A new paper from the Center for Economic and Policy Research argues that cholera treatment and prevention efforts in Haiti have fallen woefully behind, leading to thousands of preventable deaths, even though the dramatic rise in new cases this spring and summer was entirely predictable. The paper, “Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti”, by researchers Jake Johnston and Keane Bhatt, argues that it is not too late to bring the 10-month old cholera epidemic under control and save thousands of lives by ramping up treatment and prevention efforts. Below is the Executive Summary of the paper, to read it in its entirety, click here.
A 11,849-word article by journalist Janet Reitman in the new issue of Rolling Stone provides a sometimes fascinating and always disheartening overview of relief and reconstruction in Haiti since the earthquake. Reitman, who has recently been in the news herself over her new book, Inside Scientology, spent months researching the report, both in the U.S. and in Haiti, and so she is able to cover a good deal of ground. Much of her focus falls on the failings of various initiatives by often prominent individuals and organizations, which often contrast with their public images and their stated goals and intentions. Addressing the role of big NGO’s, for example, Reitman writes
On top of the earthquake, aid workers in Haiti are contending with a cholera crisis, a disease of poverty spread through poor sanitation and contaminated drinking water. These are all things that NGOs like the Red Cross have expertise in fighting, but larger structural issues often trump their best intentions. Because international NGOs get most of their money from large government agencies, they are beholden to the broader policy imperatives of their funders. "The big problem is that most NGOs are only really accountable to their donors, when we should really be accountable to the people we're trying to serve," says Dr. Louise Ivers, senior health and policy adviser for Partners in Health, a Boston-based NGO that has worked in Haiti for 25 years. Some organizations, she notes, "exist only to write grant proposals that respond to specific donor requests. If your mandate is just to follow the money, then the money determines what happens."
CHF International is one NGO that comes in for scrutiny further on:
[American field-office director for CHF International, Ann] Lee admits that [CHF], a vast NGO with relief operations in 25 countries around the world, has never done "micro-urban planning," as she calls it — nor have the half dozen or so other NGOs planning similar projects in Port-au-Prince. "It's a complete learning experience for all of us," she says. All that's needed to make the project a reality, she adds, are more funds.
As was reported in the Brazilian and other Latin American press, but generally ignored by English language media (save for brief mentions by Americas Quarterly and Haiti Libre), new Brazilian Defense Minister Celso Amorim made public remarks the other day regarding a possible draw down of Brazilian troops from MINUSTAH.
As Haiti Libre and other outlets have noted, Amorim’s remarks are significant in part because Amorim was “the 'artisan' of the participation of Brazil in the Minustah [UN Mission for Stabilization in Haiti]” during his previous tenure as Foreign Minister.
Haiti Libre goes on to report that
Already in 2010, as Foreign Minister under the government Lula, Amorim expressed the necessity of replacing the military presence in Haiti by engineers and social workers to collaborate in the development and the economy of Haiti.
Amorim’s remarks are the latest sign that an end to the UN Mission, so widely unpopular in Haiti, may soon be on the horizon. As we’ve noted in various earlier posts, MINUSTAH has been controversial from its start, when it often appeared to aid police in their post-coup crackdown on Fanmi Lavalas members, social movement activists, and others in the wake of the 2004 U.S.-backed coup. The Blue Helmets have since killed innocent civilians in violent raids on slums, attacked journalists, and seen over 100 troops expelled from Haiti over child prostitution and related charges. These are just the documented crimes, which are supplemented by other suspicious incidents. But the Mission’s popularity undoubtedly hit a new low following the cholera outbreak last October, which quickly was traced back to a MINUSTAH camp in Mirebalais.
Haiti may thankfully be spared the heavy impact of Tropical Storm Emily, as the storm seems to have weakened as it hit Hispaniola’s mountains. Health workers and others have been tracking the storm’s progress with trepidation, as it was heavy rains in June that led to a resurgence in cholera cases. Unfortunately, even a weakened storm may still bring strong rains, and more cholera. The PBS Newshour's Talea Miller reported yesterday:
A tropical storm bearing down on Haiti threatens to make daily life more miserable for tens of thousands homeless still living in tent camps and could deepen the cholera epidemic that has already killed more than 5,800.
Tropical Storm Emily was on a path toward the Dominican Republic and Haiti Wednesday, and forecasts predicted heavy rains and possible flooding -- perfect conditions for the spread of water-borne diseases like cholera.
