Via Foreign Affairs, an excellent (and disturbing) article by Adam Houston: Lessons on Peacekeeping and Public Health from the Haitian Cholera Epidemic. Excerpt:
For centuries, war and disease have gone hand in hand. Smallpox served as vanguard for the Spanish forces in their conquest of the Americas, and yellow fever and typhus finally turned the tide—in Haiti and Russia, respectively—against the strategic genius of Napoleon.
In fact, it wasn’t until World War I that a major conflict saw more soldiers perish on the battlefield than from disease—yet those soldiers’ comrades played a key role in spreading the 1918 flu pandemic, which claimed far more lives worldwide than the war.
Not long after the United Nations was formed in the aftermath of World War II, the world came to the novel conclusion that soldiers could be used not to wage war but to promote peace, resulting in the creation of United Nations Peacekeeping. Although peacekeeping has changed the role of the soldier, however, it has not severed the connection between soldiers and the spread of disease.
The Haitian cholera epidemic, which has resulted in more than 730,000 infections and 8,900 deaths since 2010, originated with UN peacekeepers. This tragedy serves as a warning, as yet largely unheeded, about preventing those sent to help vulnerable populations from becoming a vector for disease.
Until peacekeepers brought Vibrio cholerae to Haiti, the country had not recorded a case of cholera in at least a century. Conclusive scientific proof about the origins of the epidemic—Nepalese peacekeepers stationed at a base in Mirebalais, from which human waste was negligently allowed to enter the rivers that serve as the primary water source for tens of thousands of Haitians—has not spurred the United Nations to take effective action to end the epidemic, compensate the victims, or even simply admit responsibility.
This is despite the fact that the risks of cholera transmission were well known, and that its introduction easily avoidable; effective screening of troops before deployment would have helped, as would have adhering to basic principles of sanitation on the base.
Left with no other options, victims of the epidemic have turned to the courts to enforce their rights; the UN has responded to their claims by declaring itself immune from suit. This litigation thus raises important questions around the boundaries of UN immunity and about the organization’s legitimacy in promoting human rights and the rule of law.
Determining the UN’s obligations to the victims of the cholera epidemic is important. So too, however, is examining how current UN practices leave other vulnerable populations at risk. Despite the scale of the Haitian tragedy, it has spurred surprisingly little action on the part of the UN to prevent such a tragedy from happening again.
UN peacekeeping constitutes a uniquely high-risk activity in this regard. Peacekeepers are dispatched to war-torn areas, where existing health and sanitation infrastructure has frequently been damaged. Once there, they regularly interact with displaced persons and other populations whose circumstances make them particularly vulnerable to disease.
Compounding the risk is the current model of UN peacekeeping, which increasingly relies on large troop contributions from countries which themselves face high burdens of infectious disease. A CDC briefing eight months before the Haitian epidemic highlighted the vulnerability of post-earthquake Haiti to waterborne disease, but noted that cholera importation was unlikely given that “most current travelers to Haiti are relief workers from countries without endemic cholera.” Peacekeepers were almost certainly the single biggest exception to this statement.
Given this potent mix of risk factors, the cholera epidemic in Haiti is not even the worst-case scenario. That distinction would likely go to the spread of drug-resistant malaria. Most current UN peacekeeping missions take place in sub-Saharan Africa, the region that accounts for the vast majority of global malaria morbidity and mortality. The region’s malaria burden has been rolled back in recent years, in large part due to the availability of effective artemisinin-based drugs. Given their importance, it is extremely worrying that artemisinin resistance has emerged in Southeast Asia.