Haiti Relief & Reconstruction Watch

Haiti Relief & Reconstruction Watch

Haiti: Relief and Reconstruction Watch is a blog that tracks multinational aid efforts in Haiti with an eye towards ensuring they are oriented towards the needs of the Haitian people, and that aid is not used to undermine Haitians' right to self-determination.

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.

Now, simultaneous with Amorim’s remarks, come new allegations of MINUSTAH again dumping fecal waste into a river (the Guayamouc) – an incident likely to provoke even more outrage and impatience with what many Haitians see as an “occupation” force.

Considering that Brazil’s leading role in the Mission has long been unpopular at home, Amorim’s remarks may resonate with the Brazilian public, and could perhaps influence other Latin American nations where MINUSTAH participation enjoys similarly lackluster enthusiasm.

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.

Now, simultaneous with Amorim’s remarks, come new allegations of MINUSTAH again dumping fecal waste into a river (the Guayamouc) – an incident likely to provoke even more outrage and impatience with what many Haitians see as an “occupation” force.

Considering that Brazil’s leading role in the Mission has long been unpopular at home, Amorim’s remarks may resonate with the Brazilian public, and could perhaps influence other Latin American nations where MINUSTAH participation enjoys similarly lackluster enthusiasm.

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).

Haiti’s relative lack of sanitary water was the principle reason that so many health workers feared the consequences were a water-borne disease such as cholera to emerge. As Partners in Health’s Joia Mukherjee explains in a new interview with Caribbean Journal, the after-effects of the earthquake, combined with heavy rains, made the cholera outbreak much more devastating:

the cholera epidemic …started in St Marc, and that was the site for a lot of displaced people. But they were tented refugees, not in camps. The majority of displaced people, or a huge number, were staying with already very poor relatives in very overwhelmed situations with very poor sanitation. I think that’s one of the many reasons we saw the cholera epidemic in that region — that the system of clean water was woefully inadequate already, and then was put under an enormous amount of stress by the number of people.

That, coupled with the drastic decline in NGOs providing cholera treatment (as we’ve previously noted) over the past six months (from 128 in January [PDF], to 48 as of July 25 [PDF], according to the Health Cluster) meant that the large number of cholera cases (over 300,000 so far) was entirely predictable. As the American Red Cross’ Julie Sell explains in the PBS report: “There are some aid organizations that have had to pull out of Haiti or dramatically reduce their activities due to lack of funding. That’s been a concern for the Haitians.”

In her Caribbean Journal interview, Mukherjee outlines what PIH sees as an effective roadmap for bringing cholera under control and reducing mortality as much as possible:

We feel very strongly that one priority is absolutely developing municipal water and sanitation in Haiti. That has to be a key part of Haiti’s reconstruction. Two, we have to have health facilities that work, so we can treat people. Three, we have to really be paying, training and supervising an army of community helpers that can do an education in the community. And four, very importantly, we feel that the cholera vaccine has to be rolled out in Haiti, if we’re going to prevent tens of thousands of deaths. That last part is, oddly, somewhat controversial, because they don’t know what the strategy would be. In public health, as is often the case, the sense is that it’s too big, too expensive, too hard. We think nothing is harder than seeing an entire community devastated by cholera. Whatever it is that is hard, we can do that, because the alternative is huge, unnecessary death.

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).

Haiti’s relative lack of sanitary water was the principle reason that so many health workers feared the consequences were a water-borne disease such as cholera to emerge. As Partners in Health’s Joia Mukherjee explains in a new interview with Caribbean Journal, the after-effects of the earthquake, combined with heavy rains, made the cholera outbreak much more devastating:

the cholera epidemic …started in St Marc, and that was the site for a lot of displaced people. But they were tented refugees, not in camps. The majority of displaced people, or a huge number, were staying with already very poor relatives in very overwhelmed situations with very poor sanitation. I think that’s one of the many reasons we saw the cholera epidemic in that region — that the system of clean water was woefully inadequate already, and then was put under an enormous amount of stress by the number of people.

That, coupled with the drastic decline in NGOs providing cholera treatment (as we’ve previously noted) over the past six months (from 128 in January [PDF], to 48 as of July 25 [PDF], according to the Health Cluster) meant that the large number of cholera cases (over 300,000 so far) was entirely predictable. As the American Red Cross’ Julie Sell explains in the PBS report: “There are some aid organizations that have had to pull out of Haiti or dramatically reduce their activities due to lack of funding. That’s been a concern for the Haitians.”

In her Caribbean Journal interview, Mukherjee outlines what PIH sees as an effective roadmap for bringing cholera under control and reducing mortality as much as possible:

We feel very strongly that one priority is absolutely developing municipal water and sanitation in Haiti. That has to be a key part of Haiti’s reconstruction. Two, we have to have health facilities that work, so we can treat people. Three, we have to really be paying, training and supervising an army of community helpers that can do an education in the community. And four, very importantly, we feel that the cholera vaccine has to be rolled out in Haiti, if we’re going to prevent tens of thousands of deaths. That last part is, oddly, somewhat controversial, because they don’t know what the strategy would be. In public health, as is often the case, the sense is that it’s too big, too expensive, too hard. We think nothing is harder than seeing an entire community devastated by cholera. Whatever it is that is hard, we can do that, because the alternative is huge, unnecessary death.

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).

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.

Last Thursday, Jeena Shah gave an update on Camp Django:

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.”

Amnesty noted that “City authorities had designated a small plot of marshland two kilometres away to relocate the displaced people. However, there has only been space to accommodate approximately 100 families there and the site has no facilities whatsoever. It is not known where the other families have gone.”  Previous studies have shown that many leave the IDP camps for damaged homes. As Dr. Miyamoto explained to anthropologist Timothy Schwartz in a USAID-sponsored report:

“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 both Amnesty and OCHA pointed out, the stadium was on a list of priority sites for relocation that the Martelly government distributed after his taking office. Yet OCHA noted that “the municipal authorities took the decision to relocate the families without consulting the humanitarian community, while the site where some of the families have been relocated was not planned.”

Oxfam has called on the authorities to “implement a relocation strategy” that “must ensure that these people have access to basic services such as drinking water, sanitation services, health care, education and employment opportunities so that they can finally start to rebuild their lives.” In response, Patrick Rouzier, an advisor to the president, told AP:

“I understand Oxfam’s position but we have a comprehensive plan that we are finalizing,” Rouzier said by telephone. “This has been in the works for the past three months. … We are on it 100 percent.”

But in the face of such flagrant abuse of Haitian citizens, patience is dwindling. In a public statement released on Friday, Rep. Donald Payne (D-NJ) “strongly condemned” what has become a regular pattern:

Words cannot fully describe how disappointing it is to hear of such vicious attacks towards the people of Haiti.  Members of Congress have previously condemned Mayor Jeudy’s forceful evictions and we will continue to do so until such actions come to a halt…The United States government did not invest dollars, resources, and manpower to have the people of Haiti mistreated by their own government.

Payne notes that “women, children, men and the elderly continue to be abused and displaced, in violation of Haitian and international law.” In this hostile environment, human rights advocates, NGOs, the international community, and–most importantly–the hundreds of thousands of displaced continue to wait for a comprehensive relocation plan.

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).

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.

Last Thursday, Jeena Shah gave an update on Camp Django:

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.”

Amnesty noted that “City authorities had designated a small plot of marshland two kilometres away to relocate the displaced people. However, there has only been space to accommodate approximately 100 families there and the site has no facilities whatsoever. It is not known where the other families have gone.”  Previous studies have shown that many leave the IDP camps for damaged homes. As Dr. Miyamoto explained to anthropologist Timothy Schwartz in a USAID-sponsored report:

“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 both Amnesty and OCHA pointed out, the stadium was on a list of priority sites for relocation that the Martelly government distributed after his taking office. Yet OCHA noted that “the municipal authorities took the decision to relocate the families without consulting the humanitarian community, while the site where some of the families have been relocated was not planned.”

Oxfam has called on the authorities to “implement a relocation strategy” that “must ensure that these people have access to basic services such as drinking water, sanitation services, health care, education and employment opportunities so that they can finally start to rebuild their lives.” In response, Patrick Rouzier, an advisor to the president, told AP:

“I understand Oxfam’s position but we have a comprehensive plan that we are finalizing,” Rouzier said by telephone. “This has been in the works for the past three months. … We are on it 100 percent.”

But in the face of such flagrant abuse of Haitian citizens, patience is dwindling. In a public statement released on Friday, Rep. Donald Payne (D-NJ) “strongly condemned” what has become a regular pattern:

Words cannot fully describe how disappointing it is to hear of such vicious attacks towards the people of Haiti.  Members of Congress have previously condemned Mayor Jeudy’s forceful evictions and we will continue to do so until such actions come to a halt…The United States government did not invest dollars, resources, and manpower to have the people of Haiti mistreated by their own government.

Payne notes that “women, children, men and the elderly continue to be abused and displaced, in violation of Haitian and international law.” In this hostile environment, human rights advocates, NGOs, the international community, and–most importantly–the hundreds of thousands of displaced continue to wait for a comprehensive relocation plan.

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”.

A more thorough look at the annual report, however, shows that although the HRF has disbursed a significant portion of the funds raised, much of that money remains unspent in the hands of partner agencies. In fact, the World Bank, which is the administrator of the Neighborhood Housing Reconstruction Project, has yet to disburse a single dollar for the project, while the Inter-American Development Bank (IDB) has yet to disburse any aid that has been transferred from the HRF.

The HRF was established in March of 2010 by the World Bank, and validated by the Haitian government in May of 2010. With contributions of $351 million from 19 donors, the HRF describes itself as “[t]he largest source of unprogrammed funding for the reconstruction of Haiti”. A significant share (20 percent) of donor contributions has gone to the HRF. The steering committee is headed by representatives from the government of Haiti, as well as major donors who have donated more than $30 million. Although the steering committee approves funding decisions, the projects the HRF funds are all projects that have been approved by the IHRC, which has not always properly incorporated Haitians into the decision making process.

Disbursement Rate

The HRF annual report, and subsequent media coverage has focused on the 71 percent of funds that has been disbursed to various entities, but fails to acknowledge that much of this money remains unspent. The HRF report notes that “The Trustee has transferred funds totaling US$197 million in respect of those approved projects and associated fees to the Partner Entities”, and an additional $40 million is set to be transferred. Together the $237 million is equal to 71 percent of the total funds raised. However, as the HRF notes, this money has not actually been spent on the ground, but simply transferred to their Partner Entities (the World Bank, UN and IDB). The disbursement of funds from those organizations is just $35 million, or about 10 percent of the total contributions received. The IDB, which has received $37 million in HRF funds has yet to actually disburse any of this total.