"[The weather service] is talking about possibly 10 inches in Haiti. That's a huge amount of water," said Julie Sell, spokesperson for the Haiti mission at the American Red Cross. "In a country where people are frequently using the same water sources to bathe, [such as] as a toilet, and to drink, the last thing you want is standing water."
But missing from the report was any mention of the role the U.S. government played in undermining Haiti’s provision of potable water. As described in great detail elsewhere, the U.S. government, under the Bush administration, directed the Inter-American Development Bank, in a highly unusual move, to withhold loans to the Aristide government that would have provided hundreds of millions of dollars for a potable water project, among other purposes. The Aristide administration was even forced to pay interest on the loans, despite their non-disbursal (in other words, the “loans” actually took money from Haiti while offering nothing in return).
On July 21, President Martelly declared “my government is against forced evictions,” but as of yet has done little to stop this systematic violation of rights. The UN Office for the Coordination of Humanitarian Affairs (OCHA ) reports that over 125,000 people face the imminent threat of eviction every day. Yesterday, the residents of Camp Django in Delmas protested (click for photos) for their right to adequate shelter and for Martelly to live up to his promises after having faced the constant threat of eviction for months (follow developments on Twitter under #noevictions). In June, Bill Quigley and Jocelyn Brooks of the Center for Constitutional Rights, reported:
Last Saturday, a group of five men, some armed with guns, stormed into the camp and threatened the residents. Four of the men were wearing green t-shirts that read “Mairie de Delmas” (The Office of the Mayor of Delmas).Last Thursday, Jeena Shah gave an update on Camp Django:
The Mayor’s men told the people that they would soon destroy their tents. They bragged they would mistreat people in a manner worse than “what happened at Carrefour Aero port,” referring to the violent unlawful eviction of a displacement camp at that location by the same mayor and police less than a month ago.
The Mayor’s men pushed their way through the camp, collecting the names and identification numbers of heads of household and marking tents with red spray painted numbers.
When the men pounded on the wooden door of the tarp covered shelter where 25-year-old pregnant Marie lived with her husband, she tried to stop them from entering. Marie tried to explain that her husband was not home. But the leader of the group, JL, violently slammed open the wooden door of her tent into her stomach, causing her to fall hard against the floor on her back.
Three days later, Marie remained in severe pain and bed ridden, worried sick about her baby.
Jeena Shah, a BAI attorney, arrived at Camp Django while government agents were still there. Jeena asked JL [the leader of the group] who had sent his group to Camp Django and why they had marked the tents with numbers. JL was evasive, repeating over and over that “the government” had sent him. Finally he stated that “the National Palace,” a reference to current President Michel Martelly, had sent him.
At around 9 am this morning, two truckloads of police officers along with one of the mayor’s agents returned to the camp. By this time, Camp Django residents had begun protesting just outside of their camp. The police officers proceeded to beat camp residents with their batons and boots and arrest them. Several victims required medical attention. One family’s tent – that of the camp leadership’s spokesperson, who had spoken out against the Mayor’s past threats against the camp – was ransacked by police officers as they searched for her to arrest her. The mayor’s agent and police officers were unaccompanied by a judicial officer, and neither did they present any judicial order to evict the residents, as required under Haitian law.What happened to Camp Django was not an isolated incident. In mid-July some 500 families were forcibly evicted, illegally, from the area around Sylvio Cator Stadium in Port-au-Prince. The UN Office of the High Commissioner for Human Rights characterized the eviction as not respecting the right to adequate housing and added that “the former camp residents will be much more vulnerable than they were in the camp.” Amnesty International added that:
“Port-au-Prince's Mayor must stop these illegal forced evictions of earthquake victims until adequate alternative housing can be found for all the displaced families,” said Javier Zuñiga, Special Advisor at Amnesty International.
“By pushing families out in the street for a third time since last year’s earthquake, Haitian authorities have failed to protect their rights to an adequate standard of living and basic shelter.”
Last Friday, as the board of the Interim Haiti Recovery Commission (IHRC) was meeting, the Haiti Reconstruction Fund (HRF) released their first annual report. (Note: we obtained a copy by asking one of the report’s media contacts for one; the report itself unfortunately has still not been made publicly available.) The report, which received cursory but positive media coverage, touted the high level of aid disbursement and the flexibility with which the HRF can operate, while rightly noting that the wider international community was failing to keep up. As AFP reported:
At an international donors conference held in New York in March 2010, 55 donors pledged $4.58 billion in grants in 2010 and 2011 for rebuilding the country. But as of June, donors had disbursed $1.74 billion, just 38 percent of the pledges, the World Bank said.In releasing the report, the HRF also pointed to major reconstruction projects, such as the Neighborhood Housing Reconstruction Project as “highlights of the work done so far”.
