Haiti"s deadly cholera outbreak "a stain on our reputation", UN says

The cholera outbreak that killed more than 9,000 Haitians after it was spread by peacekeepers has been a stain on the UN’s reputation, the world body admitted on Thursday, as it set out long-awaited plans for eliminating the disease from the country.

The announcement of the strategy – unveiled as the UN’s outgoing secretary general, Ban Ki-moon, bids to leave a global health legacy – was overshadowed by question marks about its funding and disappointment in some quarters at what was perceived as a failure to offer an unqualified apology.

The world body had doggedly refused to address the issue of how its own peacekeepers, relocated from Nepal to Haiti in 2010 following a major earthquake, brought the deadly cholera bacterium with them.

A first tacit admission of blame came in August, but the UN’s “explicit and unqualified denial of anything other than a moral responsibility” was subsequently branded a disgrace by its own human rights special rapporteur.

A strategy unveiled on Thursday by the UN focuses on long-term issues including water, sanitation and health systems, as well as the development of a package of material assistance and support to those Haitians most directly affected by cholera.

“The people of Haiti deserve this tangible expression of our respect and solidarity, as well as our regret, and the genuine support that comes with it,” said the organisation.

“The United Nations should seize this opportunity to address this tragedy which has also negatively affected its reputation and global mission.”

The UN endeavours to deploy “responsible peace operations that operate at minimum risk to people, societies and ecosystems”, said the statement, which described the cholera outbreak as “a stain on our reputation”.

In a reference to the simmering levels of anger directed towards the UN by many in Haiti, the statement conceded: “The package is not likely to fully satisfy all those who have been calling for such a step, nor will it happen overnight. However, the secretary general has concluded that it is better to take this step than not to.”

Ban, the document said, “wishes to propose a solution, not leave an unresolved problem, for his successor”.

However, a lack of finance may inhibit the delivery of the package. The announcement conceded that efforts to tackle the outbreak have been undermined by insufficient funding.

Brian Concannon, executive director of the Institute for Justice and Democracy in Haiti, a partnership of Haitian and US human rights advocates, said the initial wording of the announcement marked “a refreshing change from six years of ignoring victims’ voices and the UN’s clear legal obligations to them”.

But he noted that the use of the phrase “moral responsibility” was the same language that the UN secretary general used during his trip to Haiti in July 2014, and appeared to be calculated to address the concerns of UN lawyers more than those of the people of Haiti.

“Haitians are looking for a less qualified apology – for both introducing cholera and for the six years of denial of responsibility, which was an insult to Haitian dignity,” said Concannon.

Stéphane Dujarric, a spokesman for the secretary general, said that the new approach went to the root of the problem with long-term investments in sanitation facilities and by “putting people and communities affected by cholera at the heart of our efforts”.

Haiti"s deadly cholera outbreak "a stain on our reputation", UN says

UN"s own expert calls its actions over Haiti cholera outbreak "a disgrace"

The United Nations’ refusal to accept responsibility for the devastating cholera outbreak that has claimed more than 9,000 lives in Haiti has been branded a “disgrace” by the organisation’s own human rights special rapporteur.

Human rights groups working with victims had reacted with jubilation earlier this year following the UN’s first tacit admission that it was to blame for the outbreak after doggedly refusing to address how its peacekeepers brought the disease to Haiti in 2010.

However, in a scathing report (pdf) to the UN general assembly, the organisation’s special rapporteur on extreme poverty and human rights, Philip Alston, said that flawed and unfounded legal advice provided by the UN lawyers was preventing it from accepting responsibility for the outbreak.

“The UN’s explicit and unqualified denial of anything other than a moral responsibility is a disgrace,” Alston said. “If the United Nations bluntly refuses to hold itself accountable for human rights violations, it makes a mockery of its efforts to hold governments and others to account.”

Alston accused the UN’s Office of Legal Affairs (OLA) for coming up with a “patently artificial and wholly unfounded legal pretence for insisting that the organisation must not take legal responsibility for what it has done”.

The criticism comes as the administration of the outgoing UN secretary general, Ban Ki-moon, is moving to provide compensation for the first time to victims of the outbreak. The UN plans to make cash payments from a proposed $ 400m (£328m) cholera response package, the New York Times reported.

