Think-Piece Commentary by Professor Rosa Freedman (University of Reading) and Dr Nicolas Lemay-Hebert (University of Birmingham)
In December 2016 the United Nations apologised for the cholera epidemic in Haiti that has killed at least 10,000 and sickened nearly 1 million people since 2010. That apology came after many years of silence from the UN, and was coupled with a promise to prevent future deaths and suffering and to remedy those that had occurred. Former UN Secretary-General Ban Ki-Moon acknowledged that the UN bears a duty towards the victims, which was a significant step forward in the quest for accountability and justice. However, since then, the UN has done nothing to deliver on its promises, especially its promises to consult with and remedy the victims.
If Haiti had to deal with numerous problems over the years, one of the few problems that Haiti had not contended with in its recorded history was cholera. Since 2004, the UN has fielded a peacekeeping mission in Haiti (MINUSTAH) to assist with the stabilisation and the rebuilding of the country. Some of those peacekeepers brought cholera with them. The UN did not screen its peacekeepers for cholera, and it also did not build adequate toilet facilities in its peacekeeping camps. As a result, raw faecal waste carrying cholera flowed directly into a stream that runs into a tributary that feeds Haiti’s main river, the Artibonite. Given that vast numbers of the population rely on this river for washing, cooking, cleaning and drinking, cholera quickly spread throughout many parts of the country.
Since the outbreak the UN has failed to contain and eradicate cholera, and the disease is now pervasive. People continue to be sickened and killed at an alarming rate by this preventable and treatable disease. The UN has also failed to provide a mechanism through which victims can seek treatment. Although, peacekeeping missions are legally bound to set up claims commissions for victims of civil wrongs, MINUSTAH has refused to do so for cholera victims. Instead, after years of pressure through a class action lawsuit and related advocacy campaigns, the UN has pledged to provide remedies through a UN-led, ‘victim-centred approach’.
In September 2016 the UN appointed a Task Force, led by David Nabarro and Ross Mountain, to advise on a new approach to cholera in Haiti. Despite initial recommendations for prevention and remedies adopted in December 2016, that Task Force now seems to have backtracked and is focusing solely on development aid and group projects. The New UN Plan includes both a commitment to consult with victims, and a preference for collective reparations. While containing and eradicating cholera is key, the types of remedies being presented are neither appropriate nor just in the circumstances. The UN is proposing to build health centres and schools, or provide other collective remedies, which may be worthwhile but will not provide the means to put victims back in the position they were in before cholera swept across the countryside killing and sickening almost one tenth of Haiti’s population. What is fast-becoming apparent is that any consultations with victims will only take place after the UN has determined what those remedies will look like, and those determinations are based more on development aid and political considerations than on what victims need.
In March 2017 we, academics who have researched and published extensively on this area over the past 4 years, travelled to Haiti in order to observe the current victim outreach work undertaken by the public interest lawyers who have represented the cholera victims since 2011. Those lawyers, the Bureau des Avocats Internationaux, adopt an approach of capacity-building and awareness-raising at the grassroots level in order to empower victims to use their voices and mobilise for their rights. That work is supported by efforts in New York (where the UN headquarters is based) to make victim’s voices heard by those who sit at the UN’s decision-making tables. Alongside the lawsuit filed against the UN in New York courts, Bureau des Avocats Internationaux has ensured that the UN receives letters by cholera victims and stories of their suffering. That work has empowered the victims and has placed significant pressure on the UN and its member states.
The purpose of our visit was to meet with Bureau des Avocats Internationaux and the cholera victims they represent in order to gather testimony about their views on the UN consulting with them about the remedies that ought to be provided. Those meetings took place in the countryside around Mirebalais where cholera first broke out and where some of the most affected communities are located. At each location, members of nearby localities were invited to training sessions to facilitate the creation of Victims’ Representative Committees. Those representatives will receive further training in advance of the UN consulting with the communities, in the hope that such consultations will take place. The training sessions were geared towards providing victims with information about the UN’s pledges as well as bringing people together to discuss their priorities and enabling them to participate meaningfully in a future consultation process.
