Skip to content

Deadly Strain

How the UN sought to deny its role in Haiti’s cholera epidemic

Earthquakes are short; their aftermaths are long. Within thirty-five seconds on January 12, 2010, a 7.0 magnitude quake laid waste to Haiti’s capital, killed too many people to count, and turned more than a million others out of their homes. Well before the last remains were pulled from the rubble, health workers were preparing for the next catastrophe: an outbreak of waterborne disease. Before the disaster, only about 20 percent of Haitians had daily access to a suitable toilet; in its wake, inadequate sanitation had become a deadly threat. Throughout Port-au-Prince, survivors lived under tents and tarps packed tight in plazas, parks, soccer pitches, and cul-de-sacs. When the rains came, they got soaked, and the ground became mud. Many displaced people avoided the latrines, which were inadequate in number, dangerous after dark, and foul from infrequent de-sludging. Where humans languished, health workers warned, disease could flourish.

But when the first cases of cholera did come, in October, they appeared far away from the quake zone, where life was relatively normal. This detail was vital but often elided. It was easy enough for the rest of the world to associate cholera with Port-au-Prince’s squalid encampments. Others figured cholera was just another incarnation of the country’s cosmic misfortune. The mere idea of Haiti has long carried racist associations with disease.

In fact, there had never been a confirmed case of cholera in Haiti until that point; Haitians and their immune systems were innocent of the bacterium. The strain of the pathogen, Vibrio cholerae, was particularly ravaging. Especially in the early months, the afflicted could perish within hours of their first symptoms. Death was swift, painful, abject. Victims retched water, their feces streamed clear; they would hallucinate from dehydration and then collapse. As quickly as the humanitarian apparatus built new treatment centers, where patients could be rehydrated and, in most cases, revived, the facilities were overwhelmed with patients. Teenagers brought diapers to elders who waited in line for cots and IV feeds—only to return a few days later, having contracted the disease themselves. By mid-November, cholera had spread from the Artibonite Department throughout the country, including the capital’s displacement camps. It had killed at least two thousand people by December. During Thanksgiving week, less than a year after the quake, corpses reappeared in the well-to-do Port-au-Prince neighborhood where I was living at the time. Passersby kept a frightened distance. Haitian workers in Hazmat suits used long hoses to spray the bodies with disinfectant, then loaded the dead onto truck beds.

Earthquake and epidemic were the tentpoles of that annus horribilis, with raging storms and the bungled sham of a presidential election taking up the slack. The country’s nerves were frayed. “Appalling luck,” a UN humanitarian spokesperson remarked, likening cholera to the mysterious forces that had animated the tectonic plates beneath our feet ten months before.

But the true story of cholera’s origin in Haiti was not just a case of bad luck, any more than lead in the drinking water of Flint, Michigan, was a matter of bad luck. As for a causal link to the earthquake—that was obscure at best, on the same notional scale as a butterfly causing a hurricane. The facts are simple, but it took years of struggle to bring them to light and force the most powerful institutions in the world to concede them: cholera was introduced to Haiti by the UN peacekeeping force MINUSTAH. Its negligence allowed its soldiers’ feces to contaminate one of the country’s main waterways. From there, the disease spread quickly, infecting at least 820,000 people and killing almost 10,000. Given poor recordkeeping, especially in the far reaches where people are most vulnerable to the disease, the actual death toll may be several times larger.

Sometimes, as the adage goes, the cover-up is worse than the crime. Having reported on Haiti for many years, including during the earthquake and its aftermath, I believe that the UN’s failure to take responsibility for the cholera epidemic is a tragedy unto itself, global in scale.

