FOREIGN POLICY NOVEMBER 8, 2010
In the immediate aftermath of the earthquake that leveled much of Port-au-Prince last January 12, there was a great deal of talk among the great and the good that this time it was going to be different. Not only would the Haitian capital be rebuilt and its 600,000 homeless housed once more, but at long last the major international donors would not leave once this (in reality, appalling) status quo ante had been restored. This time they would not withdraw until real progress had been made in bringing Haiti out of the crushing poverty that had been its burden since it wrested its independence from France in 1804.
At first, these promises came fast and furious. President Obama declared that Haiti would become a major priority for American policymakers and that, as he put it, not only would the United States help the Haitian people get back on their feet, but a new Haiti would be built out of the ruins of the old. Former president Bill Clinton, who had been appointed the U.N. special envoy for Haiti almost eight months before the earthquake, went further. "Everybody that has seriously followed Haiti for a long time,” he said, “believed Haiti had the best chance in our lifetime to break the chains of its past, to build a true and modern state," adding: "I won't feel successful if all we do is get it back to where they were the day before the earthquake came.” And Secretary of State Hillary Clinton, on a visit to Port-au-Prince shortly after the earthquake, seemed to be promising that even the post-earthquake reconstruction would be undertaken in the context of long-term development, saying that the goal should be "not just taking a building that's half-demolished and trying to patch it together, but thinking about what should this whole street look like, what should this neighborhood look like?”
The psalmist’s warning, “put not your trust in princes,” is always good advice (even in the case of a progressive prince whose rallying cry is the contentless slogan, “Yes, we can!”). And, in retrospect, to have believed any of this sanctimonious, self-congratulatory rubbish looks like just what it is: a particularly egregious example of the triumph of hope over experience. But in fairness, the promise of $5.3 billion in reconstruction and development aid from the major international actors made at a U.N.-sponsored donor conference last march, including $1.5 billion from the United States, at least gave those hopes a spar on which to alight.
Lots of luck. While the immediate relief efforts, like paying for supplies for the tent cities where hundreds of thousands of Haitians who lost their homes still live, have continued to be funded, and private relief agencies continue to operate at full tilt in Haiti, the international donors have done almost nothing to meet their pledges. Most of the promised U.S. rebuilding money for Haiti remains tied up in Congress, with the administration and the Republicans blaming each other for the delay. Globally, as of mid-July, only 2 percent of the monies promised had been handed over. Getting to 25 percent by the early part of 2011 would represent an enormous accomplishment, and of course realistically is almost certainly too ambitious a goal.
In the real world, where the poor might actually do better if the rich delivered more but promised less, there is little reason to see how it could be otherwise. For all the bluff talk at the time of the earthquake about the global significance of what had taken place, and the worldwide outpouring of sympathy that it engendered, Haiti soon went from being a lead story on the news to being a subject that, outside of Haiti itself and of the Haitian Diaspora, had become largely of concern to activists, aid workers, and officials of donor governments and of the United Nations. In this, the Port-au-Prince earthquake has followed the same trajectory as Cyclone Nargis in the spring of 2009, and the Asian tsunami of late-December, 2004. Elizabeth Kubler-Ross’s five stages of grief—denial, anger, bargaining, depression, and acceptance—is an extremely debatable generalization about how people deal with the imminent prospect of their own deaths. But a case can be made that huge natural disasters in the poor world, like the Port-au-Prince earthquake, do engender a fairly predictable staged progression of reactions in the rich world: shock, followed by intense interest and demands for action, followed by a calming down when politicians make a show of saying they will act, followed by the story being supplanted by other stories, followed by forgetfulness. Where disasters are concerned, the donor governments and their donating publics are like serial monogamists: they obsess, but sooner or later, they move on.
Of course, there are times when a new development in an “old” disaster event can indeed rekindle public concern. The most recent demonstration of this in Haiti was last month’s outbreak of cholera. After months of being virtually ignored in the media, Haiti once more became a leading news story. The situation was presented as extremely menacing. If the epidemic were to spread to the capital from the Central Plateau and from Artibonite in the east central part of the island where it had apparently originated, it threatened the lives of tens of thousands of people. What the degree of risk actually was is harder to gauge than these reports suggested. An out-of-control epidemic was certainly possible, but cholera is not a hard disease to treat and the relief agencies on the ground in the country have both the expertise and the access to the water-purification and patient rehydration supplies needed to do this effectively. It is too often forgotten that humanitarian agencies have a tendency to exaggerate. Some aid workers who have been in Haiti over the past year have suggested that the generally-accepted toll of 250,000 dead in Port-au-Prince last January is far too high.
