The UN’s Shame and Haiti’s Suffering

It’s well known at this point that the United Nations brought cholera to Haiti. The worst cholera outbreak in recent global health records, in a country that hadn’t seen cholera in its recorded history. 9700 people died. The UN then spent six years attempting to avoid admitting to its role in the transmission. Finally, molecular epidemiology traced the outbreak to a detachment of peacekeeping forces recently arrived from Nepal. Due to their improper disposal of human waste – they dumped it in a river without appropriate treatment – it took just four days after their arrival for the first case of cholera to occur.

Cholera is now endemic in Haiti, with an average of 30,000 cases per year since 2010. This is a substantial increase over the average number of reported cases from 1910-2010, which was zero. Hurricane Matthew has pushed outbreak levels even higher.

In December 2016, the UN finally came clean. It released a 16-page report that concluded, “the preponderance of the evidence does lead to the conclusion that personnel associated with the [UN’s peacekeeping] facility were the most likely source.” Secretary General Ban Ki Moon then personally apologized to the people of Haiti, in three languages, “We apologize to the Haitian people. We simply did not do enough with regard to the cholera outbreak and spread in Haiti. We are profoundly sorry for our role.”

The report also outlined a new approach to fighting cholera in Haiti based on global best practices. It called for a $400 million plan to reduce the incidence of cholera in Haiti and establishing a fund to support people who had suffered as a result of the cholera epidemic. Global Health experts praised the plan, as did human rights activists.

Now, three months later, the fatal flaw in this redress effort becomes apparent. Despite the handsome apology, the UN continues to disclaim any legal responsibility for the cholera outbreak. As a result, victims can’t sue for compensation. And the fund to support victims hasn’t materialized. Neither has the grand new approach in improving cholera surveillance and treatment.

Why? There’s no money for it. There never was. The United Nations funds this kind of emergency activity by issuing a funding appeal that calls for targeted donations from UN member states. They issued a $400 million appeal for cholera in Haiti and established a multi-donor trust fund to administer the money, with the intention of splitting the funding 50/50 between the efforts to fight cholera and the support fund.

Thus far, the appeal has raised $8 million, primarily from France and South Korea. That’s 2% of its funding goal. UN officials in Haiti are now quietly trying to lower everyone’s expectations. Victims of the epidemic will have to continue struggling on their own, or with a tiny amount of additional support. David Nabarro, the UN advisor tasked with raising money for the fund, has said that “I have never found it so hard to raise money for an issue as I am finding it to raise money for this.”

The reason for the fundraising failure is unknown, but its consequences are clear. Cholera will remain endemic to Haiti.

The UN harmed Haiti once, and then turned away, indifferent. That indifference, it seems, has spread to the international community. Given the chance to support justice for cholera victims and break the hold of cholera on the nation, donor countries have instead turned away.

This isn’t just a compassion problem. It’s also a systems problem. Having to hold an appeal every time its wants to implement a major activity is no way to run a functioning international organization. If we want the UN to be able to do real work, it needs a real budget. The fact we’ve chosen not to provide one is a telling statement about how the world views the UN.

I know I said I would be updating here, and I’m not back to writing Blood and Milk full time. You’ll still find most of my content at This World Needs Brave. It turns out, though, that this blog is a hard habit to break.

Self-promotion down here:

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Facing change

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I love this blog and I always will; it’s some of my best work. For a long time I thought I’d start writing here again. I actually reorganized my whole life to give myself time to write. I shifted from full time work to independent consulting and coaching so I wouldn’t have to worry about employer approval of my work. As a bonus, I now live in Cairo, a city with a thousand inspirations to write.

It turns out that I still want to write, but not here. This blog is the story of me facing a particular situation; the transition from entry-level development work into jobs with real responsibility. When you stop being a serf and start being able to shape things, you need to think very hard about your impact. This blog is where I did that thinking. It’s me, growing up, as a development professional. It’s where I identified what I believe to be true about good development work.