Empty Promises

The international human rights system is undergirded by a simple precept: “When there is a violation of rights, there needs to be a remedy,” said Philip Alston, a professor at NYU Law School and former UN Special Rapporteur on Extreme Poverty. The United Nations has never taken legal responsibility for the lives lost due to its recklessness in Haiti, the suffering and want that ensued, or the strain it placed on the country’s health system. Over the years, it has steadfastly refused to compensate the families of the dead or make any form of individual reparation. Repeatedly called to make amends, the UN has insisted that it is immune from all forms of legal process, as provided by the Convention on the Privileges and Immunities of the United Nations (CPIUN). It is a terrible irony—or hypocrisy—that the organization charged with spreading the rule of law in countries like Haiti claims to be above it. At a time when the world is ever more conscious of the need to repair past harms, especially with regard to Haiti, which has been exploited and expropriated like no other country, it’s galling that the UN has squandered the opportunity to lead on reparations.

Immunity was never supposed to mean impunity, or that the MINUSTAH was beyond the law.

The best it ever managed was a “sorry, not sorry.” On December 1, 2016, after a five-year campaign by cholera victims, their lawyers, and advocates, scientists, and media professionals, Secretary-General Ban Ki-moon finally acknowledged that the UN had indeed played a role in the epidemic. But his statement, heavy on the passive voice, was as much legal defense as apology. He did not mention that the UN had introduced cholera to Haiti through its negligence, or that it had attempted to cover it up, stonewalled inquiries, and berated lawyers demanding justice. An accompanying rollout of the UN’s “New Approach” to cholera included, as one of its two tracks, “material assistance and support to those most severely impacted by cholera.” This inelegantly avoided the term “compensation,” in line with the UN’s yearslong refusal to adopt any language that might suggest a legal duty. Contributions to the $400 million United Nations Haiti Cholera Response Multi-Partner Trust Fund were deemed voluntary, rather than mandatory—“assessed,” in the parlance—as they are for administration, peacekeeping, and other critical functions.

In Haiti, victims cheered nonetheless. They heard what they hoped. Based on sentences like “We apologize to the Haitian people” and “We are profoundly sorry for our role”—spoken by Ban in Kreyòl, no less— they believed that the UN would at last make reparation for their losses. Several weeks later, Ban was out the door, his term ended. The UN never followed through. Seven years after its launch, the fund has collected a meager 5.4 percent of its goal, or $21.9 million. “Material assistance” has failed to materialize. Instead of compensation to affected families and individuals, the funds have trickled into the usual development hodgepodge: local consultations, assessments, miniscule infrastructure projects, and something the UN reports call “more holistic community development-based approaches.”

“The refusal of the UN to come out and acknowledge . . . their peacekeeping officers caused the cholera epidemic in Haiti was a flagrant disrespect of the Haitian people, of all the victims that were affected by it,” said Ancito Etienne. The twenty-eight-year-old activist, now based in Boston, was a high schooler in Port-au-Prince when his grandfather died of cholera. Not long after, seven of his family members—three uncles, two aunts, and two cousins—were hospitalized with it. Several years ago, Etienne wrote an editorial for the Haitian Times that included the line, “I never expected the UN to be unconcerned about its moral failure and not to live up to promises of reparations.”

The episode bodes ill for humanitarian law, the United Nations, its peacekeeping operations, and the future of Haiti, which is now in extreme peril. Five years ago, the country erupted in protests over government corruption and a hike in gas prices, and almost each day since has struck residents as worse than the last. There are massacres, kidnappings, and the increasing incursions of gangs. Since the July 2021 assassination of President Jovenel Moïse, in his bedroom, gangs have consolidated their control over the capital and made normal life impossible. Since 2022, nearly two hundred thousand people have been displaced by violence.