But this tropism toward exaggeration of risk and institutional self-aggrandizement, while real enough, is by no means the grave moral failure that the cheaper critics of the relief world, like Linda Polman in her recent book, The Crisis Caravan, claim it to be. It is all very well to condemn boys who cry wolf, but what would happen if they did not invoke the direst outcomes? After all, while these threats are not nearly as likely as aid workers claim, they are rarely implausible. And it has been demonstrated time and time again that the interest of the donor public in the rich world usually is contingent on a great deal of publicity and the claim that the disaster is of epochal dimensions. In a world where almost every organization, no matter how high-minded, thinks in terms of branding and public relations, understatement is never viewed as a viable strategy. So we sell other people’s tragedies not so very differently from the way we sell soap, with no apparent practical disadvantage in doing so.
The moral costs are something else again. A relief system based on hype, which like any other form of branding depends on at least the illusion of novelty and constantly needs to be ratcheted up, is bound to engender short attention spans and shallow commitments. It is not that there is no constituency for either emergency relief or development. To the contrary, the success of faith-based relief NGOs in building such constituencies, and of secular NGOs, notably Doctors Without Borders, in creating similar ones, testifies to their breadth. But these constituencies are largely driven by what is featured in the media. While Haiti is on the front page, they are quick to mobilize. When it is no longer the focus, the constituency moves on—something that is easy to do, since there is at least one major crisis every year. Surveying the landscape, it is hard not to conclude that even sympathy needs novelty to sustain itself.
And if not novelty, then at least a cognitive template that can seemingly be applied to virtually anything. There is a saying that, to a hammer, everything looks like a nail. I am beginning to think that, to a human rights activist, every crisis must look like a human rights crisis. In a recent piece in Foreign Policy entitled "Why Democracies Do Not Get Cholera,” Joe Amon, the director of the health and human rights division at Human Rights Watch, looks at the cholera outbreak in Haiti through what he claims to be the prism of Amartya Sen’s celebrated insight that, in Amon’s somewhat simplistic summary, anyway, “famines do not occur in well-run, democratic countries.” It gets worse. “The same is almost always true for cholera epidemics,” Amon argues. And he goes on to expand on this highly questionable generalization, arguing that “disease and democracy often work in opposite directions: vulnerable populations and inadequate government action create both the conditions for cholera to emerge and to become unmanageable.”
Not being a fool himself, of course, Sen never made his argument in such a sweeping and reductive way, as Amon surely must know. Indeed, as India’s lack of success and China’s huge accomplishments illustrate, democracy is not even a guarantor of important decreases in the rate of chronic malnutrition (as opposed to the acute kind that occurs when people are starving), let alone of epidemics like cholera, which, in any case, is a particularly poor example of such an analysis, even within the framework of infectious disease. To put it starkly, unlike famine prevention and democracy, where there is indeed a strong link if not an inevitable one, as the Chinese dictatorship’s own success in eliminating famine once the Maoist madness had ended demonstrates, the correlation between cholera and democracy is tenuous at best.
It is indeed unquestionably true that the spread of cholera can be correlated with poverty, above all the lack of potable water and adequate sanitation that afflict the poor in countries like Haiti. But the link to democratic accountability is far more tenuous. China is by no means the only unaccountable tyranny in history to have substantially reduced its poverty rates or significantly improved the health status of its population. The case of the cholera pandemic that began in Peru in 1991 and in a relatively short time spread throughout Central and northern South America, from Mexico to Panama, and from Ecuador to the Chilean border, actually illustrates the tenuousness of such linkages.
Despite what Amon claims, there is actually far more evidence that cholera outbreaks can be correlated to rises in water temperature than to the lack of democratic accountability. Some species of plankton can serve as hosts for dormant cholera organisms, and, as a World Resources Institute paper on the subject puts it, “the organisms persist in coastal waters for long periods, and then “reappear” after years of seeming absence.” The report goes on to point out that this “cholera-plankton connection probably also offers the disease a means of long-distance travel, hitchhiking with the plankton on ocean currents across thousands of kilometers and over periods of months and years, and might explain how an Asian cholera strain could find its way to several points along the coast of South America without stowing away in ballast water.”
In the case of the recent outbreak in Haiti, David Sack of the Bloomberg School of Medicine at Johns Hopkins has speculated that a rise in the temperature and salinity of the river estuaries flowing into the Bay of St. Marc in the Artibonite contributed significantly to the outbreak in much the way that, previously, many scientists have linked the El Nino effect of increased water temperatures to the 1991 outbreak. This does not mean that combating poverty is not an essential element in controlling future cholera outbreaks. Amon is right about that. But as the Chinese example demonstrates (as that faux democracy, Singapore, did before it), it is not democracy or a regime’s accountability to its own people that is the essential variable here, but instead a strong state. Starkly put, it doesn’t matter all that much whether that state is democratic or authoritarian, so long as it is serious about committing the resources necessary to tackle poverty and ensure that there is clean water and adequate sanitation.
