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Haiti: Between Emergency and Reconstruction

An inadequate response
Jean-Marc Biquet
This article is a translation of:
Haïti : entre urgence et reconstruction

Abstract

Editor’s notes : This paper is a contribution to the ‘Policy Debate’ section of International Development Policy. In this section, academics, policy makers and practioners engage in a dialogue on global development challenges. Papers are copy-edited but not peer-reviewed. Instead, the initial thematic contribution is followed by critical comments and reactions from scholars and policy makers.
Authored by Jean-Marc Biquet, Research Officer at Doctors without Borders (MSF), the paper focuses on the failure of the aid system in Haiti. The country has been struck by two disasters in a raw: the January 2010 earthquake and a cholera epidemic starting in October the same year. Despite repeated requests to - and commitments from - the UN (UNOCHA in particular) to provide a response, we did unfortunately not get any written reaction to MSF's article. But we did receive critical comments by Andrea Binder, Associate Director of the Global Public Policy Institute (GPPi) in Berlin ‘Is the Humanitarian Failure in Haiti a System Failure?’, which we publish together with Mr Biquet's initial contribution. Dr. Biner has been involved in the Inter-Agency Real-Time Evaluation of the disaster response to the Haiti Earthquake.

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Index terms

Mots-clés géographiques :

Haïti

Mots-clés thématiques :

aide humanitaire

Thematic keywords :

humanitarian assistance

Geographic keywords :

Haïti
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Author's notes

The opinions expressed in this article reflect the opinions of the author and not necessarily those of MSF. The author would like to particularly thank Catrin Schulte-Hillen, Philippe Calain and Aurélie Lachant for their vital contributions.

Full text

‘This country has the best chance to escape its past than it's ever had… As horrible as this is, it gives them a chance to start again.’ Bill Clinton, March 2010.1

  • 2  The figures themselves are subject to much controversy. According to the Haitian government at the (...)

1On 12 January 2010, an earthquake struck Haiti. The cities and towns of Port-au-Prince, Gressier, Jacmel and Léogâne were mostly destroyed. Thousands of inhabitants were killed and hundreds of thousands of others found themselves homeless.2

  • 3  According to the PAHO, 40% of Haitians had no physical access to a healthcare service before the e (...)
  • 4  Source Ministère de la Santé Publique et de la Population – Haïti (MSPP) (Ministry of Public Healt (...)

2To make matters worse, the capital, where most of the infrastructure and the administration are concentrated, was severely affected. This was to have a definite impact on the capacity to deploy and organise the relief. The availability of healthcare, which was already underdeveloped,3 was completely overwhelmed: 30 of the 49 hospitals in the damaged areas were destroyed or suffered significant damage.4 Medical personnel were also deeply affected by the earthquake.

3Nearly all actors and observers recognise that the first phase of the earthquake response was adequate. Once the initial days of chaos were over, the mobilisation of aid actors was impressive. Médecins Sans Frontières (MSF) is not the only humanitarian organisation to have said that its post-earthquake investment in Haiti constitutes its biggest single action since its creation.5

Unkept promises and mixing roles

  • 6  This gave him the opportunity to recycle the ‘Build Back Better’ slogan, which he had already used (...)
  • 7  This figure excludes the reduction of the country’s debt. Data available in: United Nations Office (...)
  • 8  In September 2012, only 52.3% of this sum had actually been disbursed.
  • 9  Approximate figure provided by the United Nations Office of the Special Envoy for Haiti

4The former US president, appointed special envoy for Haiti by the United Nations Secretary-General, worked hard to mobilise donor countries in order to fund the response for this devastated country:6soon after the earthquake (New York Conference in March 2010), some USD 5.33 billion were pledged by donor countries to rebuild Haiti for the period between 2010 and 2012 alone.78 This substantial amount came on top of some USD 3 billion paid by private donors to the thousands of NGOs that mobilised for the emergency and early recovery.9

  • 10 See the recommendations of the NGOs in CAFOD, Christian Aid, Progressio and Tearfund (2011).

5With a sense of urgency, the international mobilisation quickly evolved from emergency relief to aid for early recovery and reconstruction. This paradigm shift corresponded to a shift in priorities: the urgency was no longer to meet the immediate needs of Haitians, but to work on improving conditions to address the needs of tomorrow, by rebuilding the country and strengthening the government through good governance, democracy, etc.10

  • 11  February 2010 figure.

