The United Nations announces its latest response to the cholera epidemic brought to Haiti by its soldiers

December 12, 2012

Yesterday at the United Nations in New York City was the launch of "The Secretary-General’s Initiative for the Elimination of Cholera in Haiti." You can watch the 20-minute announcement on UN Web TV, consisting of remarks by UN Secretary-General Ban Ki-Moon, Haiti Prime Minister Laurent Lamothe and Minister of Health of the Dominican Republic Lorenzo Wilfredo Hidalgo. Watch the broadcast here (there is silence until the three-minute mark of the broadcast). Enclosed below is the UN press release on the announcement.

The Secretary-General said that $215 million in funding pledges from donor countries and agencies is pledged to the Initiative. He also announced that Dr. Paul Farmer has accepted to serve as the Special Advisor to the Secretary-General on cholera treatment and prevention.
No mention of the United Nations MINUSTAH military mission in Haiti as being the source of the cholera epidemic was made throughout the formal proceedings, nor was there any mention of the legal action against the UN demanding compensation for the victims of cholera and a rapid program to build clean water infrastructure throughout the country. Little specific mention was made aboout the Haitian and international agencies that have been heroically battling the cholera epidemic over the past fourteen months, excepting a brief mention by the minister of health of the DR regarding Cuba's medical brigade in Haiti. The Secretary General spoke more of cholera vaccine than of clean water supply and sanitation systems in the fight against cholera.
Prime Minister Lamothe spoke for four minutes. He gave thanks to governments and agencies in Haiti assisting with cholera treatment. He said that his government has a two-year plan to fight cholera that it estimates to cost "about $600 million." He said that the $215 million pledged by the Secretary-General plus another $23 million from an existing commitment is the financial head start of his government's cholera plan. "We have to work together to bridge the remaining gap," he said.

A statement by the Pan-American Health Organization on January 12, 2012, the two-year anniversary of the Haiti earthquake, said that improvements to sanitation and clean water supply in Haiti and the Dominican republic were "absolutely essential." It estimated those costs as "$746 million to $1.1 billion," citing as sources the Inter-American Development Bank, Office of the Haitian Primer Minister and World Bank.
A PAHO statement on June 29, 2012 announced, "Representatives of international and civil society organizations today agreed to promote major investments in water and sanitation infrastructure in Haiti and the Dominican Republic as the long-term solution to the cholera epidemic in those countries." No details nor fund amounts were reported.
The prime minister said that his government's policy of encouraging foreign investment in factory investment is a key to improving Haiti's social and public health conditions. A cholera prevention program, he said, will be an important "job creation" program.
At the end of the 20-minute ceremony, it was announced that Nigel Fisher would speak to media in a separate room. There is apparently no webcast of this proceeding. See the enclosed news report on this media exchange, the next item below.
If you have not already done so, please sign the international petition on Avaaz, initiated by film director Oliver Stone and others, urging the UN Secretary-General to respond to Haitian calls, including legal action, for a robust program of cholera treatment and prevention and compensation for the victims of the epidemic. Read and sign the petition here.
--CHIP website editors


UN Launches $2.27 Billion Cholera Plan For Haiti, Dominican Republic But Needs Funds

By Alexandra Olson, Huffington Post, Tuesday, Dec. 11, 2012

UNITED NATIONS -- U.N. Secretary-General Ban Ki-moon announced a $2.27 billion initiative Tuesday to help eradicate cholera in Haiti and the Dominican Republic, vowing to work aggressively to secure donations for the ambitious but still mostly unfunded 10-year plan.

Cholera has killed at least 7,759 people in Haiti since the outbreak started in October 2010, likely brought to the country by a unit of U.N. peacekeepers from Nepal. More than 420 have died in the Dominican Republic, which shares the island of Hispaniola with Haiti.

Ban said bilateral and multilateral donors have so far given $215 million and the U.N. has committed another $23.5 million for the initiative, which will mostly focus on improving clean water and sanitation infrastructure. But Ban said Haiti alone will need $500 million over the next two years to implement its national cholera plan.

Ban promised to "use every opportunity" in the next months to advocate for more funding for the plan.

"We know the elimination of cholera is possible. Science tells us it can be done," Ban said. "It can and will happen in Haiti."