Dr. Paul Farmer, UN Deputy Special Envoy for Haiti and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, released a new book last week to coincide with the 18-month anniversary of the Jan. 12, 2010 earthquake. In addition to containing a dozen short essays by various contributors, Haiti After the Earthquake provides Farmer's firsthand account of his relief and reconstruction efforts as a diplomat and co-founder of the NGO Partners in Health, which has over a quarter-century of experience in Haiti.
Farmer is perhaps unique in his successful straddling of distinct, and at times, conflicting spheres of international development. While having authored numerous indictments of U.S. policy toward Haiti, in early 2009 he contemplated accepting a position in the Obama State Department to coordinate overseas health initiatives or to run the U.S. Agency for International Development (USAID). Shortly thereafter, former President Bill Clinton, who was appointed UN Special Envoy to Haiti in April 2009, asked him to be his deputy at the United Nations. He was apparently undeterred by Farmer's prior denunciations of the "cynical realpolitik of Bill Clinton's presidency" of the 1990s. In particular, Farmer had characterized as an "abomination and a crime" Clinton's continuation of "his predecessor's policies" of indefinite detention of Haitian asylum seekers in a Guantánamo Bay naval base, which "resembled a dungeon." Farmer and Clinton have since forged a camaraderie as the Clinton Foundation assisted Partners in Health in its AIDS initiatives in Haiti in 2003, and, in "an honorable gesture," the foundation "declined to work in Haiti under the regime installed after the coup" in 2004 against Jean-Bertrand Aristide, the democratically elected president (28). Clinton then spurred Farmer to launch a major rural health initiative in Rwanda, where Farmer currently resides, and in the book, Farmer refers to Clinton as a "mentor and colleague" (27).
While delving into some history and politics, Haiti After the Earthquake's aim is narrower than Farmer's previous works like The Uses of Haiti. Farmer's overriding concern, as related in the book, is how to "build back better," considering that "the quake offered a chance to do reconstruction right" (38, 100). The book often highlights Farmer's endeavors to promote a principled, Haitian-driven agenda within elite spheres of policymaking. He explains how he accepted Clinton's honorary post at the UN, despite its "huge, largely military, presence in Haiti" (38). Farmer had strongly condemned the UN-bolstered de facto government after the coup d'etat, and in the book, he continues to express his "doubts about the peacekeeping mission in Haiti, stemming from the events of 2004 and after" (41). Although he delimited his own agenda within the UN to health, education and food security, his ambitions and influence are much broader. Upon entering the UN, he "insisted on bringing Haitians onto the team—none had been proposed," while hoping to "move the [UN's] focus from military assistance to development assistance, from security to human security, towards freedom from want" (37-38).
U.S. diplomatic cables now released from Wikileaks make it clearer than ever before that foreign troops occupying Haiti for more than seven years have no legitimate reason to be there; that this a U.S. occupation, as much as in Iraq or Afghanistan; that it is part of a decades-long U.S. strategy to deny Haitians the right to democracy and self-determination; and that the Latin American governments supplying troops – including Brazil – are getting tired of participating.
One leaked U.S. document shows how the United States tried to force Haiti to reject $100 million in aid per year – the equivalent of 50 billion reais in Brazil’s economy – because it came from Venezuela. Because Haiti’s president, Préval, understandably refused to do this, the U.S. government turned against him. As a result, Washington reversed the results of Haiti’s first round presidential election in November 2010, to eliminate Préval’s favored candidate from the second round. This was done through manipulation of the Organization of American States (OAS), and through open threats to cut off post-earthquake aid to the desperately poor country if they did not accept the change of results. All of this is well-documented.
Earlier this week the French Embassy in Haiti announced an extension of their local procurement program in Haiti. Since 2005 France has worked with local farmers to try and stimulate local production by purchasing food aid locally. This new initiative significantly increases the amount to be purchased locally with France now committed to buying over 1,000 metric tons of rice from local producers in 2011.