The de facto government leader, Ariel Henry, is regarded as a cardboard placeholder propped up by the United States. But seven months into his illegitimate term, he seized on a sliver of good news: Haiti had not seen a reported case of cholera in three years, which meant, by World Health Organization standards, that cholera had been eradicated. “Unfortunately, that was a bit premature,” said Ralph Ternier, the director of clinical programs for Zanmi Lasante/Partners in Health. Not nine months later, in October 2022, cholera returned to Haiti. Tests confirmed it was the same strain that had allegedly been vanquished after MINUSTAH inadvertently brought it to Haiti a dozen years earlier. The most recent figures from the country’s ministry of public health report over sixty-three thousand suspected cases and nearly nine hundred confirmed deaths since then. Although the current outbreak hasn’t been as severe as the one that began in 2010, health workers are fearful. Gangs have blocked off access from Port-au-Prince to various parts of the country, basic supplies like fuel and water have been inconstant, the administrative state is in ruins, and foreign donors are pulling back.

“All the ingredients are there” for an outbreak as deadly, or worse, than the first, Dr. Ternier told me. Space was scant in the overwhelmed clinics, which were understaffed over the summer—many Haitians who can are fleeing the country—and the rainy season was underway. “After ten years of cholera,” he said, “we shouldn’t have to deal with these big, big spikes.” Had the UN and its member states delivered on the promise in the “New Approach,” according to Etienne, “we would not have this weird resurgence in the country that’s killing people on top of other things.” He blamed the “indifference” of the UN and its member states for contributing to the weakening of the country’s public health system.

False Hope

There had been hope when the New Approach was unveiled in 2016. Even Haiti’s prominent human rights lawyer Mario Joseph exulted. “From 2011 to 2016, the UN was like a monster,” the fast-talking, hard-charging advocate told me over the phone, from his office in Port-au-Prince. “When I heard the news, that Ban Ki-moon had asked Haitians for their pardon, I thought, he doesn’t realize what he just said.” Hearing the statement, some of Joseph’s clients believed that cholera reparations were imminent. Joseph knew otherwise (“I wasn’t naïve”), but he was happy too.

It had been a long fight for Joseph, his colleagues, and his clients. (Disclosure: I worked at Joseph’s law office, the Bureau des Avocats Internationaux, in 2007.) In the first days of the outbreak, the UN tried to sweep its liability under the rug, and it might have succeeded had the evidence not been so plain and noxious. Haitians living near the peacekeeping base in Mirebalais had immediately surmised the source of the disease afflicting their neighbors. Besides depending on the river to bathe, wash clothes, and collect cooking water, many locals were farmers—the region is the rice basket of Haiti—and were highly attuned to water quality. They had complained about the base’s open waste pits, perched atop a hill. They had observed, and smelled, the raw sewage that, when it rained, overflowed the pits and cascaded into the Meille River, a tributary of the Artibonite.

For weeks after the first reported cases, the UN stonewalled questions from reporters, even those who visited the base, spoke to the people living there, and filmed the pipes leaking dark liquid down the riverbank. Journalists were gaslit, browbeaten, or misled. In November, upon inquiring about anti-UN protests in the country, I was told that they were a tactic to “manipulate the population” in advance of an election. It emerged that none of the soldiers at the base had been screened for cholera or given prophylaxis for it. This in spite of the fact that they were from Nepal, where cholera is endemic, and an outbreak had just occurred. When forensic epidemiologists matched Haiti’s strain of the cholera bacterium to the “South Asian strain,” the UN went into attack mode, claiming that investigating the cause of the outbreak would divert efforts to mitigate it.

In May 2011, a panel of “independent experts” appointed by Ban Ki-moon issued a mealymouthed report on the origins of cholera in Haiti. Though the bulk of its thirty-two pages affirmed the peacekeeping base was the origin of the cholera bacterium, its conclusion attributed the outbreak to a “confluence of circumstances” and stated that its source was now irrelevant. The only thing it made clear was that the UN would never hold itself to account.

