14286: Minsky: Paul Farmer article: Unjust embargo deepens Haiti's health crisis (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: "tminsky@ix.netcom.com" <tminsky@ix.netcom.com>


Unjust embargo deepens Haiti's health crisis


By Paul Farmer and Mary C. Smith Fawzi, 12/30/2002

http://www.boston.com


IN HAITI'S central plateau, lack of resources and medical personnel
combined
with a growing burden of disease are responsible for increasingly desperate
social conditions. The causes of worsening conditions are many, but the
connection between unnecessary suffering and an aid embargo led by the
United
States is undeniable.


US-sponsored embargoes against Haiti have a long history. From 1804-62, the
United States, a major slave-owning economy, simply refused to recognize
the
existence of Haiti. According to a US senator from South Carolina speaking
on
the Senate floor in 1824, ''the peace and safety of a large portion of our
union forbids us even to discuss'' it. The United States occupied Haiti
militarily from 1915-34, and since that time has supported a number of
undemocratic governments. Under the Duvalier dictatorships, generous aid,
primarily from the United States, flowed steadily, as it did during the
military juntas later convicted of war crimes after the violent overthrow
of
Haiti's first democratically elected president, the Rev. Jean-Bertrand
Aristide.


During the early 1990s, the UN imposed a trade embargo in order to push
forward the restoration of Aristide. When in 1994 he returned to office and
a
devastated country, $500 million in development aid was promised by the
United States and multilateral organizations. This aid might have helped
resuscitate the hemisphere's poorest country, but it has been withheld.


The lack of development aid has been a burden, but even more troubling has
been the embargo on humanitarian assistance and loans. For example, loans
totaling $146 million (for health sector improvement, education reform,
potable water enhancement, and road rehabilitation) already approved
through
the Inter-American Development Bank have been blocked by the United States
in
response to alleged irregularities during May 2000 legislative elections.


After the presidential election of November 2000 (widely recognized as free
and fair), the funds were to be released, but the Bush administration used
its veto power to continue to block release of funds on the grounds that
Haiti has not demonstrated an adequate commitment to governing the country
in
a democratic manner - objections not heard during the long years of
dictatorship.


This policy persists despite a September resolution by the Organization of
American States stating that the Haitian government has taken the
appropriate
steps to foster democracy and that normal relations with international
financial institutions should be reinstated.


Putting legal arguments aside for the moment, what are the health
implications of withholding $500 million in development assistance and
blocking $146 million in loans to improve health, education, and water
quality?


During the past two years, at our 80-bed hospital in rural Haiti, we have
seen demonstrable declines in the public health infrastructure and the
health
status of the populations surrounding our clinic. With a staff of 10
Haitian
physicians and a large corps of community health workers, our organization,
Zanmi Lasante, runs one of the largest charity hospitals in Haiti. Our
support comes largely from private donors and foundations, and we see
ourselves as disinterested observers of the events above given that we have
never received significant government assistance or funding from the
Inter-American Development Bank or the US government.


Over the past year, our general ambulatory clinic has seen an enormous
increase in demand. We are staffed to receive no more than 25,000 visits
per
year, but will this year see an estimated 160,000 patients.


Meanwhile, neighboring clinics and hospitals have seen a decrease in
patient
load. While several neighboring facilities remain open, they sell or
prescribe medications at prices that are beyond the reach of the
population,
over 80 percent of which live in poverty. We have noted a spike in trauma
cases due in large part to road accidents (there is no money to maintain
the
rural road network). Malaria remains a major contributor to anemia and
death,
exacerbated by lack of access to care. Polio, previously believed
eradicated
from the Western hemisphere, has again resurfaced on the island. Other
infectious disease outbreaks - anthrax, meningitis, and drug-resistant
tuberculosis - have also occurred. The degree to which these pathogens
spread
will be determined largely by the capacity of the public-health system to
respond.


The story is no different beyond our hospital's expanding catchment area.
For
example, there has been a significant decrease in Haitians' access to
potable
water, particularly in Port-au-Prince ($54 million of the $146 million that
has been blocked was intended for improving water treatment). This
situation
recalls the years of military rule in the early 1990s, when the population
with access to potable water in Port-au-Prince declined from 53 percent
(1990) to 35 percent (1994). It should come as no surprise that during the
past several years, Haiti's life expectancy has continued to decline.


Can this decline in life expectancy be attributed directly to the embargo?
This question is difficult to answer, but it is clear enough that our
affluent and powerful country is failing once more to help the Haitian
people
achieve decent conditions for themselves and their families. It is also
clear
that aggressive humanitarian aid could have an immediate and salutary
impact
if it can be channeled through institutions with national reach.


Increasingly, however, aid has been decreased or funneled to nongovernment
organizations that, like our own, are often limited to serving local
populations of no more than some tens of thousands of people. UN agencies
and
other multilateral organizations need to play a critical role in providing
humanitarian assistance to vulnerable populations in Haiti to mitigate the
effects of the aid embargo currently imposed by the United States.


In the 19 years that Zanmi Lasante has been working in Haiti, we have seen
US
aid flow smoothly and generously during the years of Duvalier dictatorship
and the military juntas that followed. The current embargo has been
enforced
during the tenure of a democratically elected government, a situation
inconsistent, in our view, with the articulated US policy and the views of
the American people, and is on the face of it immoral.


Such policies are both unjust and a cause of great harm to the Haitian
population, particularly to those living in poverty.


----------------------
Dr. Paul Farmer is medical director of Zanmi Lasante and a professor at
Harvard Medical School. Mary C. Smith Fawzi

is an epidemiologist Zanmi Lasante and an instructor at Harvard Medical
School.


http://www.boston.com/dailyglobe2/364/oped/Unjust_embargo_deepens_Haiti_s_he
al

th_crisis+.shtml

This story ran on page A15 of the Boston Globe on 12/30/2002.

© Copyright 2002 Globe Newspaper Company.

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