Nepal denies link to Haiti cholera outbreak

<img src="http://www.irinnews.org/images/ (IRIN) – Authorities in Nepal have strongly denied ongoing allegations connecting Nepali UN peacekeeping troops to a 2010 outbreak of cholera in Haiti.

“It is easy to blame the Nepali soldiers as they contribute a lot to UN peacekeeping missions, and they happened to be in Haiti at the right time when the epidemic occurred, but it is dangerous to pinpoint a group of nationals,” said Dr Babu Ram Marasini, Director of the Epidemiology and Disease Control Division of Nepal’s Department of Health Services (DOHS).

The issue resurfaced in October 2013, when lawyers representing families of the victims in Haiti filed a lawsuit in New York against the United Nations, charging the outbreak had been triggered when sewage from infected peacekeepers was discharged into the water system.

Following the devastating 7.0 magnitude earthquake on 12 January 2010 that killed more than 200,000 people, Haiti reported an outbreak of cholera – an acute diarrhoeal disease that can kill within hours if untreated – for the first time in over a century.

According to US Centres for Disease Control and Prevention, the outbreak became the largest cholera epidemic in decades.

From October 2010 to 10 October 2013, the total number of cholera cases reached 682,573, of which 379,870 were hospitalized (55.6 percent) and 8,330 died, the World Health Organization (WHO) reported.

Scientists initially linked the origin of the cholera outbreak to a rise in temperature and salinity in a river in western Haiti. This hypothesis was backed by cholera experts in a a 2012 epidemiology article.

However, reports by international news agencies sparked debate among observers when they suggested the epidemic had links to unsanitary conditions and inconsistent medical exams at a UN peacekeeping military camp, where 1,280 Nepali peacekeeping troops were living at the time.

The blame game

A cholera epidemic in 2010 in Nepal’s Midwest region killed five children and infected 1,400 people, but according to Nepal’s DOHS the epidemic was under control by August. But protestors in Haiti publicly blamed Nepali troops in 2010 for bringing cholera to the island.

The Nepalese Army, which administers the recruitment of Nepali soldiers for UN peacekeeping missions, denied the allegations and insisted their personnel were given regular health checks, especially considering Nepal’s history of diarrhoeal and cholera epidemics. Each soldier is properly vaccinated while serving domestically and when travelling abroad, officials said.

“The UN has already made it clear that our Nepali soldiers had nothing to do with the epidemic, and that is also our official position,” Nepalese Army spokesperson Brig Gen Jagdish Chandra Pokhrel told IRIN.

The UN’s position is in fact not quite so categorical, saying instead that the source of the outbreak cannot be identified with total certainty and that its development into an epidemic was attributable to a range of factors including the poor state of sanitation and health infrastructure.

According to UN’s 2011 Final Report of the Independent Panel of Experts on the Cholera Outbreak in Haiti, “The precise country from where the Haiti isolate of Vibrio cholerae O1 arrived is debatable”, noting, however, preliminary genetic analysis indicate that the strains isolated during the cholera outbreak in Haiti and those circulating in South Asia, including Nepal, at the same time in 2009-2010, are similar.

“This kind of blame game is dangerous because now again the Nepali connection in Haiti’s epidemic is [being] published in media stories across the world,” public health expert Resam Lamichanne from the DOHS said, pointing out that cholera has been successfully controlled in Nepal and there were zero cases in 2013.

International analysis

Nepali health officials strongly deny that the cholera outbreak originated in their country, and note the lack of symptoms among peacekeepers when a Haitian public health team met them at the UN camp in 2010.

But a 2013 report published by the Global Health Justice Partnership at Yale Law School in the US claims the cholera strain in Haiti has been scientifically linked to a single origin in Nepal, and that the troops “inadvertently carried the disease [to Haiti].”

Citing deep anger over the outbreak among the Haitian public, the report calls on the UN to “re-establish its institutional legitimacy” in Haiti by taking concrete steps to apologize publicly, and ensure such outbreaks never occur again.

“The world is not blaming the Nepali peacekeepers,” said Daniele Lantagne, a cholera specialist from the US, who co-authored a report by an independent panel formed by the UN Secretary-General to investigate the source of the 2010 outbreak.

She said the outbreak resulted from a confluence of events, which included someone infected with cholera being in Haiti, the person’s faeces being disposed of inappropriately, and cholera proliferating in the environment, compounded by a lack transmission prevention once the bacteria were in the open. “All four [factors] were required to start the current Haitian outbreak,” Lantagne said.

Public reaction

Four years after the outbreak, people in Nepal are still reacting to the claims against the country’s soldiers.”I live in Kathmandu where we see some cases of cholera, but that doesn’t mean we are all infected with the disease. I think it’s unfair to blame the Nepalis,” said Ranjana Chettri, a medical student at Tribhuvan University Teaching Hospital.

Shiva Yadav, a community health worker at a government health post in Banke District, 500km west of Kathmandu, agreed: “I really feel sorry about the situation in Haiti and we are ready to offer our help because of our own success in controlling the epidemic.”

According to Nepal’s Ministry of Foreign Affairs , the country is the seventh largest provider of peacekeeping troops in the world, with more than 4,000 troops active in 2012.

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– Provided by Integrated Regional Information Networks.

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