Alston added that the OLA’s approach “has been cloaked in secrecy: there has been no satisfactory official explanation of the policy, no public attempt to justify it, and no known assessment of its consequences for future cases. This goes directly against the principles of accountability, transparency and the rule of law that the UN itself promotes globally.”

Peacekeepers who were relocated from Nepal to Haiti in 2010 in the wake of a major earthquake imported the deadly cholera bacterium with them. Studies have found that the UN troops could have been screened for the illness, and the disaster averted, for as little as $ 2,000.

Alston said the UN’s legal position appears to be largely explained by the approach of the US, the main contributor to the UN’s peacekeeping budget.
“Despite numerous requests to do so, the United States itself has never publicly stated its legal position on the responsibility of the UN for causing cholera in Haiti,” he added.

“Instead, it seems to have pressed the UN to adopt the position frequently taken by lawyers in the US that responsibility should never be accepted voluntarily, since it could complicate future litigation. But this rationale is completely inapplicable to the UN, which enjoys absolute immunity from suit in national courts and whose reputation depends almost entirely on being seen to act with integrity.”

The special rapporteur said that the current stance of the UN’s lawyers ensures that it would never admit its responsibility for introducing cholera. “And avoiding legal responsibility hinders the UN from learning lessons and making sure that the fatal mistakes made in Haiti are not repeated elsewhere.”

Ban’s office said in a statement earlier this year that the organisation had decided to step up its efforts to fight cholera in one of the world’s poorest countries. A reference to the UN’s “involvement in the initial outbreak” was greeted as a breakthrough by groups working with cholera victims.

Ban appeared to have been bounced into making a clearer recognition of responsibility than ever before by the advent of a draft report by Alston into how the UN handled the crisis. Alston had also been one of five experts working for the UN who earlier this year wrote a heavily critical letter to Ban in which the secretary general’s resistance to accepting any responsibility was torn apart.

UN"s own expert calls its actions over Haiti cholera outbreak "a disgrace"

Hurricane Matthew: Haiti needs vaccines to stop deadly cholera spreading | Dr Anita Zaidi and Helen Matzger

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9,000 people died in Haiti’s last cholera outbreak. We must act fast in disaster-affected hotspots to help prevent history repeating itself

Six years ago, as the country attempted to rebuild following a massive earthquake, cholera began spreading in Haiti. And it didn’t stop.

Adults and children – many of whom contracted cholera by drinking untreated water from familiar rivers and streams – lay listless in hospitals packed to capacity with emergency cases. The death toll mounted. The months passed. The cases continued. Stories of pregnant women and tough little girls and boys struggling to survive became the norm and were well recorded by partners on the ground, who were bearing witness to what is now considered the worst cholera outbreak in recent history.

Related: Hurricane Matthew: preparations and aftermath – in pictures

Related: UN makes first public admission of blame for Haiti cholera outbreak

Continue reading…

Hurricane Matthew: Haiti needs vaccines to stop deadly cholera spreading | Dr Anita Zaidi and Helen Matzger

Cholera vaccine: the rapid-correct to the South Sudan outbreak?

Vaccinations could be the solution to cholera outbreaks in unsanitary conditions such as refugee camps. Photograph: Ashraf Shazly/AFP/Getty Images

With news of the worsening cholera crisis in South Sudan – reported by WHO to have killed 62 people and affected 2,400 more – and an anticipated outbreak in Syrian refugee camps in northern Iraq, the need for a robust international response grows. Such a situation reveals the tension between advocates for vaccines and those pressing for action on sanitation.

Cholera is a form of acute watery diarrhoea, which spreads from person to person through food and water contaminated with the bacterium vibrio cholerae. It is a miserable condition involving massive fluid loss and dehydration and left untreated can quickly lead to death. Cholera is common in places with poor water and sanitation – WHO estimates 3 to 5 million cases and up to 120,000 cholera deaths globally each year – but it’s when large epidemics occur that cholera grabs the world’s attention. The disease is highly contagious and rapidly acting, so outbreaks can be explosive.

