Gaps in Downward Accountability: the UN and the Cholera Outbreak in Haiti

By: Isabelle Hazel ’15
A free-standing mural depicting a U.N. peacekeeper as an animal is displayed in the median of a downtown street of Port-au-Prince, Haiti, Thursday Sept. 8, 2011. The words in Creole read, from left, clockwise: Homosexual, rapists, robber, killer, kidnappers and cholera. The mural appeared in recent days in response to allegations that Uruguayan peacekeepers sexually abused a young Haitian man inside their U.N. base. Demonstrators in Haiti this week have stoked anger over the scandal and called for an immediate pullout of the U.N. force. (AP Photo/Ramon Espinosa)
A free-standing mural depicting a U.N. peacekeeper as an animal is displayed in the median of a downtown street of Port-au-Prince, Haiti, Thursday Sept. 8, 2011.  (AP Photo/Ramon Espinosa)

The idea of accountability is increasingly becoming integrated into the dialogues of international development and humanitarian assistance organizations. When assessing this topic, there are a number of scholars and professionals working in the field of international development and crisis management who utilize the United Nations as a case study.i This is due to the UN’s historical 1945 establishment as a forum in which member states could collaborate, “to keep peace throughout the world…encourage respect for each other’s rights and freedoms…[and] be a [center] for harmonizing the actions of nations.”ii At its birth, the UN was intended to be an international governance institution, and this legacy has established its principles and practices as a model for other international organizations.

However, the organization’s history is not free from controversy, and there are cases of human rights violations conducted at the hands of UN peacekeepers in regions like Kosovo and East Timor.iii Cases such as these have called into question the nature of accountability in international development and its role in legitimizing international organizations. The UN’s status as an international governance organization accords it the responsibility of establishing normative behavior and practices. This paper examines the shortcomings in the UN’s response to the cholera outbreak in Haiti following the 2010 earthquake. Employing this case study, the paper then discusses the pressing need for greater downward accountability in international development work so that international organizations’ objectives may be fully realized. Due to its historical charters and treaties, the UN has the power to establish normative behavior in the field of international development; and the field’s current gap in downward accountability can begin to be remedied if the UN accepts responsibility for its role in the Haitian cholera outbreak.

Cholera Outbreak in Haiti and Shortcomings of UN Response

In 2004, the UN Security Council resolution 1542 established the Mission des Nations Unies pour la stabilization en Haiti (MINUSTAH), a peacekeeping mission aimed at restoring order in the aftermath of a coup that ousted then president, Jean-Bertrand Aristide, from power.iv As a UN peacekeeping forces, MINUSTAH is comprised of military and police personnel provided by about 50 of the member states, including Brazil, Canada, Philippines, and Kyrgyzstan to name a few.

On January 12, 2010 at 4:53 PM EST, a magnitude 7.0 earthquake stuck about 10 miles away from Haiti’s capital Port-au-Prince. This natural disaster killed between 230,000 to 316,000 Haitians, injured 300,000 and displaced close to 1.5 million.v The United Nations itself lost 96 of its peacekeeping soldiers who had been working in the country. vi As a result of the chaos and instability caused by the 2010 earthquake, the UN Security Council resolution 1908 increased the number of MINUSTAH forces operating in the nation from 6,940 military personnel and 2,211 police to support of up to 8,940 military personnel and 3,711 police.vii

Within ten months of the earthquake, 7,000 Haitians became infected with cholera by way of the Artibonite River.viii An investigation carried out by The Associated Press claimed that the epidemic most likely spread due to a sewage leak at a base for Nepalese MINUSTAH forces in Mirebalais, a town resting alongside a tributary of the Artibonite River. As epidemiologists began to confirm that the strain of cholera matched a strain that had been infecting the nation of Nepal, The Associated Press’ initial accusation gained credence.ix However, the UN was and remains hesitant to confirm the link between the negligence of its peacekeeping forces and the outbreak of this devastating epidemic. A pending lawsuit filed in the New York District Court by 5,000 individuals affected by the outbreak outline the UN’s wrongdoings as such:

The UN did not adequately screen and treat personnel coming to Haiti from cholera stricken regions. It did not adequately maintain its sanitation facilities or safely manage waster disposal. It did not properly conduct water quality testing or maintain testing equipment. It did not take immediate corrective active in response to the cholera outbreak.x

While the negligence of the Nepalese MINUSTAH forces are inherently inflammatory topics, the United Nations’ failure to acknowledge its own shortcomings and accept partial (if not all) responsibility in this calamity is unsettling and immoral.xi The international governance institution has made efforts to hedge the spread of the epidemic by distributing potable water and water purification tablets, utilizing radio stations to educate local populations on disease prevention, and providing latrines to the Artibonite Department. While these efforts are certainly meritorious, they are undercut by the UN’s simultaneous efforts to put distance between itself and the origins of the epidemic. Should the United Nations acknowledge their role in introducing cholera to Haiti and allowing the disease to continue to spread through its passive actions, the international governance institution can then take steps forward by offering reparations such as funding for proper water infrastructure in the Artibonite Valley. Rather than engage in dialogues in which it is critiqued, the United Nations has chosen to preserve its reputation as an institution that upholds the “dignity and worth of the human person” by distancing itself from the epidemic and offering minimal assistance.xii

