16133: Slavin: Dr. Paul Farmer writes in Le Monde Diplomatique (fwd)

[Bob Corbett <corbetre@webster.edu>]

From: PSlavin@unicefusa.org

http://MondeDiplo.com/2003/07/11farmer>

July 2003

DRUGS SHOULD BE A COMMON GOOD

Haiti: short and bitter lives

------------------------------------------------------------------------
When the International Development Bank's representative visited one of the
few clinics in Haiti, he was told that the staff called the victims of
typhoid 'IDB kids': because, for as long as the IDB withholds loans to
supply clean water, many Haitians will die prematurely from disease.
By PAUL FARMER

HAITI'S dictator François Duvalier (Papa Doc) was succeeded by his son,
Jean-Claude (Baby Doc) in April 1971. Their regime was accurately described
as a kleptocracy, and their strategy of "distributing" foreign aid, mostly
from the United States, was theft (1). After their 29-year rule, Haiti was
governed by a military administration that soon became a dictatorship.
During this time foreign aid flowed in, although only a trickle ever
reached its intended destination.

In 1990 democratic elections brought a Catholic priest to power, Father
Jean-Bertrand Aristide, head of the Fanmi Lavalas (Lavalas Family)
movement. He was inspired by liberation theology and his election brought
hope to those fighting to improve health conditions in Haiti. But in 1991 a
military coup abruptly dashed these hopes. In the central region, where we
run a community clinic, economic and social conditions quickly worsened.
Yet the number of people seeking treatment at our clinic dropped. We were
threatened and our clinic was targeted for repression (2).

The coup's immediate impact was severe, with thousands killed and hundreds
of thousands displaced. The next three years were catastrophic for
healthcare. There were outbreaks of measles and other diseases for which
vaccines are available; there were also epidemics of dengue fever.

Haiti's infant, juvenile and maternal mortality rates are the highest in
the northern hemisphere. HIV/Aids and tuberculosis are now the leading
causes of death among young adults (with rapes committed by military
personnel and their "attachés" worsening the Aids situation). These
infectious diseases are linked to, or worsened by, malnutrition. During the
years of the military coup, 1991-94, the nationwide network of clinics and
public hospitals fell into disrepair, and most healthcare professionals
fled the country.

The situation began to change when, with UN Security Council resolution 940
providing cover, US troops landed in Haiti in September 1994, toppling the
military regime. On 15 October Aristide became president, though the
country he inherited was described as a field of ruins. A broad
international coalition announced plans for $500m in foreign aid. All
observers agreed that rebuilding the health and social services
infrastructure would be impossible without massive injections of capital.
The Inter-American Development Bank (IDB) and financing bodies approved and
launched projects to revamp the education, health and transport systems
(many roads had been destroyed).

But for reasons connected with Haiti's polit ical crisis, none of which
corresponded to vital interests in the northern hemisphere, this aid never
materialised (3). Help for Haiti's poor, which should have flowed into the
public sector, was distributed by governmental agencies. Even these
revenues have dropped significantly. Last year infectious diseases were
ravaging the country, morale among healthcare workers was low and Haiti was
the only nation in the northern hemisphere where life expectancy was below
50.

With 100 beds and 12 Haitian doctors, Zanmi Lasanté is one of Haiti's
largest private not-for-profit clinics. Yet we have received no significant
financial aid from the Haitian government, the IDB or even the US Agency
for International Development (Usaid). As neutral observers, we are also
direct victims of the collapsing public healthcare system. With more
clinics and hospitals closing their doors, the destitute are being turned
away. That is why they come to our clinic. In 2000 there were no doctors or
nurses to care for Thomonde's 40,000 residents.

After the disputed elections of 21 May 2000, the US, the European Union and
international financing organisations froze aid to Haiti (4). This embargo
has targeted the northern hemisphere's most vulnerable population, the
poorest people with the most fragile economy, ecology and society. The
impact has been profound, as an IDB report noted: its officials concluded
that "the major factor behind economic stagnation is the withholding of
both foreign grants and loans, associated with the international
community's response to the critical political impasse. These funds are
estimated at over $500m" (5).

If the IDB can conclude this, why is it among the institutions punishing
Haiti? US Congresswoman Barbara Lee said in spring 2002: "The US has used
its veto powers on the IDB's board of directors to stop all loans
designated to Haiti and has chilled funding opportunities at the other
financial institutions, pending a resolution of the political situation in
Haiti. This situation is unique because the loans in question have been
approved by the bank's board of executive directors, and the Haitian
government has ratified the debt and signed contractual documents. This
veto is particularly disturbing since the charter of the IDB specifically
states that the Bank shall not intervene in the politics of its member
states. The Bush administration has decided to leverage political change in
a member country by embargoing loans that the Bank has a contractual
obligation to disburse" (6).

Consider IDB loan no 1009/SF-HA: $22.5m was earmarked for the first phase
of a project to decentralise and rebuild Haiti's healthcare system. The
need for improvements was urgent since there are only 1.2 doctors, 1.3
nurses and 0.4 dentists for every 10,000 Haitians. Most of them are
concentrated in the city, whereas most Haitians live in rural regions such
as those we serve. And 40% of people have no access to any primary
healthcare, while HIV and tuberculosis rates are by far the highest in
Latin America.

The IDB project was supposed to target 80% of people, giving them access to
primary health care through the construction of low-cost clinics and local
health dispensaries. The funds would have been used to purchase equipment
and essential medicines. According to its own criteria, to be considered a
success the project would have to result in the infant mortality rate
dropping from 74 to 50 deaths per 1,000 live births; a drop in the juvenile
mortality rate from 131 to 110 deaths per 1,000 births; a fall in the birth
rate from 4.6 to 4.0; and a fall in the mortality rate attributable to the
lack of proper healthcare from 10.7 to 9.7 per 1,000. These goals were not
overly ambitious. Most people who evaluated the project found it feasible
and well designed. And the state of urgency was obvious.