I’m still thinking. But when I face a challenge now, I know what to do. I don’t have answers, but I know how to attack a problem. My outrage has been (mostly) transfigured into motivation. I don’t need to think through the kinds of problems I used to, because I have done that thinking and it’s part of me now.

I’m still writing. Just not here.

Here at Blood and Milk, I figured out what I know. My next step is how to apply it: This World Needs Brave. I’m thinking now about how to be a decent person in a broken world. How to be brave enough to make things better. If I have figured out that you can’t run a decent health project without buy-in from nurses, how do I go about using that knowledge in my work? When do I speak up? And how? It’s a mixture of coaching and career advice and me trying to learn from the many, many mistakes I’ve made. It’s about finding my brave and helping other people find theirs.

I won’t be taking down Blood and Milk. People still find it useful, and I’m happy to pay the hosting fees. But if you have liked Blood and Milk, you might like this new thing, too. Please take a look.

I’ll finish with a quote from the new blog:

“Our systems are too damaged to function without exceptional people. So it’s time to become exceptional. To do jobs that matter, to do them better, to leverage our time and our money and our willingness to make a lot of fucking noise in an attempt to force this broken world to turn out just a little bit better.”

 

 

Career Question: What do I study in undergrad?

Dear Alanna:

I would really like to go to University next year but am still unable to decide what to study.  All i know is that i am interested in social problems such as poverty, poor education and inequality to name a few.  I am not sure what degree would suit me or give me the skills to make positive changes that actually work and would have a lasting impact.

This is probably the most common question I get, and the easiest to answer. There is no undergraduate degree that will give you the skills you need to achieve lasting change in the world. Choose a degree that sounds fascinating to you, and has classes that sound like you’d love to take them. Once you have an undergrad degree, then you can look at jobs that bring change in the world and probably a graduate degree. In the beginning, though, just start with an undergrad education you can love.

Where I’ve been

Observant readers will have noticed I have not updated this blog since February. I have every intention of starting again soon. Really soon. In the meantime, I’ve started writing in other places.

I am now writing regularly for UN Dispatch on global health issues – see me eviscerate Russian HIV policy right over here. I will also be contributing to Humanosphere. My first piece, of which I am rather proud, is an op-ed explaining exactly why we should allow as many Syrian refugees as possible into the US. I’m also still active on twitter, and on Instagram.

That’s half my big news. Here’s the other half: I left my job with USAID and I am out in the world as an independent consultant. This is mostly great. I can write anything I want to without worrying about clearances, I can choose work I care about, and I can live in Cairo, the big mango, the mother of the world.

However. I have to market myself and go around talking people into hiring me. This is horrific. But if you need someone to troubleshoot your underperforming project, force your logframes to make sense, or write a proposal, keep me in mind.

Globalization and its discontents

A friend of mine in Tajikistan used to consistently buy prepackaged foods for her children. Anything specifically marketed to kids caught her attention. She’d buy it – all of it, and feed it to them, even when it was more expensive than other options. So, functionally, she was raising her kids on a diet of junk food.

I do my best to let people be people. They’re allowed to make the choices they need to make, and my friends don’t need me to be hanging over them judging their choices. So for a long time I said nothing. Eventually, though, I broke down and asked. Why? Why the junk food, when fresh food was cheaper?
And she said (of course) that the food made for children was better for children. Because it was made for children. I responded with an impassioned rant about marketing and corporations and selling to people. I was very into it. I was, I felt, very convincing.
My friend (of course), didn’t believe a word of it. Alanna, she said. They make these products for children. Sure, they make money. But they feed children.
I realized she came from a village in a country where people feel responsibility to their community. She knew there are terrible people in the world – and in her own government – but she thought of them as isolated bad guys. She couldn’t conceptualize that a company made of ordinary decent people would target products to children that were bad for the kids. It just didn’t fit in her world view.
Honestly, I wish it didn’t fit into mine.