Amon is also quite correct to note that in 1991, many of the countries affected by the cholera pandemic were dictatorships, unaccountable to their populations. But it is pure human rights mysticism to argue that this is why the pandemic took hold. Amon takes no notice of the fact that the pandemic never reached Hispaniola (the island that comprises both Haiti and the Dominican Republic), nor of the even more significant datum that there had been no cholera in Haiti for at least half-a-century before the recent outbreak. And yet Haiti was hardly more democratic or accountable to its citizens under Duvalier than it was under the current government of Rene Preval. If anything, as Amon must know, the opposite was the case.
And yet he seriously maintains that, “Not long after Haiti's earthquake in January, public health officials warned that poor sanitation and lack of potable water were creating conditions ripe for an outbreak of infectious disease. They were right. In the last week, a cholera outbreak has swept this impoverished country, with more than 3,100 confirmed cases and 250 deaths reported so far.” So why, Amon demands indignantly, “if we knew that there was a danger of cholera—couldn't it have been avoided?” For him, the answer is self-evident. “Because disease and democracy often work in opposite directions,” he writes, and “vulnerable populations and inadequate government action create both the conditions for cholera epidemics to emerge and to become unmanageable.”
The logic of such a statement seems unimpeachable; it isn’t. Amon’s inflammatory, irresponsible, and, above all inaccurate language is bad enough. Whatever he may choose to imagine, the epidemic has not “swept” Haiti. To date, about 8,000 people have been infected, of whom almost 600 hundred have died—and almost all outside of devastated Port-au-Prince—out of a total Haitian population of 9.7 million people. His account of what public health officials were worried about in the immediate aftermath of the earthquake is little better. The officials’ worry was for the displaced people in Port-au-Prince, not those in the Plateau Central or the Artibonite, which are relatively far from Port-au-Prince. Indeed, cholera is such an alien phenomenon in Haiti that many people in the Artibonite are convinced that the outbreak was entirely exogenous and came from Nepalese U.N. peacekeepers stationed in the area, coming, as they do, from a country where cholera is not uncommon—a view that, while still probably more the product of people’s understandable fear and their ignorance about how cholera travels across the world, has been fueled by an announcement by the U.S. Centers for Disease control that the infections in Haiti were of a strain that is common in Asia.
If you want your views to be taken seriously, you ought to at least try to present the facts in context, no matter how much that context may complicate the picture or make your own organization’s sales pitch more difficult. This should be of particular importance if, as Human Rights Watch so often does, you present yourself as possessing the moral authority to pronounce confidently on what a just world would look like.
Wouldn’t it be refreshing if something of the reality of the world in, yes, all its doubtless unsatisfactory complexity, were allowed to play as important a role in the human rights narrative as they do on the ground? (And in fairness, as the best human rights activists present their arguments when they are off the record and not pitching some policy or seeking a more important role for their organizations.) Deploying the current litany of high-minded catch words—accountability, participation, transparency, the empowerment of civil society—in much the way worshippers say the Creed at Mass, is no substitute for intellectual rigor. A sense of tragedy would help too, but that is doubtless too much to ask for from a movement wedded to a rigid progress narrative.
Haiti deserves better. But neither the rhetoric-heavy, financing-light commitments of Washington and the countries of the European Union, nor the pieties of human-rightsism, will do much for the Haitian people—no matter how much this rhetoric and those pieties may console all of us in the rich world. In any case, unless the cholera spreads massively in Port-au-Prince, which is possible though not very likely given the extraordinary efforts of the Haitians themselves and of the foreign medical relief agencies on the ground there, it will not be long before Haiti once more disappears from the media, to be replaced by…what?
Well, at present, barring a last minute deal, South Sudan would be a good bet. But none of this will shake the self-regard of the Bill Clintons and Human Rights Watches of this world. It will be the Republicans’ fault, or the Tea Parties’, or Obama’s, or the lack of sustained commitment by the American public. On no account will the bien-pensant dictionary of received ideas need to be revised in any serious way. Neither will the self-reinforcing and institutional clichés of the human rights movement, nor what Rony Brauman has rightly called the “compassionate conservatism” of the UN’s Millennium Development Goals—a consensus of the powerful of this world whether in government, most mainline NGOs, the major philanthropies, and the business establishment, that makes the so-called Washington Consensus put forward in the 1980s at such cost to the poor of the world seem nuanced, reflective, and self-critical by comparison.
David Rieff is the author of eight books including A Bed for the Night: Humanitarianism in Crisis.