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How Human Rights Can Build Haiti
Activists, Lawyers, and the Grassroots Campaign
By Fran Quigley
Vanderbilt University Press Copyright © 2014 Vanderbilt University Press
All rights reserved.
Kolera and the United Nations
Heading northeast by car from the center of Port-au-Prince, it takes more than an hour to escape the capital's sweaty, traffic-choked streets. I am traveling with a BAI lawyer and an interpreter. We pass piles of smoldering, rotting garbage flanked by vendors selling toilet paper, cooked meals, and secondhand clothes. The vendors have set up in front of concrete buildings whose walls are painted with colorful advertisements for lottery tickets, cell phones, and private elementary schools. Small motorcycles cut in and out of traffic. In front of us, an ancient truck belches clouds of blue-gray exhaust while a half-dozen young men cling to its rear door. Women balancing impossible loads of bottles and food on their heads step around the gray water flowing through the gutter. Checkpoint police carry automatic rifles and wear bulletproof vests under their beige uniforms.
It is a relief when we finally turn left, away from the chaotic main streets outside Croix-des-Bouquets, and are suddenly in the countryside on our way to Mirebalais. We pass a vast brown field that has been cleared for post-earthquake housing, though there are still no signs of actual buildings. Then our car begins climbing Mon Kabrit—Goat Mountain.
Our destination is the village of Rivye Kano, where we plan to see several BAI clients. We soon make another turn and are now off the paved road. Our car lurches up and down a pitted dirt and rock path. Sugar cane lines the left side of our route; corn is planted on the right. We pass skinny goats, children in sun-yellow school uniforms, and a younger boy jumping rope. The rope jumper is wearing a blue-and-white checkered shirt and no pants. Harvested corn hangs in enormous bunches from the trees, up high enough so that the rats can't get to it at night. We steer to the right to give room to an older woman riding a donkey. We pass a young man, casually swinging a machete as he walks. Our car fords a stream where another young man, his clothes piled on the bank, fully immerses himself, holding a bar of soap.
The village center of Rivye Kano turns out to be a crossroads where we are directed to pull off and park between a mango tree and a banana tree. The initial greeting party of a half-dozen people quickly swells to fifty or more. Two young men—one wearing a green and white shirt with the printed message "You looked better on MySpace"—each bring out two wooden chairs and place them in the shade of the mango tree. The lawyer, the interpreter, and I are directed to sit in three of the chairs, with the fourth chair facing us. Everyone else stands silently. Then, one at a time, the people of Rivye Kano sit down and tell us about the horror that descended on their community in the fall of 2010.
Andre Paul Joseph goes first. He describes how, in the middle of the night, he was suddenly seized by violent diarrhea followed by vomiting. Then Semans Pierre shares a similar story. One after another the residents of Rivye Kano come forward, and we hear about desperate family members rushing fathers and mothers and children down the mountain to the closest hospital. There, they found a panicky staff already tending to dozens of others in similar distress. It was a massive outbreak of cholera.
The World Health Organization labels cholera "an easily treatable disease." The main remedy is rehydration, often with oral salt solutions and sometimes with intravenous fluids and a course of antibiotics. But treatment works only if it is provided soon after infection, and many here in Rivye Kano did not reach care in time. Saint Claire Vincent watched her mother die at the hospital in Mirebalais. Her body was quickly placed in a bag and taken away to be thrown into a pit with other kolera victims. Maudena Zalys and her brother survived cholera infection, but their father did not. "I can't explain the feeling I got when they announced he had died," she tells us. Cholera is not gone from Rivye Kano or the rest of Haiti. The community leader scheduled to welcome us at this meeting had to send his regrets. He was burying his father today, another victim of cholera.
In both its origins and its effects, cholera is a decidedly foul disease. The process starts when feces-contaminated water carries the bacterium Vibrio cholera. The resulting infection causes acute watery diarrhea in the afflicted, thereby spreading its pathogen with ruthless, disgusting proficiency. Left untreated, the diarrhea caused by cholera quickly drains the body and can cause death within hours. Extremely virulent, and with a short incubation period of two hours to five days, cholera moves quickly. In scholarly articles and white papers describing the course of cholera in Haiti, academic and scientific terminology invariably gives way to the adjective "explosive." The term is used to describe both the disease outbreak and the debilitating diarrhea suffered by its victims.
Before mid-October 2010, hospital admission records along the valley of the Artibonite River, Haiti's longest river, show a pattern of only occasional treatment of a patient for diarrhea, and those treated were mostly children. Then, on October 18, an agricultural worker fell ill with diarrhea and was dead on arrival at Albert Schweitzer Hospital in Deschapelle. The same night, an adult died of acute diarrhea in Mirebalais Hospital. St. Nicholas Hospital in St. Marc went from zero cases of diarrhea on October 18 to eighteen cases on October 19. The hospital then saw 404 cases on the 20th, with 44 deaths. One witness described the facility as a "horror scene": "I had to fight my way through the gate as a huge crowd of worried relatives stood outside, while others screamed for access as they carried dying relatives into the compound. The courtyard was lined with patients hooked up to intravenous (IV) drips. It had just rained and there were people lying on the ground on soggy sheets, half-soaked with feces."