6The earthquake – a disaster – became an opportunity to (re)build the country –‘a once-in-a-century chance for change’ (Oxfam International, 2010). The mobilisation of pledges from donors was just as impressive as the mobilisation of aid actors: as many as 600 actors enlisted in the Health Cluster, a mechanism to coordinate international actors operating in the health sector.11

7The optimism inherent in slogans was passed on as advice to actors in the field: according to Merlin, for example, it is necessary to ‘ensure that all humanitarian responses contribute and build towards the longer term development of the health work force and health system’ (Merlin, 2011). The emergency response based on current needs is seen as having a negative impact on the objectives of future development.

  • 12  Report cited and commented on by the Center for Economic and Policy Research (CEPR) (2012) Evaluat (...)

8Three years on from the earthquake, what has become of the situation in Haiti? Some observers, such as Dara, an independent organisation that has evaluated donors’ response to the earthquake, consider that the famous ‘Build Back Better’ is nothing more than a slogan (Dara, 2011).12

  • 13  Whose webpage for ‘Projects and Operations’ in Haiti gives ‘No records found’. Accessed 30/11/2012 (...)

9Uncertainty reigns supreme in terms of reconstruction projects, with respect to both those of the Haitian government and those of major donors such as the World Bank.13 Projects announced amidst much media attention have not begun, apparently for lack of means, such as the construction of a hospital in Carrefour by the Brazilian Cooperation or that of a hospital in Gressier by the Luxembourg Red Cross, etc.

  • 14  370,000 people are still living in tents according to OCHA figures (September 2012).

10Meanwhile, the Haitian population has heard public announcements of international aid and witnessed its mass deployment, while results in terms of assistance have become less and less visible as time went by. For example, the emergency response aiming to guarantee shelter for the greatest number in the immediate aftermath of the earthquake rapidly provided the vast majority of the homeless with tarpaulins or tents, however, the situation has unfortunately progressed little since then. In fact, the most ‘adequate’ solutions still depend on development programmes. Many Haitians are still living beneath these tents or tarpaulins almost three years after the earthquake, which is very problematic in a region so susceptible to hurricanes.14

11This has created a lot of tension between international aid actors, the authorities and the population. Perhaps too easily, distrust towards humanitarian organisations is palpable in both rhetoric and in the field. Cynically, the inhabitants of Port-au-Prince speak of the ‘Republic of NGOs’. Identifiable by the colours of their flags and stickers, it is not uncommon for the cars of humanitarian organisations to be stoned.

  • 15  Pierre Salignon, Director-General of Doctors of the World, interviewed in the magazine Là-Bas (Jan (...)

12The reactions of NGOs have been uneasy and the rhetoric more cautious. But the frustration remains: ‘Firemen cannot be blamed for extinguishing a fire, but nor can they be asked to reconstruct the building.’15 Yet there is clearly an imbalance between the means and the energy deployed on the one hand and, on the other, the limited results – or perceived results – of the collective effort made by aid actors. And the gap between what this discourse suggested and the reality is immense. Major donors and the Haitian government obviously bear a heavy responsibility, and the actors in the field have theirs. By promoting the belief in a rapid recovery, they participated in fostering frustration.

13The competition for media exposure – a supposed guarantee for access to funding –, the media pressure requiring the prevailing discourse to continue in the absence of new information to provide, or the need to provide token evidence to financial backers may potentially explain part of the lack of congruence between the promising messages conveyed, the visible deployment of actors and the actual results of this deployment. But other factors explain the rapid shift – at least in the rhetoric – towards immediate recovery.

14The automatic and systemic nature of the transition in the order of priorities from the emergency to the reconstruction phase appeared to lack substance and be more part of a sequential theoretical model than the fruit of a rigorous analysis of the situation.

15Yet while immediate recovery is perhaps conceivable in the very short term in some aid sectors (education, agriculture, etc.), this cannot be the case in the health sector as long as the Haitians do not determine themselves what health system and policy they would like to establish and as massive means in terms of infrastructure and training have not been invested.

  • 16  Such as the Clinton Bush Haiti Fund or Canada.
  • 17  For example, see the comments by William H. Frist published in the Washington Times (2012) Helping (...)

16The shift to the slogan ‘Trade not Aid’, advocated by the recently elected president in Haiti and reprised by the major donors,16 could be based on the same principle of reality denial:17 in the mobilisation of efforts and resources, focusing on what may pave the foundation for decent and dignified living conditions for all in Haiti while, in the interim, hiding the fact that entire segments of Haitian society are without access to basic services (medical care, housing, water, etc.). Yet this should be one of the main drivers behind the mobilisation of aid actors and their sponsors.

The aid apparatus has become an obstacle to the emergency response

  • 18  To return to the origins of the introduction of the reform of the previous system initiated in 200 (...)

17The current system of relief provision was modelled some years ago in response to past shortcomings.18 The international community’s efforts to coordinate emergency relief led to the creation of a formal system, set up to rationalise ‘humanitarian aid’ as a whole. Today, this system is based on a Consolidated Appeal Process (CAP) for financial support, inter-organisational planning processes and ‘collective’ communication with the public, in the name of all.

