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Haiti: Relief and Reconstruction

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Haitian Prime Minister: Cholera Under Control Print
Wednesday, 26 September 2012 15:46

In an interview following his meeting with UN Secretary General Ban Ki-moon, Haitian Prime Minister Laurent Lamothe told Reuters that cholera is “really under control.”  Well, that certainly depends on your definition of under control. Since tropical storm Isaac swept across Haiti last month, some 83 Haitians have reportedly died from cholera and this is almost certainly an understatement, as the surveillance system has become increasingly unreliable. Over the same time, more than 8,200 Haitians have been sickened. Since April of this year, when the rainy season began, 514 have died and over 63,000 have been sickened by cholera.

As for the government’s response, according to the United Nations, “national capacity to respond to potential outbreaks, especially during the rainy season, remains very weak.” From May to June this year, just as the rainy season was beginning, three cholera treatment centers and 13 cholera treatment units were closed down, leaving just 17 and 61 left open, respectively. This is down from 38 and 205 last August. Additionally, as CCO Haiti pointed out last month, “many public health workers in the Cholera Treatment Center (CTCs) have not received salaries for several months and there are reports of strikes by front line medical staff to redress this situation. This is a serious issue negatively affecting the effectiveness of the cholera response and it needs to be urgently addressed.”

Of course, this is not entirely the government’s fault. Most of the cholera response bypassed the government entirely and now, as NGOs pull out of the field, the government has been left to pick up the slack without adequate resources. Nevertheless, to the hundreds of Haitians falling ill every day with cholera, Prime Minister Lamothe’s assertion must ring especially hollow.

Update 9/27: The post has been updated to reflect newly posted data on cholera deaths and cases.

 
USAID Says More than 9% of Funds Going to Local Groups. Really? Print
Wednesday, 26 September 2012 15:08

This past weekend, USAID Administrator Rajiv Shah said that by 2015 the goal is to have 30 percent of aid funds going to local groups. This is in line with the goals put forth in the USAID Forward reform agenda, which aims to reach this target agency-wide by 2015. Shah also made a surprising announcement regarding local procurement in Haiti, as reported in the Miami Herald:

Before the January 2010 earthquake, Shah said less than 9 percent of USAID money was going to Haitian organizations. “We’re over the pre-earthquake level now,’’ said Shah during an interview with The Miami Herald. He wasn’t more specific.

As we have noted numerous times before, according to the available data, it appears that far less than 10 percent of USAID funds have gone directly to local organizations. A review of data on USAID contracts for work in Haiti from the Federal Procurement Database System reveals that just 1.3 percent of USAID funds have gone directly to Haitian companies, as can be seen in Table I.

Table I: USAID Contracts by Recipient Location
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UN Secretary General Recommends Creating Timeline for MINUSTAH Withdrawal Print
Friday, 14 September 2012 16:20

In his mandated report on MINUSTAH, the United Nations Secretary General for the first time outlines the creation of a timetable for withdrawal of MINUSTAH personnel from Haiti. UNSG Ban Ki-moon writes:

The plan foresees a narrowing of the Mission’s activities to a core set of mandated tasks that are achievable within a reasonable time frame (envisioned to be a period of between four and five years for planning purposes) aimed at consolidating stabilization gains to a point beyond which the presence of a large peacekeeping operation will no longer be required. The Mission will work with the Government, civil society, the United Nations country team and international partners to agree on a transition compact that will set out a limited number of stabilization benchmarks that will serve as key indicators of progress in the stabilization process.

Calling for a concrete timetable for progressive withdrawal of the foreign contingents is a small, but important first step.   Last year’s authorization of MINUSTAH [PDF] lacked any details on withdrawal and instead mandated that, “future adjustments to its force configuration should be based on the overall security situation on the ground.” Ban Ki-moon is now recommending creating a “transition compact” with the Haitian government that would have specific benchmarks on the road to withdrawal. The main benchmark for reducing the number of MINUSTAH personnel would be sufficient strengthening of the Haitian National Police, while other “benchmarks will evaluate the maturity of key rule of law oversight and accountability mechanisms.”