The problems with traditional food aid are described by the embassy:
In Haiti, close to three million people now depend daily on food aid programs in order to eat. But, paradoxically, this support, made up essentially of agricultural surpluses imported from Western nations, is a double-edged sword: though it may be essential to the survival of nearly 30% of the country’s inhabitants, it also deprives Haitian farmers of a big part of their clientele. These local farmers thus find themselves squeezed between food aid that’s generously offered by Western countries, and the very low-priced commercial imports (as they are subsidized by the producer countries and taxed little by Haiti) by large traders : as they are unable to match these prices, these farmers thus abandon their land and move to the miserable slums of big cities… Where they swell the ranks of the food aid dependent population.
While the EU and the WFP have begun efforts to increase local procurement of food aid, the U.S. has lagged behind its peers. In December of 2010 the Robert F. Kennedy Center for Justice & Human Rights—in partnership with Partners In Health and Zanmi Lasante released a report looking at U.S. food aid policies in Haiti, entitled “Sak Vid Pa Kanpe: The Impact of U.S. Food Aid on Human Rights in Haiti.” The preface notes:
U.S. food aid—bound by requirements that U.S. assistance earmarked for food be based on the “donation” of U.S.-produced food delivered by U.S. shipping companies—is either given out to the poor (as direct food assistance) or sold by NGOs to support their overhead and operating costs (a process known as monetization). This type of food aid can undermine local production of food by falsely reducing the price of food that can be garnered by farmers, often leading to financial ruin and forcing people to abandon agriculture as a livelihood altogether. If done differently, food aid could be effectively tailored to address urgent needs without harming the local economy, while also encouraging local agriculture and production, for example through the use of local or regional purchase of commodities by donor countries.
The paper gives a series of recommendations to the U.S. about ways in which they could change their food aid policies to greater promote Haitians’ human right to food. The US has, however, taken small steps to increase flexibility in food aid. But not only are the resources not sufficient, but Haiti has not been included in the US’ Department of Agriculture Local and Regional Procurement Pilot Project despite the obvious need. Instead, the U.S. Agency for International Development (USAID) has relied on cash transfers through the Emergency Food Security Program. Last year a USAID funded study acknowledged that “LRP (Local and Regional Procurement) can stimulate local production, increase income-generating opportunities along the marketing chain, while simultaneously reducing dependence on imported foods whose market structures are less competitive than locally-produced foods.” Although USAID has focused on cash transfers, the USAID study notes that a “significant portion of the transfer spent on food will be directed towards imports, which will increase household food security but will not simultaneously stimulate domestic production.”
The AP’s Trenton Daniel reported over the weekend on the rise in cholera cases that have been seen since heavy rains hit Haiti early in June. Daniel reports:
The number of new cases each day spiked to 1,700 day in mid-June, three times as many as sought treatment in March, according to the Health Ministry. The daily average dropped back down to about 1,000 a day by the end of June but could surge again as the rainy season develops.
According to data from the Health Ministry, over 5600 people have now died from cholera, while over 380,000 have been sickened. In addition, throughout June, on average 8 people were dying each day, up from an average of 3.5 in May. As Daniel points out, however, “[t]he precise total is unknowable since many Haitians live in remote areas with no access to health care.”
Yet despite the renewed strength of the epidemic, there are signs that the health sector is being stretched thin:
The disease faded in winter and spring, when rain is less frequent, and many aid workers moved on. U.N. troops in Haiti turned their attention to the country's many other pressing problems.
Now there is a fear among aid workers who remain that there won't be enough resources if the latest surge gets much worse.
"If the cases continue on the same path we could see a lot of health-worker fatigue," said Cate Oswald, a Partners in Health co-ordinator. "The health care force is already stretched thin."
After heavy rains hit Haiti last month, the Red Cross and Doctors Without Borders (MSF), among others, issued statements saying they would be reopening cholera treatment centers (CTCs) in the capital to respond to the renewed outbreak. Updated lists released in late June by the Health Cluster, however, reveal that the decline in the number of CTCs has continued throughout the beginning of the rainy season. Table 1 shows the evolution of CTCs in each department over the last four months. The only department that saw an increase in the number of CTCs was the Ouest department, and even there it was only by one. While more than one CTC was reopened in the Ouest, nearly the entire gain was offset by the closing of other centers. Although the number of CTCs has fallen, the total capacity of cholera facilities (including CTUs) seems to be holding steady, according to partial numbers from the Health Cluster. This may be further evidence that those health providers that have continued to operate have been forced to stretch resources to make up for the exit of other organizations.
