In the search for the cause of Haiti’s recent cholera outbreak, which has claimed more than 4,500 lives and sickened 300,000 people, the finger of blame cannot be pointed at a single source, says a new report

According to an independent panel of experts commissioned by the United Nations (UN), the disease that has ravaged the country since last November was spawned by a multitude of factors, rather than one guilty party. 

This conclusion challenges the commonly held belief that a group of Nepalese peacekeepers, stationed near the site of the first reported cholera cases, was solely responsible for the outbreak. 

Last December, an evaluation of the epidemic, conducted by French epidemeologist Renaud Piarroux, traced it to the town of Mirebalais, where he said feces from those UN soldiers contaminated the Artibonate River with the pathogen, which then spread downstream and throughout the country.  

Following this discovery, anger among the Haitian populace spurred a wave of violence around the country.

This latest report disperses responsibility for the epidemic among a variety of sources. 

It acknowledges that the strain of Vibrio cholerae rippling through Haiti most closely matches strains previously confined to South Asia, and was likely introduced into the Artibonite near Mirebalais. 

Sanitation conditions at the Mirebelais camp were “not sufficient to prevent contamination of the Meye Tributary System with human fecal waste,” it finds.

However, a variety of other shortcomings in the country’s sanitation system contributed to the disease’s devastating effects, says the report.

“The Independent Panel concludes that the Haiti cholera outbreak was caused by the confluence of circumstances … and was not the fault of, or deliberate action of, a group or individual,” it says. “The introduction of this cholera strain … could not have been the source of such an outbreak without simultaneous water and sanitation and health care deficiencies.”

According to the panel, the circumstances that contributed to the destructive nature of the epidemic include:

— Tens of thousands of Haitians use the Artibonite River for washing, bathing, drinking and recreation

— Thousands of Haitian agriculture workers, particularly those working on rice paddy fields,are regularly exposed to the river’s waters

— The country’s population has not built up immunity to the disease

— Infected individuals fled their homes, thus dispersing the disease

— Conditions of medical facilities used to treat patients did not adequately reduce the spread    of the bacteria

In order to prevent future outbreaks on the scale of the current one, the report recommends that Haiti work to contain and treat its drinking water supply, and to educate people on the importance of sanitation techniques such as hand washing and safely disposing fecal waste. 

It also advises that UN workers be immunized or take antibiotics before entering a cholera- infected area, and that they receive more extensive training on controlling and treating the disease.  

Secretary-General Ban Ki-moon announced that the UN would convene a task force to follow up on the panel’s findings.   

The investigation was led by Dr. Alejandro Cravioto of the International Center for Diarrhoeal Disease Research in Bangladesh, and co-authored by Dr. Claudio Lanata of the Instituto de Investigacion Nutritional in Peru, Daniele Lantagne of Harvard University and Balakrish Nair of the National Institute of Cholera and Enteric Diseases in India.