These benchmarks have yet to be drawn up, however, and so the plan could be overly optimistic in terms of its drawdown timetable. Growth and reform of the police has been a key benchmark for MINUSTAH’s mission completion all along, yet eight years after MINUSTAH began, “the country’s still limited police force cannot guarantee the security needed to protect citizens, enforce the law and underpin political stability,” according to the International Crisis Group. (It is notable that the UNSG’s four-five year timeline is compatible with the five-year extension called for by the International Crisis Group, which it recommends in order to, as it puts it, ensure “a third peaceful handover of democratic power …at the end of the Martelly presidency,” and “the completion of the second five-year police development plan.”)

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Reduced Charges Against Uruguayan MINUSTAH Troops Latest Example of Lack of UN Accountability Print
Tuesday, 04 September 2012 12:13

Last week, four Uruguayan peacekeepers who were repatriated from Haiti nearly one year ago after video evidence emerged showing the assault of an 18-year old Haitian man, apparently inside the Uruguayan’s Port Salut base, were finally charged. The prosecutor, however, is charging the four soldiers with “coercion” as opposed to sexual abuse.

As AFP reported last week:

"The evidence on record does not support findings of sexual assault. The indictment concerns only the crime of coercion," said the prosecutor in the case, Enrique Rodriguez.

The Latin American nation's penal code states that coercion -- a crime punishable by three months to three years in prison -- involves the use of physical or psychological restraint to force someone to take or abstain from an action against their will.

"In this case, force was used to oblige another person to tolerate an action against their will," Rodriguez said, noting that the judge has not yet ruled in the case.      

The Uruguayan press, reporting on the charges notes that the judge, even if he finds the accused soldiers guilty, could still forgo giving prison sentences.

The case stands as just the latest example of the problems of holding the UN Peacekeeping mission in Haiti accountable for abuses, from the introduction of cholera to the sexual abuse of Haitians. Under the UN’s Status of Forces Agreement, those accused of abuse are repatriated quickly, where they face judges of their home country as opposed to local Haitian courts where they could face significantly longer and tougher sentences. In March, three Pakistani police were found guilty of rape, yet were sentenced to just one year in prison by a Pakistani military tribunal. Despite evidence implicating MINUSTAH personnel in a cover-up of the abuse, the case in local courts has stalled. In another example of injustice, over 100 Sri Lankan troops were returned to Sri Lanka in 2007 after evidence emerged of their involvement in sexual exploitation and prostitution with Haitian children and women. There is no sign that the troops have faced any form of punishment since.

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Chronicle of a Disaster Foretold? Print
Friday, 24 August 2012 12:16

The latest news from the Associated Press suggests Tropical Storm Isaac may not reach hurricane strength before hitting Haiti:

Tropical Storm Isaac strengthened slightly as it spun toward the Dominican Republic and vulnerable Haiti on Friday, threatening to bring punishing rains but unlikely to gain enough steam to strike as a hurricane.

Forecasters now expect the storm to stay below hurricane force until it's in the Gulf of Mexico, staying to the west of Tampa, Florida, where the Republican National Convention starts on Monday, though there is still an outside chance it could hit there.

In Haiti, the government and international aid groups announced plans to evacuate several thousand people from one of the settlement camps that sprang up in the aftermath of the 2010 earthquake.

Isaac was expected to dump eight to 12 inches (20 to 30 centimeters) of rain on the island of Hispaniola that is shared by Haiti and the Dominican Republic.

"That kind of rain is going to cause some life-threatening flash floods and mudslides," said Dennis Feltgen, a spokesman for the Hurricane Center in Miami.

AP’s Trenton Daniel goes on to describe the Haitian government’s emergency measures and the reactions that some Haitians had to them:

In flood-prone Haiti, where the storm's eye is likely to blow ashore late Friday, Prime Minister Laurent Lamothe urged people to avoid crossing rivers, to tape their windows, and to stay calm, saying "panic creates more problems."

Lamothe and other Haitian officials said the government had set aside about $50,000 in emergency funds and had buses and 32 boats on standby for evacuations.