The sessions took place in communal buildings such as a church or a school, and were attended by anyone who was willing and able to travel many miles on foot or mototaxi, and who was sufficiently seized of the issue to do so. Each session began with a video screening of Ban Ki-moon’s apology to the cholera victims. Discussions initially focused on what that apology means to the victims. The apology has been well received by most individuals, with many insisting however on the importance of Ban Ki-moon recognizing that the UN had acted wrongly and acknowledging that ‘apologies do not cure diseases’. And from there discussions focused on what would be required to remedy the harms caused by the cholera outbreak.
In the large group, and then again in smaller group formats, victims stood up and explained whether and why they would prefer collective or individual remedies from the UN. Community projects, such as health centres and schools, might help to address the causes of why cholera spread so quickly and why it had such devastating impacts. But victims time and again emphasised that projects in Haiti start and are not finished for many years: ‘By the time the health centre is built, all of the cholera victims will have died’ said more than one participant. Some believed that corruption in the State, at national and local levels, means that collective remedies will benefit those who did not suffer from cholera:
‘Why should the state be given the money when they will keep it for themselves and we who suffered will never see any benefit from it.’
And even those who do want collective projects emphasised that such projects are not adequate remedies for the specific harms suffered as a result of cholera and that the State has an obligation to provide basic services:
‘Yes, we are hungry. Yes, we are poor. Yes, we need schools and health centres and help for our old people. But those are our rights that the State has to provide. The State says it will give us free education, but we still have to pay for schools. The State says it will build us hospitals, but we still do not have any. The State needs to do these things, not the UN. What we need from the UN is to give us back the money that we had to spend when we got sick.’
Drilling down into the question of what individual remedies would look like, it swiftly became clear that people simply wanted back the money they spent to take family members to hospital, to pay for medicines, or to bury the dead. When cholera broke out people literally died in droves on the sides of roads whilst trying to get to hospital. Mototaxis and taxis charged exorbitant fees, not knowing whether taking a victim to hospital would result in the driver becoming sick or dying. In the most rural areas people were put onto horses or planks of wood and carried for many miles to try to reach a road where they could pay someone to drive the sick person to hospital. People talked of selling land or goats, or borrowing money from neighbours, and the impact that has six years later:
‘I just want to buy back my land so that I can have enough money to pay for my children to go to school.’
‘We just want to be put back on the path, to be given back the money we spent with our fingers.’
‘I buried two children and the money will not bring them back, but it is money that the UN should pay and not me.’
The mantra repeated by international policy makers is that UN does not want to consult with these people affected by cholera, not until it knows whether its members will donate money to pay for remedies. And states do not want to donate money until they know what it will be used for and what remedies the UN will provide. As previously mentioned, the New UN Plan includes both a commitment to consult with victims, and a preference for collective reparations. In our meetings, the victims clearly expressed the willingness to meet with and talk to UN officials, but also expressed a strong preference for individual reparations. It is clear that waiting indefinitely to organise consultations with the victims is not a solution; the UN needs to organise these meetings, and hear the victims’ voices as soon as possible.
In our meetings with victims, doubts regarding the collective approach appeared clearly. For many individuals, collective projects are not always followed through (by international non-governmental organisations or by the government). These projects also tend to favour those who are already in position to benefit from them, including through the staffing of the projects once completed (professors of schools; health workers in clinics). The individuals we have met expressed the feeling that these projects will tend to exclude those who are not in position to benefit from these projects, including the population living remotely in the countryside. There are also real risks that the money aimed at these collective projects will be diverted to other use, including for personal gains. Finally, collective projects do not target specifically those who have been affected by the illness, and who are currently struggling to make ends meet. Individual compensation would enable financial support to be targeted to specific individuals who have suffered and continue to suffer emotionally and economically from the consequences of the illness.
The Haiti cholera epidemic remains a blight on the reputation of the UN and its peacekeeping missions. On the basis of our meetings with victims, we argue that the situation will only improve when a resolution package is fully developed and implemented. Whatever form a material assistance package takes, there must be victim involvement in the process. The package must be victim-centred and ensure that justice is done and is seen to be done.