Another blocked loan was supposed to improve access to drinking water. Even
people who are not healthcare professionals know that drinking contaminated
water is probably the leading killer of Haitian children; typhoid fever
also kills many adults and adolescents. Experts at the Centre for Ecology
and Hydrology, part of the United Kingdom-based Natural Environment
Research Council, developed a water poverty index, which they used to
evaluate 147 countries in 2002. Haiti came last. Whenever we treat new
patients with typhoid or other diseases linked to contaminated water, we
call them "IDB kids". Our staff was quick to point this out to the IDB's
local director, who visited the clinic last year.

Why is there a hold-up? For the IDB to disburse funds, the Haitian
parliament had to ratify the loan agreement. However, the office of prime
minister became vacant in June 1997. In October 1998 the health minister
presented the project to Haiti's obstructionist 46th legislature, which is
against the president. For weeks parliament failed to meet. When it finally
did, it could not get a quorum. The crisis continued when the Chamber of
Deputies was dissolved and the government proved unable to organise new
legislative elections. Initially set for September 1999, these finally
happened on 21 May 2000. But the results of these elections did not please
either the Haitian elite or its foreign supporters. Aristide's supporters
claimed victory, and Aristide won the presidential elections the following
November.

In October 2000 the more representative 47th legislature was sworn in. The
new parliament voted immediately to ratify the health project, along with
the three other vital IDB loan agreements. These funds, totalling $146m,
were earmarked for education, drinking water and road construction. On 8
January 2001 Haitians were told that the money was still en route,
according to an official decree in the governmental newspaper. Three months
later the IDB had still not disbursed the loan, although it an
nounced its intention to work with Aristide's new government and to finance
projects in the pipeline.

The IDB laid down conditions: one was that the Haitian government would
have to repay $5m in loan arrears. On 15 May, even though not a penny of
this or any other IDB loan had been disbursed, the IDB told Haitians that
their government would be required to pay a 0.5% "credit commission" on the
entire balance of undisbursed funds, effective 12 months after the date the
loans were approved. As of 31 March 2001, Haiti owed the IDB $185,239.75 in
"commission fees" for loans it never received. Fees relating to five IDB
loans taken out in previous decades totalled $2,311,422. The IDB told the
government that repayment would begin on 15 September, with the balance due
on 5 October 2001. In mid-May, amid rumours that it was about to close its
offices in Haiti, the IDB announced that its representatives and top staff
had been recalled to Washington for consultations.

According to the Associated Press, these consultations were not heartening.
The chief IDB officer in Haiti called for the repayment of "$20m in loan
arrears and reform [of governmental] economic practices" before Haiti could
be granted access to the pre-approved loan. Many of the outstanding loans
had been made to dictatorships and military juntas. Even if the education
loan went through, the IDB officer acknowledged that "if other loans are
not added, Haiti will probably be paying back more than it is getting" (7).


This is not the first time Haiti was obliged to repay more than it
received. In 1825 France's King Charles X ordered former French slaves to
pay 150m francs before France would grant diplomatic recognition to Haiti,
Latin America's oldest republic. A French diplomat recently told me,
without irony, that during François Mitterrand's presidency, "Haiti still
owed us part of that debt".

Analysing loans in such detail may seem nitpicking. But the loan embargo
has dealt poor Haitians a serious blow. The public infrastructure has been
ruined and there is no money left for drinking water or primary education.
The international aid embargo has affected the whole population. As
Haitians are fond of saying, you can't get blood from a stone.
------------------------------------------------------------------------

* Paul Farmer is a doctor and author of Pathologies of Power: Health, Human
Rights and the New War on the Poor (University of California Press, 2003)
and AIDS and Accusation: Haiti and the Geography of Blame (University of
California Press, 1992)

Read also : Deprivation is also a symptom and Unhealthy profits

(1) Hancock Graham, Lords of Poverty: The Power, Prestige and Corruption of
the International Aid Business, Atlantic Monthly Press, New York, 1989.

(2) See Paul Farmer, The Uses of Haiti, Common Courage Press, Monroe, ME,
1994 (new edition forthcoming).

(3) René Préval, the prime minister in the previous administration and a
supporter of the Lavalas movement, was sworn in as president on 7 February
1996, replacing Aristide, who was constitutionally prevented from serving a
second consecutive term. The Lavalas movement was subsequently rocked by
serious infighting, seriously weakening Préval's government.

(4) These elections aimed to re-elect parliamentary deputies and senators.
Although they did not invalidate the results, observers from the
Organisation of American States did challenge the methodology used to
determine the vote percentages.

(5) Roberto Machado and D Robert, "Haïti: situation économique et
perspectives", Inter-American Development Bank, economic evaluation of the
country, 2001.

(6) Report by Congresswoman Barbara Lee, 23 May 2002. See also
Congressional Resolution 382: "Urging the President to end any embargo
against Haiti and to no longer require, as a condition of providing
humanitarian and development assistance to Haiti, the resolution of the
political impasse in Haiti, and for other purposes", 107th Congress, 2nd
session, 2002.

(7) Michael Norton, "Haiti Clamors for Release of Blocked Loans That Might
Take Years to Disburse", Associated Press, New York, 11 March 2002.

Original text in English

ALL RIGHTS RESERVED © 1997-2003 Le Monde diplomatique

UNICEF in Iraq: Operation Child Survive
http://www.unicefusa.org/emergencies/iraq/index.html