The need for a multi-tool and integrated approach to prevention and control is widely acknowledged, but new evidence for the effectiveness of vaccines is pushing the debate toward their more widespread use, especially during outbreaks.

A new study about an outbreak in Guinea shows that two doses of the oral cholera vaccine Shanchol were able to protect people by 86%. In their vaccination strategy, Médicin Sans Frontières (MSF) and the Guinean ministry of health were able to administer over 300,000 doses of the vaccine in two rounds to the affected coastal districts, covering 75% of the population, reducing transmission of cholera and containing the outbreak. The authors of the study say that this vaccine provides protection quickly and should be used to control future outbreaks.

Shanchol was reported to be safe and efficacious in a larger trial in Kolkata with long-term results, and it is cheap: two doses cost about $ 3, or about one-third the price of the only other WHO-pre-qualified vaccine Dukoral, which has a shorter length of protection and is mostly geared toward travellers.

Both Dukoral and Shanchol require refrigeration, which is impossible in many settings, and with the more expensive product a large amount of clean water is needed for mixing the vaccine before consumption – again, unavailable in the impoverished environments where cholera is endemic or where outbreaks occurs.

Two weeks ago it was announced that another Indian firm is developing a cheaper powder form of the cholera vaccine that may require only one dose, no refrigeration, and just $ 1 to purchase. The non-profit biotechnology company Hilleman Laboratories, backed by Merck & Co and the Wellcome Trust, says it is starting clinical trials next year.

But issues around vaccine delivery, their feasibility and acceptability to communities, as well as cost concerns will continue to plague the vaccine approach to cholera. Critics have questioned whether the extensive resources required to develop, manufacture, purchase and deploy vaccines across affected populations would be better spent on basic water and sanitation infrastructure. Robust water and sewage systems are what prevents cholera from being an issue in developed countries. Indeed, even though WHO began last year stockpiling Shanchol for emergencies, it advises the use of simple oral rehydration solution as the first line approach to cholera, which is both cheap and widely available, or antibiotics for more severe diarrhoeal cases. The vaccine has not been regarded as a key public health tool.

During the cholera outbreak after the 2010 Haiti earthquake attempts for a vaccine campaign by the medical charity Partners in Health were spurned by the local government and public health officials concerned with costs and unconvinced by the vaccine’s effectiveness. Other NGOs working in the field feared that attention and resources directed toward a vaccine campaign that could cover just a fraction of the population would deflect from the need to provide clean water and permanent sanitation infrastructure.

After all, access to clean water and sanitation (which 2.5 billion people lack – half the developing world) is a precondition for improvements in most if not all other areas of health and development: poverty, hunger, gender-based violence and education to name a few. Any attention to water and sanitation in the cholera context, then, will bring wider and necessary benefits to populations.

Undeniably the key to controlling cholera is clean water, sanitation, and hygiene. The challenge is to press for attention to these more basic needs even as new research strengthens the case for implementing cholera vaccination programmes to prevent, treat, and eliminate this deadly disease.

Dr Jocalyn Clark is executive editor at International Centre for Diarrheal Disease Research. Follow @jocalynclark on Twitter.

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Cholera vaccine: the rapid-correct to the South Sudan outbreak?

UN chief methods up fight against Haiti cholera epidemic

UN chief Ban Ki-moon leaves a home he visited throughout a journey to the cholera-afflicted rural village of Los Palmas in Haiti. Photograph: Marie Arago/Reuters

The UN secretary common has flown to Haiti on a “essential pilgrimage” to help the fight against cholera, a condition that many Haitians blame UN peacekeepers for introducing to the Caribbean country.

Ban Ki-moon is looking for assistance for a $ 2.2bn, ten-yr cholera elimination campaign that he launched in December 2012 with the presidents of Haiti and the neighbouring Dominican Republic.

“I know that the epidemic has brought on significantly anger and dread. I know that the illness continues to have an effect on an unacceptable quantity of people,” he informed parishioners at a church support in Los Palmas. “My wife and I have come right here to grieve with you. As a father and grandfather, and as a mom and grandmother, we feel incredible anguish at the discomfort you have had to endure.”

The UN has not accepted accountability for the cholera epidemic that has killed eight,500 people and contaminated much more than 700,000 considering that October 2010, regardless of proof that suggests it was brought to Haiti by Nepalese peacekeepers stationed near a significant river.

Ban’s check out was criticised by some in Haiti who mentioned the UN should accept duty for introducing the ailment and supply compensation to families. “It is an insult to all Haitians for the secretary standard to come to Haiti for a photo possibility when he refuses to take obligation for the 1000′s of Haitians killed and the hundreds of 1000′s sickened by the UN cholera epidemic,” mentioned Mario Joseph, a Haitian human rights lawyer.

Cholera, which had not been documented in Haiti in almost a hundred years prior to the outbreak, is an infection that leads to significant diarrhoea that can lead to dehydration and death, and is triggered by poor sanitation.

Donors had been slow to react to the initial cholera elimination campaign, Ban advised the Miami Herald newspaper, including that the UN had struggled to raise an initial $ 400m essential in the very first two many years.

Attorneys have filed three lawsuits towards the UN seeking compensation for Haitian victims of the epidemic. The Nepalese troops were stationed near a tributary of the Artibonite river and discharged raw sewage that carried a strain of cholera, sparking the outbreak, the lawsuit explained.

An independent panel appointed by Ban to examine the epidemic issued a report in 2011 that did not figure out conclusively how the cholera was launched to Haiti. The US Centres for Illness Management and Prevention said proof strongly recommended UN peacekeepers from Nepal were the supply.

Some senior UN officials, which includes the human rights chief Navi Pillay, have said Haiti’s cholera victims need to be compensated.

Together with Haiti’s prime minister, Laurent Lamothe, Ban also launched a sanitation campaign, noting that one in two Haitians lack entry to satisfactory sanitation systems.

The scheme seeks to train folks to build latrines, as effectively as installing water filter methods in colleges, well being centres and markets. The UN and the World Financial institution are targeting 55 communities worst affected by cholera, covering three.8 million individuals inside the up coming five years.

UN chief methods up fight against Haiti cholera epidemic

South Sudan capital faces worsening cholera outbreak

Overall health officials are setting up new therapy centres in Juba, South Sudan, to deal with conditions connected to contaminated water and poor sanitation. Photograph: David Mwangi/Reuters

Overall health officials are warning that a cholera outbreak in South Sudan’s capital, Juba, which has left 23 folks dead and forced far more than 670 others to look for remedy, could be receiving worse. Laboratory exams have confirmed that at least 1 man or woman residing in a Juba displacement camp has contracted cholera and there are fears the ailment could spread quickly inside the crowded site.

Officials are setting up new treatment method centres across the city and treating the water sources they feel are accountable for spreading the illness, but said they anticipate at least one,000 much more people might need to have to be hospitalised prior to the outbreak ends – and that is only if cholera does not spread to other places of the nation.

Wellness minister Riek Gai Kok officially announced the cholera outbreak almost two weeks in the past – the initial in South Sudan given that 2009 – and pledged “as the government, as a nation [we] will assistance any efforts created to have this ailment”.

The outbreak was not unexpected. The Planet Wellness Organisation’s (WHO) Abdinasir Abubakar said the ministry and wellness partners had presently began preparing for the physical appearance of cholera and other communicable diseases “simply because of the context. Because we had a great deal of population motion and that population motion usually brings some overall health troubles.”

Displacement brings condition

5-and-a-half months of fighting in South Sudan has forced far more than a million men and women to flee their houses – and the situation continues to deteriorate. Despite a renewed cessation of hostilities agreement signed virtually three weeks in the past by President Salva Kiir and opposition leader Riek Machar, fighting has continued. The UN reports an additional 70,000 individuals have been displaced considering that then, some into areas with no clean water or ample latrines.

When the outbreak was announced, UN companies and partners began focusing on some of the most significant water, sanitation and hygiene (Wash) concerns – both in the displaced populations and amongst lengthy-term Juba residents.

Much of the water individuals use for drinking and cooking is collected from the Nile and delivered by tanker truck. Unicef’s Wash chief Lillian Ukwiri stated efforts are becoming produced to track down every truck and make sure every single shipment is chlorinated, some thing that ought to destroy cholera bacteria.

