Water is Life

Haiti in the Shadow of Cholera – NY Times Editorial April 23, 2014

The problem of ending Haiti’s cholera epidemic does not stem from an absence of planning. There is a 10-year plan to eradicate cholera from Hispaniola, the island Haiti shares with the Dominican Republic, by 2022. Within the 10-year plan is a two-year plan to get the 10-year plan up and running. The United Nations has its own two-year plan to support that two-year plan. To tackle the crisis immediately, with treatment, vaccinations and other prevention efforts, there was a one-year plan for last year, and a new one for 2014.

In Port-au-Prince on Tuesday, Haitian government officials and international health agencies met to examine the progress of the cholera response. As they surely realized, the difficulty is never a lack of plans, but a lack of money. Last year’s plan called for spending $38 million, but raised only $10 million. The 2014 plan is for about $40 million. It has raised about $6 million. The government says it needs $448 million to carry out its two-year plan; it has raised less than half that.

The 10-year plan, an ambitious campaign to supply vaccinations and treatment and to build the clean water, sewage and health systems Haiti has never had, is expected to cost $2.2 billion. Needless to say, it is off to a bad start. And not surprisingly, other trends are moving in the wrong direction, as The Times reported last week.

The number of cholera treatment centers has plummeted, from 120 to barely 40, as aid organizations leave Haiti. The percentage of cholera patients who die in treatment centers is rising. The rainy season, which began this month, is expected to increase the caseload by tens of thousands as flooding spreads the disease in contaminated rivers and streams used for drinking and bathing.

More than 700,000 Haitians have been sickened since the outbreak began in 2010. More than 8,500 have died.

No one should get cholera, and no one who gets it should die. The cure is astoundingly simple: clean water and rehydrating salts, given intravenously if necessary, can swiftly bring a person back from the edge of death. The long-term solution, clean water and sewage systems, is straightforward. But the outpouring of good will and pledges of aid after the 2010 earthquake have dissipated, leaving little in the way of permanent improvements. Promises made are not the same as money delivered.

The United Nations is in an awkward spot in this crisis. It has been blamed for bringing cholera to Haiti in the first place, through its negligent soldiers who contaminated a river with their sewage. Because it has steadfastly refused to accept responsibility, it is a tarnished advocate, begging donors to send money that they have gotten tired of giving. But even if the conscience of the world no longer shocked by Haitian sickness and deaths, the Haitian people still need the world’s help. At current rates, officials expect 45,000 people to contract cholera this year. In what other country would such a vast and preventable tragedy be tolerated, with little more than wrung hands, empty promises and underfinanced plans?

By THE EDITORIAL BOARD JAN. 10, 2014

Four years after the earthquake, Haiti is a fragile, largely forgotten country. It’s possible that some natural or man-made crisis this year could push it back into the headlines. But sustained attention, with the kind of support from outside that Haiti still needs to rebuild and become more self-sufficient, is mostly gone.

The United Nations says as much in a recently published Humanitarian Action Plan for Haiti that strives for an ambitious and hopeful tone but mostly sounds forlorn. It notes some positive changes. More than three-fourths of young children are now in primary school, up from about half. Cholera deaths are down, as is the number of homeless quake survivors. The population in the camps reportedly fell to 172,000 last year, from a peak of 1.5 million who were without shelter just after the quake in 2010.

But such hopeful signs are easily displaced by other dreary facts. Humanitarian aid is petering out as agencies leave and money dries up. The decline means Haiti’s partners should be stepping up development efforts, to put the country on a sustainable recovery path, but that isn’t happening. Meanwhile, Haiti still has half the world’s cholera cases, as the United Nations — whose troops caused the epidemic — is battling it with an underfinanced eradication plan.

For all the talk — and the $14 billion pledged by governments the world over since Jan. 12, 2010 — what is there to show? The grand total of new homes built in four years since the quake is dismally low: 7,515. The signature American-led redevelopment project — an industrial park in Caracol, on Haiti’s north coast, which was supposed to create as many as 60,000 jobs — had created 2,590 at the end of 2013. Workers’ rights advocates reported last fall that garment factories at Caracol and elsewhere routinely violate Haitian minimum-wage laws and pay most workers too little to live on.

The new United Nations action plan lacks the loftiness of previous development proposals, but it focuses on four critical, and surely achievable, goals: housing the homeless, reducing cholera, feeding 600,000 “food insecure” Haitians and strengthening national institutions. Financing it for one year will take $169 million.

The United States should stick to its commitments to Haiti, with a particular focus on building and repairing housing (permanent homes, not temporary shelters), supporting agriculture and building the capacity of the Haitian government and local businesses and organizations. Data from the United States Agency for International Development show that barely 5 percent of its financing for projects in Haiti in 2012 went to Haitian-led institutions; that is not good enough.

It would help, meanwhile, to have a better idea of what’s going on. A bill, the Assessing Progress in Haiti Act, would require more detail and transparency from the State Department in reporting to Congress how humanitarian and development money is spent. The bill, sponsored by Representative Barbara Lee, a California Democrat, passed the House with bipartisan support; the Senate should follow suit.

The United Nations plan notes that “the slightest shock” to Haiti could send it into another round of misery and death. It is a country still in the grips of an emergency, even though beyond its shores, nobody seems to remember.