In 1982, the Centers for Disease Control published a public health warning in response to AIDS, a then-little-understood pandemic that had recently reached American shores. The literature declared four categories of people “high-risk” for transmission: heroin users, hemophiliacs, homosexuals, and Haitians. In doing so, the CDC’s warning supported two dangerous, speculative trends in preventative medicine and the culture at large. The first was that diseases can be comfortably linked to marginalized people, and the second, consequently, that these people spread disease through their deviant behavior. Enthusiasm for human blame stuck, and spread like it was also communicable; thirty years later, public ideas about who gets HIV/AIDS originate from some of this initial guesswork. But when the Food and Drug Administration introduced a policy to ban blood donations from Haitians and Haitian-Americans in 1990, the community countered.
“This policy is on the basis that Haitian blood is dirty, that it is all infected with the HIV virus,” Doctor Jean Claude Compas, former president of the Haitian Coalition on AIDS, told the New York Times during the spate of protests responding to the FDA proposal. On April 20, 1990, an estimated 100,000 Haitians — almost a third of the Haitian population living in the New York metropolitan area at the time — barricaded themselves on the Brooklyn Bridge, blocking traffic for hours in an effort to raise awareness about the FDA’s decision. Four days later, the FDA announced it would reverse the proposition.
The cycle of racialized blame, Haitian-led accountability, and rhetorical reparation played out again this month. Haiti has been suffering from a cholera epidemic since October of 2010 — the same year thousands of U.N. soldiers entered the country, responding to the January earthquake that had decimated it. In the six years since, a reported 700,000 cases of cholera infection have been documented. Over 9,000 people have died. (Many consider that estimate, like the 150,000 death toll of the earthquake, conservative.)
For years, arms of the Haitian community, both in the country and abroad, have argued that the actions of Nepalese U.N. peacekeeping soldiers were responsible for importing cholera into the country. In 2012, scientific research overwhelmingly proved this to be the case — yet the U.N. consistently denied the accusation. Until now: On August 17, the U.N. Secretary-General Ban Ki-moon, on behalf of the world body, admitted responsibility for the outbreak. “Over the past year, the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera,” his spokesman said in a statement released via email last week.
Cholera is a modern plague as racially charged as HIV/AIDS, but it will likely never become known and treated like a first world disease. That’s because it thrives in dense locales wracked by poverty, impoverished urban and public health infrastructures, and catastrophic natural disaster. The scientist who discovered modern cholera, John Snow, associated the illness with the miasma, or “bad air,” of lower-class, 19th-century industrial London. Today, the victims of cholera are mostly black and brown residents of “developing” countries.
Cholera is a phenomenon of improperly discarded human waste. Inelegant, intestinal diseases are too easily associated with ideas of what poor countries can host, fit too perfectly with a picture of black destitution. The stereotype that Haitians are “dirty” — unhygienic and immorally behaved — is the bedrock for these dangerous occasions of conjecture-based public health policy. During Dominican dictator Rafael Trujillo’s genocidal campaign in the 1930s, racialized prejudice against Haitians gained a name: Antihaitianismo. The U.N.’s repeated denial of culpability in the spread of cholera was in part informed by their refusal to engage Haitian people as anything more autonomous than the citizens of the “poorest country in the world.” To add insult to injury, it was the organization’s own lax protocol on cleanliness that endangered a country, a people, and the countries near it. Worse still, the international stage minimized the demands of redressal by Haitian people, siding with the foreign body. Disdain for the U.N. has grown so considerably in Haiti that there’s an informal graffiti movement against it.
Since 2010, Haiti, where over 61,000 Haitians continue to live in tent cities propped up in places towns once stood, has been a site of structural and environmental vulnerabilities. Vibrio cholerae, the bacterium that causes the infection, multiplies in pockets of stale water, directly or indirectly contaminated with human feces. Dehydration, vomiting, and white diarrhea the consistency of “rice water” are the immediate symptoms. Coma and death come if cholera goes untreated. The strain of the current outbreak in Haiti can kill children two hours after it is initially contracted.
“My wife and I have come here to grieve with you,” Ban said in 2014, when he traveled to Haiti to launch a sanitation plan in conjunction with the Haitian government. “As a father and grandfather, and as a mother and grandmother, we feel tremendous anguish at the pain you have had to endure.” A few months earlier, 1,500 Haitians had brought a lawsuit against the U.N. for their role in the outbreak. Damning research found that the soldiers who had arrived in the country 10 months after the earthquake were pathogenic carriers of the same molecular strain, and that the U.N. hadn’t been screened for any diseases before entering, as is protocol. The tests cost $2.54. Further, these soldiers were housed at a peacekeeping base with poor toilet facilities. The infrastructure could have been fixed for less than $2,000. The U.N. neglected to fix the waterways. The soldiers used the river instead. Before 2010, there was never a confirmed case of cholera in the country. After, Haitians had to make a word for the disease.
When Ban visited back in 2014, though, he categorically refused to address evidence against the Nepalese soldiers who’d traveled to Haiti four years before, claiming the U.N. had diplomatic immunity that protected it from legal recourse.
The biology of bacteria isn’t the only factor that causes the proliferation of disease. Environment does, and so does racism, even if by omission. The prevailing doctrine decides that disease is natural, even inevitable, in the sewage-laced disorder of atomized urban centers, or following natural disasters. This isn’t good public health analysis and it’s never been true. Sentimental journalism (coverage of the outbreak was dominated by invocations of “tragedy,” rather than investigation of how the epidemic began) perverts our sense of accountability. “The risk for outbreaks after natural disasters is low,” the World Health Organization found in 2007. What does increase the risk of outbreak is mismanaged human intervention. Jonathan Katz, one of the prominent journalists covering the U.N.’s actions in the cholera outbreak, diagnosed the mythmaking in 2013: “Conditioned to look for a problem that wasn’t there, responders ignored the biggest public health problem of them all: themselves.”
Institutions admitting blame is admittedly rare. What isn’t rare is the dogged pursuit of justice by concerned Haitian activists. And what does the U.N. plan to do to assuage its guilt? No payments, no reparations, because the body, ironically, maintains “immunity”; instead, it has pledged humanitarian response — something that translates to a prolonged presence in Haiti. While a lack of infrastructure can cause an epidemic, the episode of failed leadership, in this case feared to be “permanent,” justifies and protracts the power of said infrastructure. Cheap fixes and even cheaper beliefs exact enormous human toll in countries dealing with unregulated populations. There are the pipes in Haiti that could have been fixed on a negligible budget. There are the pipes in Flint, Michigan, that could have been replaced for less.