Interview with Pedro Medrano Rojas, former UN Senior Coordinator for the Cholera Response in Haiti

Pedro Medrano Rojas, Senior Coordinator for the Cholera Response in Haiti. UN Photo

23 February 2015 – Despite severe infrastructure and financial constraints, concerted efforts by Haiti and its partners succeeded in drastically reducing the number of reported cholera cases in the country – down from a peak of over 350,000 reported cases for 2011, to around 28,000 reported cases for 2014

The persistence of cholera in Haiti is mainly due to the lack of access to clean water and appropriate sanitation facilities, and although considerable improvements have been made in this regard, the small Caribbean nation continues to host the largest cholera epidemic in the Western Hemisphere. To date, the epidemic has affected some 725,600 people and claimed over 8,800 lives in Haiti since October 2010.

The UN has been working with the Haitian Government and partners on the ground to tackle the disease, including helping to reinforce the water and sanitation infrastructure and the health system. In December 2012, Secretary-General Ban Ki-moon launched an initiative for the eWe are not competing with Ebola. I think that every emergency deserves the support of the international community.limination of cholera in Haiti and the Dominican Republic that focuses on prevention, treatment and education. The initiative supports an existing campaign – known as the Initiative for the Elimination of Cholera in the Island of Hispaniola – established by the Presidents of the two countries.

Spearheading the UN system’s efforts is Pedro Medrano Rojas of Chile, the Senior Coordinator for the Cholera Response in Haiti. Based in New York, the veteran humanitarian official and diplomat is tasked with ensuring that the UN system optimizes its resources and actions in support of the national plan. Mr. Medrano spoke with the UN News Centre as he prepared to depart on a multi-country tour to update donors on the latest developments and to urge continued support to achieve the goal of eliminating cholera.

A doctor assists a patient suffering from cholera at the L'Estere medical centre near Port au Prince where the UN Children's Fund (UNICEF) is working to contain the cholera outbreak. UN Photo/UNICEF/Marco Dormino (31 October 2010)

UN News Centre: You’re about to embark on an international tour. What is the purpose of this trip and which countries will you visit?

Pedro Medrano Rojas: For the United Nations, the cholera outbreak in Haiti is a priority. It is perhaps the worst epidemic we have in the Western Hemisphere. In that sense, what we need now is to raise awareness and support for the efforts we are doing in Haiti, with the Government of Haiti, in the elimination of cholera… The international community, after so much investment, needs to understand that we cannot at this stage forget about this very important epidemic that is affecting thousands of people in this country.

UN News Centre: Which countries will you visit?

Pedro Medrano Rojas: I’m planning to visit Cuba. Then I’m traveling to Spain and other capitals in Europe, mostly to update on the situation in Haiti. I think the international community, particularly those countries that I’m going to visit, they have been extremely generous with the efforts we are conducting in Haiti, and that’s why I think it’s important at this stage to meet with them to update them on the situation, to inform them about the challenges we are facing in Haiti.

Mr. Medrano visits with students at a rural school in Cité Soleil that has a new safe water system. UN Photo (May 2014)

UN News Centre: Speaking of challenges, the international community has found itself facing emergencies like the Ebola outbreak in West Africa. To what extent has this affected the financing and resources to fight cholera in Haiti?

Pedro Medrano Rojas: I think that the Ebola epidemic in West Africa has also been a very important priority for the United Nations and the whole international community. There is no doubt that, in the last year in particular, the attention of the international community has been focusing on how to control and eliminate Ebola. But at the same time, the cholera outbreak in Haiti has been somehow overshadowed by other crises around the world. What we would like to do is to remind the international community how important it is to keep our efforts going, and more importantly at this stage because we are facing a surge in cases in the last month in Haiti. [We would] also remind them that even if Ebola is important, this other outbreak we have… deserves the same attention by the international community.

UN News Centre: Do you think this situation with Ebola has meant a decrease in funding for the cholera epidemic in Haiti?

Pedro Medrano Rojas: I think that it is not just because of the response we have in West Africa. I think that we have so many crises around the world and we are confronted with competing demands. But I think that what is important is perhaps to remind the international community how important it is today not to forget the cholera outbreak in Haiti. That’s the main purpose. We are not competing with Ebola. I think that every emergency deserves the support of the international community. But I think there’s no justification in today’s world to have thousands of people affected and even people dying because of cholera – a disease that can be treated, and it’s not necessarily a disease that kills if it is properly treated and in a timely way.

The UN mission (MINUSTAH) is part of a joint pilot project with the Direction Nationale de l’Eau Potable et de l’Assainissement (DINEPA) to install water filtration systems and provide hygiene training Port-au-Prince. Seen here is a 'train the trainer' session for community leaders who will be responsible for managing the filtration systems. UN Photo/Nektarios Markogiannis (25 April 2014)

UN News Centre: Turning to the situation in Haiti, with all the efforts being undertaken by the UN and its international partners, how would you describe the current status of the epidemic in the country? Can we speak about any progress?

Pedro Medrano Rojas: Of course, I think that progress has been made. Last year, we had 28,000 new cases of cholera. If we compare this with previous years – 2013 and 2012 – in those years, we had over 60,000 cases per year. Prior to that, we had over 100,000 new cases of cholera. So progress has been made. But we need to understand that in Haiti, the water and sanitation infrastructure, even the health infrastructure, is very weak. So it will take years to have proper systems in place, in particular water and sanitation. Haiti is perhaps the country with the lowest coverage of water and sanitation in the whole Latin American region. So that’s the reason why the Government has launched this national plan for the elimination of cholera in Haiti. There’s no doubt that progress has been made.

