In 2010, United Nations (U.N.) peacekeepers caused a devastating cholera outbreak in Haiti. Nearly a decade later and with COVID-19 threatening an already fragile situation, affected communities are still waiting for access to remedy. Beatrice Lindstrom, clinical instructor and supervising attorney in Harvard Law School’s International Human Rights Clinic, has been working for nearly a decade on pathbreaking advocacy to secure accountability from the U.N. for the destruction it caused. Lindstrom was lead counsel in Georges v. United Nations, a class action lawsuit on behalf of those injured by cholera. Prior to joining Harvard Law School, Lindstrom was the legal director of the Institute for Justice & Democracy in Haiti.

Harvard Law Today: How and why did the 2010 cholera outbreak begin in Haiti?

Beatrice Lindstrom: Cholera was introduced to Haiti when the U.N. deployed peacekeepers from Nepal—which was experiencing a cholera outbreak—without testing or treating them for the disease. The peacekeepers were stationed on a base in rural Haiti that had reckless waste disposal practices. Untreated waste from the base’s toilets was routinely dumped into unprotected open-air pits that overflowed into the surrounding community and into a nearby tributary. That tributary feeds into the Artibonite River, the primary water source for tens of thousands of Haitians. The resulting outbreak is the deadliest cholera epidemic in the world: At least 10,000 people have died and approximately one million people have been sickened since 2010. To put it in context, the number of cholera infections per capita in Haiti still exceeds the COVID-19 infection rate in any nation.

HLT: How has the United Nations responded?

Lindstrom: Despite scientific consensus that the U.N. base was the source of the outbreak, the U.N. denied responsibility for six years and refused victims access to any forum to hear claims for remedies. The U.N. enjoys broad immunity, but is required to settle claims by civilians out of court. In 2011, the Haitian human rights organization Bureau des Avocats Internationaux (BAI) and its U.S.-based partner Institute for Justice & Democracy in Haiti (IJDH), where I then worked, filed claims on behalf of 5,000 victims. The U.N. rejected the claims without offering any legal justification, and has refused to refer the claims to an independent claims commission as required under international agreements. The U.N.’s own Special Rapporteur on extreme poverty and human rights called the U.N.’s response “morally unconscionable, legally indefensible, and politically self-defeating.”

It took an extraordinary mobilization of cholera-affected communities and allies in Haiti and abroad to persuade the U.N. to shift course. In 2016, the Secretary-General finally issued a public apology and launched a $400 million “New approach to cholera in Haiti.” But over three years later, the U.N. has raised only 5% of the $400 million promised, and has not paid any compensation to victims. Despite initially pledging to center victims in decision-making, critical decisions about the direction and content of the New Approach have been made without victim input. These deficiencies stem from the U.N.’s continued denial of legal responsibility for the outbreak, which would trigger funding through assessed contributions from its member states and ensure that responsibility is shared collectively across the organization. Instead, remedies for cholera victims is treated as charity and left to compete with other humanitarian causes.

HLT: Why do you think the U.N. has been reluctant to accept responsibility?

Lindstrom: In the absence of an independent mechanism to determine responsibility, the decision becomes a political one driven by the self-interests of powerful member states and officials within the U.N. bureaucracy. I think there have always been people within the U.N. who have wanted to see the organization do the right thing in Haiti, but without adequate leadership from the Secretary-General, the forces pushing for inaction have prevailed. The U.N.’s Legal Counsel has reportedly waged “an extraordinary internal campaign” against anything that would resemble an acceptance of responsibility. Lawyers are often concerned about setting precedent, but here there is consensus among legal experts that the claim falls within the U.N.’s existing duty to compensate for “private law” claims, so the only precedent set would be one of compliance. If the concern is that it would in practice invite claims in other contexts, this implies that the U.N. anticipates many other situations where civilians will be harmed by U.N. negligence. Others resist accepting responsibility because of the financial implications. The $400 million that the U.N. is now seeking for cholera, however, is only a fraction of the $4 billion that it has spent on its stabilization mission in Haiti since the outbreak started. And as governments are now rightly investing trillions of dollars in financial support for households impacted by COVID-19, it is increasingly clear that more could be done for cholera victims if the political will was there.