The case fell to Joseph, his partners at the U.S.-based Institute for Justice and Democracy in Haiti, and a newly minted attorney named Beatrice Lindstrom. Armed with little more than a standard claims form downloaded from the internet, the lawyers traveled throughout Haiti to document the toll of cholera, focusing on the hard-hit Artibonite region, where Joseph was born and raised. Many had lost their only child or the family breadwinner. Others lost their businesses and the means of sending their children to school. They had gone into onerous debt paying for treatment and funerals. All told, the team collected complaints and supporting evidence from five thousand individuals harmed by cholera. Almost everyone who agreed to file a complaint had been living on the knife’s edge of destitution before the disease arrived. The petition that accompanied the claims alleged that MINUSTAH’s negligence had resulted in thousands of deaths and that it was responsible for introducing cholera to Haiti. It demanded at least $250 million in compensation, formal acknowledgement of fault, and a forum for the complaints to be heard.

In the United States, such a case would have been a slam dunk. There is a reason that manufacturers avoid dumping toxic waste into American rivers: their business is often one negligence lawsuit away from bankruptcy. In Haiti, things were more complicated. Indeed, one of the remedies Joseph’s clients had demanded—a forum—raised a question that, for lawyers, is almost metaphysical: What forum can hear a demand for an adequate forum?

Under the CPIUN, UN peacekeeping operations and their troops enjoy immunity from legal process in the nations where they serve. But immunity was never supposed to mean impunity, or that MINUSTAH was beyond the law. A provision of its Status of Forces Agreement with Haiti called for a “standing claims commission” where Haitians could bring allegations of personal injury or property damage against MINUSTAH or its personnel. If a soldier accidentally kills a pedestrian, or an airdrop of food damages someone’s house, the UN is meant to make restitution. And though, ostensibly, it had done so, the standing claims commission had never been set up.

Eventually, the lawyers were told to deposit their clients’ massive sheaf of complaints and the accompanying petition at an office at MINUSTAH headquarters in Port-au-Prince.

More than a year later, in February of 2013, they received a response from the UN headquarters in New York. The bulk of the two-page letter enumerated UN efforts to fight the outbreak in Haiti. A single paragraph toward the bottom stated the cholera victims’ claims were “not receivable” because considering them would entail a “review of political and policy matters.” This reasoning, if you could call it that, was as befuddling as it was terse. What did “not receivable” mean? What did the improper disposal of contaminated feces have to do with politics or UN policy? We will never know. Again the UN stonewalled reporters’ inquiries. No legal analysis justifying their decree was forthcoming. Indeed, even within the confines of their workplaces, far from the harassments of the democratic press, UN officials effectively instituted an omertà around the issue of cholera in Haiti.

When Joseph’s colleague, Brian Concannon Jr., followed up with a request for meeting or mediation, the answer that came back from UN legal counselor Patricia O'Brien was curt:

In relation to your request for the engagement of a mediator, there is no basis for such engagement in connection with claims that are not receivable. As these claims are not receivable, I do not consider it necessary to meet and further discuss this matter.

In a scathing report three years later, Alston described such tactics as part of “an abdication approach.” The Special Rapporteur lambasted the response as sterilely formalistic, unimaginative, and ultimately, “contrary to both the interests of justice and the interests of the United Nations.”


The anxieties of international jurists carried little weight in the court of public opinion. By summer 2013, a pattern had developed. The harder the UN resisted an admission of guilt for its role in cholera, the louder the voices demanding accountability grew. Scientists on the UN’s Independent Panel clarified their report on cholera’s origins to say “the preponderance of the evidence” indicated that MINUSTAH personnel were the “most likely source” of the bacteria. News articles in mainstream outlets, including several of mine for The Economist, regularly raised the issue. An Al Jazeera documentary devoted to the case and the UN’s stonewalling aired and would go on to win an Emmy for investigative journalism; a documentary short that featured Joseph’s work with cholera victims premiered at the Tribeca Festival. Disaffection within the UN’s rank-and-file grew, and friends who worked there would call to tell me of their shame. In the fall of that year, the UN High Commissioner for Human Rights, Navi Pillay, called for the cholera victims to be compensated.