As one physician put it later, cholera had hit central Haiti "like a bomb." Within the span of a few days, cholera went from a disease that had been off Haiti's radar screen for generations to an infection that killed two thousand people in a month. Hospitals unprepared for the onslaught did not have adequate supplies of rehydration salts and were without "cholera cots"—beds with holes in the middle to allow the volumes of diarrhea to exit from patients unable to control their bowels. Instead, patients defecated in the beds or on the way to toilets, and the floors were often covered in human waste. By October 2013, cholera had killed over 8,600 Haitians and infected over 684,000, a figure that represents nearly one in every fifteen people in the country. To put that into context, that same rate of nearly 7 percent infection in the United States would cause twenty-two million people to be sickened, more than the population of the New York metropolitan area.
Paul Farmer, the physician founder of Haiti-based Partners In Health, describes the country's heightened vulnerability to catastrophe with the medical term "acute on chronic." Farmer refers to the ongoing ("chronic") poverty and infrastructure deficiencies that leave Haitians vulnerable to devastation when struck by sudden ("acute") phenomena like earthquakes, hurricanes, and, in this case, an infectious disease outbreak. A waterborne disease like cholera could hardly have found a more welcoming community than Haiti, where river water is used for bathing, drinking, and washing, and sewage and wastewater treatment facilities simply do not exist. "The Artibonite is not only Haiti's largest river, it is the country's breadbasket, where most people are living off the land farming," said Cate Oswald, Haiti country director for Partners In Health. "They are not just drinking the water, they are using it for their crops, they are bathing in it. And so it is this vicious cycle."
Haiti is home to so many charitable non-governmental organizations that Haitians sometimes wryly refer to their country as the "Republic of NGOs." But it takes government-scale efforts to cover the breadth of systemic water, health, and sanitation reform. It's not as if the government of Haiti hasn't tried: in 2001, Haiti secured a commitment for $146 million in loans for water and sanitation infrastructure from the Inter-American Development Bank (IDB). But the George W. Bush administration expressed its displeasure at the left-leaning policies of Haiti's then-president, Jean-Bertrand Aristide, by blocking the loans. All told, the political maneuvering cost Haiti access to $500 million in loans, and the European Union withheld aid as well, choking off the Aristide government's ability to provide services and stunting the water and sanitation improvement plans. The consensus among public health experts is that, now that cholera has reared its ugly head in Haiti, it is destined to become endemic there.
* * *
To the casual observer of this troubled country, an infectious disease outbreak was sad but unsurprising news. Haiti certainly has endured more than its share of public health crises in the past century, from the HIV pandemic that hit Haiti hard in the 1980s to the massive 7.0 earthquake that rocked Port-au-Prince in January 2010. But cholera was not among Haiti's many problems. The country had not reported a single instance of cholera in over a century. What triggered this sudden, deadly onset?
It was not hard to track the path of the infections. The first hospitalized cholera patients lived in Meille (also spelled Meye), a small village near the Rivye Kano community and a few kilometers south of Mirebalais. The villagers consumed water from the Meille Tributary, which flows into the Artibonite. The cholera outbreak then traveled down the Lower Artibonite and spread out into the valley surrounding it. Just a few hundred meters upstream from the homes of those first sickened in Meille sits a UN camp that houses troops serving as part of the UN mission in Haiti, known by its French acronym, MINUSTAH.
Within hours of the outbreak, accusations were directed toward the UN camp. The mayor of Mirebalais, Lochard Laguerre, said that, even before the outbreak, he had complained to the camp commander about the dumping of sewage near the river. Days after cholera-stricken Haitians began flooding into hospitals, Associated Press reporter Jonathan Katz visited the UN camp and observed an overflowing sewage tank, a smell "like a toilet had exploded," and dark, foul-smelling liquid pouring out of a broken pipe toward the river. Katz also saw uncovered waste pits of feces sitting uphill from the river and observed waste from the UN base being transported to the pits by a private contractor. A reporter from Al Jazeera News observed the same fetid scenario that Katz did. Area residents said that, during rainfall, the sewage pits routinely overflowed into the Artibonite tributary below. "Frankly, the place was a sanitation clusterfuck," Katz wrote in a blog later. "The cholera could have come from anywhere there."
Although MINUSTAH had issued a statement the previous day saying there was no reason for concern, Katz saw UN military police at the base testing for cholera. The camp was populated with troops from Nepal, and new contingents of peacekeepers had arrived from Nepal at the Mirebalais camp in three groups between October 9 and October 16. The troops had come from the Katmandu valley, which in the previous two months had reported a surge in cholera.
The UN presence in Haiti is both enduring and vast. MINUSTAH was created by the UN Security Council in April 2004. As of late 2013, over eight thousand uniformed UN personnel were in Haiti. The fiscal year 2014 budget for the mission was nearly $577 million. The UN's global peacekeeping operations received the Nobel Peace Prize in 1988, but its Haitian activities have been mired in a steady flow of controversy. MINUSTAH's 2004 arrival in Haiti came on the heels of the forced exit of President Aristide, still a cause of resentment among the many Haitians who saw the event as a US-supported coup d'état. After arrival, MINUSTAH provided little or no protection to the civilians targeted by the coup government, as evidenced by one Doctors Without Borders hospital alone reporting the treatment of over 2,500 victims of Port-au-Prince gun violence in just sixteen months over 2005 and early 2006.