HLT: What have you and the International Human Rights Clinic been doing to hold the U.N. accountable?

Lindstrom: The Clinic filed a complaint with U.N. special procedures that documents how the U.N.’s failure to deliver on the “New Approach” amounts to a violation of the right to effective remedies under human rights law. We recently succeeded in prompting fourteen mandates to sign on to an allegation letter accusing the U.N. of denying justice to victims. It is unprecedented for such a broad coalition to call out the U.N. itself for human rights violations. The U.N. has 60 days to respond to the letter, and we are hoping that it spurs the Secretary-General to reassess his approach and commit to fulfilling the U.N.’s legal and moral obligations in Haiti.

HLT: What is the status of cholera in Haiti today? And are Haitians experiencing the COVID-19 pandemic?

Lindstrom: Haiti is in a critical time in the fight to eliminate cholera. There have not been any new laboratory-confirmed cases in the last year, suggesting the disease may be on its way out, but since Haiti still lacks the water and sanitation infrastructure that is key to elimination, it’s a precarious situation. Now, COVID-19 is another disaster the country faces. Haiti has very limited capacity for testing, and even lower capacity to respond to what many fear is becoming a surge—especially as the United States deports people exposed to COVID-19 back to Haiti. COVID-19 presents a particular threat to cholera-affected communities. Without remedies for cholera, households that lost breadwinners and went into debt to pay for medial and funeral expenses for loved ones are now especially ill-equipped to protect themselves from the new virus. Basic things like clean water and soap are often out of reach, and the poverty that was compounded by cholera means people cannot self-isolate. We are all holding our breaths.

HLT: Has the cholera outbreak in Haiti changed the way the U.N. thinks about humanitarian missions to nations in distress? Or have they adopted new procedures to prevent a recurrence of this type of tragic epidemic on future missions?

Lindstrom: Following the cholera outbreak, the U.N. updated its sanitation and pre-deployment and protocols, acknowledging “…the danger inherent in the introduction of diseases into the host country’s environment, particularly where such diseases are assumed to be non-existent prior to peacekeeping.” But implementation has been woefully lacking. It took five years for the U.N. to fully correct its waste mismanagement across bases in Haiti, even as the epidemic raged. And U.N. audits show alarmingly widespread waste mismanagement on U.N. bases globally, including in Côte d’IvoireSudanSomalia, the Central African RepublicAbyeiLiberiaLebanon, and the Democratic Republic of the Congo.

In the face of COVID-19, the U.N. has stressed the unique vulnerability of peacekeeping host communities and has introduced important measures to prevent transmission, including suspending the rotation of troops. But in South Sudan, the first four confirmed COVID-19 cases were U.N. personnel, and activists there have accused the U.N. of delays in testing and quarantining the first individual, and in notifying South Sudanese authorities of the first case. It is critical that the U.N. applies lessons from Haiti and prioritizes adequate prevention, transparency and accountability.

HLT: Is there a chance that the U.N. will be more reluctant to send people, for fear of unintended (and perhaps deadly) consequences?

Lindstrom: The takeaway from Haiti should not be less peacekeeping, but more responsible peacekeeping. A study conducted by scientists at Yale found that the U.N. could have prevented the introduction of cholera by investing $2,000 in treatment for the infected soldiers. Simple measures like these, along with basic sanitation management that we expect of anyone, can and should be a part of every peacekeeping operation.

More accountable peacekeeping is also key to effective peacekeeping. The U.N. depends on its moral authority to persuade governments, warlords, and other rights violators to respect human rights and comply with rule of law. When the U.N. itself defies those principles, that erodes its credibility as a champion for human rights. The Secretary-General has acknowledged this, and in apologizing to Haitians, stressed that the U.N. must right its wrongs in Haiti “for the sake of the Haitian people, but also for the sake of the United Nations itself.” As we approach the ten-year anniversary of the outbreak, it is high time to deliver.