But at the same time, we need to also keep in mind that this epidemic is affecting the poorest section of society, particularly when we have the rainy seasons because when we have the rainy season, we have a surge in new cases of cholera. But we also need to be prepared. So that’s the reason why we have this two-track approach. While we deal with the emergency, while we are taking care of those affected, at the same time, we have to make the investments in water, sanitation, health… because this is what history has taught us, that when we have systems in place, then even if we have bacteria, we are not going to have an epidemic.

The 'train the trainer' session for community leaders who will be responsible for managing the water filtration systems. UN Photo/Logan Abassi (23 April 2014)

UN News Centre: What is the next step? What is the type of assistance that Haiti would need to find a permanent solution to the causes that lead to cholera prevalence in the country?

Pedro Medrano Rojas: What we have learned from previous epidemics… in Asia, Europe and even Latin America… I think that water and sanitation are key for the elimination of cholera, and not only cholera, also other water-borne diseases. And as I said before, Haiti has the lowest coverage. So we have to continue our work in this area in terms of ensuring a proper system of water and sanitation, at least to have the same level as the rest of the region. But in parallel to that, what we need now is the resources to deal with the surge, the new cases, and for this we need the health system, the health workers. We need vaccines. We need to have our partners on the ground.

Unfortunately, because of the lack of resources, numerous partners have left Haiti. I think it’s because there is this perception that there is no emergency in Haiti. And in my view, any country in the world with such a large number of cases – 28,000 cases last year – any country in the world would consider this as an emergency.

Pedro Medrano Rojas discusses the Organization's ongoing battle against Haiti's devastating cholera epidemic. Credit: UN News Centre

UN News Centre: You have mentioned that some partners have left due to the lack of resources. Could you mention some of the countries or NGOs that have remained and have had a significant impact in the fight against cholera?

Pedro Medrano Rojas: It’s worth mentioning for example the work of Médecins Sans Frontières, the work of the Red Cross Federation… also the work of the United States through its own agencies. Of course, the United Nations system, we are working on the ground with many partners. And I think that what we are facing now is, as I said before, this perception that because of the progress that has been made, there is no longer an emergency there… and also the other crises around the world. Also, the fact that this is not prominent in the major media, it is not perceived as an emergency. I think that is the purpose of our work. That’s the reason why I am reaching out to partners, Member States, not to forget Haiti. Otherwise, we will continue to have not only the surge we have just mentioned but an increasing number of people affected and also fatalities – that can be avoided, by the way.

During a visit to Haiti in July 2014, Secretary-General Ban Ki-moon (third from the right) launched with Prime Minister Laurent Lamothe (centre) the country’s “Total Sanitation Campaign” which aims to scale up sanitation and hygiene in rural areas. They are seen here visiting with a family in Los Palmas. UN Photo/Paulo Filgueiras

UN News Centre: You mentioned you are traveling to Cuba. Has Latin America played a positive role in addressing the epidemic in Haiti?

Pedro Medrano Rojas: It’s important to mention the extraordinary work of the medical doctors from Cuba… and to have also support from other countries of the region, particularly Brazil. Recently, the Government of Chile contributed resources for the vaccine. But I think that we can do more. I think that it is in the interest of all of Latin America to eliminate cholera in Haiti. In the last CELAC [Community of Latin American and Caribbean States] meeting that took place in Costa Rica, again it was mentioned the need to continue support for Haiti. But it’s not just resources. We also need technical assistance because the institutions in Haiti also need technical support. We need to have the capacity there on the ground not only for the response but in the middle and long term to ensure that the health system, water and sanitation infrastructure is there.

UN News Centre: Does the current political instability in Haiti have any impact on the fight against cholera?

Pedro Medrano Rojas: I think so. We hope that this political crisis will be solved. It doesn’t help to have a political crisis in the midst of all these humanitarian challenges. There is also the need to have well-functioning Government agencies and institutions and the fact that there is now a stalemate in terms of the elections and the Congress doesn’t help. We are confident that the authorities and the Government of Haiti and the people of Haiti will find a solution because certainly it is important to have a Government that works and that the international community can work with.

Mr. Medrano (second from left) with Prime Minister Laurent Lamothe (left) during a visit to Haiti in July 2014. UN Photo/Paulo Filgueiras

UN News Centre: Can you tell us about the status of cholera vaccines?

Pedro Medrano Rojas: We have a plan for this year to vaccinate 300,000 people. Last year, we were able to vaccinate about 200,000 people. Vaccines can help to prevent the transmission of the disease. For this year, we need $3.5 million and we have been able to raise resources from Norway and Chile in the amount of $1,300,000 to purchase the vaccines for this year. But we need to work on that. We need to also explain that a vaccine, even if it is not a long-term solution, can help to prevent people getting sick, and more important to save lives. There is evidence there that the vaccines have 80 per cent efficacy and can last three [to] four years. So we are working on that area.

UN News Centre: How do you perceive the role of the UN in the fight against the crisis and what are the actions that the Organization is willing to take in 2015?

Pedro Medrano Rojas: We all know the Secretary-General visited Haiti last year. We have a commitment to support the Government of Haiti – this is a high priority for the United Nations and for the international community. The UN system is working on the ground with the Government of Haiti. We have established a mechanism to work with the Government – a high-level committee. So our commitment is there. It is a high priority, and also for the Secretary-General it’s a high priority. I think that this is reflected in the work we are doing on the ground.

Mr. Medrano holding a child during a July 2014 visit to the community of Las Palmas. UN Photo/Paulo Filgueiras