Paul Farmer, the U.N. deputy special envoy for Haiti, has been appointed as the secretary-general's special adviser for the cholera initiative. The U.N. will be working with Farmer in the coming months to seek contributions from governments, multilateral organizations, the private sector and individual philanthropists, said Nigel Fisher, the humanitarian coordinator for the U.N. peacekeeping mission in Haiti.

The Dominican Republic will require $70 million over 10 years to implement its cholera eradication plan. Fisher said the country will invest heavily from its own national budget, although it, too, needs resources.

"But Haiti is much more constrained financially, and you've heard that significant funding is urgently needed," he said.

Fisher said 70 percent of the $2.2 billion for the Haiti initiative will go toward developing water and sanitation infrastructure. The rest will go to other projects including delivering vaccines to high-risk areas such as densely populated urban neighborhoods and isolated rural districts.

Sanitation access in Haiti is the worst in the Western Hemisphere. About half the people in the country of 10 million have no bathroom at all.

Fisher would not comment on whether the U.N. peacekeeping mission is to blame for bringing cholera to Haiti. Scientific studies have suggested that U.N. peacekeepers from Nepal inadvertently introduced the disease, and protests erupted in Haiti amid reports of sanitation problems at a base that was housing the troops.

That issue "is with the legal office and as a staff member I am not authorized to say anything about the legal process at this time," Fisher said. "My focus is on today, as it has been since the outbreak, and is on making sure that Haitians stay alive."

Mirta Roses Periago, the director of the Pan American Health Organization, said it is not necessarily advisable to screen every peacekeeper for diseases before they are deployed. But she said PAHO has advised the secretary-general "to have special provisions for people coming from endemic areas and being sure that there is no outbreak going on at the time that people are being deployed."

She stressed that the main problem is poor sanitation and water infrastructure that helps spread the disease. She noted that about 100 cases of cholera are imported to the United States each year without causing an epidemic.

The U.N. has already spent $118 million on responding to the cholera epidemic in Haiti. Fisher credited international and local efforts for a drop in death and infection rates this year. He said 850 people have died from cholera in the country this year.


UN launches new initiative to eliminate cholera in Haiti and Dominican Republic

UN News Center, December 11, 2012

11 December 2012 – The United Nations today announced a new initiative to help eliminate cholera in Haiti and the Dominican Republic, the two nations that make up the Caribbean island of Hispaniola.

“The new initiative will invest in prevention, treatment, and education – it will take a holistic approach to tackling the cholera challenge,” said Secretary-General Ban Ki-moon at the initiative’s launch. “The main focus is on the extension of clean drinking water and sanitation systems – but we are also determined to save lives now through the use of an oral cholera vaccine.”

“Because global vaccines are in short supply, we will first target high-risk areas: densely populated urban areas and rural areas far removed from health services,” he added. “As production increases, the vaccine effort will expand its reach.”

Launched at UN Headquarters in New York in the presence of government officials (sic) from the two countries, the new initiative will support an existing campaign – known as the Initiative for the Elimination of Cholera in the Island of Hispaniola – established almost a year ago by the Presidents of Haiti and the Dominican Republic.

Cholera is an acute intestinal infection caused by eating food or drinking water contaminated with the bacterium known as vibrio cholerae. The disease has a short incubation period and produces a toxin that causes continuous watery diarrhoea, a condition that can quickly lead to severe dehydration and death if treatment is not administered promptly.

In his remarks at the launch, the Secretary-General noted that in Haiti the disease has claimed the lives of more than 7,750 people, infected over 620,000, and added more suffering to a country already recovering from a major earthquake in 2010, the largest natural disaster in the history of the western hemisphere.

Ten months after the earthquake, the Caribbean nation experienced a major cholera outbreak.

The United Nations and its partners have been working with the Haitian authorities to respond to the outbreak, with a focus on water and sanitation facilities, as well as on training, logistics and early warning.

“Haiti has seen a dramatic fall in infection and fatality rates. But this will not be a short-term crisis,” Mr. Ban said. “Eliminating cholera from Haiti will continue to require the full cooperation and support of the international community.”

The UN chief said resources will be critical, with Haiti needing almost $500 million over the next two years to carry out its national implementation plan for the disease.

Noting that the relevant humanitarian appeals are less than half-funded, Mr. Ban said he will “use every opportunity” in the months ahead to mobilize more funding.