But among many Haitians, the notion of disaster preparedness in a country where most people get by on about $2 a day was met with a shrug.

"We don't have houses that can bear a hurricane," said Jeanette Lauredan, who lives in a tent camp in the crowded Delmas district of Port-au-Prince.

About 400,000 people remain in settlement camps comprised of shacks and tarps in the wake of Haiti's devastating 2010 earthquake.

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Tropical Storm Isaac Heads for Haiti, Likely to Leave a Spike in Cholera in its Wake Print
Thursday, 23 August 2012 16:02

There has been much discussion in the media over the past day regarding whether Tropical Storm Isaac might rain on the Republican National Convention in Tampa, Florida, and possibly cause delays or a cancellation. Receiving less attention is that 400,000 some people in Haiti are still living in tents, under tarps and various forms of makeshift housing – people who became internally displaced persons (IDP’s) after the 2010 earthquake, and they are also in the storm’s projected path.

Aside from the more obvious threats that flooding and strong winds could mean for IDP camps and other vulnerable communities, Isaac could also bring a spike in cholera infections. As we have pointed out before, along with countless news articles, medical reports, and NGO press releases, Haiti’s cholera infections surge with rainy weather, and tropical storms and hurricanes pose an especially ominous threat. The lack of adequate sanitation and safe drinking water in IDP camps means that drinking water sources are likely to be contaminated by waste water when flooding occurs – along with the tents, tarps, and much bedding and other possessions. And it is not just the IDPs who face increased dangers with heavy rain. As the cholera response has been scaled back, access to cholera treatment centers in rural Haiti has decreased. While flooding and mudslides pose extreme danger on their own, they can also prevent those in need from traveling to secure the care that is needed.

We wrote two weeks ago that the Haitian health ministry reported a slower rate of infection this summer, which it attributed to unusually dry weather, but that they predicted an increase in the coming months as the hurricane season begins. The Pan American Health Organization estimates that Haiti could see up to 170,000 new cases this year, which would mean an average of about 20,000 cases per month over the next five months – 5,000 more cases per month than in the previous three months. We further noted that the UN Office for the Coordination of Humanitarian Affairs was reporting a “very weak” “capacity to respond to potential outbreaks,” such as could occur with a drenching tropical storm.

The United Nations, meanwhile, whose troops caused the epidemic in October 2010, has yet to take responsibility by taking steps to contain and control cholera.

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Durable Housing Solutions Hampered by “the Project Syndrome” Print
Tuesday, 21 August 2012 15:23

Last week Deborah Sontag of the New York Times reported in depth on the lack of sustainable housing solutions in Haiti since the earthquake:

Two and a half years after the earthquake, despite billions of dollars in reconstruction aid, the most obvious, pressing need — safe, stable housing for all displaced people — remains unmet.

In what international officials term a protracted humanitarian crisis, hundreds of thousands remain in increasingly wretched tent camps. Tens of thousands inhabit dangerously damaged buildings. And countless others, evicted from camps and yards, have simply disappeared with their raggedy tarps and rusty sheet metal into the hills.”

Sontag notes that $500 million was spent on transitional shelters that were “not built to last”, meaning “All the money spent on T-shelters will be melted away,” as H. Kit Miyamoto, an engineer working in Haiti, told Sontag. Meanwhile, although some 200,000 houses were damaged or destroyed:

international aid has led to an estimated 15,000 repairs and 5,700 new, permanent homes so far. Most of the new houses are outside greater Port-au-Prince, where it was easier to obtain land, and some have yet to be occupied.

Though many are quick to tout the decrease in camp population as a sign the housing and displacement crisis is being met, it is clear the number of new housing solutions can only explain a fraction of the camp population reduction. The lack of adequate housing has led 33 international organizations to sponsor the Under Tents campaign. Working with Haitian grassroots groups, the campaign seeks to win housing rights for the hundreds of thousands of Haitians who remain displaced or living in unsustainable housing.