As far as the rest of the world was concerned, cholera was just another incarnation of Haiti’s cosmic misfortune.

The next day, Joseph, Lindstrom, and Concannon brought their clients’ case to U.S. court. They knew the UN would seek a dismissal on the basis of their immunity. UN representatives did not even respond to the summons: lawyers from the U.S. Department of Justice argued on the UN’s behalf. Eventually the suit was thrown out, a ruling upheld on appeal. A separate lawsuit on behalf of fifteen hundred cholera victims was dismissed a year later.

But back in October 2013, the lawyers were trying to serve a summons to the Secretary-General of the United Nations. Miraculously, I still have my notes from a conversation with Lindstrom about the difficulties of that process. Lindstrom told me they had sent a process server to the Office of Legal Affairs at UN headquarters every day for a week and were told that the documents had to be faxed—which was not recognized in the rules of procedure. (Also, who had a fax machine in 2013?) If necessary, she said, they would petition the court for permission to provide notice in some other manner, perhaps a newspaper advertisement. Eventually, they nailed the complaint to the front door of Ban’s New York residence.

Some months later, I read that a lawyer representing Haitian plaintiffs in the other lawsuit, Stanley N. Alpert, claimed that Ban had been personally served. The Secretary-General had been on his way to make a speech at the Asia Society on New York’s Upper East Side. Alpert said his process server put the summons directly into Ban’s hands before a security guard smacked the papers onto the ground. Alpert called it a precedent: “This is a significant development in the fight to hold the United Nations responsible for the tragic events in Haiti.” A spokesman for Ban denied his boss had ever touched the papers.

Unanswered Questions

After all these years, it is hard to understand the UN’s side of the story. The institution is deliberately opaque: its lawyers have never disclosed their reasoning. Alston has suggested the UN was fearful that acknowledging legal responsibility would open the floodgates to all sorts of demands for reparation. Another legal scholar, Rosa Freedman, suggested the UN’s lawyers may have perceived an existential threat. The CPIUN is outdated, she said, a snapshot of global power as it existed when the convention was signed in 1946. Modifying its application to suit the times, in their overblown fear, could have sent the whole legal structure of the UN crashing down.

The question remains: When presented with an opportunity to model basic principles of justice, why did the UN instead retreat into a fortress? Even without a compensation fund, a full-throated apology that admitted fault for introducing cholera to Haiti would have been “a good start,” Etienne told me. Alternatively, the UN might have disclaimed all liability but ensured those who were harmed received payments anyway. Which raises yet another question: Why were contributions to the trust fund for the New Approach made voluntary, dooming any chance that Haitians would receive compensation? Alston and others who were closer to the negotiations believe the United States played a large role in that decision.

Recently, I contacted the office of current Secretary-General António Guterres in an attempt to learn what was at stake for the UN in the cholera saga. In a written statement, spokesperson Stéphane Dujarric offered a few tidbits. The New Approach fund is just one source of monies the UN has used to fight cholera, he claimed; also, the international community had spent over $700 million to fight cholera in Haiti. Explaining why contributions to the New Approach fund were voluntary, Dujarric wrote, “Assessed contributions certainly would have been a welcomed decision,” but “in a context where resources are limited and the world is affected by multiple humanitarian crises, the UN thanks all the donors that have supported and that are supporting the cholera response through the different mechanisms.” There was no mention of the UN’s fault or compensation, not that I expected any. What did surprise me were a few lines toward the bottom:

The UN’s response to the current outbreak began before the first case was even identified. Prior to the current outbreak, funding from the Multi-Partner Trust Fund was allocated to the cholera surveillance mechanism, which ultimately functioned as designed and was the principal tool used by the Haitian Authorities to identify the first suspected cases of cholera in October 2022.

Just think: if the UN had never brought cholera to Haiti in the first place, there never would have been a Multi-Partner Trust Fund to pay for the cholera surveillance mechanism that ultimately caught its reemergence. The mind boggles.