The duplicitous and contradictory actions of the United Nations in handling the cholera outbreak in Haiti illuminate the complexities of a larger theme of accountability in international aid work. International organizations are accountable to multiple entities, including donors, other organizations operating within their field, and beneficiaries of their services and programming. The politics of the field usually place higher priority on accountability to donors because it is largely their resources that fund projects and keep the international organization operating. More often than not, accountability to beneficiaries becomes an afterthought, in part because international organizations may insentiently presume that beneficiaries’ objectives align with their own. Another factor that may be contributing to lack of accountability to beneficiaries is more reflective of the issues brought up by the cholera outbreak in Haiti. When missteps occur, international organizations may be disinclined to recognize their role in bringing harm to beneficiaries because they believe it will disintegrate their credibility and lead to their own demise as donors withhold resources, beneficiaries refuse their help, and other international organizations take their place.

However, there are greater pitfalls at stake should international organizations, especially the UN, continue to neglect downward accountability, or accountability to beneficiaries. Should international organizations cause harm and not accept responsibility, the missions and ideologies they uphold will become invalid. Looking back at the case study, the United Nations states that it upholds a set of humanitarian principles that include doing no or minimal harm when carrying out projects.xiii As discussed before, the United Nations holds a critical position in international aid work and has the power to establish normative practices. In refusing to recognize its role in activating the cholera outbreak in Haiti, the UN is perpetuating contradictory business practices and a lack of downward accountability. The UN is violating its own principles as well as the human right to clean water and sanitation as stipulated by international law.xiv

Defining Accountability: Reconciling Aspirations with Realpolitik

For the purposes of this paper, an international organization has achieved accountability when it, “recognizes that it has made a promise to do something and accepted a moral and legal responsibility to do its best to fulfill that promise.”xv Should the organization fall short of its moral and legal responsibilities, it has the obligation to acknowledge its limitations so that all actors involved may move forward by determining the appropriate actions to amend the situation while considering lessons learned. International organizations’ accountability is separated into three levels—upward: the donor public, the media, taxpayers, ministers, parliaments, and other powerful public sector agencies who determine international aid policy; lateral: the common standards agreed by agencies; and downward: the beneficiaries of services and/or programming.xvi

In theory, the objectives of all three levels should be granted equal weight when international organizations craft policy and programming. In reality, “international organizations are political creatures, set up by political actors for political reasons and in order to carry out political tasks.”xvii The realpolitik of international organization accountability is that donors possess the resources to set policy into action. Their objectives are too often out of touch with the needs of beneficiaries and it is this juxtaposition that can impede sustainable development or appropriate recovery. The voices of beneficiaries become lost as their needs are dictated to them through the services and aid they receive. This notion of downward accountability negligence is bolstered by a survey conducted by Schmitz, Raggo and Bruno-van Vijfeijken in which they found that there is, “a gap between the rhetorical commitment to downward accountability and a persistent emphasis on financial accounting and donors.”xviii The structure of their questions revealed that while there has been a normative shift towards considering the voices of beneficiaries, there have been few mechanisms put into place that ensure beneficiaries are involved in determining policy and programming; there are also few organizations that have methods of determining whether beneficiaries define these aid projects as useful and successful.

This widespread gap in downward accountability is a point of critical concern when harm is done at the hands of international organizations. As illuminated by the aforementioned survey, international organizations prioritize upward accountability and beneficiaries remain largely voiceless in the situation. Should missteps occur, beneficiaries do not have the capacity to express their grievances and upward accountability can prevent international organizations from acknowledging they have done harm because their credibility and funding (and consequently their existence) will be at stake.

In the case of the cholera outbreak in Haiti, it can be argued that the United Nations is reluctant to accept responsibility because the nature of the misstep will undermine the principles the organization upholds. However, there is something larger at stake should downward accountability to the affected Haitian people continue to be neglected. An international organization effectively trades accountability for support; by making itself accountable to the expectations of particular stakeholders, an international organization garners those stakeholders’ continued support.xix In neglecting downward accountability, the United Nations is sacrificing the support of the Haitian people—an outcome manifested in the fact that a group of nearly 1,500 Haitian cholera victims have filed a lawsuit against the UN.xx

Not Just a Blame Game: the Importance of Downward Accountability

There are competing arguments labeling the extensive work of epidemiologists, the reporting of journalists, and the calls for accountability by advocacy groups and academics as an unnecessary “blame game” that detracts from cholera response efforts.xxi Others, including the United States Department of Justice, argue that because of the nature of the United Nations’ work and its treaties and charters, the international organization enjoys “absolute immunity.”xxii As an international governance institution, the United Nations is expected to respond to any and all conflicts and natural disasters. It is expected to restore peace and stability to the area, and often complex situations warrant complex solutions. It is by this logic that the “absolute immunity” argument builds cogency.

