A report by a leading French cholera expert, Dr. Renaud Piarroux, concludes that the outbreak of the disease in Haiti in mid-October originated at a base maintained by the United Nations Stabilization Mission in Haiti (MINUSTAH) near Mirebalais in the Central Plateau. “No other hypothesis could be found,” Piarroux wrote, even though he and his team had looked for “another explanation, even an improbable one, [that] could be advanced to explain the sudden occurrence of this cholera epidemic.”
MINUSTAH is a 13,000-member military and police force that has occupied Haiti since June 2004; it was the target of repeated protests even before the cholera outbreak.
In interviews with Haitian, Cuban and World Health Organization (WHO) medical personnel and with local residents in the most severely affected areas, Piarroux, who heads the mycology and parasitology department at the La Timone hospital in Marseilles, found that the first reported case was in the village of Meillé, near Mirebalais, on Oct. 14. MINUSTAH troops from Nepal, which had been experiencing a cholera epidemic, arrived in the area on Oct. 8 and Oct. 12; their base is located upstream from Meillé on a small tributary of the Artibonite River, a major waterway which traverses central Haiti.
The epidemic spread downstream to Mirebalais by Oct. 16, and then it appeared in a more explosive form on Oct. 19 in the Artibonite delta region near the western coast. From there it has spread to other departments and to the Dominican Republic. The official death toll from the disease in Haiti had reached 2,120 as of Dec. 10.
Cholera is generally transmitted through human excrement, and Meillé residents reported that a “nauseating” black liquid had been flowing into their river from pipes at the base in mid-October. Although there were no problems at the base when he inspected in early November, Piarroux noted that “nothing can exclude the possibility that measures were taken to eliminate the suspect fecal matter and to erase the traces of a cholera epidemic among the soldiers.” He recommended the opening of “a judicial inquiry into the origins and development of the epidemic, for even if the epidemiological inquiry leaves no doubt about what happened, it wasn’t intended to establish the responsibilities of specific parties.”
The French and Haitian governments had asked Piarroux to carry out the investigation, but as of Dec. 10 the report had not been officially released. UN spokesperson Martin Nesirky said in New York on Dec. 7 that the evidence wasn’t conclusive. According to the French daily Le Monde, the UN is concerned about protecting its troops, while “the Haitian government has preferred to suppress the matter so not to embarrass MINUSTAH during an electoral period”–presidential and legislative elections were held on Nov. 28—”which is delicate for the authorities.” (Washington Post, Dec. 8, from AP; Le Monde, France, Dec. 11, Dec. 12)
In a Dec. 7 newspaper column, former Cuban president Fidel Castro wrote that reports from Cuban doctors in Haiti support Piarroux’s conclusions. Cuban medical brigades have been a major force in treating patients since the epidemic started [see Update #1058]. But Castro cautioned against blaming Nepal, a former colony of the United Kingdom, for the situation. Nepalese men “were utilized in [Britain’s] colonial wars, and now they seek employment as soldiers,” he noted. (La Jornada, Mexico, Dec. 8)
A group of researchers wrote in a Dec. 9 article in the New England Journal of Medicine that genome sequences from Vibrio cholerae bacteria pointed to South Asia—which includes Nepal–as the most likely source of the epidemic. They dismissed claims that the current epidemic was caused by the effect of climate changes on dormant local bacteria. “Our data distinguish the Haitian strains from those circulating in Latin America and the US Gulf Coast and thus do not support the hypothesis that the Haitian strain arose from the local aquatic environment…. It is therefore unlikely that climatic events led to the Haitian epidemic, as has been suggested in the case of other cholera epidemics.” (NEJM, Dec. 9)
From Weekly News Update on the Americas, Dec. 12.
See our last post on Haiti.