In fact, MINUSTAH troops were implicated as facilitators to several incidents of political violence. (See the discussion of the Jimmy Charles murder in Chapter 3.) In July 2005, MINUSTAH launched a raid in the poverty-stricken Port-au-Prince community of Cité Soleil, an operation that MINUSTAH claimed targeted armed gangs but critics say actually targeted political opponents of the ruling government. MINUSTAH troops shot over twenty thousand bullets and killed at least five civilians in that raid, while suffering no troop casualties.
Beyond incidents of political violence connected to MINUSTAH, the troops have been implicated in multiple allegations of sexual assault against Haitians. Sexual misconduct with underage girls caused more than one hundred Sri Lankan troops to be sent home in December 2007. In the summer of 2011, a cell phone video was circulated that appeared to show Uruguayan MINUSTAH troops raping an eighteen-year-old Haitian youth. Uruguayan MINUSTAH troops in Port-Salut were also accused of trading their food rations for sexual favors from Haitians. In March 2012, two Pakistani peacekeepers with MINUSTAH were convicted by a Pakistani military court of raping a fourteen-year-old Haitian boy, and sentenced to one year in prison.
Even beyond the sexual scandals and incidents of violence, it is galling to many Haitians that the international community has devoted as much as $800 million per year to a UN presence marked by soldiers with seemingly little to do. The ubiquitous phrase heard in Haiti is "MINUSTAH se an vakans"—MINUSTAH is on vacation. With so many unmet needs in their country, most Haitians believe the UN could put its resources to better use. In an August 2011 survey of Port-au-Prince residents, less than a quarter of the respondents agreed with the statement "MINUSTAH's presence is a good thing." In his farewell address to the UN Security Council, then-president René Préval said that MINUSTAH's presence was no longer necessary. "Tanks, armed vehicles and soldiers should have given way to bulldozers, engineers, more police instructors and experts on reforming the judicial and prison systems," Préval said. His successor, Michel Martelly, echoed the sentiments in March 2013, asking the UN to divert some of its billions spent on security to development. "Real insecurity will prevail when you have people who are looking for jobs, people who are looking for food," Martelly said. "Contrary to what is being said Haiti is not insecure. We need to think more about sustainable development than security."
The international community outside Haiti feels differently about MINUSTAH's presence, but apparently the well-being of Haitians is not at the forefront of that analysis. Cables from then-US ambassador to Haiti Janet Sanderson obtained by WikiLeaks contained repeated references to how MINUSTAH's presence protects US interests and the interests of global capital, including a frank admission in a 2008 cable that "a premature departure of MINUSTAH would leave the [Haitian] government ... vulnerable to ... resurgent populist and anti-market economy political forces—reversing gains of the last two years."
Mark Weisbrot, the codirector of the Center for Economic and Policy Research, wrote a 2011 column for the UK's Guardian labeling the cell phone video of the rape by Uruguayan troops MINUSTAH's "Abu Ghraib moment." Weisbrot echoed Haitians who questioned the purpose of the ongoing UN presence, where troops have played virtually no role in protecting internally displaced persons from unlawful evictions from their camps and have not helped to deter the spike in post-earthquake rapes. In fact, a 2011 report by the HealthRoots student organization at the Harvard School of Public Health documented that most of the unrest the MINUSTAH troops have responded to within Haiti was triggered by acts attributed to the UN troops themselves. "There is no legitimate reason for a military mission of the United Nations in Haiti," Weisbrot wrote. "The country has no civil war, and is not the subject of a peace-keeping or post-conflict agreement. And the fact that UN troops are immune from prosecution or legal action in Haiti encourages abuses."
That immunity from prosecution is guaranteed in Haiti by the Status of Forces Agreement, executed between the UN and the post-Aristide government of Haiti when MINUSTAH was launched in 2004. Similar immunity guarantees are standard operating procedure for UN peacekeepers around the world, but they have fueled resentment and charges of hypocrisy. Allegations of sexual assaults involving UN troops have occurred across the globe, including in Cambodia, Bosnia, and the Democratic Republic of Congo. International human rights experts have long called for the UN to practice what it preaches in terms of accountability for rights abuses. They point out the irony of the world's leading proponent of the rule of law meticulously drafting and enforcing contracts that place it beyond the reach of legal sanctions. Marek Nowicki, the ombudsman for the UN's mission in Kosovo until 2006, called out the organization on this contrast between its rhetoric and its actions. "From a legal point of view Kosovo is the black hole of Europe or like a novel by Kafka. The UN arrives to defend human rights and at the same time deprives people of all legal means to claim these rights."
Excerpted from How Human Rights Can Build Haiti by Fran Quigley. Copyright © 2014 Vanderbilt University Press. Excerpted by permission of Vanderbilt University Press.
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