However, in contaminating the water supply of millions of people and in introducing a strain of cholera that has affected 530,000 Haitians and killed 7,000 by April 2012, the United Nations violated these peoples’ right to water and ultimately their right to life.xxiii Arguments proposing that the UN possess “absolute immunity” because of its historical treaties and charters do not consider the fact that there are multiple instances where the UN’s charter states that the the organization’s mission is to uphold human rights. The preamble to the UN charter states, “the people of the United Nations determined to reaffirm faith in fundamental human rights,”xxiv while Article 1 states the United Nations’ purpose is “to develop friendly relations among nations based on respect for the principle of equal rights.”xxv

Declarations to prioritize human rights are found not only in the beginning of the charter, but they are also scattered throughout the document. The reiteration of this idea bolsters the notion that the respect and promotion of human rights is a primary objective of the United Nations. It is difficult, arguably impossible, for an organization whose primary objective is protecting human rights to be “absolutely immune” from being held responsible for human rights violations. While it can be argued that accepting fault in these situations will undermine international organizations’ credibility, not accepting fault is more detrimental to the future of the international organization because it will negatively affect the relationship between itself and the beneficiaries. International organizations will be met with resistance in the areas they are working, thereby making programming ineffective and ultimately wasting the resource of donors. There are also lateral implications because the legacy of missteps can cause beneficiaries to be distrustful of other international organizations in an effort to protect themselves from further harm.

Additional reasons why it is imperative for the United Nations to acknowledge its role in the Haitian cholera outbreak and establish downward accountability include the legacy of the HIV/AIDs stigma and the UN’s obligation as a leader in the field of international work to be a proponent of normative moral behavior in word and action. Neglecting to provide a definitive cause for the Haitian cholera outbreak will prove detrimental to social and emotional development of the Haitian people. If the UN refuses to inform the international community of its faults, the stigma of another disease will be attributed to the people of this nation. The Haitian people have been disempowered in the past when they bore the weight of the HIV/AIDs stigma. At the hands of the CDC, Haitians were deemed a “high-risk” group as carriers of the immunodeficiency disease until 1985.xxvi In being associated with the spread of the global pandemic, Haitians faced social prejudice as well as difficulty acquiring proper healthcare treatment because they were deemed inevitable victims of the disease. The legacy of disempowerment and victimization during this period could be seen as one motivating factor behind the Haitian families’ decision to sue the UN. Haitians have suffered under the stigma of one epidemic and refuse to be cited as the cause of another; the HIV/AIDs stigma has been one factor holding Haiti’s development back and allowing history to repeat itself is unwise.

Arguably the most critical reason for the UN to practice downward accountability also cites the nature of the UN’s work and its historical treaties and charters. The 1945 establishment of the United Nations as the world’s foremost international governance institution bestows on it the obligation to maintain morally sound business practices so that it may lead the field by example. As mentioned multiple times throughout this paper, the UN has the power to shape normative behavior in the field along with other key players like the International Federation of the Red Cross/Red Crescent and NATO. Not only is the credibility of the United Nations at stake, but should the gap in downward accountability remain the norm, the entire field of international aid and crisis response will come to a stalemate. Policy and programming decisions will continue to neglect the objectives of beneficiaries, mistakes will continue to be made, and beneficiaries will foster a culture of distrust thereby preventing program objectives from being fully realized. The ripple effects of the UN cholera outbreak can still be prevented if the UN accepts responsibility for the outbreak, thereby reinforcing the practice of downward accountability.

Conclusions and Policy Recommendations

The United Nations stands at a critical juncture in which it can decide to practice downward accountability by accepting responsibility in the Haitian cholera outbreak and compensating the families of cholera victims. Neglecting to do so will prove detrimental to the United Nations as well as the entire field of international development and crisis response. The United Nations has the power to establish normative behavior in the field, and continuing to neglect downward accountability can potentially result in distrust among beneficiaries as well as ineffective programming and policies.

To prevent these outcomes, the Obama administration should place pressure on the Justice Department to revoke its statement that the United Nations possesses “absolute immunity” and call for a trial to occur. Upward accountability is a common practice of the UN, and a call for a trial by one of its most powerful member states may be effective. Similarly, if organizations like the International Federation of Red Cross and Red Cross Societies (IFRC) call for the trial, the UN will feel compelled by way of lateral accountability to change its stance on the topic. The UN has been negligent in Haiti and caused irreversible harm to many families in the nation. Downward accountability is key to repairing the relationship between the UN and the Haitian people so that all actors involved may move forward with development efforts.


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The Globe Staff

Author: The Globe Staff