Interview with Assistant Secretary-General Pedro Medrano Rojas, Senior Coordinator for the Cholera Response in Haiti

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

5 December 2013 – Since October 2010, cholera has taken an unacceptable toll on the small Caribbean nation of Haiti, which was already dealing with the aftermath of a devastating earthquake that occurred 10 months earlier. The epidemic has so far affected 680,000 people and claimed over 8,000 lives.

In December 2012, Secretary-General Ban Ki-moon launched an initiative for the elimination 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.

The UN has worked with partners in the community and international groups to launch a series of actions, including establishing/upgrading cholera treatment facilities, constructing waste water treatment plants, purchasing oral cholera vaccines, and supporting community-based hygiene campaigns. To reinforce these efforts, Mr. Ban appointed Pedro Medrano Rojas of Chile as Senior Coordinator for the Cholera Response in Haiti. Based in New York, Mr. Medrano is tasked with ensuring that the UN system optimizes its resources and actions in support of the national plan.

Mr. Medrano, a veteran humanitarian official and diplomat, spoke with the UN News Centre ahead of the one-year anniIf we can mobilize the support we need, I am convinced we can eradicate cholera in Haiti.versary of the launch of the Secretary-General’s initiative for the elimination of cholera.

UN News Centre: Could you tell us a little bit about your appointment as Senior Coordinator for the Cholera Response in Haiti. What is your brief and how do you hope to take things forward?

Pedro Medrano Rojas: The Secretary-General of the United Nations asked me to oversee the coordination work on Haiti and cholera out of UN Headquarters. My job is essentially to support and sustain the efforts of our teams on the ground to combat the cholera epidemic on the island of Hispaniola. My assignment in New York also includes ensuring a coherent response by the UN system vis-à-vis the epidemic. I work with the Deputy Secretary-General and our Working Group in Haiti, with the Special Representative of the Secretary-General, Sandre Honoré, and her team on the ground and with the Government of Haiti, since it is very important to be in contact and synchronize our efforts with those of the government to eliminate cholera.

UN News Centre: What actions has the UN family taken to address cholera? Can you give us a sense of the progress made fighting cholera on the ground?

Pedro Medrano Rojas pays a visit to Mireballais. Photo: MINUSTAH/Nektarios Markogiannis

Pedro Medrano Rojas: I think we have made significant progress. We have reduced the amount of cases by half, and today we have a lower incidence of cholera than we had two or three years ago. The number of cases on average currently reaches 4,000 or 5,000 per month. In the past we had 10,000 to 15,000 cases monthly. The number of deaths due to the epidemic has also been reduced substantially.

I believe the UN system has been working from day one that the alarm was sounded in Haiti. We work within the Country Team to support the efforts of the government. Our job is to support the efforts that the government has put in place and the national plan the government has adopted is our frame of reference. Within this plan, the UN system plays a lead role, both coordinating actions with other actors as well as between UN agencies. We need to acknowledge the progress that has been made, but also the challenges that remain. It is possible to eliminate cholera, as has been shown in other parts of the world, in much more difficult conditions, and to substantially reduce not only the number of cases, but also the number of deaths from cholera.

A remarkable aspect in my opinion is the effort made by the government and the people of Haiti, who have had to grapple with the earthquake, cyclones, natural disasters and so on. Despite all the problems the country has faced, and the scant resources that the international community has made available, progress is significant though much work remains.

UN News Centre: Who are some of the partners you would commend for their efforts? What new partnerships could be formed to help fight cholera?

Pedro Medrano Rojas: I would first like to point out and highlight the efforts made by the country itself, a country that saw its health infrastructure destroyed, a country that has been facing a dire situation in terms of water and sanitation, a country that has been struck by hurricanes and storms, but has, nonetheless, made a great effort. The leadership of the Ministry of Health, and water and sanitation management, has been remarkable.

Assistant Secretary-General Pedro Medrano Rojas, Senior Coordinator for the Cholera Response in Haiti, speaks about eliminating cholera in that country. Credit: UNTV

Among the countries in the region, I would like to highlight the efforts of Cuba, the Cuban doctors in particular, who have done a remarkable job. There are over 700 people working closely with the Ministry of Health and they have, in my opinion, really delivered amazing results, given the conditions of the country.

Also I need to mention the work of other organizations such as Doctors Without Borders, International Medical Corps, the International Red Cross, not to mention of course the work done by the Pan American Health Organization in supporting the government in surveillance and alert systems, the work done by UNICEF in everything related to water and sanitation, the work of the International Organization for Migration, which is also notable. There are many examples of countries who have contributed, such as Mexico and Brazil and others.

Although there have been individual contributions, along with resources made available by the international community, leading to progress that has been significant, in my opinion, we need to redouble our efforts.

UN News Centre: What initiatives could be added to this effort?