Despite this, the HRF press release on Friday listed a number of projects as “highlights of the work done so far”. HRF manager Josef Leitmann commented to the Financial Times:

“That’s no mean feat in an environment like Haiti where there are so many obstacles and challenges to getting things done on the ground,”

Yet these projects – even though funding has been made available by the HRF — have not actually been undertaken. As is clear from the HRF’s own report, nowhere near $240 million has been spent “on the ground”.

Aid as “Accompaniment”

Last month the UN Special Envoy for Haiti released a report, “Has Aid Changed? Channelling assistance to Haiti before and after the earthquake” [PDF], which suggested aid should be evaluated based on the principle of accompaniment, and concluded that “aid is most effective at strengthening public institutions when it is channelled through them.”

The HRF, in their communications strategy notes that, “The HRF should be perceived as an efficient, responsive and flexible source of financing for reconstruction priorities as determined by the Government of Haiti”. The report adds that “In line with the principle of “accompaniment” as advocated by the Office of the Special Envoy for Haiti, the Government of Haiti and the IHRC which it has established are very much in the driver’s seat when it comes to operating the HRF and allocating its resources.” Indeed, the HRF does appear to work much more in coordination with the Haitian government than many other organizations. 23 percent of the total budget support received by the Haitian government was channeled through the HRF. As opposed to direct budget support however, the HRF takes a more indirect route, as explained by the Special Envoy:

Budget support that is provided through the HRF is first transferred to the World Bank, which acts as trustee of the HRF; then, on approval from the HRF steering committee, to the relevant partner entity (the World Bank or the IDB); and finally, to the Haitian treasury. The partner entities do not charge fees if the contribution can be combined with their existing budget support operations.

Projects from the HRF, although carried out under the administration of one of their partner entities are then carried out on the ground by “a variety of different entities.” According to the annual report, the Haitian government is the implementing partner for 88.4 percent of HRF funds, an impressive total. The report points out that it is a “reflection of the strong ownership of the government in the implementation of HRF projects.” Yet the report also points out that “HRF’s most important partner is the Interim Haiti Recovery Commission [IHRC] which sets priorities for how HRF resources are used and is responsible for endorsing and forwarding all requests for financial support to the Fund”. Although the government of Haiti is a significant partner in the IHRC, the commission has previously come under scrutiny for the lack of Haitian input. As Penelope Chester at UN Dispatch noted:

On the same day that the Haiti Reconstruction Fund Annual Report was released, President Martelly announced plans to reform the Interim Haiti Reconstruction Commission, which oversees the disbursement of donor funds from the Fund. Martelly is struggling to strike a balance between Haitian ownership of reconstruction and proper administration and management of funds. A Martelly advisor said: “The IHRC itself has become this extra entity outside of the government, and that is what we need to fix.”

The advisor, Michele Oriole, went on to say, “We have to say, ‘OK, this is an important forum to keep the momentum and focus on Haiti, but here is how we want it to function.'”

Donors Preferencing Contributions

In April, Jacqueline Charles of the Miami Herald reported on how small organizations have largely been left out of rebuilding projects. In the article, Charles noted that, “the U.S. and other donors even specify preferences when donating to the trust fund. As a result, the fund, which was initially envisioned as a place to pool resources to fill funding gaps, has little extra money for priorities like debris removal and schools.” This criticism is echoed in the HRF annual report, as one of the goals for next year is to “To dissuade existing and future donors from preferencing their contributions so that the GoH has maximum flexibility to use HRF resources to finance strategic priorities.” The US, which is the largest contributor to the HRF, attached preferences to the entire $120 million that was given. Although the sectors the US for which it earmarked its donations are all important, it takes away the flexibility that is supposed to be the hallmark of the HRF and limits the ability of the government of Haiti to lead the reconstruction process. According to the Special Envoy, only about half of the $100 million that has yet to be allocated is not preferenced.

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”.

A more thorough look at the annual report, however, shows that although the HRF has disbursed a significant portion of the funds raised, much of that money remains unspent in the hands of partner agencies. In fact, the World Bank, which is the administrator of the Neighborhood Housing Reconstruction Project, has yet to disburse a single dollar for the project, while the Inter-American Development Bank (IDB) has yet to disburse any aid that has been transferred from the HRF.

The HRF was established in March of 2010 by the World Bank, and validated by the Haitian government in May of 2010. With contributions of $351 million from 19 donors, the HRF describes itself as “[t]he largest source of unprogrammed funding for the reconstruction of Haiti”. A significant share (20 percent) of donor contributions has gone to the HRF. The steering committee is headed by representatives from the government of Haiti, as well as major donors who have donated more than $30 million. Although the steering committee approves funding decisions, the projects the HRF funds are all projects that have been approved by the IHRC, which has not always properly incorporated Haitians into the decision making process.

Disbursement Rate

The HRF annual report, and subsequent media coverage has focused on the 71 percent of funds that has been disbursed to various entities, but fails to acknowledge that much of this money remains unspent. The HRF report notes that “The Trustee has transferred funds totaling US$197 million in respect of those approved projects and associated fees to the Partner Entities”, and an additional $40 million is set to be transferred. Together the $237 million is equal to 71 percent of the total funds raised. However, as the HRF notes, this money has not actually been spent on the ground, but simply transferred to their Partner Entities (the World Bank, UN and IDB). The disbursement of funds from those organizations is just $35 million, or about 10 percent of the total contributions received. The IDB, which has received $37 million in HRF funds has yet to actually disburse any of this total.

Despite this, the HRF press release on Friday listed a number of projects as “highlights of the work done so far”. HRF manager Josef Leitmann commented to the Financial Times:

“That’s no mean feat in an environment like Haiti where there are so many obstacles and challenges to getting things done on the ground,”

Yet these projects – even though funding has been made available by the HRF — have not actually been undertaken. As is clear from the HRF’s own report, nowhere near $240 million has been spent “on the ground”.

Aid as “Accompaniment”

Last month the UN Special Envoy for Haiti released a report, “Has Aid Changed? Channelling assistance to Haiti before and after the earthquake” [PDF], which suggested aid should be evaluated based on the principle of accompaniment, and concluded that “aid is most effective at strengthening public institutions when it is channelled through them.”

The HRF, in their communications strategy notes that, “The HRF should be perceived as an efficient, responsive and flexible source of financing for reconstruction priorities as determined by the Government of Haiti”. The report adds that “In line with the principle of “accompaniment” as advocated by the Office of the Special Envoy for Haiti, the Government of Haiti and the IHRC which it has established are very much in the driver’s seat when it comes to operating the HRF and allocating its resources.” Indeed, the HRF does appear to work much more in coordination with the Haitian government than many other organizations. 23 percent of the total budget support received by the Haitian government was channeled through the HRF. As opposed to direct budget support however, the HRF takes a more indirect route, as explained by the Special Envoy:

Budget support that is provided through the HRF is first transferred to the World Bank, which acts as trustee of the HRF; then, on approval from the HRF steering committee, to the relevant partner entity (the World Bank or the IDB); and finally, to the Haitian treasury. The partner entities do not charge fees if the contribution can be combined with their existing budget support operations.

Projects from the HRF, although carried out under the administration of one of their partner entities are then carried out on the ground by “a variety of different entities.” According to the annual report, the Haitian government is the implementing partner for 88.4 percent of HRF funds, an impressive total. The report points out that it is a “reflection of the strong ownership of the government in the implementation of HRF projects.” Yet the report also points out that “HRF’s most important partner is the Interim Haiti Recovery Commission [IHRC] which sets priorities for how HRF resources are used and is responsible for endorsing and forwarding all requests for financial support to the Fund”. Although the government of Haiti is a significant partner in the IHRC, the commission has previously come under scrutiny for the lack of Haitian input. As Penelope Chester at UN Dispatch noted:

On the same day that the Haiti Reconstruction Fund Annual Report was released, President Martelly announced plans to reform the Interim Haiti Reconstruction Commission, which oversees the disbursement of donor funds from the Fund. Martelly is struggling to strike a balance between Haitian ownership of reconstruction and proper administration and management of funds. A Martelly advisor said: “The IHRC itself has become this extra entity outside of the government, and that is what we need to fix.”

The advisor, Michele Oriole, went on to say, “We have to say, ‘OK, this is an important forum to keep the momentum and focus on Haiti, but here is how we want it to function.'”

Donors Preferencing Contributions

In April, Jacqueline Charles of the Miami Herald reported on how small organizations have largely been left out of rebuilding projects. In the article, Charles noted that, “the U.S. and other donors even specify preferences when donating to the trust fund. As a result, the fund, which was initially envisioned as a place to pool resources to fill funding gaps, has little extra money for priorities like debris removal and schools.” This criticism is echoed in the HRF annual report, as one of the goals for next year is to “To dissuade existing and future donors from preferencing their contributions so that the GoH has maximum flexibility to use HRF resources to finance strategic priorities.” The US, which is the largest contributor to the HRF, attached preferences to the entire $120 million that was given. Although the sectors the US for which it earmarked its donations are all important, it takes away the flexibility that is supposed to be the hallmark of the HRF and limits the ability of the government of Haiti to lead the reconstruction process. According to the Special Envoy, only about half of the $100 million that has yet to be allocated is not preferenced.

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).

Agriculture

One of Farmer’s official goals, food security, allows him to lay out a broad economic vision, informed by Haitian voices. Agriculture, he notes, “continued to be hammered by the forces of nature, by the punishingly unfair political economy…and by the simple fact that few young Haitians wanted to work in a sector that offered diminishing returns…Addressing these problems required massive pro-poor investments in agriculture, which would do more to alleviate Haitian poverty than fifty thousand new assembly jobs” (35). One of the essay contributors to Haiti After the Earthquake, journalist and UN Secretary-General Ban Ki-moon’s former spokeswoman Michèle Montas-Dominique, conducted a series of surveys and discussion groups with displaced persons, farmers and tradespeople. Farmer made sure her findings were presented at the UN’s International Donors Conference in March, 2010. On the issue of agriculture, she found:

The Haitians we spoke to, including city-dwellers, stressed agricultural production as a top priority. Agriculture—perhaps more than any other sector—is considered essential to the country’s wealth, and the prevailing sentiment is that the peasantry has always been neglected. Invariably, interlocutors made concrete demands for training, equipment, seeds, easier access to credit, and the introduction of modern agricultural techniques…Many people said they would rather work on the land than seek informal jobs in the towns, from selling second-hand clothing in the streets to the “cash for work” menial jobs available since the quake. All agreed that the country can and should become self-sufficient in food. (268)

In a CEPR paper published over a year ago entitled “Using Food Aid to Support, Not Harm, Haitian Agriculture,” we noted that it is crucial “to immediately reduce the harm caused by imported, subsidized rice. This can be done by having the international community immediately commit to buying Haitian rice” at a premium, to then distribute nationally. France’s commitment to increase locally purchased rice for food aid, which we wrote about this week, could provide the impetus for other donor countries to follow suit.