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Cholera Continues to Spread as Response and Surveillance Weaken Print
Thursday, 09 August 2012 15:50

The latest data from the MSPP (Ministry of Health) shows that the number of cholera cases and resulting deaths continues to rise. As of August 2, there have been a total of 583,871 cases and 7,497 deaths reported since October 2010 and this almost certainly is an underestimate. While the number of cases this summer has not spiked as high as it did last year, there have still been 377 deaths and nearly 45,000 cases reported in just the last three months.

The MSPP attributes the slower rate of infection this summer to unusually dry weather; however they predict an increase in the coming months as the hurricane season begins. The Pan American Health Organization estimates that Haiti could see up to 170,000 new cases this year, which would mean an average of about 20,000 cases per month over the next five months. Over the previous three months, the average number of cases has been over 15,000. Despite this, funding for the cholera response, as well as for the infrastructure needed to stem the spread of the disease, has been inadequate.  At the end of July, the Comite de Coordination des ONGs Internationales en Haiti (CCO Haiti), which is made up of many international NGOs operating in Haiti, released a statement on the situation:

The cholera outbreak that has already claimed thousands of lives all over the country remains a major threat to public health. Cholera prevention and response should be a key priority for the Haitian Government.



Furthermore, many public health workers in the Cholera Treatment Center (CTCs) have not received salaries for several months and there are reports of strikes by front line medical staff to redress this situation. This is a serious issue negatively affecting the effectiveness of the cholera response and it needs to be urgently addressed. In addition, there is evidence that the MSPP struggles to carry out its work efficiently due to poor logistics and inefficient fleet maintenance. This seriously hinders the material distribution within the CTCs, Cholera Treatment Units (CTUs) and Acute Diarrhea Treatment Centers (ADTCs), and affects the appropriate collection of cadavers. Necessary arrangement should be made to correct the situation. Overall, the MSPP must once again reinforce its leadership and coordination roles at both central and departmental levels.

Donors must provide sustained and adequate funding to support a comprehensive and integrated approach to cholera prevention and care.

Although less severe than the cholera outbreak last year, the current situation on the ground is much worse than statistics portray. And yet, a shortage of funding has translated into fewer health partners and created serious gaps in coverage. From August, 2011 to May, 2012, the number of Cholera Treatment Centers (CTCs) has declined from 38 to 20, and the number of Cholera Treatment Units from 205 to 74.
In their latest humanitarian bulletin, the UN Office for the Coordination of Humanitarian Affairs (OCHA) noted that, “national capacity to respond to potential outbreaks, especially during the rainy season, remains very weak. The country has only 468 beds for cholera admissions, with 233 of these already occupied. At the height of the epidemic in June 2011, 2500 beds were available.” Despite this, OCHA notes that “significant progress has been made especially in the surveillance and reporting of the epidemic as well as in the integration of cholera care in the national healthcare system.” 

Despite OCHA’s positive assessment of strengthening the national health care system, as CCO Haiti pointed out, MSPP is still facing serious issues in their response to cholera. One reason why the Haitian government has had a hard time leading the response is that the international community largely bypassed the government in their provision of funding for cholera. The government of Haiti received only $4.9 million in funds for the cholera response, while the Red Cross alone received $6.1 million. While CCO Haiti calls for increased funding from donors, it is imperative that this money not simply be channeled to international NGOs, but through the MSPP. As the UN Special Envoy has noted, “aid is most effective at strengthening public institutions when it is channelled through them.”
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Several Adults Killed in Forced Eviction, With Little Notice by International Media Print
Tuesday, 07 August 2012 16:53

The killing of four adults, and – according to some reports – disappearance of four children in a violent forced eviction on July 23rd has gone all but unnoticed by the major English language media, but some details have emerged through Haitian and some independent English language press. Haïti Liberté has a detailed report in English of the incident at Parc La Visite in Seguin, Marigot, on the southern coast. Haïti Liberté and other outlets’ reports are based in large part on the work of Haitian journalist Claudy Belizaire of the Reference Institute for Journalism and Communication (RIJC), who also took graphic photos of the killing’s aftermath. 

