Cholera is an infection of the small intestine caused by ingesting food or water contaminated with the bacterium Vibrio cholerae, which can be deadly. The bacteria can easily spread through water and to humans, especially in places with poor sanitation and lack of clean drinking water. A new article in The Lancet Regional Health - Americas, co-authored by Queen’s global health researcher Susan Bartels (Emergency Medicine) and Sandra Wisner, senior staff attorney with the Institute for Justice & Democracy in Haiti, raises awareness of the cholera epidemic in Haiti caused by United Nations peacekeepers.

The peacekeeping mission inadvertently introduced cholera into Haiti's most extensive water source in October 2010, after sewage leaked from a UN camp housing cholera-infected peacekeepers. Since 2010, confirmed cholera infections have claimed around 10,000 lives and infected over 820,000 people in the country.

In 2016, after the UN acknowledged its part in spreading cholera in Haiti, it promised financial assistance for improved water and sanitation infrastructure and assistance for families affected by cholera. These promises have largely gone unfulfilled, especially the assistance for families. What concerns Dr. Bartels is that the UN will be able to declare Haiti cholera-free if there are no new cases of cholera transmission in three years — and the three-year period was reached at end of January 2022. Due to the pandemic, cholera testing decreased in Haiti as health care providers pivoted to focus on COVID-19. This has raised doubts about whether there is truly no cholera transmission in Haiti or whether it is just not being detected with the decreased testing.

Dr. Bartels says the pressing concern is that the UN might disengage even further once the country is declared ‘cholera-free’ and that the support and assistance owed to affected community members will not be provided. Dr. Bartels’ Lancet publication is a call-to-action for the UN to uphold their financial commitments to Haiti.

“We wrote this Lancet article to raise awareness about the fact that Haitian community members affected by cholera are still waiting on the assistance and support promised by the UN. In 2016, when the UN finally acknowledged their role in the cholera epidemic, the organization promised $200 million towards cholera elimination and improved water and sanitation infrastructure, in addition to $200 million towards material assistance for cholera-affected families. For the most part, Haitian community members are yet to receive this support,” Dr. Bartels says.

As well, research has shown that despite the UN's promises to improve water, sanitation, and hygiene, there is an ongoing lack of access to clean water and adequate sanitation in Haiti.

For Dr. Bartels, this work initially began as research into sexual exploitation and abuse perpetrated by UN peacekeepers in Haiti, and quickly expanded to include a focus on cholera. The topic of cholera came up repeatedly in the surveys and discussions with Haitian partner organizations. Since little data about how Haitian community members were affected by the cholera outbreak exists, Dr. Bartels and her team felt it was important to analyze the collected data for advocacy purposes. 

Dr. Bartels began researching cholera in Haiti in 2017, conducting mixed qualitative and quantitative research. This was done in collaboration with three Haitian organizations Komisyon Fanm Viktim pou Viktim, the former Enstiti Travay Sosyal ak Syans Sosyal, and the Institute for Justice and Democracy in Haiti/ Bureau des Avocats Internationaux.

Studies have shown that cholera has had significant socio-economic impacts in Haiti, with a relationship between cholera and household food insecurity.

“The structural violence, including that introduced by foreign intervention in Haiti, needs to be recognized and addressed as it continues to contribute to intergenerational cycles of poverty and oppression,” Dr. Bartels says. “It is important for the UN to provide the remedies promised in 2016. It is equally important, however, to ensure that all Haitian community members have access to clean water and appropriate sanitation.”

For more information, read the article in the Lancet.