Haitian infrastructure

Haiti After the Earthquake‘s dominant argument is to use aid to support, not harm, Haitian institutions. Farmer approvingly quotes journalist Linda Polman, who says “disasters generally attract a garish array of individual organizations, each with its own agenda, its own business imperatives, and its own institutional survival tactics” (214). Farmer’s book echoes his latest report on donor disbursements, which is unstintingly critical of the relief effort, targeting the lack of follow-through on international aid pledges, and the fact that over 99% of relief funding “circumvent[s] Haitian public institutions,” making recovery “almost impossible.” In such an environment, Farmer, writing at the twilight of President Prèval’s tenure, argues in his book against overzealous critiques of Haitian corruption. Denouncing the evisceration of Haiti’s public sector, he sets out to refute a persistent tendency to “blame the Haitians: their culture, institutions, and lack of ownership over reconstruction and development schemes” (212):

[I]t’s not very helpful to criticize a government such as Haiti’s in a vacuum. A sound analysis situates Haitian politics and bureaucratic performance in a broader context, historical and geographical. Few years in Haiti’s history are unmarked by foreign intervention or meddling of some kind. What we know about democracy in Haiti is this: whenever a popular leader (elected by significant margins) is given a chance to hold office, he will, as surely as night follows day, soon face embargoes and bad press and possibly worse. No one would deny that the current government has certain inveterate weaknesses, but perhaps it’s time to let Haitian democracy run its course, to let Haitian civil services grow and take root. Second, to avoid corruption, public institutions–from the line ministries to facilities such as the General Hospital–need an infrastructure of transparency: modern bookkeeping, electronic disbursement of payroll, performance-based financing, effective communications technology. For the last two decades, the Haitian state has been starved of resources. Long accustomed to paltry tax revenues, embargoes intended to pressure the governments in the direction of foreign business interests emptied the meager federal coffers. Instead, money flowed to NGOs, which wittingly or unwittingly weakened the public sector. By the close of the millennium, the Republic of NGOs had undermined the Republic of Haiti’s capability to fulfill its government mandate. (369)

Cholera

The book describes a range of strategies he has deployed toward this aim—strengthening Haitian institutions—with varying degrees of success. As sharp critiques against NGOs such as the Red Cross were further amplified during the cholera epidemic, Farmer explains how Port-au-Prince’s General Hospital, “months after the quake, still faced the double burden of the biggest caseload in the country and perhaps the biggest facility funding shortage. But international NGOs had raised millions of dollars for earthquake relief.” Farmer’s team “went to the American Red Cross and asked them to invest money in salaries for nurses, janitors, surgeons, and others at the General Hospital. It took convincing by a number of people (including President Clinton), but they said yes. The Red Cross provided—through what was for them a modest grant—invaluable medical equipment and staff salary support” (211).

Haiti After the Earthquake helps elucidate Farmer’s influence within the UN’s bureaucracy as well. When in late 2010 the cholera outbreak was first reported, along with almost-immediate speculation of UN troops’ role in its transmission, Farmer publicly called for an “aggressive investigation” of its source, including the hypothesis that UN forces from Nepal were responsible. Edmond Mulet, then head of the UN mission in Haiti, refused to take the possibility seriously, stating: “It’s really unfair to accuse the U.N. for bringing cholera into Haiti. We don’t want to stigmatize any nation or any people.” In the midst of “reluctance to delve further into what caused the outbreak” on the part of the UN, Centers for Disease Control and World Health Organization, Farmer spoke out to the press again, saying that it “sounds like politics to me, not science.” At the same time, according to Haiti After the Earthquake, Farmer provided Mulet with a copy of a book he had written, “which describes the predictable responses to epidemic disease that we were seeing with cholera. When I returned a few days later, Mulet had read most of the book, highlighting passages with a yellow marker.” Farmer also promised him that his recommendations to investigate the outbreak’s origin were “eminently technical” (197). Thus, the Associated Press reported:

But Mulet now says Farmer was right all along, and that he is consulting with experts, including a French epidemiologist who met with him this week to discuss how to investigate the Nepalese base.

“We agree with him there has to be a thorough investigation of how it came, how it happened and how it spread. … There’s no differences there with Dr. Paul Farmer at all.”

Haiti After the Earthquake also contains Farmer’s reflections on significant failures. As we noted last week, debates on the prioritization of treatment versus prevention have inhibited efforts to fight the spread of cholera, which is currently infecting about 1,000 people a day in Haiti. Farmer explains the gridlock among health organizations and clinical experts as divided between ideological “battle lines”:

[O]n the one hand, the minimalists favored heavy investment in health education and massive distribution of chlorine tablets for drinking-water disinfection. On the other hand, the “maximalists” argued that, although there might be no way to stop cholera in its tracks in Haiti, all the tools for preventing its spread (from improved sanitation, including chlorine tablets, to effective and safe vaccines) and for treating those already stricken (from rehydration and replacement of electrolytes to antibiotics) needed to be promptly integrated with the more restrained public health responses. (199)

Farmer squarely places himself in the maximalist camp, considering it “absurd” that with more than $57 million committed by the U.S. alone to fighting cholera, “it was impossible to launch a comprehensive, integrated response, including ramping up vaccine production” (202). But in spite of devoting his energy to pushing this agenda in conference calls, consensus statements and opinion pieces in widely circulated magazines, he writes that he felt “nothing less than shame. If our goal had been to scale up on integrated and comprehensive cholera response using all available interventions, including vaccine, we had failed miserably” (207).

Aristide and the elections

Dr. Farmer’s insistence on promoting the will of Haiti’s “poor majority” has sometimes led him to completely step outside established channels. Farmer’s book leaves out his participation as a signatory of a full-page advertisement in the Miami Herald‘s Sunday edition on Jan. 23. It stated that the “United States, France, Canada, and the United Nations forces in Haiti” were blocking former President Aristide’s right as a Haitian citizen to return from exile in South Africa. Considering that “10,000 people took to the streets in Port-au-Prince to commemorate President Aristide’s birthday and call for his return,” Farmer, along with over 150 others, “call[ed] on the international authorities, particularly the United Nations and the United States government, to end their opposition to President Aristide’s return.”

Similarly, in the lead-up to Haiti’s flawed elections in Nov. 2010, which were supported by the U.S. and UN, Farmer publicly expressed his concern “that all Haitian people and parties be allowed to participate.” Though the book was written before Martelly’s inauguration in May, Farmer reiterates his view that the “exclusion of the political party identified with Aristide [Fanmi Lavalas] will mean less participation in the electoral process. But a strong government requires strong civic support and not only from the vocal members of ‘civil society’—code…for the non-poor. The non-poor are a minority in Haiti, a tiny economic elite and small middle class” (227).

The blame game

Haiti After the Earthquake is a departure from Farmer’s more outspoken writings, and this undoubtedly stems from his responsibilities as a UN representative working closely with Bill Clinton and major donor governments, the U.S. in particular. For example, although he played a pivotal role in moving the UN toward greater transparency and accountability in the wake of Haiti’s cholera outbreak, he is careful to stress that “it was certainly not my intention to fan the blame game” (194).

This diplomatic quality has been reflected in his recent media appearances. Last week, he focused on aid and development when WNYC’s Leonard Lopate asked him whether “Barack Obama [will] be apologizing for his administration’s actions after he leaves office.” Farmer demurred. “Actually,” he replied, “the US government has been really trying hard to improve the quality of our development assistance and humanitarian aid to Haiti.”

Similarly, in his book, Farmer rightly lauds Hillary Clinton’s stated philosophy on aid coordination:

Hillary Clinton put it succinctly: “the government of Haiti must and will be in the lead. We cannot any longer in the twenty-first century be making decisions for people and their futures without listening and without giving them the opportunity to be as involved and make as many decisions as possible.” (90)

Haiti After the Earthquake concentrates on development assistance, but whatever the Obama administration’s intentions on this front, it made concerted efforts to prevent Aristide’s return, and consistently opposed democratic, inclusive elections. Secretary of State Hillary Clinton, outside of the realm of aid coordination, did not adhere to her commitment to allow Haitians to make their own decisions when she blatantly subverted Haiti’s exercise of sovereignty and democracy.

When pressed to comment on this particular theme last week on Democracy Now!, Farmer provided his theory for why, according to WikiLeaks, the U.S., Canada and others financed the elections, knowing they were exclusionary:

Some of it sounds like Cold War thinking to me: [the Haitian] people keep on electing these left-wing nuts, and we won’t have it. And whereas when I’m living and working there, what I hear is people, not as left-wing or right-wing or—it’s really who’s going to side with the poor majority? And again, I think it’s their business to choose the leadership that they want.

On PBS’s Charlie Rose Show, Farmer continued: “You really can’t pursue public health goals without some level of social stability, and I think that’s going to come more quickly if we actually let the Haitian people choose their own governments and decide what their own destiny is going to be, and support that.” It seems unlikely, however, that Farmer’s aspirations for Haitian self-determination will ever be shared within the U.S. State Department.

Its priorities have changed little since 2000, when, as Farmer noted in his Congressional testimony last year, “the U.S. administration sought, often quietly, to block bilateral and multilateral aid to Haiti, having an objection to the policies and views of the administration of Jean-Bertrand Aristide, elected by over 90% of the vote…Choking off assistance for development and for the provision of basic services also choked off oxygen to the government, which was the intention all along: to dislodge the Aristide administration.” The current administration reprised the U.S. role of the previous decade, assuring that Haiti’s “popular movement, to a considerable extent excluded from formal participation in the [2010] elections, was scattered and leaderless in Haiti” (239).

