A new approach to cholera in Haiti: Report by the Secretary-General (A/71/620)
On 19 August 2016, the Secretary-General announced a new approach by the United Nations to cholera in Haiti. In his accompanying public statement, he indicated that he deeply regrets the terrible suffering the people of Haiti have endured as a result of the cholera epidemic and that the United Nations has a moral responsibility to the victims of the cholera epidemic and to support Haiti in overcoming the epidemic and building sound water, sanitation and health systems. He stressed that eliminating cholera from Haiti will take the full commitment of the Haitian Government and the international community and, crucially, the resources to fulfil this shared duty.
The new approach has two tracks. Track 1 involves intensifying the Organization’s support in order to reduce and ultimately end the transmission of cholera, improve access to care and treatment and address the longer-term issues of water, sanitation and health systems in Haiti. Track 2 involves developing a package that will provide material assistance and support to those Haitians most directly affected by cholera. These efforts must include, as a central focus, the victims of the disease and their families. The Secretary-General urged Member States to demonstrate their solidarity with the people of Haiti by increasing their contributions to eliminate cholera and provide assistance to those affected.
The new approach was rendered more challenging by Hurricane Matthew, which struck Haiti on 4 October 2016, causing immense devastation, loss of life and thousands of new cases of suspected cholera.
The present report provides information on Tracks 1 and 2 of the new approach, identifies challenges in connection with its implementation and sets out a proposed timeline.
The Secretary-General hopes that he can count on the support of Member States.
The United Nations new approach is intended to intensify efforts to eliminate cholera from Haiti and assist and support those most directly affected. Cholera broke out in October 2010, only nine months after an earthquake had devastated the country. The country was ill-prepared to face this additional blow. Only one quarter of the population has access to decent toilets and one half to clean water, making it the country with the poorest water and sanitation infrastructure in the western hemisphere. Cholera has, to date, afflicted nearly 800,000 people and may have caused over 9,000 deaths.1 Concerted international and Haitian efforts since the outbreak have resulted in a drastic reduction in the number of suspected cholera cases and deaths. The overall incidence of the disease has been reduced by approximately 90 per cent since its peak in 2011. However, cholera continues to take a heavy toll on the lives of Haitian people, and Haiti still reports the highest number of cholera cases in the world. The deterioration in the capacity to respond to and treat cholera due to reduced funding, the rainy season and Hurricane Matthew, which destroyed much of the southwest of the country, has contributed to increased risk and an increase in reported cases of suspected cholera.
Over the ensuing years, a variety of initiatives have been undertaken to mobilize the necessary resources and interventions for the elimination of the disease from the country. The Secretary-General has visited Haiti to assess the situation and to demonstrate his solidarity with the people. However, the measures taken were not enough to eliminate the disease, or to prevent a shadow being cast upon the relationship between the Organization and the people of Haiti.
For decades, the United Nations has stood by the Haitian people, supporting them in their quest for democracy, human rights and the strengthening of their institutions and helping to rebuild the nation after the earthquake. Globally, the Organization endeavours to deploy responsible peace operations that operate at minimum risk to people, societies and ecosystems. This is vital to the legitimacy and credibility of the United Nations and its global peace operations. The cholera outbreak became a stain on the Organization’s reputation.
It was for those reasons — for the sake of not only the Haitian people, but also the Organization, and in particular to protect the integrity of its peace operations in the future — that the Secretary-General became convinced of the need to do more. He wishes to propose a solution, not leave an unresolved problem, for his successor. These reasons informed his announcement, on 19 August 2016, of a new approach to cholera in Haiti. The new approach represents an act of good faith and a genuine effort to concretely demonstrate deep regret for the suffering of Haitians as a result of the cholera epidemic. The Secretary-General will elaborate further on this issue when he addresses the General Assembly on 1 December 2016.
The United Nations new approach has two tracks. Track 1 consists of a greatly intensified and better resourced effort to respond to and reduce the incidence of cholera in Haiti. The aim is to address the short- and longer-term issues of water, sanitation and health systems and to significantly improve access to care and treatment. Those steps, in addition to eliminating cholera in the long term, are essential to the achievement of many of the Sustainable Development Goals in Haiti, especially Sustainable Development Goal 6, ensuring availability and sustainable management of water and sanitation for all.
Track 2 is the development of a package of material assistance and support to those Haitians most directly affected by cholera, centred on the victims and their families and communities. Affected individuals and communities will participate in the development of the package. This will inevitably be an imperfect exercise, fraught with practical and moral hazards, and it has been complicated by the impact of Hurricane Matthew. The package is not likely to fully satisfy all those who have been calling for such a step, nor will it happen overnight. However, the Secretary-General has concluded that it is better to take this step than not to. It represents a concrete and sincere expression of the Organization’s regret for the fact that the people of Haiti suffered yet another blow when they had already suffered more than they should have to endure.
Eliminating cholera from Haiti and living up to our moral duty to those who have been most directly affected will require the full commitment of the international community and, crucially, the resources necessary to deliver on both Tracks. Just as peace operations are a collective endeavour by Member States, United Nations entities and partners outside the United Nations, so too is a lasting solution to the problem of cholera in Haiti. This is not an endeavour that the Secretariat or even the United Nations system can shoulder alone. The new approach outlined in the present report has been developed in this spirit.
The people of Haiti deserve this tangible expression of our respect and solidarity, as well as our regret, and the genuine support that comes with it. The United Nations should seize this opportunity to address this tragedy, which has also had a negative effect on its reputation and global mission.
At the strategic level, the Secretary-General has appointed David Nabarro to lead the new approach by the United Nations and Ross Mountain to lead Track 2.