Almost five years after a rampaging cholera epidemic coursed through the Artibonite River region of Haiti and moved rapidly around the country, the United Nations, which acknowledges that a deadly strain of the disease originated in or around a Nepali peacekeepers’ base, is tightening medical prevention rules for soldiers and police.
National governments will now be responsible for ensuring that vaccinations or prophylactic drugs have been given to troops coming from (or going to) areas of endemic disease. If countries fail to abide by the rules and the UN must assume the task of providing preventive medication, troop-contributing countries will be billed for this service as a deduction from payment for peacekeeping work.
The decision to make vaccinations, including cholera as well as antimalarial medications and equipment like mosquito nets and bug sprays, mandatory for all deploying peacekeeping personnel was made in January 2015 by the UN departments of management and field support, based on the revised Contingent-Owned Equipment Manual, 2014 edition.
For the first time, the decision whether to vaccinate or to take other medical precautions is not being left to the troop contributors. The new policy was transmitted to the General Assembly for distribution early this year, and the Department of Field Support, part of the Department of Peacekeeping Operations, is working with troop-contributing governments to put the new procedures into practice, UN officials said.
The manual, which covers many areas of troop contributors’ logistical commitments, is clear on the vaccination policy:
“The administration of vaccinations, as recommended by the United Nations, is a national responsibility. The United Nations will provide necessary information on what kind of vaccination and preventive measures will be given to all United Nations personnel prior to deployment.
“If any United Nations personnel deploy without proper vaccinations and prophylaxes, the United Nations will provide necessary booster shots and prophylaxes. In this case, the United Nations will deduct any expenses for initial vaccinations, which could have been initiated prior to deployment from the self-sustainment payment of troop/police-contributors.”
UN officials have also clarified in interviews the system under which sanitation and other facilities are constructed in countries where UN troops and police are deployed. It has been customary to hire local contractors for numerous construction and maintenance jobs. In Haiti, the latrines found to be faulty on the Nepali battalion’s base, allowing raw sewage to seep into natural waterways, were built by Haitian contractors, not by UN employees, officials said.
Agreements between the UN and countries contributing troops and police officers to missions are concluded in memoranda of understanding that can take a relatively long time, often months, to finalize. There are cases where the troops arrive at a duty station before a formal agreement has been signed. In the past — apart from bringing endemic illnesses that may not have been detected because of lack of symptoms — troops from some countries have arrived without proper equipment or clothing for the task or location to which they are assigned.
The revised manual and its predecessors attempt to set out in writing exactly what is expected of troop contributors, who are paid through assessments of UN member nations.
On medical issues, decisions by governments have been mixed. In October 2014, Sierra Leone quarantined an 800-member battalion of peacekeepers preparing to be sent to Somalia to join an African Union mission after one soldier tested positive for Ebola. The soldier had gone AWOL from a military camp, apparently to return to his village for a visit, during which he was infected. All 800 troops were confined in isolation for 21 days, the Reuters news agency reported.
The behavior of the Nepali government and military was very different, although cholera is endemic to Nepal (and India) and there had been recent cases in the region. Haiti’s consequent cholera epidemic became a sharp lesson for the UN in what happens when anything about peacekeeping is left to chance.