Last Thursday, in the Dominican Republic, every westbound bus traveling on the transportation artery Autopista Las Américas (The Americas highway) was stopped upon its arrival in the capital city of Santo Domingo between 7 a.m. to 10 a.m., according to Listín Diario. A joint operation between immigration officials, the National Police and the Dominican Army set up checkpoints, which led to the detainment of “dozens” of “illegal Haitians.”
The sugar-producing East, from which the buses came, is a hub for thousands of Haitian migrants working under brutal conditions cutting cane. As was reported by Dominican Today, “When inspectors entered the buses and asked the Haitians for their ID, if they were in order, they weren’t bothered, but dozens of them that didn’t [have appropriate documentation] were escorted onto buses to clearing centers.”
This description gives a good idea as to how Dominican authorities ascertain whether or not one is in the country illegally—by targeting those who appear to be Haitian. Summary detentions and mass deportations of Haitians amount to a longstanding and ubiquitous dynamic in Dominican law enforcement. The seemingly straightforward protocol of asking for proper identification quickly becomes an exercise in discrimination, as many Dominican nationals also have difficulty obtaining valid documentation. A 2006 survey by the Dominican government’s National Office of Statistics found that 22% of children born during the previous five years did not have birth certificates, “and thus,” Unicef noted, “legally, did not exist.” The crackdown against illegal immigration is closely linked to efforts to remove those of Haitian descent from the country.
The human rights community has strongly opposed mass repatriations to Haiti. Earlier this year, Amnesty International demanded that the D.R. “immediately halt the mass deportation of Haitian migrants.” Last month, the UN Office of the High Commissioner of Human Rights appealed to all governments to “refrain from conducting returns to Haiti” [PDF]. Given the “current situation prevailing in Haiti,” the High Commissioners also asked governments to “renew, on humanitarian grounds, residence permits and other mechanisms that have allowed Haitians to remain outside the country.” Similarly, the ACLU, along with more than 50 other groups, has called on the U.S. to stop deportations to Haiti.
The Associated Press reports that Martelly has officially announced that Bernard Gousse will be his nominee for Prime Minister. As the AP notes, Gousse was “justice minister under the interim government that took power in 2004 after former President Jean-Bertrand Aristide was ousted. Critics accused him of persecuting supporters of Aristide.” Jacqueline Charles of the Miami Herald reported today on Gousse’s “rocky past” noting his “god awful” reputation as Justice Minister. Charles reports that his nomination “has sparked outrage among some parliamentarians, who repeatedly warned Martelly in meetings this week that Gousse was an unacceptable choice and his nomination would be rejected.” While the Miami Herald article scratches the surface of Gousse’s “rocky past”, one could go even further. The government and its supporters after the coup, while Gousse was justice minister, were responsible for some of the worst political violence in the hemisphere. The medical journal The Lancet estimated in 2006 that the dictatorship installed after the 2004 coup murdered around 4000 people in the greater Port-au-Prince area alone. At the same time the government jailed hundreds of Lavalas supporters and officials from the ousted, democratic government – sometimes for years, and often without charge, or on trumped-up charges that were later thrown out. Under Gousse, some media outlets that opposed the coup, such as Radio-Télé Ti Moun, were shut down, and some journalists arrested.
Gousse’s record as Justice Minister led 10 members of the US Congress to write to Secretary of State Condoleeza Rice in 2005:
First, it is obvious that interim Justice Minister Gousse must be removed immediately. He has clearly demonstrated that he is unwilling to conduct his duties in an objective and responsible manner. His continued presence in the government eliminates any chance that elections planned for later this year will be free and fair. Put simply, both his attitude and his actions have actually increased Haiti’s instability and have guaranteed that Haiti will remain volatile even after the elections.
Revelations about MINUSTAH are in the news again. First, a new study published in a U.S. Centers for Disease Control and Prevention (CDC) journal affirms that a MINUSTAH camp was the origin of the cholera outbreak which has killed over 5,500 people so far.
As AP reports:
"Our findings strongly suggest that contamination of the Artibonite (river) and 1 of its tributaries downstream from a military camp triggered the epidemic," said the report in the July issue of Emerging Infectious Diseases, a journal of the U.S. Centers for Disease Control and Prevention.
The article says there is "an exact correlation" in time and place between the arrival of a Nepalese battalion from an area of its South Asian homeland that was experiencing a cholera outbreak and the appearance of the first cases in the Meille river a few days later.