Haïti Liberté reported that the four were killed when 36 “Haitian police [officers] …destroyed seven homes in an attempt to clear peasants from a remote mountain-top park where they have lived and farmed for the past 70 years,” noting that “The bloody confrontation …occurred exactly 25 years to the day after an infamous 1987 peasant massacre near the northwestern town of Jean-Rabel…”

The RIJC reported the four confirmed dead to be “Desire Enoz - 32 years; Nicolas David - 28 years, Robinson Volcin - 22 years and Desire Aleis - 18 years.”

Belizaire, as translated by Haïti Liberté, wrote that three days later, “since this serious incident, no state official has come to Seguin, where barricades have been erected by the people, in protest. The only item known about this negotiation was an envelope of 50,000 gourdes [about $ 1,250] promised to each family (50% before departure, 50% after).”

The $600 before, $600 after moving payments are reminiscent of Martelly's much-criticized cash incentive plan to get people to relocate.  Bureau des Avocats Internationaux (BAI) attorney Mario Joseph describes the government’s strategy in a new letter [PDF] of complaint to the Inter-American Commission on Human Rights (IACHR):

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A Closer Look at USAID Food Aid Programs in Haiti Print
Friday, 27 July 2012 12:47

A review of publicly available reports and recently released documents obtained via an Associated Press (AP) Freedom of Information Act request reveal that the U.S. Agency for International Development (USAID) has spent over $200 million on Title II food aid in Haiti since the earthquake. Title II food aid, administered by USAID and implemented by NGOs and intergovernmental organizations (primarily the World Food Program - WFP), is “the main avenue for U.S. food assistance.” As can be seen in Figure 1, in fiscal years 2010 and 2011, USAID obligated over $200 million and distributed over 174,000 metric tons of food aid in Haiti. Although most of this came in the form of emergency food aid following the earthquake, food distributions have continued in 2011 as well.

Figure 1.

alt
Source: USAID, Author’s Calculations

The Numbers


According to a report prepared for USAID’s Office of Food for Peace, in fiscal year 2010, USAID Title II food aid totaled 153,000 metric tons (MT), of which over 115,000 came in the form of emergency food aid. In 2011, these totals decreased drastically to 21,430 MT, of which 5,950 MT was emergency aid. According to the report, emergency food aid was distributed through two avenues: Single-Year Assistance Programs and the World Food Program. Based on documents obtained by the AP, USAID obligated over $21 million to World Vision, Catholic Relief Services (CRS) and Agricultural Cooperative Development International and Volunteers in Overseas Cooperative Assistance (ACDI/VOCA) for program costs associated with these emergency distributions. Additionally, USAID, which covers the cost of commodities and shipping, valued these services at over $100 million.

Non-emergency food aid takes the form of food distribution, but also often incorporates agricultural productivity, natural resource management as well as other issues related to food security. The majority of non-emergency food aid, which totaled over 50,000 MT in FY 2010 and 2011, came through Multi-Year Assistance Programs implemented by the same partners as the above-mentioned emergency, single-year programs: ACDI/VOCA, World Vision and CRS. These three programs all began prior to the earthquake and are ongoing until at least September 2012. A recent audit conducted by the USAID Inspector General (IG) reveals that, since the programs began in 2008, these partners have spent $46 million dollars in program costs. According to the AP documents most of this came after the earthquake. Together, the three organizations distributed nearly $70 million in commodities.

The Inspector General, in its audit of these multi-year programs, noted that “assistance generally has improved conditions for targeted beneficiaries…However, we could not determine whether the effects will last well into the future.” Nevertheless, the IG found a number of problems in the management of these programs, including overlapping with other USAID projects; lack of data management; the use of duplicative, excessive and uncoordinated indicators; uneven and poorly tracked integration of key activities; and other problems.

Overall, the documents obtained by the Associated Press show that World Vision, ACDI/VOCA and CRS have received $57 million since the earthquake from USAID for program costs related to Title II food aid, as can be seen in Figure 2. As will be discussed in more detail later, while this data shows program costs, the provision of the actual commodities for distribution and the shipping of those commodities are paid for directly by USAID, and so do not show up in Figure 2.

Figure 2.

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Source: USAID, Associated Press

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