Pedro Medrano Rojas: I believe there are two areas that need to be addressed simultaneously. The immediate needs include medical treatment and prevention which have to be integrated in the short term. In the medium and long term, what is needed is the investment required to equip Haiti with critical infrastructure, which enables people to have access to safe water, access to a sanitation system, sewage treatment and waste disposal.

We're talking about an out-and-out tragedy at the regional level, in a country that has been affected by storms and earthquakes. We all know what Haiti has suffered, and that too even before the cholera epidemic, in terms of social indicators: infant mortality, maternal and child mortality.

I would like to stress one thing. Although cholera today affects Haiti and the Dominican Republic, there are now signs that it can spread to other countries in the region. It's appeared in Cuba, in some Caribbean countries, and has just been reported in Mexico. The region has confronted an epidemic in the past which began in Peru when a ship docked at a port, but which later expanded to over 18 countries in the region, affecting more than 1 million people and resulting in more than 10,000 dead.

At a camp for displaced persons in Port-au-Prince, Haiti, residents get bleach and water purification tablets which are used in cholera prevention. Photo: MINUSTAH/Logan Abassi

There is a possibility that history could repeat itself.

Our concern is, although an effort has been launched, not only by the UN system, but the international community and the countries and organizations that I have mentioned, we need to recognize that this is an emergency of disastrous proportions, and we have to attack it, address it in its entirety, and not only in terms of the immediate goals. Or else it will become endemic and then the costs to eliminate a pandemic will be much higher.

UN News Centre: Do you have any responsibilities related to the legal case lodged against the UN?

Pedro Medrano Rojas: No, this is not within my terms of reference. My main role is to help the Secretary-General [and] the Deputy Secretary-General to have a coherent, coordinated approach in support of the efforts the UN is doing with our partners in support of the Government of Haiti. I am not dealing with the legal issues. Today our focus is to do our best to fight this epidemic. We have today the largest epidemic in the hemisphere. People are dying and these deaths are preventable. Nobody should be dying of cholera in today’s world.

It’s also important to stress that we have been working in Haiti for a long time, not just because of cholera. We have in the past been close to the people of Haiti, supporting the Government, supporting the people in times of need. We have done it over the years, in different sectors – in water, sanitation, food, nutrition and rebuilding the country after the earthquake. It’s been said that in today’s world, it is unacceptable that anybody should die of cholera.

In a country like Haiti, we are showing that this is possible, if we have the resources. Unfortunately, we don’t have today the resources to fight cholera, to eradicate cholera.

But coming back to the question, I am concerned with the epidemic. I think this is our main responsibility. We’re going, as the Secretary-General has said, to do our best to eliminate cholera in that country.

UN News Centre: What can you tell us about the follow-up to earlier efforts to look into the cholera outbreak such as the Investigation Panel’s findings (set up by the Secretary-General) and the subsequent Task Force that was created?

The UN Mission in Haiti (MINUSTAH) in cooperation with Catholic Relief Services delivers cholera medicine to flood victims in outlaying areas of the south. Photo: Victoria Hazou/MINUSTAH

Pedro Medrano Rojas: Immediately after the outbreak of the epidemic, the Secretary-General asked an independent panel of experts to provide him with recommendations. We have been working to implement those recommendations. An internal panel has been established within the UN system to report periodically on the progress of the implementation of the recommendations. We are about to release by early next year a report that will show what has been done in different areas and what is needed going forward. The recommendations of the panel are the basis for our work, not only in Haiti but in other parts of the world as well.

UN News Centre: At the one-year anniversary of his initiative, how does the Secretary-General hope to redouble efforts?

Pedro Medrano Rojas: I think it’s important to mention that the Secretary-General has been, since day one, extremely committed and concerned about the situation in Haiti. His initiative was intended to support the national plan for the elimination of cholera. He has used every opportunity to appeal to the international community to redouble its commitment and resources to fight this epidemic. Today, we can say that we have made progress. We have been able to reduce the number of cases to half of those we had in previous years. But it is not enough.

We have learned that this disease can be eliminated. Under very difficult circumstances, we have been able today to halve the number of cases, [and] also to reduce the fatality rate to below 1 per cent on average. This, in my view, is progress. But as we approach the one-year anniversary of the initiative, the message is that we are not out of the woods. If we want not to lose the gains made, we need to redouble our efforts in prevention, in particular. We have evidence that it is possible to cut the transmission if we make the investment during the next six months, during the dry season which provides a window of opportunity. We also need to assemble the equipment, the medicine, the kits, the purification tablets – everything that is required to stop the transmission. If we are able to mobilize the resources that we need to fight cholera, in the next two or three years, we can reduce not only the number of cases substantially but also the fatality rate.