Haiti After the Earthquake offers insight into Paul Farmer’s decision to work within the domain of elite policymaking and the complex considerations that accompany his role as a UN diplomat. The book serves as partial documentation of this impressive balancing act—pushing for a comprehensive agenda committed to Haiti’s poor majority while effectively maneuvering within inflexible, and at times, hostile realms of international decision-making. It is worth mentioning that this period in his career may be shortlived—Clinton’s Special Envoy mandate is set to terminate at the end of this year. This book, like the recent UN Special Envoy Office’s report, clearly portrays Farmer’s growing frustration and disillusionment in the face of the reaffirmation of the old aid trends that continue to undermine Haitian institutions. His next step remains to be seen.

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).

Agriculture

One of Farmer’s official goals, food security, allows him to lay out a broad economic vision, informed by Haitian voices. Agriculture, he notes, “continued to be hammered by the forces of nature, by the punishingly unfair political economy…and by the simple fact that few young Haitians wanted to work in a sector that offered diminishing returns…Addressing these problems required massive pro-poor investments in agriculture, which would do more to alleviate Haitian poverty than fifty thousand new assembly jobs” (35). One of the essay contributors to Haiti After the Earthquake, journalist and UN Secretary-General Ban Ki-moon’s former spokeswoman Michèle Montas-Dominique, conducted a series of surveys and discussion groups with displaced persons, farmers and tradespeople. Farmer made sure her findings were presented at the UN’s International Donors Conference in March, 2010. On the issue of agriculture, she found:

The Haitians we spoke to, including city-dwellers, stressed agricultural production as a top priority. Agriculture—perhaps more than any other sector—is considered essential to the country’s wealth, and the prevailing sentiment is that the peasantry has always been neglected. Invariably, interlocutors made concrete demands for training, equipment, seeds, easier access to credit, and the introduction of modern agricultural techniques…Many people said they would rather work on the land than seek informal jobs in the towns, from selling second-hand clothing in the streets to the “cash for work” menial jobs available since the quake. All agreed that the country can and should become self-sufficient in food. (268)

In a CEPR paper published over a year ago entitled “Using Food Aid to Support, Not Harm, Haitian Agriculture,” we noted that it is crucial “to immediately reduce the harm caused by imported, subsidized rice. This can be done by having the international community immediately commit to buying Haitian rice” at a premium, to then distribute nationally. France’s commitment to increase locally purchased rice for food aid, which we wrote about this week, could provide the impetus for other donor countries to follow suit.

Haitian infrastructure

Haiti After the Earthquake‘s dominant argument is to use aid to support, not harm, Haitian institutions. Farmer approvingly quotes journalist Linda Polman, who says “disasters generally attract a garish array of individual organizations, each with its own agenda, its own business imperatives, and its own institutional survival tactics” (214). Farmer’s book echoes his latest report on donor disbursements, which is unstintingly critical of the relief effort, targeting the lack of follow-through on international aid pledges, and the fact that over 99% of relief funding “circumvent[s] Haitian public institutions,” making recovery “almost impossible.” In such an environment, Farmer, writing at the twilight of President Prèval’s tenure, argues in his book against overzealous critiques of Haitian corruption. Denouncing the evisceration of Haiti’s public sector, he sets out to refute a persistent tendency to “blame the Haitians: their culture, institutions, and lack of ownership over reconstruction and development schemes” (212):

[I]t’s not very helpful to criticize a government such as Haiti’s in a vacuum. A sound analysis situates Haitian politics and bureaucratic performance in a broader context, historical and geographical. Few years in Haiti’s history are unmarked by foreign intervention or meddling of some kind. What we know about democracy in Haiti is this: whenever a popular leader (elected by significant margins) is given a chance to hold office, he will, as surely as night follows day, soon face embargoes and bad press and possibly worse. No one would deny that the current government has certain inveterate weaknesses, but perhaps it’s time to let Haitian democracy run its course, to let Haitian civil services grow and take root. Second, to avoid corruption, public institutions–from the line ministries to facilities such as the General Hospital–need an infrastructure of transparency: modern bookkeeping, electronic disbursement of payroll, performance-based financing, effective communications technology. For the last two decades, the Haitian state has been starved of resources. Long accustomed to paltry tax revenues, embargoes intended to pressure the governments in the direction of foreign business interests emptied the meager federal coffers. Instead, money flowed to NGOs, which wittingly or unwittingly weakened the public sector. By the close of the millennium, the Republic of NGOs had undermined the Republic of Haiti’s capability to fulfill its government mandate. (369)

Cholera

The book describes a range of strategies he has deployed toward this aim—strengthening Haitian institutions—with varying degrees of success. As sharp critiques against NGOs such as the Red Cross were further amplified during the cholera epidemic, Farmer explains how Port-au-Prince’s General Hospital, “months after the quake, still faced the double burden of the biggest caseload in the country and perhaps the biggest facility funding shortage. But international NGOs had raised millions of dollars for earthquake relief.” Farmer’s team “went to the American Red Cross and asked them to invest money in salaries for nurses, janitors, surgeons, and others at the General Hospital. It took convincing by a number of people (including President Clinton), but they said yes. The Red Cross provided—through what was for them a modest grant—invaluable medical equipment and staff salary support” (211).

Haiti After the Earthquake helps elucidate Farmer’s influence within the UN’s bureaucracy as well. When in late 2010 the cholera outbreak was first reported, along with almost-immediate speculation of UN troops’ role in its transmission, Farmer publicly called for an “aggressive investigation” of its source, including the hypothesis that UN forces from Nepal were responsible. Edmond Mulet, then head of the UN mission in Haiti, refused to take the possibility seriously, stating: “It’s really unfair to accuse the U.N. for bringing cholera into Haiti. We don’t want to stigmatize any nation or any people.” In the midst of “reluctance to delve further into what caused the outbreak” on the part of the UN, Centers for Disease Control and World Health Organization, Farmer spoke out to the press again, saying that it “sounds like politics to me, not science.” At the same time, according to Haiti After the Earthquake, Farmer provided Mulet with a copy of a book he had written, “which describes the predictable responses to epidemic disease that we were seeing with cholera. When I returned a few days later, Mulet had read most of the book, highlighting passages with a yellow marker.” Farmer also promised him that his recommendations to investigate the outbreak’s origin were “eminently technical” (197). Thus, the Associated Press reported:

But Mulet now says Farmer was right all along, and that he is consulting with experts, including a French epidemiologist who met with him this week to discuss how to investigate the Nepalese base.

“We agree with him there has to be a thorough investigation of how it came, how it happened and how it spread. … There’s no differences there with Dr. Paul Farmer at all.”

Haiti After the Earthquake also contains Farmer’s reflections on significant failures. As we noted last week, debates on the prioritization of treatment versus prevention have inhibited efforts to fight the spread of cholera, which is currently infecting about 1,000 people a day in Haiti. Farmer explains the gridlock among health organizations and clinical experts as divided between ideological “battle lines”:

[O]n the one hand, the minimalists favored heavy investment in health education and massive distribution of chlorine tablets for drinking-water disinfection. On the other hand, the “maximalists” argued that, although there might be no way to stop cholera in its tracks in Haiti, all the tools for preventing its spread (from improved sanitation, including chlorine tablets, to effective and safe vaccines) and for treating those already stricken (from rehydration and replacement of electrolytes to antibiotics) needed to be promptly integrated with the more restrained public health responses. (199)

Farmer squarely places himself in the maximalist camp, considering it “absurd” that with more than $57 million committed by the U.S. alone to fighting cholera, “it was impossible to launch a comprehensive, integrated response, including ramping up vaccine production” (202). But in spite of devoting his energy to pushing this agenda in conference calls, consensus statements and opinion pieces in widely circulated magazines, he writes that he felt “nothing less than shame. If our goal had been to scale up on integrated and comprehensive cholera response using all available interventions, including vaccine, we had failed miserably” (207).

Aristide and the elections

Dr. Farmer’s insistence on promoting the will of Haiti’s “poor majority” has sometimes led him to completely step outside established channels. Farmer’s book leaves out his participation as a signatory of a full-page advertisement in the Miami Herald‘s Sunday edition on Jan. 23. It stated that the “United States, France, Canada, and the United Nations forces in Haiti” were blocking former President Aristide’s right as a Haitian citizen to return from exile in South Africa. Considering that “10,000 people took to the streets in Port-au-Prince to commemorate President Aristide’s birthday and call for his return,” Farmer, along with over 150 others, “call[ed] on the international authorities, particularly the United Nations and the United States government, to end their opposition to President Aristide’s return.”

Similarly, in the lead-up to Haiti’s flawed elections in Nov. 2010, which were supported by the U.S. and UN, Farmer publicly expressed his concern “that all Haitian people and parties be allowed to participate.” Though the book was written before Martelly’s inauguration in May, Farmer reiterates his view that the “exclusion of the political party identified with Aristide [Fanmi Lavalas] will mean less participation in the electoral process. But a strong government requires strong civic support and not only from the vocal members of ‘civil society’—code…for the non-poor. The non-poor are a minority in Haiti, a tiny economic elite and small middle class” (227).

The blame game

Haiti After the Earthquake is a departure from Farmer’s more outspoken writings, and this undoubtedly stems from his responsibilities as a UN representative working closely with Bill Clinton and major donor governments, the U.S. in particular. For example, although he played a pivotal role in moving the UN toward greater transparency and accountability in the wake of Haiti’s cholera outbreak, he is careful to stress that “it was certainly not my intention to fan the blame game” (194).

This diplomatic quality has been reflected in his recent media appearances. Last week, he focused on aid and development when WNYC’s Leonard Lopate asked him whether “Barack Obama [will] be apologizing for his administration’s actions after he leaves office.” Farmer demurred. “Actually,” he replied, “the US government has been really trying hard to improve the quality of our development assistance and humanitarian aid to Haiti.”

Similarly, in his book, Farmer rightly lauds Hillary Clinton’s stated philosophy on aid coordination:

Hillary Clinton put it succinctly: “the government of Haiti must and will be in the lead. We cannot any longer in the twenty-first century be making decisions for people and their futures without listening and without giving them the opportunity to be as involved and make as many decisions as possible.” (90)

Haiti After the Earthquake concentrates on development assistance, but whatever the Obama administration’s intentions on this front, it made concerted efforts to prevent Aristide’s return, and consistently opposed democratic, inclusive elections. Secretary of State Hillary Clinton, outside of the realm of aid coordination, did not adhere to her commitment to allow Haitians to make their own decisions when she blatantly subverted Haiti’s exercise of sovereignty and democracy.

