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Haiti: Relief and Reconstruction

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Paul Farmer's "Haiti After the Earthquake" - An Impressive Balancing Act Print
Friday, 22 July 2011 15:35

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).

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"Brazil, MINUSTAH, Need a Timetable for Withdrawal" - Mark Weisbrot in Folha de Sao Paulo Print
Thursday, 21 July 2011 14:10

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 well-documented.

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France Increases Local Rice Procurement for Food Aid; Will the US Follow Suit? Print
Monday, 18 July 2011 10:32

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.”

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Cholera Treatment Funding Lags Far Behind New Infections Print
Tuesday, 12 July 2011 12:04

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.

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Dominican Republic Intensifies Targeting of Haitians Print
Monday, 11 July 2011 13:29

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.

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Martelly's Wild Gousse Chase Print
Thursday, 07 July 2011 10:34

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.

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MINUSTAH Brought Cholera Into Haiti; Sought to Keep Aristide Out Print
Friday, 01 July 2011 11:18

Revelations about MINUSTAH are in the news again. First, a new study published in a U.S. Centers for Disease Control and Prevention (CDC) journal affirms that a MINUSTAH camp was the origin of the cholera outbreak which has killed over 5,500 people so far.

As AP reports:

"Our findings strongly suggest that contamination of the Artibonite (river) and 1 of its tributaries downstream from a military camp triggered the epidemic," said the report in the July issue of Emerging Infectious Diseases, a journal of the U.S. Centers for Disease Control and Prevention.

The article says there is "an exact correlation" in time and place between the arrival of a Nepalese battalion from an area of its South Asian homeland that was experiencing a cholera outbreak and the appearance of the first cases in the Meille river a few days later.

The remoteness of the Meille river in central Haiti and the absence of other factors make it unlikely that the cholera strain could have come to Haiti in any other way, the report says.

As we described in detail when suspicions first arose that Nepalese blue helmets had brought the cholera strain to Haiti, MINUSTAH rejected the claims and showed little interest in uncovering the truth about the cause of the epidemic. Cholera, meanwhile, continues to spread, recently increasing with the heavy rains:

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Donor Aid Disbursements Increase 0.6 Percentage Points in 2.5 Months Print
Thursday, 23 June 2011 15:31

The UN Special Envoy for Haiti has released updated numbers on international aid pledges from last March’s donor conference, showing just a minor increase since the last update in early April. Although many donors claimed they were waiting for the new government to take power before releasing aid disbursements, the recent analysis shows that so far at least, little new aid money has been forthcoming from Haiti’s largest donors. In a statement released today, the Special Envoy reported that 37.8 percent ($1.74 billion) of the $4.6 billion in aid pledges had been disbursed through June, up from just 37.2 percent ($1.71 billion) through March. The United States has disbursed just $120 million of the over $900 million appropriated for Haiti, a disbursement rate of just 13.7 percent. This is lower than what had previously been reported.

In an accompanying report, looking at aid to Haiti both before and after the earthquake, Dr. Paul Farmer writes:

After the earthquake, the international community pledged significant financial resources for both the relief and recovery efforts. Yet many of us have been frustrated with the transition between the two phases. Over the past year, donors have disbursed over $1.74 billion for recovery activities, but over half—$2.84 billion—of what was pledged for 2010 and 2011 remains in donors’ hands.

And yet disbursing funds is only part of the aid picture. We know from our shared experiences in Haiti and elsewhere that the way aid is channelled matters a great deal, and determines its impact on the lives of the Haitian people. For example, with over 99 percent of relief funding circumventing Haitian public institutions, the already challenging task of moving from relief to recovery—which requires government leadership, above all—becomes almost impossible.

We have heard from the Haitian people time and again that creating jobs and supporting the government to ensure access to basic services are essential to restoring dignity. And we have learned that in order to make progress in these two areas we need to directly invest in Haitian people and their public and private institutions. The Haitian proverb sak vide pa kanpe—“an empty sack cannot stand”—applies here. To revitalize Haitian institutions, we must channel money through them.

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Wikileaked Cable Describes How State Department Influenced Aljazeera's Post-Quake Coverage of Relief Effort Print
Friday, 17 June 2011 16:40

As we’ve previously described, State Department cables Wikileaked last year revealed a State offensive against unfavorable media coverage of the U.S. role in the aid effort, with Hillary Clinton instructing all embassies to “push back” against “inaccurate and unfavorable international media coverage of America's role and intentions in Haiti.”

A newly released cable, made available through Wikileaks’ partnership with Haiti Liberté and The Nation, reveals in detail how such “push back” worked, in one case at least.

Diligently following up on Secretary Clinton’s instructions, the U.S. Embassy in Doha, Qatar noticed that “On Sunday, January 17, Al Jazeera's English (AJE) news channel, headquartered in Doha, began running inaccurate coverage of U.S. and international relief efforts in Haiti.” In response, the Embassy took actions resulting in a State Department spokesperson appearing on Aljazeera English in Washington “within hours”; called Aljazeera English Director Tony Burman ahead of another call by Judith A. McHale, Under Secretary of State for Public Diplomacy and Public Affairs, and made sure Burman  “understood the serious concerns that the Undersecretary would convey”; and, after said “flakking” took place, monitored Aljazeera coverage, which it noted with satisfaction became “less and less” “inaccurate and confrontational”, “evolv[ing] markedly” “with reporting focused on the work being done by U.S. military forces - particularly airdrops - and 50 orphans who had  been sent to the United States on an expedited basis.” The coverage now included more context, the Embassy noted, including regarding logistical obstacles to U.S. efforts at aid distribution.

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Heavy Rains Test Haiti’s Preparedness for Hurricane Season Print
Wednesday, 08 June 2011 14:41

Heavy rains dumped up to six inches of rain across Port-au-Prince and throughout much of Haiti Monday night. Continued rain is predicted through Thursday. The storms left 23 dead, injured many and left thousands more displaced. A damage assessment by the Département de la protection civile and the IOM found that 32 of 187 camps were flooded and that nearly 500 families were affected in Cite Soleil, one of the worst hit areas. Some camps were under up to four feet of water. The assessment also noted an increase in the number of cases of cholera, and that "latrines have been reported to overflow in some camps."

The deadly storm comes just a week into the Atlantic hurricane season and less than a week after the UN's Nigel Fisher proclaimed that Haiti was better prepared than last year. Following the storm, Jacqueline Charles of the Miami Herald spoke with Elise Young of ActionAid:

ActionAid called for better coordination between the U.S. Agency for International Development, the Haitian government and nongovernmental organizations to prevent further disaster this hurricane season. The new devastation, ActionAid said, highlights the need for newly elected President Michel Martelly to immediately implement a long-term housing strategy for Haitians, hundreds of thousands of whom remain under flimsy tents and tarps nearly 17 months after a catastrophic earthquake.

“Disaster mitigation must be prioritized not only in Port-au-Prince, but in vulnerable communities throughout the country that are at risk of severe flooding,’’ Elise Young, an analyst with ActionAid, told The Miami Herald.
This year, although the camp population may be lower than last year, hurricane preparedness is complicated by the high number of people living in damaged housing. Charles reports:
Mellicker said that reality makes “this year much more complex because of the migration patterns to unrepaired homes that are either red or yellow.’’ A home designated as red is one that should be demolished and the yellow label means in need of repair.

A controversial USAID-commissioned report said that 64 percent of red homes have been reoccupied in the Greater Port-au-Prince area.
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