The remoteness of the Meille river in central Haiti and the absence of other factors make it unlikely that the cholera strain could have come to Haiti in any other way, the report says.
As we described in detail when suspicions first arose that Nepalese blue helmets had brought the cholera strain to Haiti, MINUSTAH rejected the claims and showed little interest in uncovering the truth about the cause of the epidemic. Cholera, meanwhile, continues to spread, recently increasing with the heavy rains:
The UN Special Envoy for Haiti has released updated numbers on international aid pledges from last March’s donor conference, showing just a minor increase since the last update in early April. Although many donors claimed they were waiting for the new government to take power before releasing aid disbursements, the recent analysis shows that so far at least, little new aid money has been forthcoming from Haiti’s largest donors. In a statement released today, the Special Envoy reported that 37.8 percent ($1.74 billion) of the $4.6 billion in aid pledges had been disbursed through June, up from just 37.2 percent ($1.71 billion) through March. The United States has disbursed just $120 million of the over $900 million appropriated for Haiti, a disbursement rate of just 13.7 percent. This is lower than what had previously been reported.
In an accompanying report, looking at aid to Haiti both before and after the earthquake, Dr. Paul Farmer writes:
After the earthquake, the international community pledged significant financial resources for both the relief and recovery efforts. Yet many of us have been frustrated with the transition between the two phases. Over the past year, donors have disbursed over $1.74 billion for recovery activities, but over half—$2.84 billion—of what was pledged for 2010 and 2011 remains in donors’ hands.
And yet disbursing funds is only part of the aid picture. We know from our shared experiences in Haiti and elsewhere that the way aid is channelled matters a great deal, and determines its impact on the lives of the Haitian people. For example, with over 99 percent of relief funding circumventing Haitian public institutions, the already challenging task of moving from relief to recovery—which requires government leadership, above all—becomes almost impossible.
We have heard from the Haitian people time and again that creating jobs and supporting the government to ensure access to basic services are essential to restoring dignity. And we have learned that in order to make progress in these two areas we need to directly invest in Haitian people and their public and private institutions. The Haitian proverb sak vide pa kanpe—“an empty sack cannot stand”—applies here. To revitalize Haitian institutions, we must channel money through them.
As we’ve previously described, State Department cables Wikileaked last year revealed a State offensive against unfavorable media coverage of the U.S. role in the aid effort, with Hillary Clinton instructing all embassies to “push back” against “inaccurate and unfavorable international media coverage of America's role and intentions in Haiti.”
A newly released cable, made available through Wikileaks’ partnership with Haiti Liberté and The Nation, reveals in detail how such “push back” worked, in one case at least.
Diligently following up on Secretary Clinton’s instructions, the U.S. Embassy in Doha, Qatar noticed that “On Sunday, January 17, Al Jazeera's English (AJE) news channel, headquartered in Doha, began running inaccurate coverage of U.S. and international relief efforts in Haiti.” In response, the Embassy took actions resulting in a State Department spokesperson appearing on Aljazeera English in Washington “within hours”; called Aljazeera English Director Tony Burman ahead of another call by Judith A. McHale, Under Secretary of State for Public Diplomacy and Public Affairs, and made sure Burman “understood the serious concerns that the Undersecretary would convey”; and, after said “flakking” took place, monitored Aljazeera coverage, which it noted with satisfaction became “less and less” “inaccurate and confrontational”, “evolv[ing] markedly” “with reporting focused on the work being done by U.S. military forces - particularly airdrops - and 50 orphans who had been sent to the United States on an expedited basis.” The coverage now included more context, the Embassy noted, including regarding logistical obstacles to U.S. efforts at aid distribution.
Heavy rains dumped up to six inches of rain across Port-au-Prince and throughout much of Haiti Monday night. Continued rain is predicted through Thursday. The storms left 23 dead, injured many and left thousands more displaced. A damage assessment by the Département de la protection civile and the IOM found that 32 of 187 camps were flooded and that nearly 500 families were affected in Cite Soleil, one of the worst hit areas. Some camps were under up to four feet of water. The assessment also noted an increase in the number of cases of cholera, and that "latrines have been reported to overflow in some camps."
