Haiti, the UN and cholera on election day

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My third day in Haiti, walking down Avenue John Brown in the center of Port-au-Prince I was confronted point blank with the desperation of the cholera situation.

On the side of the road, a shirtless man with brown pants and no shoes lay on the sidewalk outside a busy market entrance -- eyes open, with his arm in the gutter and flies buzzing around his face. He was dead. A couple photographers quickly snapped photos and jumped back into their vehicles as the ambulance crew arrived to pick up the body. He was another victim of an outbreak which will only kill the poor and the vulnerable -- which unfortunately makes Haiti a deadly conductor for the spread of the disease.

Despite denials by the United Nations and the Nepalese army, the cholera outbreak in Haiti has been traced to the Nepalese contingent of the United Nations Stabilization Mission in Haiti (MINUSTAH). The United States Centre for Disease Control and Prevention has officially confirmed that current strain of cholera spreading throughout the shattered nation matches an outbreak confirmed earlier this summer in Nepal.

The Swedish Ambassador to the Caribbean, Claes Hammar, stated ``unfortunately that is the case. It has proved that the cholera came from Nepal," and when pressed about the source of the information Hammar stated [2], "I consider my source to be a reliable one. It is a U.S. official, but I cannot say who." While the transmission of cholera was released through a disregard for proper sanitation at the United Nations camp in Mirebalais, it raises serious questions about the benefits -- or lack thereof -- that MINUSTAH has brought to the majority of the Haitian people as a "stabilizing force."

According to the MINUSTAH website, "MINUSTAH's original mandate was to restore a secure and stable environment, to promote the political process, to strengthen Haiti's government institutions and rule-of-law-structures, as well as to promote and to protect human rights." However, the protection of human rights and the promotion of democracy which MINUSTAH has promoted on paper has not translated into practice on the ground.

Since the 2004 coup of democratically elected President Jean-Bertrand Aristide and his Lavalas party, MINUSTAH and Haitian police have continually referred to Lavalas supporters as "bandits," which they have used to justify illegal arrests and extrajudicial killings. MINUSTAH has killed civilians in Port-Au-Prince's slums, specifically in the Lavalas strongholds of Bel Air and Cité Soleil, silencing the demands of self-determination and socio-economic justice of the people in these neighbourhoods. MINUSTAH's shoot-first tactics have been well documented, and Haiti scholar Peter Hallward has compiled a lengthy list of human rights abuses and outright massacres by MINUSTAH in his book Damming the Flood (pp. 275-310).

The recent protests are a clear signal of the discontent the Haitian populace have both against MINUSTAH and the lack of success in containing the disease. At the time of writing, the death toll has climbed to nearly 1,500 people [3] -- with the United Nations publishing grim estimates that the outbreak could kill as many as 10,000 people before the epidemic winds down [4].

Within Haiti, the camps themselves unfortunately hold the perfect conditions for the transmission of cholera. There is a dangerous lack of clean water, sanitation and access to basic health care. The overcrowded environments are teeming with people well aware of the disease and its origins, yet many of them report having no alternative than to drink water they know is contaminated. Thirty-nine per cent of respondents in a study conducted by the Institute for Justice and Democracy in Haiti (IJDH) in July highlighted this desperate and tragic fact.

On the ground in Haiti, in the internal displacement camps, it is amazing how much inhuman patience and resilience the Haitian people have displayed in dealing with all of the misfortune that 2010 has brought upon the island. The pre-existing poverty, combined with the earthquake, the lack of reconstruction, political uncertainty, hurricanes and the cholera outbreak has created a situation whereby the Haitian people have every right to voice and demonstrate their discontent. Despite this, the international media has negatively spun the cholera and anti-occupation protests as "politically motivated" -- as the ensuing violence was placed solely at the feet of subversive organizers and a few drunken thugs, not MINUSTAH.