When pressed to comment on this particular theme last week on Democracy Now!, Farmer provided his theory for why, according to WikiLeaks, the U.S., Canada and others financed the elections, knowing they were exclusionary:

Some of it sounds like Cold War thinking to me: [the Haitian] people keep on electing these left-wing nuts, and we won’t have it. And whereas when I’m living and working there, what I hear is people, not as left-wing or right-wing or—it’s really who’s going to side with the poor majority? And again, I think it’s their business to choose the leadership that they want.

On PBS’s Charlie Rose Show, Farmer continued: “You really can’t pursue public health goals without some level of social stability, and I think that’s going to come more quickly if we actually let the Haitian people choose their own governments and decide what their own destiny is going to be, and support that.” It seems unlikely, however, that Farmer’s aspirations for Haitian self-determination will ever be shared within the U.S. State Department.

Its priorities have changed little since 2000, when, as Farmer noted in his Congressional testimony last year, “the U.S. administration sought, often quietly, to block bilateral and multilateral aid to Haiti, having an objection to the policies and views of the administration of Jean-Bertrand Aristide, elected by over 90% of the vote…Choking off assistance for development and for the provision of basic services also choked off oxygen to the government, which was the intention all along: to dislodge the Aristide administration.” The current administration reprised the U.S. role of the previous decade, assuring that Haiti’s “popular movement, to a considerable extent excluded from formal participation in the [2010] elections, was scattered and leaderless in Haiti” (239).

Haiti After the Earthquake offers insight into Paul Farmer’s decision to work within the domain of elite policymaking and the complex considerations that accompany his role as a UN diplomat. The book serves as partial documentation of this impressive balancing act—pushing for a comprehensive agenda committed to Haiti’s poor majority while effectively maneuvering within inflexible, and at times, hostile realms of international decision-making. It is worth mentioning that this period in his career may be shortlived—Clinton’s Special Envoy mandate is set to terminate at the end of this year. This book, like the recent UN Special Envoy Office’s report, clearly portrays Farmer’s growing frustration and disillusionment in the face of the reaffirmation of the old aid trends that continue to undermine Haitian institutions. His next step remains to be seen.

CEPR Co-Director Mark Weisbrot wrote in Folha de São Paulo, Brazil’s largest circulation newspaper, yesterday:

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 welldocumented.

The UN troops were brought to Haiti to occupy the country after the United States organized the overthrow of Haiti’s democratically elected president, Jean-Bertrand Aristide, for the second time, in 2004. Some 4,000 Haitians were targeted and killed in the aftermath of the coup, and officials of the constitutional government jailed while the UN troops “kept order.” Many more would perish after the earthquake because Haiti’s public infrastructure was crippled during the four-year international aid cutoff that Washington organized to topple the elected government.

Read the rest here.

CEPR Co-Director Mark Weisbrot wrote in Folha de São Paulo, Brazil’s largest circulation newspaper, yesterday:

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 welldocumented.

The UN troops were brought to Haiti to occupy the country after the United States organized the overthrow of Haiti’s democratically elected president, Jean-Bertrand Aristide, for the second time, in 2004. Some 4,000 Haitians were targeted and killed in the aftermath of the coup, and officials of the constitutional government jailed while the UN troops “kept order.” Many more would perish after the earthquake because Haiti’s public infrastructure was crippled during the four-year international aid cutoff that Washington organized to topple the elected government.

Read the rest here.

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.”

After the earthquake, noting that Haiti has gone from producing nearly 50 percent of their annual rice consumption in 1988 to around 15 percent now, CEPR published a report on food aid to Haiti that  proposed “that international donors seeking to support Haiti’s agricultural sector and provide food to those in need could help Haiti become more self-sufficient by purchasing the entire Haitian rice crop over the next two years. The paper finds that buying up all of Haiti’s rice should be close to the amount of food aid for rice that the international community is likely to provide this year, and would provide a tremendous boost to Haitian farmers, who currently are unable to compete with low-cost rice imports from the U.S.”

Although the French initiative is a welcome development, it still represents a small portion of overall food aid. The 1,085 MT of rice that France has committed to purchasing locally accounts for 3.5 percent of the total amount of rice given as aid in just the first six months of 2010. It is just 2 percent of the total 2009 Haitian rice crop. Similar to what was suggested in the CEPR paper, France has set a price that is “sufficiently high to allow these farmers to live off their work and prepare the next harvests, but low enough to avoid an increase in the price of food goods on local markets.“ This addresses the primary concern raised in the USAID-sponsored study that local procurement could lead to inflation in food prices. The cost of purchasing the entire local crop would be, based on our estimates (which are consistent with the French government’s analysis), between $62 and $82 million a year; a small portion of the $5.3 billion that international donors have pledged for Haiti.

France and much of the rest of the world appear to be learning from past aid failures and working to increase the long-term sustainability of Haitian agriculture through local procurement.  Will the US follow suit?

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.”

After the earthquake, noting that Haiti has gone from producing nearly 50 percent of their annual rice consumption in 1988 to around 15 percent now, CEPR published a report on food aid to Haiti that  proposed “that international donors seeking to support Haiti’s agricultural sector and provide food to those in need could help Haiti become more self-sufficient by purchasing the entire Haitian rice crop over the next two years. The paper finds that buying up all of Haiti’s rice should be close to the amount of food aid for rice that the international community is likely to provide this year, and would provide a tremendous boost to Haitian farmers, who currently are unable to compete with low-cost rice imports from the U.S.”

Although the French initiative is a welcome development, it still represents a small portion of overall food aid. The 1,085 MT of rice that France has committed to purchasing locally accounts for 3.5 percent of the total amount of rice given as aid in just the first six months of 2010. It is just 2 percent of the total 2009 Haitian rice crop. Similar to what was suggested in the CEPR paper, France has set a price that is “sufficiently high to allow these farmers to live off their work and prepare the next harvests, but low enough to avoid an increase in the price of food goods on local markets.“ This addresses the primary concern raised in the USAID-sponsored study that local procurement could lead to inflation in food prices. The cost of purchasing the entire local crop would be, based on our estimates (which are consistent with the French government’s analysis), between $62 and $82 million a year; a small portion of the $5.3 billion that international donors have pledged for Haiti.

France and much of the rest of the world appear to be learning from past aid failures and working to increase the long-term sustainability of Haitian agriculture through local procurement.  Will the US follow suit?

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.

Table 1. Number of Operational CTCs
CTC_Image

Data from Health Cluster

The number of cholera treatment units (CTUs), which are smaller than the CTCs, has stayed relatively constant (217 in March to 219 in June), while the number of Oral Rehydration Centers (ORCs), which decreased from April to May, has recently increased.

Warning Signs

At the end of March, OCHA warned that:

A Water, Hygiene and Sanitation (WASH) and CCCM Cluster analysis reveals that most of the funding to partners to support sanitation, water trucking activities and camp management will be exhausted by June 2011. As a result, it is expected that the number of humanitarian actors able to continue activities will be drastically reduced, which in turn will have serious consequences on the living conditions of camps residents. Their level of vulnerability will be particularly high due to the rain and hurricane season.

At the time of OCHA’s warning, the UN’s cholera appeal was 46 percent funded. Three months later, with a drastic increase in the number of cases, the appeal remains just 53 percent funded; an increase of just over $10 million. It costs $1 million to operate a CTC for three months. Since March, over 800 people have died from the cholera epidemic, according to MSPP data.

A recent Al Jazeera video report, also notes the initial underestimate of how bad the epidemic would be:

The Haitian government, UN agencies and non-governmental organizations, all badly underestimated the spread of the epidemic say specialists studying the outbreak.

Sanjay Basu, Epidemiologist, University of California: “Our best predictions so far show that over the next year or so that toll could rise to about 800,000 cases and 11,000 deaths. This is in a population of 10 million people, so you’re talking about almost one in ten people being directly affected by cholera.”

That initial underestimate means not enough resources were budgeted for cholera treatment and prevention.

 

The recent increase is especially concerning because the epidemic has become much more prevalent in the IDP camps, where hundreds of thousands remain in extremely precarious living conditions and will be especially vulnerable as the rains continue. In a statement from June 22, MSF head of mission, Romain Gitenet noted that:

During the first peak, the camps were hardly affected because there was help with latrines and distribution of chlorinated water. Since late March, the national organisation which used to distribute free chlorinated water in IDP camps began recovering costs: water is now paid for. We sounded the alarm at the time, saying that we were still in an outbreak phase. This could be in part why the camps are now infected when before they had not been.

As Michaëlle Jean, former governor general of Canada and UN special envoy to Haiti (together with Irina Bokova, the head of UNESCO) wrote at the one-year anniversary of the earthquake:

More than a million people are still living amid rubble, in emergency camps, in abject poverty; cholera, meanwhile, has claimed thousands of lives. As time passes, what began as a natural disaster is becoming a disgraceful reflection on the international community. Official commitments have not been honoured; only a minuscule portion of what was promised has been paid out. The Haitian people feel abandoned and disheartened by the slowness with which rebuilding is taking place.

Health Officials Turned Down Vaccine, WHO and Companies Say

This weekend, news also broke that late in 2010, according to the company Crucell, which manufactures the most common cholera vaccine, it had offered “tens of thousands of doses”, but the plan was rejected by health officials. One reason, as the Financial Times reports, was that the Haitian government was responding to multiple emergencies with “scant resources”. The FT continues:

Company executives said Haitian officials were under intense pressure to tackle multiple crises with scant resources following the earthquake in January last year which killed more than 230,000 people.

Peter Graaff, the current Haiti representative of the World Health Organisation, said he was unaware of the specific Crucell offer, but that a decision had been taken by the country’s health ministry at the time to reject proposals for cholera vaccination.

He questioned whether such “ring fencing” would have worked, given that it would have taken time to bring the vaccine in remote rural areas while cholera was spreading very quickly.

The vaccine requires two doses staggered a week apart, further complicating its use. At the time, Haitian officials were juggling alternative priorities including water and sanitation support, while distracted by upcoming elections.

Recently, Dr. Paul Farmer and 43 other health professionals offered their vision for a possible way forward in fighting the cholera epidemic. In their article, the health professionals call for “advocacy for scaled-up production of cholera vaccine and the development of a vaccine strategy for Haiti.” This follows a study published by The Lancet in March that found that “Vaccination of 10% of the population was projected to avert 63 000 cases (48 000—78 000) and 900 deaths (600—1500).”