The deadly storm comes just a week into the Atlantic hurricane season and less than a week after the UN's Nigel Fisher proclaimed that Haiti was better prepared than last year. Following the storm, Jacqueline Charles of the Miami Herald spoke with Elise Young of ActionAid:
ActionAid called for better coordination between the U.S. Agency for International Development, the Haitian government and nongovernmental organizations to prevent further disaster this hurricane season. The new devastation, ActionAid said, highlights the need for newly elected President Michel Martelly to immediately implement a long-term housing strategy for Haitians, hundreds of thousands of whom remain under flimsy tents and tarps nearly 17 months after a catastrophic earthquake.This year, although the camp population may be lower than last year, hurricane preparedness is complicated by the high number of people living in damaged housing. Charles reports:
“Disaster mitigation must be prioritized not only in Port-au-Prince, but in vulnerable communities throughout the country that are at risk of severe flooding,’’ Elise Young, an analyst with ActionAid, told The Miami Herald.
Mellicker said that reality makes “this year much more complex because of the migration patterns to unrepaired homes that are either red or yellow.’’ A home designated as red is one that should be demolished and the yellow label means in need of repair.
A controversial USAID-commissioned report said that 64 percent of red homes have been reoccupied in the Greater Port-au-Prince area.
It is now officially hurricane season. Rains have picked up over the previous weeks and this is already causing a surge in the number of new cholera cases. The most recent data from the MSPP (Ministere de la Sante Publique et da la Population) show that there have been over 320,000 cases, 170,000 hospitalizations and that 5,337 people have died as a result of the disease. In a statement on June 1, the Pan American Health Organization (PAHO) noted that:
During the last days the MSPP and PAHO/WHO have observed an increase in the number of alerts of cholera cases, mainly in the Departments of South-East, Grand-Anse, South, Center and West. New cholera cases have been reported in IDP camps.Also pointing out that, "due [to] lack of resources numerous NGOs have been withdrawing from these areas and interrupting their water-trucking programs. This situation makes more vulnerable the health of the IDP populations." The Health Cluster vulnerability analysis shows that the West department, because of the high concentration of IDPs, is the most at-risk part of the country. Yesterday, Oxfam reported an increase in cholera cases in the area of Carrefour where, according to the IOM, over 60,000 IDPs are spread between 124 sites. Oxfam public health promoter Mimy Muisa Kambere said:
The current cholera outbreak in the Carrefour area is far worse than the one registered in November. At that time, there were a maximum of 900 reported cases of cholera per week. Now, over 300 new cases are registered every single day. However, the number of casualties is far lower than we saw in November as people are able to get help faster.
A draft report produced for USAID has been circulating online and has generated controversy as a result of its estimates of the death toll numbers from last year's devastating earthquake in Haiti which don’t match up with previously published figures. While media outlets have latched onto this sensational story and tied it in to the discussion over continued assistance to Haiti, there are other aspects of the paper that appear much more relevant to the current situation of relief efforts in Haiti.
To begin with, the report – even if its results are only partially reliable – makes it clear that there are an extremely large number of people living in damaged and dangerous housing. According to the report, many people have returned to housing once slated for destruction, a phenomenon we have written about previously.
As Timothy Schwartz, the lead author of the study, writes:
It means that as many as 570,178 people (114,493 residential groups or families) are living in 84,951 homes that may collapse in foul weather or in the event of another tremor. That’s yellow buildings. For Red buildings it means that 465,996* people (100,430 residential groups) are living in 73,846 buildings that might collapse at any moment. Discussing the growing problem of people returning to unsafe yellow and red buildings, Dr. Miyamoto emphasized the gravity of the situation,
"Occupied yellow and red houses are extremely dangerous since many are a collapse hazard. People occupy these houses despite communications and warnings from MTPTC engineers since they have nowhere to go but the camps. People do not want to stay in these tents. Security is poor and they are exposed to diseases. I see little children sleeping next to the heavily cracked walls every day."
As we previously mentioned, last week the U.S. Government Accountability Office (GAO), the independent government agency tasked with evaluating the performance of the federal government in selected areas, released their assessment of U.S. efforts in Haiti. The report – which bears the less-than-optimistic title “Haiti Reconstruction: U.S. Efforts Have Begun, Expanded Oversight Still to be Implemented” – offers more a description of the general framework of the relief effort than a critical examination of its results to date. For those not aware of where and how hundreds of millions of dollars of federal funding are being channeled in Haiti, the report has a number of useful pie charts, flow charts and bar graphs that provide a clearer picture of where U.S. funds are being spent, and where they aren’t. Although the report offers no examination of whether the programs implemented by the U.S. Agency for International Development (USAID) are actually effective, it does shine a light on some of the structural problems affecting the international relief mission.
