14308: Lemieux: Boston Globe: Paul farmer and Mary Smith Fawzi (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: JD Lemieux <lxhaiti@yahoo.com>

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UNJUST EMBARGO DEEPENS HAITI'S HEALTH CRISIS
Boston Globe; Boston, Mass.; Dec 30, 2002; PAUL FARMER AND
MARY C. SMITH FAWZI;

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.

Full Text:
Copyright Boston Globe Newspaper Dec 30, 2002

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.

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.


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