“Today I am pleased to announce that $215 million in existing funds from bilateral and multilateral donors will be used to support the initiative. I thank the donor community for this generous commitment,” Mr. Ban said. “The United Nations will do its part. We are committing $23.5 million, building on the $118 million the UN system has spent on the cholera response to date.”

He added that the United Nations will also continue to support the Government of Haiti in tracking cholera spending and ensure the effective use of resources.

“Today, as ever, we are in Haiti for one reason alone: to help the Haitian people make their great country all that it can be. We know the elimination of cholera is possible. Science tells us it can be done. It has happened in difficult environments around the world. It can and will happen in Haiti,” the Secretary-General added.

At the launch, the Secretary-General also announced that a world-renowned humanitarian, Dr. Paul Farmer, will serve as his Special Adviser focusing on community-based medicine and on drawing lessons from Haiti that can be applied to other places in need.


International health leaders pledge to work together to eliminate cholera in Haiti and the Dominican Republic

Report by Pan American Health Organization (PAHO), published Oct 17, 2012

Washington, DC  — Marking the fifth annual Global Handwashing Day on October 15, and approaching the second anniversary of the first case of reported cholera in Haiti in 2010, Partners in Health, Veolia Environment Foundation, Zanmi Lasante, and Catholic Relief Services became the newest members of the Regional Coalition on Water and Sanitation for the Elimination of Cholera in the Island of Hispaniola.

The announcement was made during an expert-led symposium co-sponsored by the Center for Strategic International Studies (CSIS) and the Pan American Health Organization (PAHO) to discuss the ambitious efforts of the Coalition.

The Coalition was originally launched in June 2012 to bring together technical expertise, raise new funds, and mobilize previously committed pledges to support the governments of Haiti and the Dominican Republic in improving access to water and sanitation. The Coalition evolved from a call to action that the governments of Haiti and the Dominican Republic put forward last January [go to the bottoom of the linked web page]. This call to action was originally supported by a core partnership of PAHO, the Centers for Disease Control and Prevention (CDC), and UNICEF. Efforts since have focused on expanding the partnership, thus resulting in the more formal Coalition of 17 partners.

Experts participating in the symposium described the opportunities presented by regional collaboration on water, sanitation, and hygiene (WASH) activities, and identified opportunities for greater engagement on cholera elimination by the non-government sector.

Since the start of the cholera outbreak nearly two years ago, approximately 600,000 people have fallen ill due to cholera in Haiti with more than 7,500 deaths. The Dominican Republic has reported more than 25,000 cases and approximately 350 deaths from cholera over the same time period.

Individuals in resource-poor areas, like those that exist throughout Haiti, without access to safe drinking water, proper sanitation, and hygiene constitute the majority of cholera cases. Drinking unsafe, cholera-infected water or eating contaminated food heighten the spread of the disease, leaving entire communities vulnerable to acute diarrheal disease, undernutrition and other related diseases.

WASH infrastructure and behavior change are the foundation for preventing illness and death associated with cholera. For example, simple handwashing with soap can reduce diarrheal disease by 45 percent. The application of culturally appropriate and economically feasible technologies is also fundamental for long-term success.

Dr. Jon Andrus, Deputy Director of PAHO, stated, “Today, we have a unique opportunity to expand the Regional Coalition by reaching out more extensively to the private sector and NGOs. This work is a priority and is grounded in the overarching strategy of safe water and sanitation for all the citizens of Haiti and the Dominican Republic. By implementing this strategy, water and sanitation as basic human rights will finally be accessible to everyone.”

Dr. Jordan Tappero, Director of Health Systems Reconstruction Office at CDC, noted that a long term strategy is needed to expand the number of sanitary workers, especially to check and recheck the sources of water. “Few countries have declining access on WASH services as Haiti,” he said, “and the earthquake only made things worse.”

Kathleen Krackenberger, Senior Health and Human Resource Policy Advisor at the World Bank talked about their work on capacity building for the Ministry of Health of Haiti. She said that to enhance water and sanitation in the country was a key priority for the World Bank and also a way to create opportunities. “Building capacity is something we need to do all the time—not only for water and sanitation, but in every area,” she added.