The four broad sectors receiving U.S. funding are 1) Infrastructure and Energy (46% of total funds); 2) Governance and Rule of Law (16%); Health and other basic services (13%); and Food and Economic Security (7%). The breakdown of spending within each sector provides evidence of misplaced priorities. For instance, while significant funds are being channeled towards improving Haiti’s energy infrastructure, roads and permanent housing, only a comparatively small amount of allocations are going to rubble removal ($25 million), although the continued presence of rubble throughout Port-au-Prince remains the biggest obstacle to the reconstruction of Haiti’s devastated capital city.
Though the U.S. has allocated over $98 million to health care, only $10 million is being channeled to education (or approximately 1% of total U.S. spending on Haiti’s reconstruction). Haiti’s education sector was in crisis well before the earthquake – with over 60% of students dropping out of school before the sixth grade and the literacy rate hovering around 50%. There are now heaps of rubble where many schools stood and the vast majority of the hundreds of thousands of children in tent camps have no access to any form of education. Given the crucial role that education must play in Haiti’s reconstruction, it’s difficult to understand why this “sub-sector” is receiving so little funding.
The U.S. Government Accountability Office released a report last week noting, among other things, that the Interim Haiti Reconstruction Commission (IHRC) is still not operational, although it still has several months to do so before its mandate ends:
although the commission's mandate ends in October 2011, IHRC is not fully operational due to delays in staffing the commission and defining the role of its Performance and Anticorruption Office--which IHRC officials cited as key to establishing the commission as a model of good governance.
The GAO goes on to note a significant disconnect between what the Haitian government has identified as priorities, and what IHRC has green-lighted:
although the Haitian government identified nearly equal 18-month funding requirements for debris removal and agriculture, IHRC has approved about 7 times more funding for agriculture projects.
This is perhaps not surprising considering the IHRC’s problems in ensuring involvement of Haitian partners in decision-making.
The debris removal, of course, is necessary in part to clear space for new shelters, and getting displaced persons out of IDP camps, where cholera – abetted by a severe lack of adequate sanitation – can be a serious danger. (Deutsche Presse-Agentur reported this weekend on a new milestone in post-quake tragedy: 5,200 cholera deaths and 300,000 infections over the past seven months.) Yet just 20 percent of the rubble has been removed, according to various officials. USAID has not made rubble removal much of a priority either, according to the USAID Office of the Inspector General.
An editorial in the New York Times today describes the findings of a UN report that shows the cholera outbreak “may have originated” at a MINUSTAH camp, and says “The fact that the disease is still spreading is a reminder of how much more help Haiti needs and the consequences of continued neglect.”
The editorial concludes:
Even as relief agencies are winding down their presence in Haiti, about 680,000 people are still living in camps and waiting for permanent shelter. Life in this setting is precarious, without adequate access to latrines and safe drinking water.
The United Nations’ overall appeal to respond to the epidemic, for $175 million, is 48 percent financed. Haiti’s continuing health emergency may have been overlooked in a crush of world events, but while the sick and dying are waiting for the world to respond, the disease is not.
The editorial was, unfortunately, all too well-timed, as the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) and the Pan-American Health Organization issued a new warning today of expected "(fresh) outbreaks of cholera in the West, including Port-au-Prince, South and Southeast Departments" accompanying heavy rains and possible flooding.
As we have recently noted, the ongoing cholera epidemic – which now seems to be entering a deadly resurgence, and could kill as many as 11,000 people this year, is closely linked to inadequate sanitation in the IDP camps. This is a theme also addressed in OCHA's warning today: "More water means more cholera and the sanitation in the country is still very weak," Reuters reported OCHA spokesperson Emmanuelle Schneider as saying.
Poor sanitation, a lack of suitable transitional housing, and the poorly funded cholera appeal are all markers of the international community’s failings to come through for the people of Haiti. Now, members of the U.S. Congress are demanding answers. Yesterday, the House passed, by voice vote, bill HR 1016, which, the Miami Herald reports, requires the Obama administration to send to Congress
a report to assess the overall progress of relief, recovery, and reconstruction of Haiti and requires the president to assess within six months the effectiveness of U.S. assistance to Haiti.
…according to the Rep. Frederica Wilson (D – FL), who added an amendment to the bill regarding deportees.
Also covering the bill’s passage, AP's Jim Abrams reported that: