Bertrand Aristide’s government. While providing
cholera reminiscent of the 2010 outbreak that claimed the
emergency assistance following the 2010 earthquake, some
lives of thousands of people. Prior to the 2010 earthquake,
MINUSTAH troops inadvertently introduced cholera into
there had been no cholera cases in Haiti for at least a
Haiti. In 2011, a team of researchers from France and Haiti
century. According to various scientific reports, cholera
investigated and reported that “contamination of the
was introduced into Haiti by peacekeepers in the United
Artibonite [River in Haiti] and 1 of its tributaries
Nations Stabilization Mission in Haiti (MINUSTAH). Since
downstream from a [MINUSTAH] military camp triggered
then, cholera has infected almost 800,000 Haitians and
the epidemic.” The researchers noted “an exact correlation
killed over 9,000. Although the United Nations (U.N.) has
in time and places between the arrival of a Nepalese
taken action to control the 2010 outbreak and subsequent
battalion from an area experiencing a cholera outbreak and
epidemic, numerous groups contend that the agency has not
the appearance of the first cases in [the nearby town of]
responded strongly enough. Thousands of victims and their
Meille a few days after.” Other studies have come to the
families have filed legal claims demanding reparations.
same conclusion. Vulnerability to disasters—due to a lack
of immunity, overcrowded living conditions, environmental
In August 2016, U.N. Secretary-General Ban Ki-Moon said
degradation, poor construction standards, dysfunctional or
that the U.N. has a “moral responsibility” to the epidemic’s
lack of sewage and sanitation systems, and political
victims and announced a new program to support them,
instability in Haiti—has facilitated the rapid spread of the
though the U.N. continues to claim diplomatic immunity. A
disease and led to the largest cholera outbreak in the world.
bipartisan group of 158 Members of Congress sent a letter
In 2010 and 2011, roughly 57% of all global cholera cases
to Secretary of State John Kerry pressing him to urge the
and 45% of all cholera deaths occurred in Haiti.
U.N. to issue an apology to the victims and their families,
set up a fair and transparent process that allows victims to
Efforts to Control Cholera in Haiti
seek remediation, and take immediate actions to address the
In January 2012, the presidents of Haiti and the Dominican
ongoing cholera epidemic in Haiti.
Republic, in cooperation with WHO and the Pan American
Cholera: Basic Facts
Health Organization (PAHO), the United Nations
Children’s Fund, and the U.S. Centers for Disease Control
Cholera is a diarrheal infection that is contracted by
and Prevention, issued the “Call to Action for a Cholera-
ingesting food or water contaminated with the bacterium
Free Hispaniola.” The appeal urged donors both to honor
Vibrio cholerae. The World Health Organization (WHO)
the pledges they made to help Haiti recover from the 2010
estimates that there are up to 4 million annual cholera cases
earthquake and to provide new funds specifically for
worldwide, causing 21,000-143,000 deaths. The disease is
building a sound water supply and sanitation infrastructure
primarily found in countries with inadequate access to clean
to eliminate cholera. In November 2012, the Haitian
water, sanitation, and hygiene (WASH). Cholera is also
government released the National Plan for the Elimination
commonly found in urban slums and camps for internally
of Cholera in Haiti: 2013-2022, which budgeted $2.2 billion
displaced persons or refugees.
for carrying out the call to action. As of August 2016,
donors had contributed 18% of the funds sought and the
About 75% of people who are infected with cholera do not
U.N. reported that it had mobilized $307 million in support
exhibit any symptoms, although infected people can spread
of the national plan. The U.N. has used these funds to
the bacterium for up to two weeks should others ingest food
or water contaminated with their fecal matter. Cholera can
vaccinate over 400,000 people against cholera;
cause acute diarrhea and vomiting, which can lead to severe
build 5,500 household toilets;
dehydration and death within hours if not immediately
treated. People with suppressed immune conditions, such as
improve WASH in over 80 health centers and establish
malnourished children and HIV-positive individuals, are
nearly 700 water and chlorination points;
more likely to die from cholera. Common treatments
establish some 250 cholera treatment centers;
include oral rehydration salts and antibiotics. Cholera
construct wastewater treatment plants and build sanitary
vaccines provide protection for three years-five years.
facilities in more than 200 schools;
Long-term prevention of the disease requires the
establishment of clean water systems, wastewater treatment
supply more than 9 million cholera prevention and
plants, and sanitary facilities.
treatment items, including water purification tablets,
soap, and medical supplies and equipment; and
establish a global stockpile of oral cholera vaccines.
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Haiti: Cholera, the United Nations, and Hurricane Matthew
Despite its limitations, the Haitian government has led
Human rights groups contend that Haitian and international
cholera prevention and control efforts, with a particular
law guarantees a victim’s right to an effective remedy.
focus on people displaced by the 2010 earthquake, and
Several U.N. human rights experts have said an
continues to lead coordination and implementation efforts.
independent and impartial mechanism to review claims and
These initiatives have led to dramatic declines in related
ensure adequate reparation is essential. In August 2016, the
cases (Figure 1).
U.N. Special Rapporteur on Extreme Poverty and Human
Rights called the U.N.’s approach “morally unconscionable,
Figure 1. Cholera Cases in Haiti: 2010-2016
legally indefensible, and politically self-defeating.”
In August 2016, Secretary-General Ban reiterated the
U.N.’s immunity but said the U.N. is developing a plan to
intensify efforts to treat and eliminate cholera, improve
long-term access to clean water and sanitation, and provide
about $200 million in compensation to Haitian cholera
victims. The program is neither finalized nor funded.
Source: Created by CRS from PAHO/WHO, Epidemiological Update:
Current Situation
Cholera, October 18, 2016.
Persistent lapses in access to sanitation and clean water
Notes: Cholera cases in 2016 are through September 17, 2016, and
threaten efforts to eliminate cholera in Haiti, and Hurricane
exclude suspected cases in the aftermath of Hurricane Matthew.
Matthew has caused further setbacks. Haiti had made some
progress in improving access to sanitation, but access to
Hurricane Matthew’s Impact on Spread of Cholera
clean water has declined. In 1990, only 18% of Haitians had
The first category-4 hurricane to hit the country since 1964,
access to sanitation facilities; by 2015, 28% had such
Matthew caused flooding and destroyed water systems,
access. Access to clean water fell from roughly 62% in
creating conditions for the further spread of cholera. WHO
1990 to 58% in 2015. Gaps between rural and urban use of
and PAHO report that 5,840 suspected cholera cases
sanitation facilities and improved water also strain cholera
occurred from October 4 through November 6, 2016.
efforts; whereas 34% of urbanites were using improved
Roughly one week after Hurricane Matthew hit, the U.N.
sanitation in 2015, only 19% of the rural population was
issued a $119 million appeal for Haiti, including $9 million
doing so. Similarly, 65% of urbanites had access to clean
for health services and $15 million for WASH. As of
water in 2015, whereas only 48% of rural dwellers were
October 20, 2016, roughly 22% of that appeal had been
using clean water.
funded. The Haitian Ministry of Health is also partnering
The loss of international support for cholera control has
with WHO/PAHO to vaccinate over 820,000 people against
also compromised related efforts. Following the 2010
cholera. The vaccination campaign began November 8,
earthquake, hundreds of international actors arrived in Haiti
2016. The U.S. government has provided more than $48
to provide emergency assistance. The groups began to
million for Hurricane Matthew response efforts, including
leave, however, as funding fell. In 2011, 120 groups were
those aimed at controlling cholera.
conducting cholera control efforts and had partnered with
Dispute over U.N. Response
the Haitian government and U.N. agencies to establish 250
MINUSTAH operates under a Status of Forces Agreement,
cholera treatment centers (CTCs). As of June 2016, only 30
which provides broad immunity from prosecution. To
organizations were working on cholera elimination and as
counterbalance that immunity, however, the agreement
of October 28, 2016, only 67 CTCs were open.
requires the U.N. to establish an independent Standing
The Haitian government has been unable to fill the resulting
Claims Commission to hear claims and compensate victims
gaps. Lacking adequate funds to pay salaries for health and
injured by U.N. actions. The U.N. has not established such
sanitation workers, the government has closed cholera
a commission.
treatment centers and reduced the number of staff available
Human rights groups therefore filed claims directly to the
to carry out cholera surveillance, treatment, and community
U.N. in 2011 on behalf of 5,000 cholera victims demanding
awareness campaigns, as well as to provide care in health
that the U.N. compensate them for their losses, install a
facilities and cholera treatment centers. Budget shortfalls
national water and sanitation system, and publicly
also have prohibited the Haitian government from covering
apologize for its role in the outbreak. In 2013, after the
the operational costs of newly built sewage treatment
U.N. had rejected the claims and rebuffed additional efforts
plants, leaving all but one plant inoperable. Funding
to resolve the matter out of court, the groups filed a lawsuit
constraints have limited the Haitian government’s capacity
in U.S. federal court seeking damages for personal injury,
to protect the water and sanitation systems from illicit use.
wrongful death, loss of use of property and natural
The longtime lack of a fully functioning government has
resources, and breach of contract. In 2014, the U.S.
exacerbated these challenges, as well.
government filed a statement claiming that the U.N. has
immunity. In 2015, a federal court judge ruled in favor of
Maureen Taft-Morales, Specialist in Latin American
the U.N. and dismissed the case for lack of subject matter
Affairs
jurisdiction. In August 2016, an appeals court upheld U.N.
Tiaji Salaam-Blyther, Specialist in Global Health
immunity.
IF10502
Critics from outside of and within the U.N. have called for
the organization to take responsibility for the epidemic.
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Haiti: Cholera, the United Nations, and Hurricane Matthew
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