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Updated November 17, 2016
Haiti: Cholera, the United Nations, and Hurricane Matthew
Hurricane Matthew hit Haiti on October 4, 2016, causing
widespread damage and flooding and leaving 1.4 million
people in need of immediate assistance. Observers are
concerned that the country might experience a surge in
cholera reminiscent of the 2010 outbreak that claimed the
lives of thousands of people. Prior to the 2010 earthquake,
there had been no cholera cases in Haiti for at least a
century. According to various scientific reports, cholera
was introduced into Haiti by peacekeepers in the United
Nations Stabilization Mission in Haiti (MINUSTAH). Since
then, cholera has infected almost 800,000 Haitians and
killed over 9,000. Although the United Nations (U.N.) has
taken action to control the 2010 outbreak and subsequent
epidemic, numerous groups contend that the agency has not
responded strongly enough. Thousands of victims and their
families have filed legal claims demanding reparations.
In August 2016, U.N. Secretary-General Ban Ki-Moon said
that the U.N. has a moral responsibility to the epidemic's
victims and announced a new program to support them,
though the U.N. continues to claim diplomatic immunity. A
bipartisan group of 158 Members of Congress sent a letter
to Secretary of State John Kerry pressing him to urge the
U.N. to issue an apology to the victims and their families,
set up a fair and transparent process that allows victims to
seek remediation, and take immediate actions to address the
ongoing cholera epidemic in Haiti.
Cholera is a diarrheal infection that is contracted by
ingesting food or water contaminated with the bacterium
Vibrio cholerae. The World Health Organization (WHO)
estimates that there are up to 4 million annual cholera cases
worldwide, causing 21,000-143,000 deaths. The disease is
primarily found in countries with inadequate access to clean
water, sanitation, and hygiene (WASH). Cholera is also
commonly found in urban slums and camps for internally
displaced persons or refugees.
About 75% of people who are infected with cholera do not
exhibit any symptoms, although infected people can spread
the bacterium for up to two weeks should others ingest food
or water contaminated with their fecal matter. Cholera can
cause acute diarrhea and vomiting, which can lead to severe
dehydration and death within hours if not immediately
treated. People with suppressed immune conditions, such as
malnourished children and HIV-positive individuals, are
more likely to die from cholera. Common treatments
include oral rehydration salts and antibiotics. Cholera
vaccines provide protection for three years-five years.
Long-term prevention of the disease requires the
establishment of clean water systems, wastewater treatment
plants, and sanitary facilities.
MINUSTAH was established in 2004 to help restore and
maintain order after the collapse of former President Jean-
Bertrand Aristide's government. While providing
emergency assistance following the 2010 earthquake, some
MINUSTAH troops inadvertently introduced cholera into
Haiti. In 2011, a team of researchers from France and Haiti
investigated and reported that contamination of the
Artibonite [River in Haiti] and 1 of its tributaries
downstream from a [MINUSTAH] military camp triggered
the epidemic. The researchers noted an exact correlation
in time and places between the arrival of a Nepalese
battalion from an area experiencing a cholera outbreak and
the appearance of the first cases in [the nearby town of]
Meille a few days after. Other studies have come to the
same conclusion. Vulnerability to disasters-due to a lack
of immunity, overcrowded living conditions, environmental
degradation, poor construction standards, dysfunctional or
lack of sewage and sanitation systems, and political
instability in Haiti-has facilitated the rapid spread of the
disease and led to the largest cholera outbreak in the world.
In 2010 and 2011, roughly 57% of all global cholera cases
and 45% of all cholera deaths occurred in Haiti.
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In January 2012, the presidents of Haiti and the Dominican
Republic, in cooperation with WHO and the Pan American
Health Organization (PAHO), the United Nations
Children's Fund, and the U.S. Centers for Disease Control
and Prevention, issued the Call to Action for a Cholera-
Free Hispaniola. The appeal urged donors both to honor
the pledges they made to help Haiti recover from the 2010
earthquake and to provide new funds specifically for
building a sound water supply and sanitation infrastructure
to eliminate cholera. In November 2012, the Haitian
government released the National Plan for the Elimination
of Cholera in Haiti: 2013-2022, which budgeted $2.2 billion
for carrying out the call to action. As of August 2016,
donors had contributed 18% of the funds sought and the
U.N. reported that it had mobilized $307 million in support
of the national plan. The U.N. has used these funds to
* vaccinate over 400,000 people against cholera;
* build 5,500 household toilets;
* improve WASH in over 80 health centers and establish
nearly 700 water and chlorination points;
* establish some 250 cholera treatment centers;
* construct wastewater treatment plants and build sanitary
facilities in more than 200 schools;
* supply more than 9 million cholera prevention and
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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