The UN has also place out radio advertisements instructing individuals to boil water for at least 10 minutes before consuming it or cooking with it, and to wash their hands regularly. The messages also inspire folks to report to a healthcentre as quickly as they demonstrate any signs and symptoms, which includes watery diarrhoea or vomiting, because the ailment can destroy swiftly.

When the outbreak was announced, Juba Teaching hospital set up an emergency isolation ward. It filled swiftly, with sufferers sleeping in open-air corridors that have been covered with tarpaulins. Trina Helderman, from Medair, a humanitarian group supplying emergency companies in the country, has been stationed at the ward given that it opened. She told IRIN that initially they were seeing a lot more than a hundred individuals a day, however the intake has slowed.

“It would seem that the cases are going down, but based on what the specialists have told us, it could be that the peak comes back up yet again,” she explained. “We’re just waiting to see how issues play out.”

Helderman explained the messaging does seem to be functioning, with many individuals arriving as soon as they exhibit any symptoms, which can make it simpler to deal with them. They get both oral rehydration salts to change fluid lost in diarrhoea or vomiting or – in severe instances – an intravenous drip.

But some individuals are nonetheless not generating it to the overall health centres in time. Samuel Moro’s family members stated they recognised the signs and symptoms of cholera right away, but very first attempted to deal with the condition with a homemade rehydration remedy of sugar and salt. His problem worsened in excess of the subsequent 48 hours. By the time he arrived at the isolation ward, it was as well late. He died a number of hours later on.

His brother, Kagwa Apolo, told IRIN Moro’s family members was mindful of the outbreak and had heard the messages encouraging them to look for remedy, but “we were hoping we could deal with him at residence. Individuals left him to stay at residence for a prolonged time”.

Surveillance and treatment centres

WHO’s Abubakar said the outbreak’s fatality fee is even now also large. To bring it down, he explained they necessary to boost the surveillance teams so they could much more quickly identify people in need to have of treatment, like Moro. They also essential a lot more cholera treatment centres (CTCs). Médecins Sans Frontières (MSF) opened a clinic final week in one particular of the hardest-hit locations of the city and Abubakar explained health officials are taking into consideration opening two extra centres in the coming weeks.

People are not the only shortages. Abubakar said simply because the outbreak has been worse than officials at first anticipated, it has forced them to revise the anticipated number of people displaying signs of cholera from 5,000 to ten,000, two% of the population. Two thousand individuals are anticipated to be hospitalised.

“We need to have to go back to our arranging and carry much more supplies. We need to carry far more personnel in. We need to have to set up more CTCs. We need to have to train more employees and we require to expand the response.” And that was just before MSF reported this week that the condition had officially entered one of Juba’s two displacement camps.

When the fighting started in mid-December, 1000′s of individuals crowded into the UN Mission in South Sudan’s two bases in the capital. More than 14,000 individuals are nevertheless living in every single of the camps, which do not have ample latrines or other basic sanitation facilities.

Sefan Liljegren, MSF’s area coordinator, advised IRIN there was a single laboratory-confirmed case at the UN property camp on the outskirts of Juba and 7 other sufferers who showed symptoms of cholera.

Because of their circumstances, health officials presently viewed the camps as substantial-danger regions for a cholera outbreak. Earlier this year they provided two doses of oral cholera vaccines to much more than 96% of the individuals residing in the camp in an work to mitigate the impact of a feasible outbreak.

But Liljegren said the vaccine offers only 65% coverage, which implies there is still the potential for 1000′s of individuals to grow to be sick. MSF has presently set up CTCs in each of the camps.

“The advantage in the camp is that the population is aware,” he explained. “They have a extremely shut entry to the CTC, so hopefully they will be in a position to entry remedy really quickly, and as a result, also be discharged very quickly.”

Abubakar explained they are also waiting for reviews from three other regions of the country exactly where prospective instances have been reported and acknowledged. “Our estimation is the cholera outbreak might spread outside Juba.” Even without any confirmation, the government has encouraged state officials to commence rolling out public awareness campaigns and getting ready folks for the possibility that the outbreak could spread.

South Sudan capital faces worsening cholera outbreak