Like a Matryoshka doll, inside each cholera elimination initiative for Haiti one will find another and inside that, yet another. At the two-year anniversary of the earthquake, in January 2012, organizations launched a "call to action" for the elimination of cholera. Almost a year later, in December 2012, the U.N. launched a "new" initiative designed to "support an existing campaign." Then in February 2013, the Haitian government and international partners announced a 10-year elimination plan. When funding was slow to come, the U.N. and other partners began raising funds for a two-year emergency response. In March of 2014, another "high-level" committee was formed and then in July, U.N. Secretary General Ban Ki-moon traveled to Haiti to launch a "Total Sanitation" campaign within the "context" of the cholera elimination plan. Since that first announcement in 2012, 1,600 Haitians have died from cholera. Today, in a "high-level" donor conference sponsored by the World Bank, the Haitian government presented yet another plan.
"We have a plan, it's a $310 million plan for three years," Haitian Prime Minister Laurent Lamothe told the crowded 13th floor conference room in the World Bank headquarters here in Washington, DC. Lamothe urged those in attendance to "take action" and "fast-track this process" in order to "protect the lives of millions of people" and "ensure the most vulnerable of the society are protected against water-borne diseases." But the 2.5-hour conference ended up short on pledges and long on pleas, with only the event's sponsor, the World Bank, contributing substantial funds.
Cholera, which scientific studies have found was introduced to Haiti by United Nations troops in 2010, has so far killed at least 8,614 and sickened over 700,000. While no speakers at the conference mentioned how the disease was imported to Haiti, Lamothe did play a short video, in which the narrator explains that, "based on press reports, it [cholera] originated on a Nepalese camp of the United Nations peacekeeping mission in Haiti, MINUSTAH." Later in the video, a Haitian explains how he blamed the U.N. for cholera's introduction. Meanwhile, lawyers and human rights groups continue to press for U.N. responsibility through the courts. A federal court in New York will hear oral arguments on the U.N.'s immunity on October 23.
"The UN has a binding international law obligation to install the water and sanitation infrastructure necessary to control the cholera epidemic, as well as compensate those injured," said Brian Concannon of the Institute for Justice & Democracy in Haiti, who is representing cholera victims in their case against the U.N. "MINUSTAH has spent far more than $2 billion since cholera broke out on other things. It is a question of priorities."
While the U.N. has refused to accept responsibility for the disease's introduction or take direct remedial actions, in December 2012 Ban pledged to "use every opportunity" to raise the necessary funds for cholera elimination and has since cited the U.N.'s "moral obligation" to respond to cholera. Despite the support, actors have thus far failed to raise an adequate amount of funds for the eradication plan. At the conference, Ban stated that "as of today, the $2.2 billion 10-year national plan is just 10 percent funded. While a lot has been done, there is clearly much more to do."
Major donors had initially balked to providing direct support to the 10-year plan announced in 2013 as it was viewed as more aspirational than operational. In addition, donors were reluctant to contribute to a national fund, jointly run by the Haitian government, which would mean giving up operational control of aid flows. The donor conference that took place today was, in fact, scheduled for October, 2013, but has been delayed since. Responding to the complaints of donors, Haiti's government, represented by the prime minister, but also representatives from the Ministry of Health, DINEPA, the Ministry of Finance and Ministry of Public Works, presented a detailed plan that would involve building up capacity and infrastructure in 16 priority areas that have been particularly hard hit by cholera. A plan to create a national fund to coordinate donor contributions has also been scrapped.
No longer is the focus strictly on cholera, either. Expanding water and sanitation infrastructure in a country where only 24 percent of Haitians have access to improved sanitation and 38 percent do not have access to safe water will have a tremendous impact on other waterborne diseases, which remain a leading cause of infant and maternal mortality. The plan put forward today also goes further in linking public health works to water and sanitation infrastructure. More information about the plan, including presentations from DINEPA are available on the World Bank website.
Both World Bank president Jim Yong Kim and Ban urged donors to support the 3-year plan, but donors seemed more interested in discussing their own work rather than direct support for the plan. USAID director Mark Feierstein told the room that "over the next three years, we plan to invest up to $15 million dollars to reduce diarrheal disease, improve access to potable water and promote water-related hygiene." However, Feierstein quickly pivoted, stating that, "our team is currently conducting a water and sanitation assessment to determine where the gaps are and what type of future programming can be most effective." Another study, while a well-developed plan sits unfunded on the table.
In addition to the $50 million pledged from the World Bank, the only other concrete commitment was from the Japanese government in the amount of $2.5 million. Also announced at the conference, U.N. special representative Paul Farmer will begin tracking donor contributions and disbursements for cholera elimination plans. A report is expected shortly.
Speaking just before the opening session ended, Jim Kim exhorted donors to do more. "I really appreciate the statements of support, but I think we now need to really find a way to raise the $310 million dollars needed," he said.