Not everyone favors vaccines however. The World Health Organization and “a number of health charities oppose drug and vaccine donations, arguing that they are not sustainable and reduce the chance of low cost generic competition,” reports the FT.

Treatment vs. Prevention

Although the decline in the number of CTCs negatively affects the ability to treat cholera patients, it is clear more must be done to prevent the disease’s spread in the first place. Part of this effort is education on how to prevent cholera’s spread, but without a clean, reliable public water system Haiti will remain vulnerable to disease. Partners in Health pointed out soon after the epidemic was first reported back in October that:

While Haiti has not had a documented case of cholera since the 1960s, the conditions in the lower Artibonite placed the region at high-risk for epidemics of cholera and other water-borne diseases even before the earthquake of January 12, 2010. In 2008, Partners In Health working with partners at the Robert Kennedy Center for Human Rights released a report of the denial of water security as a basic right in Haiti. In 2000, a set of loans from the Inter American Development Bank to the government of Haiti for water, sanitation and health were blocked for political reasons. The city of St. Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed. We believe secure and free access to clean water is a basic human right that should be delivered through the public sector and that the international community’s failure to assist the government of Haiti in developing a safe water supply has been violation of this basic right.

As John Carroll, a doctor at a CTC at the Hospital Albert Schweizer, notes in a recent blog post:

            Cholera is indeed a horrible disease.

Ane [sic] when will this resurgence let up? Will it slow down at the end of the rainy season and then take off again with a tropical storm or hurricane that strikes after the rainy season is over?

And cholera is now endemic in Haiti. So will this all happen again with 2012’s rainy    season?

And cholera statistics are important but they seem kind of unimportant to me now. When asked how many new cholera patients we saw on a certain day I say “alot”.

Aren’t the real questions:

What are skilled men and women upstream doing to separate the good water from the bad water? Isn’t that the important thing to know? If that were happening there would be no downstream problem with cholera. And we wouldn’t have to worry about silly things like NGOs, Ringer’s Lactate, cholera tents, and begging for buckets.

If upstream changes don’t occur soon, thousands more grown Haitian men and women will be shuffling around with “zombiefied” looks clothed only in diapers.

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.

Table 1. Number of Operational CTCs
CTC_Image

Data from Health Cluster

The number of cholera treatment units (CTUs), which are smaller than the CTCs, has stayed relatively constant (217 in March to 219 in June), while the number of Oral Rehydration Centers (ORCs), which decreased from April to May, has recently increased.

Warning Signs

At the end of March, OCHA warned that:

A Water, Hygiene and Sanitation (WASH) and CCCM Cluster analysis reveals that most of the funding to partners to support sanitation, water trucking activities and camp management will be exhausted by June 2011. As a result, it is expected that the number of humanitarian actors able to continue activities will be drastically reduced, which in turn will have serious consequences on the living conditions of camps residents. Their level of vulnerability will be particularly high due to the rain and hurricane season.

At the time of OCHA’s warning, the UN’s cholera appeal was 46 percent funded. Three months later, with a drastic increase in the number of cases, the appeal remains just 53 percent funded; an increase of just over $10 million. It costs $1 million to operate a CTC for three months. Since March, over 800 people have died from the cholera epidemic, according to MSPP data.

A recent Al Jazeera video report, also notes the initial underestimate of how bad the epidemic would be:

The Haitian government, UN agencies and non-governmental organizations, all badly underestimated the spread of the epidemic say specialists studying the outbreak.

Sanjay Basu, Epidemiologist, University of California: “Our best predictions so far show that over the next year or so that toll could rise to about 800,000 cases and 11,000 deaths. This is in a population of 10 million people, so you’re talking about almost one in ten people being directly affected by cholera.”

That initial underestimate means not enough resources were budgeted for cholera treatment and prevention.

 

The recent increase is especially concerning because the epidemic has become much more prevalent in the IDP camps, where hundreds of thousands remain in extremely precarious living conditions and will be especially vulnerable as the rains continue. In a statement from June 22, MSF head of mission, Romain Gitenet noted that:

During the first peak, the camps were hardly affected because there was help with latrines and distribution of chlorinated water. Since late March, the national organisation which used to distribute free chlorinated water in IDP camps began recovering costs: water is now paid for. We sounded the alarm at the time, saying that we were still in an outbreak phase. This could be in part why the camps are now infected when before they had not been.

As Michaëlle Jean, former governor general of Canada and UN special envoy to Haiti (together with Irina Bokova, the head of UNESCO) wrote at the one-year anniversary of the earthquake:

More than a million people are still living amid rubble, in emergency camps, in abject poverty; cholera, meanwhile, has claimed thousands of lives. As time passes, what began as a natural disaster is becoming a disgraceful reflection on the international community. Official commitments have not been honoured; only a minuscule portion of what was promised has been paid out. The Haitian people feel abandoned and disheartened by the slowness with which rebuilding is taking place.

Health Officials Turned Down Vaccine, WHO and Companies Say

This weekend, news also broke that late in 2010, according to the company Crucell, which manufactures the most common cholera vaccine, it had offered “tens of thousands of doses”, but the plan was rejected by health officials. One reason, as the Financial Times reports, was that the Haitian government was responding to multiple emergencies with “scant resources”. The FT continues:

Company executives said Haitian officials were under intense pressure to tackle multiple crises with scant resources following the earthquake in January last year which killed more than 230,000 people.

Peter Graaff, the current Haiti representative of the World Health Organisation, said he was unaware of the specific Crucell offer, but that a decision had been taken by the country’s health ministry at the time to reject proposals for cholera vaccination.

He questioned whether such “ring fencing” would have worked, given that it would have taken time to bring the vaccine in remote rural areas while cholera was spreading very quickly.

The vaccine requires two doses staggered a week apart, further complicating its use. At the time, Haitian officials were juggling alternative priorities including water and sanitation support, while distracted by upcoming elections.

Recently, Dr. Paul Farmer and 43 other health professionals offered their vision for a possible way forward in fighting the cholera epidemic. In their article, the health professionals call for “advocacy for scaled-up production of cholera vaccine and the development of a vaccine strategy for Haiti.” This follows a study published by The Lancet in March that found that “Vaccination of 10% of the population was projected to avert 63 000 cases (48 000—78 000) and 900 deaths (600—1500).”

Not everyone favors vaccines however. The World Health Organization and “a number of health charities oppose drug and vaccine donations, arguing that they are not sustainable and reduce the chance of low cost generic competition,” reports the FT.

Treatment vs. Prevention

Although the decline in the number of CTCs negatively affects the ability to treat cholera patients, it is clear more must be done to prevent the disease’s spread in the first place. Part of this effort is education on how to prevent cholera’s spread, but without a clean, reliable public water system Haiti will remain vulnerable to disease. Partners in Health pointed out soon after the epidemic was first reported back in October that:

While Haiti has not had a documented case of cholera since the 1960s, the conditions in the lower Artibonite placed the region at high-risk for epidemics of cholera and other water-borne diseases even before the earthquake of January 12, 2010. In 2008, Partners In Health working with partners at the Robert Kennedy Center for Human Rights released a report of the denial of water security as a basic right in Haiti. In 2000, a set of loans from the Inter American Development Bank to the government of Haiti for water, sanitation and health were blocked for political reasons. The city of St. Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed. We believe secure and free access to clean water is a basic human right that should be delivered through the public sector and that the international community’s failure to assist the government of Haiti in developing a safe water supply has been violation of this basic right.

As John Carroll, a doctor at a CTC at the Hospital Albert Schweizer, notes in a recent blog post:

            Cholera is indeed a horrible disease.

Ane [sic] when will this resurgence let up? Will it slow down at the end of the rainy season and then take off again with a tropical storm or hurricane that strikes after the rainy season is over?

And cholera is now endemic in Haiti. So will this all happen again with 2012’s rainy    season?

And cholera statistics are important but they seem kind of unimportant to me now. When asked how many new cholera patients we saw on a certain day I say “alot”.

Aren’t the real questions:

What are skilled men and women upstream doing to separate the good water from the bad water? Isn’t that the important thing to know? If that were happening there would be no downstream problem with cholera. And we wouldn’t have to worry about silly things like NGOs, Ringer’s Lactate, cholera tents, and begging for buckets.

If upstream changes don’t occur soon, thousands more grown Haitian men and women will be shuffling around with “zombiefied” looks clothed only in diapers.

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.

In April, PBS’s Need to Know interviewed a Dominican human rights activist of Haitian descent, Sonia Pierre, who founded the organization MUDHA–El Movimiento de Mujeres Dominico-Haitianas. She refutes claims that deportations are focused solely on Haitians with no documentation who’ve only recently arrived:

They’re deporting people who’ve lived all their lives here and sending them back to Haiti. They were born here—children without their families, mothers with their newborns—sending them to a country they’ve never lived in…They don’t ask for a document. If they think you look like you could be Haitian, you’re getting on the bus. It’s that simple.

Her account is corroborated by Jesuit priest Regino Martínez, who ministers in the volatile border town of Dajabón and directs the NGO Solidaridad Fronteriza (Border Solidarity). As he explained to Inter Press Service in 2007:

“People are deported, mistreated and abused simply because they’re Haitian or especially dark-skinned…they round up and deport (Haitians) even when their papers are in order.” The main factor determining repatriation, he asserted, is “how dark their skin is,” as Haitians tend to be darker than Dominicans.

In principle, the Dominican constitution once provided for birthright citizenship, under which any child born on Dominican soil was entitled to all rights enjoyed in the Republic. Despite this, generations of Dominicans of Haitian descent had trouble accessing basic government services, including health care, higher education and basic documentation. On Jan. 26, 2010, even that principle was nullified. A new constitution was enacted which, according to the RFK Center for Justice & Human Rights, “redefine[d] Dominican citizenship and den[ied] children born on Dominican soil to immigrant parents ‘residing illegally’ in the country their legal claim to Dominican nationality.”

In an interview with IPS in 2008, Bridget Wooding, then an associate researcher on migration at the Latin American Faculty of Social Sciences, noted that “The fact that there is no pathway for Haitian immigrants and their descendants to regularise their immigration status is a serious obstacle for access to education and health services. Without documents, it is very difficult for Haitians to have their labour rights respected.”

