The U.N. cholera panel builds case against U.N. blue helmets, then clears them

On Wednesday evening, Ban Ki-moon‘s office abruptly released a long-awaited report by an independent medical panel the U.N. chief had commissioned to "investigate and seek to determine the source of the 2010 cholera outbreak in Haiti." The four-member team, headed by Dr. Alejandro Cravioto, head of the International Center for Diarrhoeal Disease Research in Dhaka, Bangladesh, never really fulfills that mandate.

Instead it concluded that the forces contributing to the spread of a disease-poor sanitation and a dysfunctional health care system — were so varied as to make it impossible to identify a specific culprit. "The independent panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances as described above, and was not the fault of, or deliberate action of, a group or individual," according to the panel’s report.

But the reports’ underlying findings appear unlikely to do much to allay Haitian suspicions that the deadly epidemic that killed 4,500 Haitians and sickened more than 300,000 was delivered to Haiti’s doorstep by a contingent of U.N. blue helmets from Nepal. On the contrary, the report adds to the existing evidence suggesting that U.N. peacekeepers are among the most likely sources.

Cholera made its first appearance in nearly a century in Haiti last October, and even today, it continues to kill and sicken Haitians. The panel concluded that the disease was introduced into the Haitian population by human activity in the Meye Tributary, a branch of the Artibonite River, and quickly spread throughout the river delta, infecting thousands of Haitians along the way. At the time, Nepalese peacekeepers were stationed at a camp in Mierbalais, along the banks of the Meye, fueling suspicion that the waste of an infected peacekeeper had flowed into the river.

The panel dismissed an earlier study by a French epidemiologist, Renaud Piarroux, who concluded that the cholera outbreak was introduced into Haiti by an infected U.N. soldier, saying he had not provided sufficient evidence to support his case. The panel also noted that U.N. medical records show no evidence that Nepalese peacekeepers had shown signs of illness before or during the outbreak.

But the panel compiled circumstantial evidence pointing at the Nepalese peacekeepers as a possible cause. Genetic analysis reviewed by the panel indicated that the Haitian cholera strain all but certainly originated in South Asia, and possibly came from Nepal.  One set of genetic tests examining mutations in cholera gene samples indicated that "the strains isolated in Haiti and Nepal during 2009 were a perfect match."

The panel also found that the "sanitation conditions" at the U.N. camp in Mierbalais "were not sufficient to prevent contamination of the Meye Tributary System with human fecal waste." The timeline of the cholera’s spread, which struck communities throughout the delta in a matter of days, "is consistent with the epidemiological evidence indicating that the outbreak began in Mirebalais and within two to three days cases were being seen throughout the Artibonite River Delta." In sum, "the evidence overwhelming 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 cholarae as a result of human activity."

Suspicion first fell on the Nepalese contingent, which arrived at Mierbalais between Oct. 8 and Oct. 24, the same period the first cholera deaths were recorded in the region. The troops had just completed three months of training in Kathmandu, Nepal, and a medical exam, though the panel does not say whether they were screened for cholera. The soldiers were then allowed to return to their homes for 10 days before traveling to Haiti. Peacekeepers from other countries, including a contingent of 60 Bangladeshi policemen posted at Mierbalais, were also deployed in the area. "The precise country from where the Haiti isolate of Vibrio cholerae arrived is debatable," the panel stated. But the "initial genetic analysis" indicates similarities with strains found in South Asia, including Nepal.

The panel acknowledges that the outbreak highlights the inherent risk of spreading cholera through the deployment of foreign aid workers and peacekeepers in a crisis zone. And it prescribes a series of measures the U.N. should undertake — including improve sewage treatment in UN camps, cholera screening and the distribution of antibiotics — to prevent the introduction of cholera into a vulnerable trouble spot. But the report provides no discussion of whether the U.N. or the team sought to conduct their own tests of the Nepalese peacekeepers after the outbreak to determine whether any had been infected.

The panel nonetheless decided to give the United Nations, and the Nepalese, the benefit of the doubt. "The introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care deficiencies. These deficiencies, coupled with conducive environmental and epidemiological conditions, allowed the spread of the Vibrio cholerae organism in the environment, from which a large number of people became infected."

In the end, the panel echoed the U.N.’s talking points throughout the cholera crisis: that the battle to end the scourge should take priority over determining how it got there. "The source of cholera in Haiti is no longer relevant to controlling the outbreak," he said. "What are needed at this time are measures to prevent the disease from becoming endemic," the report concluded.

Surely, no one would quibble with that sentiment. But wasn’t the panel’s primary mission to do just that?

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