Our goal is ambitious – it is to have zero fatality and to prevent the epidemic from becoming endemic. We have reached a critical point. It’s time for the international community to understand that it’s not only a problem for Haiti. It’s a problem for the whole region and it’s a problem for the entire international community because in a globalized world, it is not possible to think that something that is affecting one country – an epidemic like this – will just be confined to this country or the island but could also affect the whole region and the rest of the world.

UN News Centre: What are the short-term and long-terms needs to eliminate cholera in Haiti?

Pedro Medrano Rojas: First of all, we need to have adequate medical treatment; we need to have the cholera treatment centres well-staffed, well trained; we need to have the medicines; we need to have the kits to test if it is diarrhoea or diarrhoea plus cholera; we need to have the cots; we need to strengthen the alert system and to have the response system in place. And we’re working on that. We also need in the medium term to work hard to stop the transmission of the disease, preventive measures, which require hygiene, water, sanitation… not an overhaul of infrastructure, which at the end of the day is the ultimate solution. A country with water and sanitation will be in a better position to fight cholera. These two areas – medical treatment and prevention –are key in the short term.

Local health authorities along with international groups have come together to create Cholera treatment ceenters to minimize the spread of the disease. Photo: MINUSTAH/Logan Abassi

In the medium and long term, we need to build the systems – the sewage systems, the water and sanitation systems. But we cannot wait to have those structures in place. We need to act now. We all know what we need now – we need medicines, we need kits, we need to have the infrastructure in place to treat patients and also to be able to reach patients in remote areas. This is one of the major concerns we have – how to reach those communities that are far away from the cholera treatment centres. It’s just impossible for a family that earns less than $1 a day to have access to medical treatment. We need to be able to reach them. This is one of our major concerns now – how can we mobilize resources and the commitment of the international community to make sure that what is needed to treat this epidemic is put in place.

UN News Centre: In terms of resources, how much money is needed?

Pedro Medrano Rojas: We’re not talking about a huge amount of resources compared to what is needed in other parts of the world in other crises. The 10-year national plan for the elimination of cholera needs an estimated $2 billion. This will allow 90 per cent of the population at the end of this 10-year period to have access to water and sanitation. For the immediate term – the next two years – we estimated we needed about $400 million. Half of that has been mobilized. So we still have a huge gap. For the more immediate, emergency interventions, we need roughly $60 million. We have been able to raise just a third of that. We need at least for the next six months to have the resources that will allow us to implement the emergency component of the national plan.

UN News Centre: What is the overall picture of where things stand with cholera and Haiti right now?

Pedro Medrano Rojas: As I mentioned, cholera has affected 680,000 people thus far. This year we are going to have approximately 50,000 new cases. On average, we have roughly between 4,000 and 5,000 cases a month. But the fatality rate has decreased and today [it] is less than one per cent, on average. It’s not acceptable, but that’s what we have. We need to work hard to have zero fatality. We feel that in the next two, three years, we will be able not only to halve but we will be able to have a third of the cases we have today and perhaps in four, five years we can really make substantial progress in eliminating outbreaks of cholera.

Our major concern is that, unfortunately, [due to] competing demands, the international community has somehow neglected the situation on the island of Hispaniola, particularly in Haiti. The time has come for the international community to understand that, based on what we have done – not only the UN but also other partners, particularly the Government – it’s possible to eliminate cholera in Haiti. But in order to be successful, we need to have the resources and the commitment of the international community. I have already mentioned some institutions, governments that have really contributed in a very substantial way. I hope that other countries will follow these examples.  This is what is required. At the end of the day, the UN is what the international community wants the UN to be. The UN is not by itself an entity that can do things without the support of Member States. At this stage, what we need is to have the strong commitment of the international community in order for us to accomplish our goals.

UN News Centre: What are your major concerns about moving forward?

UNICEF correspondent Thomas Nybo reports on the battle against cholera in Port-au-Prince, Haiti. Credit: UNICEF

Pedro Medrano Rojas: First of all, the lack of support by the international community. Haiti can do it but cannot do it alone. We are committed to do our best. Our concern is that the progress that has been achieved to this point can be lost if we don’t have the resources to stop the transmission and to make the investment required for its elimination. Let’s hope that the international community understands that this is not just about Haiti; it’s a global health issue.

UN News Centre: As we approach the anniversary of the devastating 2010 earthquake, what can you tell us, and the people of Haiti, about the UN’s commitment?

Pedro Medrano Rojas: We have been there, as I said before, in times of need. I myself was in Haiti before the earthquake, in a humanitarian capacity. We have also suffered with those that have lost lives in Haiti, and their relatives, their loved ones. Many of our colleagues were also affected by the earthquake. But we have a commitment. We care about the people of Haiti. The people of Haiti understand this and know this because they have seen us on the ground, working closely with them. The Secretary-General has indicated to the Prime Minister of Haiti “We are with you and we will continue to be with you.” If we can mobilize the support we need, I am convinced we can eradicate cholera in Haiti.