A typical response among Dominican political leaders, like Senator Prim Pujals Nolasco, is that “We are a country of limited resources.” Former Director of Immigration Sigfrido Pared Perez echoes this argument when stating that “it’s economics. It’s a matter of survival. Many world powers would like the Dominican Republic to take on the Haitian issue, but it is not that easy. We can help with the Haitian issue, but not solve it.”

Neither addresses the issue of verified deportations of Dominicans of Haitian descent. But Haitian laborers’ legal precariousness has been an enormous boon to those Dominicans best positioned to reap the additional profits that come from using a submissive and fearful labor force. The construction sector, for example, is marred by very hazardous conditions, and low pay (sometimes none at all). But the Dominican construction industry’s workforce, including that of the lucrative luxury sector, is estimated to be 85% Haitian.

Being of Haitian descent—more so than being a Haitian citizen—has been a primary concern in much of the Dominican government’s policy and enforcement throughout the turbulent history of the two countries, which together share the island of Hispaniola. Race relations and the two countries’ mutual antagonism were chronicled this spring in the hour-long PBS feature, Haiti & the Dominican Republic: An Island Divided. Writing in Boston Review, Dominican-American author Junot Díaz touches upon this history as well:

In the modern period, few Caribbean populations have been more hostile to Haitians. We are of course neighbors, but what neighbors! In 1937 the dictator Rafael Trujillo launched a genocidal campaign against Haitians and Haitian Dominicans. Tens of thousands were massacred; tens of thousands more were wounded and driven into Haiti, and in the aftermath of that genocide the relationship between the two countries has never thawed.

The Jan. 2010 earthquake, however, carved out an opportunity to revisit prior relations, and the D.R. did so, becoming one of the major protagonists in post-quake relief work. It was singled out by then-Prime Minister Jean-Max Bellerive, along with Cuba and Venezuela, for special distinction.

As Junot Díaz notes:

In a shocking reversal of decades of toxic enmity, it seemed as if the entire Dominican society mobilized for the relief effort. Dominican hospitals were emptied to receive the wounded, and all elective surgeries were canceled for months. (Imagine if the United States canceled all elective surgeries for a single month in order to help Haiti, what a different [sic] that would have made.) Schools across the political and economic spectrums organized relief drives, and individual citizens delivered caravans of essential materials and personnel in their own vehicles, even as international organizations were claiming that the roads to Port-au-Prince were impassable. The Dominican government transported generators and mobile kitchens and established a field hospital. The Dominican Red Cross was up and running long before anyone else. Dominican communities in New York City, Boston, Providence, and Miami sent supplies and money. This historic shift must have Trujillo rolling in his grave. Sonia Marmolejos, a humble Dominican woman, left her own infant babies at home in order to breastfeed more than twenty Haitian babies whose mothers had either been seriously injured or killed in the earthquake.

Today, community-based organizations work against what they perceive to be the restoration of the status quo ante, as deportations continue and the number of cholera-related deaths in the D.R. grow. Organizations like MUDHA and Solidaridad Fronteriza are attempting to build upon the Dominican public’s outpouring of sympathy one and a half years ago to push for legal and economic rights for Haitians and Dominicans of Haitian descent.

Solidaridad Fronteriza has gone from “town to town, interviewing workers to determine how long they’ve been in the Dominican Republic, where they work, how many children they have, their identification number in Haiti, and any other bits of information they could put on legitimate-looking badges.” The aim is to create “a way for the undocumented to document themselves.” Father Martinez describes such self-identification as having “no legal authority, but a moral one.”

Efforts to build upon solidarity among the citizens of the two countries have important implications for democratic governance as well. It was during a time of chilly relations between the two countries that Haitian death squad leaders Guy Philippe and Luis Jodel Chamblain trained “rebel” forces in the Dominican Republic, using the country as a base for their operations. They went on to lead bloody incursions in Central Haiti, killing dozens, and helped to precipitate the 2004 overthrow of the democratically elected government of Jean-Bertrand Aristide.

UPDATE (June 14, 2011):

On July 13, Al Jazeera’s documentary series Witness released a half-hour report entitled “Stranded: The stateless Haitians” which focuses on the legal and economic challenges that Dominicans of Haitian descent face. The program centers around a family living in a community of predominantly Haitian descent near Santo Domingo called Batey Kilometro 43. Bateyes, or sugar workers’ towns, are often marginalized and lack basic social services. The piece documents the attempts of a Haitian cane worker’s children—all born and raised in the DR—to obtain higher education, employment and basic identification.

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.

In April, PBS’s Need to Know interviewed a Dominican human rights activist of Haitian descent, Sonia Pierre, who founded the organization MUDHA–El Movimiento de Mujeres Dominico-Haitianas. She refutes claims that deportations are focused solely on Haitians with no documentation who’ve only recently arrived:

They’re deporting people who’ve lived all their lives here and sending them back to Haiti. They were born here—children without their families, mothers with their newborns—sending them to a country they’ve never lived in…They don’t ask for a document. If they think you look like you could be Haitian, you’re getting on the bus. It’s that simple.

Her account is corroborated by Jesuit priest Regino Martínez, who ministers in the volatile border town of Dajabón and directs the NGO Solidaridad Fronteriza (Border Solidarity). As he explained to Inter Press Service in 2007:

“People are deported, mistreated and abused simply because they’re Haitian or especially dark-skinned…they round up and deport (Haitians) even when their papers are in order.” The main factor determining repatriation, he asserted, is “how dark their skin is,” as Haitians tend to be darker than Dominicans.

In principle, the Dominican constitution once provided for birthright citizenship, under which any child born on Dominican soil was entitled to all rights enjoyed in the Republic. Despite this, generations of Dominicans of Haitian descent had trouble accessing basic government services, including health care, higher education and basic documentation. On Jan. 26, 2010, even that principle was nullified. A new constitution was enacted which, according to the RFK Center for Justice & Human Rights, “redefine[d] Dominican citizenship and den[ied] children born on Dominican soil to immigrant parents ‘residing illegally’ in the country their legal claim to Dominican nationality.”

In an interview with IPS in 2008, Bridget Wooding, then an associate researcher on migration at the Latin American Faculty of Social Sciences, noted that “The fact that there is no pathway for Haitian immigrants and their descendants to regularise their immigration status is a serious obstacle for access to education and health services. Without documents, it is very difficult for Haitians to have their labour rights respected.”

A typical response among Dominican political leaders, like Senator Prim Pujals Nolasco, is that “We are a country of limited resources.” Former Director of Immigration Sigfrido Pared Perez echoes this argument when stating that “it’s economics. It’s a matter of survival. Many world powers would like the Dominican Republic to take on the Haitian issue, but it is not that easy. We can help with the Haitian issue, but not solve it.”

Neither addresses the issue of verified deportations of Dominicans of Haitian descent. But Haitian laborers’ legal precariousness has been an enormous boon to those Dominicans best positioned to reap the additional profits that come from using a submissive and fearful labor force. The construction sector, for example, is marred by very hazardous conditions, and low pay (sometimes none at all). But the Dominican construction industry’s workforce, including that of the lucrative luxury sector, is estimated to be 85% Haitian.

Being of Haitian descent—more so than being a Haitian citizen—has been a primary concern in much of the Dominican government’s policy and enforcement throughout the turbulent history of the two countries, which together share the island of Hispaniola. Race relations and the two countries’ mutual antagonism were chronicled this spring in the hour-long PBS feature, Haiti & the Dominican Republic: An Island Divided. Writing in Boston Review, Dominican-American author Junot Díaz touches upon this history as well:

In the modern period, few Caribbean populations have been more hostile to Haitians. We are of course neighbors, but what neighbors! In 1937 the dictator Rafael Trujillo launched a genocidal campaign against Haitians and Haitian Dominicans. Tens of thousands were massacred; tens of thousands more were wounded and driven into Haiti, and in the aftermath of that genocide the relationship between the two countries has never thawed.

The Jan. 2010 earthquake, however, carved out an opportunity to revisit prior relations, and the D.R. did so, becoming one of the major protagonists in post-quake relief work. It was singled out by then-Prime Minister Jean-Max Bellerive, along with Cuba and Venezuela, for special distinction.

As Junot Díaz notes:

In a shocking reversal of decades of toxic enmity, it seemed as if the entire Dominican society mobilized for the relief effort. Dominican hospitals were emptied to receive the wounded, and all elective surgeries were canceled for months. (Imagine if the United States canceled all elective surgeries for a single month in order to help Haiti, what a different [sic] that would have made.) Schools across the political and economic spectrums organized relief drives, and individual citizens delivered caravans of essential materials and personnel in their own vehicles, even as international organizations were claiming that the roads to Port-au-Prince were impassable. The Dominican government transported generators and mobile kitchens and established a field hospital. The Dominican Red Cross was up and running long before anyone else. Dominican communities in New York City, Boston, Providence, and Miami sent supplies and money. This historic shift must have Trujillo rolling in his grave. Sonia Marmolejos, a humble Dominican woman, left her own infant babies at home in order to breastfeed more than twenty Haitian babies whose mothers had either been seriously injured or killed in the earthquake.

Today, community-based organizations work against what they perceive to be the restoration of the status quo ante, as deportations continue and the number of cholera-related deaths in the D.R. grow. Organizations like MUDHA and Solidaridad Fronteriza are attempting to build upon the Dominican public’s outpouring of sympathy one and a half years ago to push for legal and economic rights for Haitians and Dominicans of Haitian descent.

Solidaridad Fronteriza has gone from “town to town, interviewing workers to determine how long they’ve been in the Dominican Republic, where they work, how many children they have, their identification number in Haiti, and any other bits of information they could put on legitimate-looking badges.” The aim is to create “a way for the undocumented to document themselves.” Father Martinez describes such self-identification as having “no legal authority, but a moral one.”

Efforts to build upon solidarity among the citizens of the two countries have important implications for democratic governance as well. It was during a time of chilly relations between the two countries that Haitian death squad leaders Guy Philippe and Luis Jodel Chamblain trained “rebel” forces in the Dominican Republic, using the country as a base for their operations. They went on to lead bloody incursions in Central Haiti, killing dozens, and helped to precipitate the 2004 overthrow of the democratically elected government of Jean-Bertrand Aristide.

UPDATE (June 14, 2011):

On July 13, Al Jazeera’s documentary series Witness released a half-hour report entitled “Stranded: The stateless Haitians” which focuses on the legal and economic challenges that Dominicans of Haitian descent face. The program centers around a family living in a community of predominantly Haitian descent near Santo Domingo called Batey Kilometro 43. Bateyes, or sugar workers’ towns, are often marginalized and lack basic social services. The piece documents the attempts of a Haitian cane worker’s children—all born and raised in the DR—to obtain higher education, employment and basic identification.

