'In Haiti, we must not repeat public health mistakes of the last decade'

 This Thursday, after a meeting between President Ruto of Kenya and President Biden, Kenya recommitted to deploy a United Nations-authorized police force to Haiti to help quell the gang violence that has brought the Caribbean nation to a standstill. But as contractors build a base to host these Kenyan forces, memories of a painful chapter resurface — the U.N.’s calamitous role in sparking a cholera outbreak in Haiti over a decade ago. 

The images are still searing: U.N. peacekeepers recklessly mismanaged sewage disposal at a base near Mirebalais, Haiti, in 2010, contaminating a major river and inadvertently introducing a cholera strain from Nepal. What followed was one of the world’s worst cholera epidemics in recent history, claiming over 10,000 Haitian lives.  

Over the last decade, as an infectious diseases doctor and public health practitioner, I have witnessed children, the elderly and pregnant women needlessly suffer and die from this ancient scourge, and fought alongside colleagues to implement centuries-old solutions for a disease from which no one should die in the 21^st century.  

The unintended consequences of U.N. intervention in Haiti extend well beyond cholera. Allegations of peacekeeper abuses, from rape and theft to exploitation, further eroded public trust, underscoring how imposed foreign interventions can devastate communities. The U.N.’s lack of accountability and inadequate remediation efforts only compounded the trauma. 

The parallels today are concerning; Kenya itself is combatting a cholera outbreak reminiscent of the Nepalese cholera outbreak that seeded Haiti’s epidemic in 2010, and it is unclear what guardrails have been placed to prevent or address other public health mistakes. To avoid history repeating itself, public health accountability will be paramount. 

First, as Kenya prepares its mission to Haiti, robust preventive measures are critical: Kenyan soldiers must be rigorously tested, provided antibiotics, vaccinated before deployment and provided support to prevent the spread of new strains of cholera and other infectious diseases. Stringent sanitation, waste and environmental protocols with independent monitors are non-negotiable. Mechanisms to prevent and deal with possible human rights abuses akin to those documented during recent military interventions in Haiti should be transparently shared and rigorously enforced. 

But military intervention alone is insufficient. It must be paired with proactively addressing Haiti’s dire public health crises — the lack of clean water, sanitation infrastructure, food security and access to healthcare that enabled the resurgence of cholera and other infectious diseases and allows violence to persist.  

In 2016, the U.N. pledged $400 million to combat cholera. Yet to date this pledge remains largely unfulfilled. President Biden should support rapidly raising and deploying these funds to address ongoing public health crises. Ironically, the U.S. has already pledged $300 million in support of the military force. Lasting peace and stability will remain elusive without investments in basic human needs. 

Transparency and accountability are equally paramount after the U.N.’s prior failures. In 2011, victims of cholera demanded reparations from the United Nations, then filed suit in U.S. courts. These demands were either met with invocations of U.N. immunity or stalled in legal limbo. These events underscore how military interventions that operate with impunity can irreparably shatter public faith.  

As another police force prepares to enter Haiti, there is no better time than now to right these past wrongs. Victims of cholera should be given the reparations they deserve, and independent bodies should be established to monitor and respond immediately to any adverse events that may arise. 

To be sure, stringent standards and comprehensive approaches could delay a rapid response to a security crisis that has brought Haiti to a standstill, critics may argue. But the proposed solutions are well-supported; they have been stymied by international neglect, not infeasibility. More importantly, we should all grapple with the likelihood that a well-intentioned police intervention that does not respond to deep and long-standing grievances may result in worse outcomes than the status quo. 

As a base for yet another foreign intervention in Haiti rises, skepticism abounds whether this one can catalyze meaningful change. But if it has any prospect of succeeding where past efforts foundered, the proposed prevention protocols, holistic public health and human rights strategies, and reparation of past mistakes are truly the bare minimum. After compounding so many humanitarian disasters, the people of this long-beleaguered nation deserve novel solutions, justice and partnership grounded in human rights — not hollow gestures or repeated harms.  

The world is watching closely. 

Wilfredo R. Matias, MD, MPH, is an infectious diseases doctor at Harvard Medical School, a Paul and Daisy Soros Fellow and a Public Voices Fellow of the OpEd Project. His work focuses on responding to epidemic infectious diseases and advancing global health equity. 

https://thehill.com/opinion/4680481-in-helping-haiti-we-must-not-repeat-the-mistakes-of-the-last-decade/