MINUSTAH head, Edmond Mulet, has called for an end to the cholera protests, stating that [5]: "Every second that passes can save or break thousands of lives. If this situation continues, more and more patients in desperate need of care are likely to die and more and more Haitians awaiting access to preventive care may be overtaken by the epidemic." While the protests present an obstacle to accessing the sick, it also must be taken within the proper context.

A crucial story which has yet to surface in the mainstream press is the role that the international community has had in undermining the Haitian healthcare system. A very big reason as to why the cholera is able to spread with such little resistance is the patchwork healthcare system, mostly provided by NGOs. The Haitian healthcare system, while never considered a model worthy of emulation, was significantly undermined, and further weakened by the numerous rounds of structural adjustment and public spending cuts demanded by international donor nations and institutions such as the International Monetary Fund.

It must be recognized that the extreme vulnerability of Haiti to such a cholera outbreak is unmistakably man made. In 1998, the Inter-American Development Bank (IDB) approved a $54 million loan which would facilitate the improvement of clean water and sanitation services -- resulting in an estimated 90 per cent decline in water costs for the poor [6]. However, the Freedom of Information Act reveals that the United States blocked the loan as a way to undermine and suffocate the government of Aristide once more.

Another haunting example of such misguided collaboration can be seen through the closing of the medical school at the University of Tabarre in Port-au-Prince -- the first ever to provide free tuition. At the time of the school's opening on February 3rd 2004, Haiti had one of the worst doctor-to-patient ratios in the world [7] (one to 10,000 in urban areas and one to 20,000 in rural areas). Less than one month after its opening, the hospital and the university complex it was part of were closed down at gunpoint and occupied by U.S. Marines and the United Nations Stabilization Mission in Haiti (MINUSTAH). The 247 new medical students watched as their classrooms were turned into barracks, their instructors forced to flee from political persecution (due to threats on his life, Dr. Yves Polynice fled to Europe), and much of their material and equipment pillaged to service the capital's private medical clinics.

Perhaps the saddest thing about the cholera epidemic is the fact that it does not need to exist at all. To be blunt, poverty is at the root of cholera. Globally, cholera and other diarrhoeal-related diseases are the second leading cause of deaths in the developing world. The western world has not had an outbreak of cholera for over 100 years. Despite the extreme poverty and lack of access to clean water in Haiti, this was also the case -- until the arrival of the Nepalese troops.

The horrific irony of the cholera epidemic is the fact that the same international community which dismantled the Haitian healthcare system through structural adjustment, conditionalities and intervention is now in charge of fighting the epidemic within the dreadful confines it helped to create. Rather than complementing and supplementing an already existing public healthcare system, it decided to undermine and erode the existing structures to the point that some 80 per cent of the country's basic services provided by the private sector through non-governmental organizations [8]. The international community must also recognize their complicity in isolating and removing the only president who was committed to expanding access and availability of social services to the poor -- Jean-Bertrand Aristide (To see a recent interview with Aristide in rabble.ca, please click here [9]).

However, with the international support and funding for the elections (and their widespread irregularities) on Sunday, Nov. 28, it becomes increasingly clear that the international community and MINUSTAH does not care about the health or welfare of the Haitian population.

The current health crisis has blatantly underscored how aid to Haiti has not been given with the intention of making the island more self sufficient, but rather more dependent on the international community. It is a tragic situation all too familiar to Haiti, where the poorest and most vulnerable are subjected to the deadly repercussions of the actions of the wealthy and powerful. The poor are demonized for the suffering while those responsible are absolved of any responsibility. If the international is seriously committed to building back a better Haiti, it needs to look at the how their actions, and that of MINUSTAH has led to greater instability, insecurity and crisis -- and divert the costs of occupation (an estimated $600 million per year since 2004) towards the building of a public healthcare system which serves the people, not the powerful [10]. 

Kevin Edmonds is a freelance journalist and graduate student at McMaster University's Globalization Institute in Hamilton, Ontario.

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