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.

 

Gousse, prior to becoming Justice Minister, had worked for USAID during the 1990s and then for the International Foundation for Electoral Systems [IFES] from 2002 up until the coup that overthrew Aristide in 2004. In a 2004 human rights investigation, the University of Miami School of Law detailed IFES’ role in the overthrow of Aristide. The report notes:

The administrators reported that IFES, through its creation or “sensitization” of associations, set the groundwork for the establishment and nurturing of the Group of 184 — the business-centered coalition led by factory owner Andy Apaid that played a major role in Aristide’s ouster. In fact, according to the Haitian administrators, when Andy Apaid’s Group of 184 held a meeting in Cite Soleil in July 2003, the IFES leadership presented a program explaining that, under Aristide, “prosecutors won’t prosecute.”

When the Group of 184 wanted to introduce its “new Social Contract” at the Inisyativ Sitwayen (“Citizens’ Initiative”) presentation in Cap Haïtien, IFES financed it. The administrators stated that this group became “the first association to effectively resist Aristide.” They stated that IFES rented the space for the meeting, paid for the logistics and sound system, funded all activities at the forum, and paid a “per diem” cash benefit to attendees.

The report continues:

The administrators claimed that President Aristide’s other serious mistake was the murder of Amiot “Cubain” Métayer, a prominent leader in Gonaïves. IFES took the position that President Aristide had Métayer killed [Ed. Note: Nobody has ever been charged in the killing]. After the killing, violence broke out in Gonaives and, according to the administrators, Bernard Gousse wanted to be there to support the victims. He traveled to Gonaives in a USAID-marked vehicle “for protection” and under the auspices of a “medical association” that IFES had formed or “sensitized,” known as IMEDH. Asked to clarify whether Gousse went to Gonaïves in support of all victims of violence or a particular group, the administrators stated that “Gousse wanted to be with the rebels.”

According to author Peter Hallward, the leader of a post-coup paramilitary death squad, Ravix Rémissanthe, claimed to have been “armed, funded and supported by members of the G184 and the de facto government, including Gousse”.

Shortly after the coup, Gousse began investigating Aristide and other members of his political party, Fanmi Lavalas, while at the same time undermining efforts to prosecute rebel leaders. While former Prime Minister Yvon Neptune was imprisoned without charges for months, two notorious rebel leaders were let off the hook. One such rebel was Jean Pierre Baptiste, known as Jean Tatoune. Human Rights Watch (HRW) described Tatoune as a “local FRAPH leader during the 1991-1994 military government” who “was sentenced to life imprisonment for the Raboteau massacre,” but had escaped from prison in 2002 and joined the insurgency against Aristide. (FRAPH was a death squad organization that killed political opponents during the 1991-1994 military dictatorship in Haiti.) In an interview with HRW, Gousse said he would consider reducing Tatoune’s sentence because “he’s fought against two dictatorships,” referring to Duvalier and Aristide.  The other rebel leader was Luis Jodel Chamblain (currently working as security chief for Duvalier), who “was convicted in absentia and sentenced to life imprisonment for the 1993 murder of Antoine Izméry, a well-known pro-democracy activist, and for involvement in the April 1994 Raboteau massacre in which some 20 people are believed to have been killed.” The comments led Joanne Mariner, deputy director of Americas Division for Human Rights Watch, to state, “The contrast between the Haitian government’s eagerness to prosecute former Aristide officials and its indifference to the abusive record of certain rebel leaders could not be more stark.”

In August of 2004, the New York Times editorial board described the initial proceedings against Chamblain, noting Gousse’s favorable opinion of the convicted murderer:

Under Haitian law, Mr. Chamblain was entitled to new trials after his return from exile. The first, in the Izméry case, was held this week. In a quickly convened overnight proceeding, the prosecution produced just one witness — who claimed to know nothing about the case — and Mr. Chamblain was promptly acquitted.

Washington rightly deplored the haste and ”procedural deficiencies” of the Chamblain retrial. But it should not have been particularly surprised.

Haiti’s justice minister, Bernard Gousse, earlier suggested that Mr. Chamblain might be pardoned ”for his great services to the nation” as a leader of the anti-Aristide rebellion in February. [Ed. Note: He was also involved in the 1991 overthrow of Aristide]

Then, some nine months later, Haiti’s supreme court overruled the 1994 ruling on the massacre in Raboteau. Reed Lindsay, writing for the Washington Times reported at the time:

Last week, the convictions of at least 15 of the Raboteau defendants were overturned by Haiti’s Supreme Court in a murky ruling that angered human rights activists.

“In a country in which the poor have been killed and brutalized with impunity for centuries, Raboteau was perhaps the only time that justice was achieved after a massacre, and in a scrupulously fair trial,” said Reed Brody of Human Rights Watch.

Last December, Justice Minister Bernard Gousse removed two prominent judges’ caseloads after they ordered the release of prisoners who were political opponents of the government.

The Supreme Court’s decision comes nine months after paramilitary leader Louis Jodel Chamblain was acquitted of the 1993 murder of pro-democracy activist Antoine Izmery in an overnight trial that Amnesty International condemned as “a very sad record in the history of Haiti.”

Gousse eventually resigned, amid continued criticism, in June of 2005.

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.

 

Gousse, prior to becoming Justice Minister, had worked for USAID during the 1990s and then for the International Foundation for Electoral Systems [IFES] from 2002 up until the coup that overthrew Aristide in 2004. In a 2004 human rights investigation, the University of Miami School of Law detailed IFES’ role in the overthrow of Aristide. The report notes:

The administrators reported that IFES, through its creation or “sensitization” of associations, set the groundwork for the establishment and nurturing of the Group of 184 — the business-centered coalition led by factory owner Andy Apaid that played a major role in Aristide’s ouster. In fact, according to the Haitian administrators, when Andy Apaid’s Group of 184 held a meeting in Cite Soleil in July 2003, the IFES leadership presented a program explaining that, under Aristide, “prosecutors won’t prosecute.”

When the Group of 184 wanted to introduce its “new Social Contract” at the Inisyativ Sitwayen (“Citizens’ Initiative”) presentation in Cap Haïtien, IFES financed it. The administrators stated that this group became “the first association to effectively resist Aristide.” They stated that IFES rented the space for the meeting, paid for the logistics and sound system, funded all activities at the forum, and paid a “per diem” cash benefit to attendees.

The report continues:

The administrators claimed that President Aristide’s other serious mistake was the murder of Amiot “Cubain” Métayer, a prominent leader in Gonaïves. IFES took the position that President Aristide had Métayer killed [Ed. Note: Nobody has ever been charged in the killing]. After the killing, violence broke out in Gonaives and, according to the administrators, Bernard Gousse wanted to be there to support the victims. He traveled to Gonaives in a USAID-marked vehicle “for protection” and under the auspices of a “medical association” that IFES had formed or “sensitized,” known as IMEDH. Asked to clarify whether Gousse went to Gonaïves in support of all victims of violence or a particular group, the administrators stated that “Gousse wanted to be with the rebels.”

According to author Peter Hallward, the leader of a post-coup paramilitary death squad, Ravix Rémissanthe, claimed to have been “armed, funded and supported by members of the G184 and the de facto government, including Gousse”.

Shortly after the coup, Gousse began investigating Aristide and other members of his political party, Fanmi Lavalas, while at the same time undermining efforts to prosecute rebel leaders. While former Prime Minister Yvon Neptune was imprisoned without charges for months, two notorious rebel leaders were let off the hook. One such rebel was Jean Pierre Baptiste, known as Jean Tatoune. Human Rights Watch (HRW) described Tatoune as a “local FRAPH leader during the 1991-1994 military government” who “was sentenced to life imprisonment for the Raboteau massacre,” but had escaped from prison in 2002 and joined the insurgency against Aristide. (FRAPH was a death squad organization that killed political opponents during the 1991-1994 military dictatorship in Haiti.) In an interview with HRW, Gousse said he would consider reducing Tatoune’s sentence because “he’s fought against two dictatorships,” referring to Duvalier and Aristide.  The other rebel leader was Luis Jodel Chamblain (currently working as security chief for Duvalier), who “was convicted in absentia and sentenced to life imprisonment for the 1993 murder of Antoine Izméry, a well-known pro-democracy activist, and for involvement in the April 1994 Raboteau massacre in which some 20 people are believed to have been killed.” The comments led Joanne Mariner, deputy director of Americas Division for Human Rights Watch, to state, “The contrast between the Haitian government’s eagerness to prosecute former Aristide officials and its indifference to the abusive record of certain rebel leaders could not be more stark.”

In August of 2004, the New York Times editorial board described the initial proceedings against Chamblain, noting Gousse’s favorable opinion of the convicted murderer:

Under Haitian law, Mr. Chamblain was entitled to new trials after his return from exile. The first, in the Izméry case, was held this week. In a quickly convened overnight proceeding, the prosecution produced just one witness — who claimed to know nothing about the case — and Mr. Chamblain was promptly acquitted.

Washington rightly deplored the haste and ”procedural deficiencies” of the Chamblain retrial. But it should not have been particularly surprised.

Haiti’s justice minister, Bernard Gousse, earlier suggested that Mr. Chamblain might be pardoned ”for his great services to the nation” as a leader of the anti-Aristide rebellion in February. [Ed. Note: He was also involved in the 1991 overthrow of Aristide]

Then, some nine months later, Haiti’s supreme court overruled the 1994 ruling on the massacre in Raboteau. Reed Lindsay, writing for the Washington Times reported at the time:

Last week, the convictions of at least 15 of the Raboteau defendants were overturned by Haiti’s Supreme Court in a murky ruling that angered human rights activists.

“In a country in which the poor have been killed and brutalized with impunity for centuries, Raboteau was perhaps the only time that justice was achieved after a massacre, and in a scrupulously fair trial,” said Reed Brody of Human Rights Watch.

Last December, Justice Minister Bernard Gousse removed two prominent judges’ caseloads after they ordered the release of prisoners who were political opponents of the government.

The Supreme Court’s decision comes nine months after paramilitary leader Louis Jodel Chamblain was acquitted of the 1993 murder of pro-democracy activist Antoine Izmery in an overnight trial that Amnesty International condemned as “a very sad record in the history of Haiti.”

Gousse eventually resigned, amid continued criticism, in June of 2005.

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