The coalition’s other members are PAHO/WHO, UNICEF, the Centers for Disease Control and Prevention (CDC), the Spanish Agency for International Development Cooperation (AECID), the Inter-American Development Bank (IDB), Brazil’s National Health Foundation (FUNASA), the Association of Haitian Medical Physicians Abroad, the Inter-American Association of Sanitary and Environmental Engineering (AIDIS), the World Bank, the Caribbean Community (CARICOM), the International Federation of Red Cross and Red Crescent Societies, and WASH Advocates.

Information on the Regional Coalition:

Media Contacts:
* PAHO/WHO: Leticia Linn, This e-mail address is being protected from spambots. You need JavaScript enabled to view it, Tel. + 202 974 3440, Mobile +1 202 701 4005,
* WASH Advocates: Cecilia Snyder, This e-mail address is being protected from spambots. You need JavaScript enabled to view it, Tel +1 202 293 4003,
* CSIS: Julia Nagel, This e-mail address is being protected from spambots. You need JavaScript enabled to view it, +1 202 775 3215,


Haiti: UN urges investing in water and sanitation services to combat cholera

By UN News Service, January 11, 2012

11 January 2012 – Dramatic improvements in water and sanitation services are needed to eliminate cholera in Haiti and the Dominican Republic, health experts who took part in a United Nations-organized briefing to outline concrete steps to stem the spread of the disease in the region said today.

The event, organized by the UN World Health Organization’s (WHO) regional arm, the Pan-American Health Organization (PAHO), urged governments and international organizations to boost investment in the infrastructure and institutional capacity required to provide water and sanitation in areas affected by the disease.

Cholera is an acute intestinal infection caused by eating food or drinking water contaminated with the bacterium known as vibrio cholerae. The disease has a short incubation period and produces a toxin that causes continuous watery diarrhoea, a condition that can quickly lead to severe dehydration and death if treatment is not administered promptly. Vomiting also occurs in most patients.

On the eve of the second anniversary of the terrible earthquake that devastated our country, marked progress has been made toward reconstruction, but much remains to be done.

While cholera no longer poses a threat to countries with high standards of hygiene, it remains a challenge in countries with limited access to safe drinking water and adequate sanitation.

PAHO Director Mirta Roses discussed the misconceptions surrounding the provision of water and sanitation, mainly that it is seen as expensive, and emphasized that the costs of not investing in these services is much higher as evidenced by the thousands of people who have died in Haiti since the cholera outbreak in October 2010, ten months after it was hit by a devastating earthquake.

Ms. Roses stressed that the right to water and sanitation is an essential human right, making it crucial for governments to strive to provide these services in every sector of society.

Ms. Roses also underscored the importance of water and sanitation as a pre-requisite for sustainable development and economic growth in any country, and warned that ignoring this would leave countries “extremely vulnerable.”

“As we fight with climate change and the scarcity of water, it is even more important to be responsible but also to be equitable in the distribution of this precious resource,” Ms. Roses said, adding that partnerships are also essential to fight the disease as countries shift from cholera control to cholera elimination.

Kevin De Cock, Director of the United States Centers for Disease Control and Prevention’s (CDC) Center for Global Health, echoed Ms. Roses remarks, stressing the role of the infrastructure in preventing the spread of cholera.

He warned that even though fatality rates have decreased because of effective treatment, “there are still 100 to 200 cholera cases daily in Haiti, and we expect surges with the onset of the rainy season.”

Mr. De Cock said that for Haiti to meet the Millennium Development Goals (MDGs), the global development targets with a 2015 deadline, some 250,000 households will need improved water sources, and another 938,000 will require access to improved sanitation.

The Chief of Water Sanitation for the UN Children’s Fund (UNICEF), Sanjay Wijesekera, argued that in addition to investing in infrastructure, an effective strategy that takes into account the various forms of transmissions is needed, as well as education to encourage behavioural change in communities.

Haitian President Michel Joseph Martelly joined the event via video link and reiterated his Government’s commitment to tackle the disease. “On the eve of the second anniversary of the terrible earthquake that devastated our country, marked progress has been made toward reconstruction, but much remains to be done,” he said.

“Safe drinking water and adequate sanitary facilities are the right of every Haitian. Only a joint, comprehensive strategic approach can help us eliminate cholera, which has stricken half a million Haitians and killed thousands.”

The President of the Dominican Republic Leonel Fernández stressed his Government’s willingness to collaborate with Haiti through vaccination programmes and control strategies.