18Our view, however, is that the actual capacity of the emergency relief deployed has not improved.

19The flood of actors makes the need for coordination between them very important. According to the model, the creation of clusters (groups of actors combined by sector of activities and skills: shelter, health, food aid, etc.) should help to organise the aid and prepare the response to new emergencies.

20Thus, immediately after the earthquake, the Ministry of Public Health and Population (MSPP), the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and many NGOs, in addition to other actors in the health domain, began to contribute to the effort in the field to ensure that Haiti would be ready in the event of a new emergency. In September 2010, emphasis was placed on the risk of hurricanes. The likelihood of a food crisis, another earthquake and an epidemic were also included in the envisaged scenarios.

  • 19  Source of the Haitian Health Ministry (MSPP). These figures are approximate, as it is very likely (...)
  • 20  More than 614,000 cases listed by the MSPP in November 2012

21Despite this preparation, the coordination system appeared to be profoundly lacking in the face of the cholera epidemic that took hold in October 2010. The epidemic was particularly virulent and came during a very tense electoral period. The Haitian Health Ministry (MSPP) quickly assumed control of operations. One of its first decisions was to push aside the Health Cluster, which had been established for this very purpose, and directly seek out operational actors to act immediately. Within three months, 209,034 cases and 4,030 deaths were recorded.19 It was a new disaster, the number of victims rapidly surpassing the total number injured by the earthquake.20

  • 21  The Huffington Post (2010) ‘Major Aid Organizations "Duped Donors" and "Failed Haiti" Group Charge (...)

22The first reaction by the UN-steered aid coordination mechanisms was to launch a funding appeal to respond to the epidemic. Yet this was at a time when, according to some reports, the funds collected in the aftermath of the earthquake were far from being spent.21

23But in terms of the reaction to the cholera epidemic itself, the humanitarian coordination and its many actors did not appear to budge. Some 80% of patients received in the first three months were taken in by two actors which were not part of this Health Cluster ‘coordination system’, namely the Cuban medical brigades and MSF (the remainder were treated by twenty-odd organisations, including the Haitian Health Ministry).

  • 22  The French Red Cross says it immediately opened its first cholera treatment centre on 25 January 2 (...)

24This period of time was actually necessary for the mobilisation to materialise in other actors effectively taking charge.22 Further still, this mobilisation did not last, as shown by a report from a US research centre published under the title Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti in August 2011 (Johnston J. and K. Bhatt, 2011).

25The response in terms of water, hygiene and sanitation – so crucial in the face of this disease – was cruelly lacking, forcing MSF notably to take charge of these needs.

  • 23  Some have done their utmost, but often by confining their response to the areas where they were al (...)
  • 24  In reference to the United Nations inter-agency website aiming to exchange information in order to (...)

26It is not the individual willingness of each organisation to react that we want to question,23 but rather the collective capacity to meet the expectations: emergency preparation – at the heart of OCHA missions – that was found lacking in the face of cholera. It was as if the quest for ‘a [perfect] solution’24 did not bring ‘any real added value to the response.’ It was as if, in the end, it was limited to making an inventory of the virtual capacities in a roadmap comprising each actor, its deployment areas, its financial backing, its available stock and its staff under the heading ‘intervention resources’. The sum of these resources forms an effective response mechanism in theory, but inoperative in practice as soon as one actor in the chain is lacking. The system legitimises all actors that aim to take part, regardless of their real capacity or impact.

27In the United Nations cluster system, relations between the various actors are standardised: Consolidated Appeal Processes (CAP), subcontracting and framework agreements with which the actors must comply in the countries where they conduct their operations.

28Funding and directives are passed down from top to bottom, while reports on ‘achievements’ and ‘lessons learned’ circulate from bottom to top. Each change in action involves an accompanying change in agreements between actors and donors. This mechanism explains the paralyses and the system’s lack of flexibility. It favours neither rapid response in a constantly evolving environment nor the deployment of effective emergency relief.

29Each failure or delay on the part of an involved actor leads to dysfunction throughout the chain and can potentially lead to inaction. However, no one party is guilty, as the responsibility is shared, and no one party complains because all feel responsible.

  • 25  A subgroup (mini cluster) involving the largest NGOs active in the health domain was created. It m (...)

30In the case of Haiti, very little space was given to debating the very practical and technical questions necessary to meet real needs.25

31In light of the shortcomings of the international community’s humanitarian response since the reform initiated in 2005, large traditional NGOs, combining to form a consortium, launched a ‘transformative agenda’ process with the aim of providing improvements to aid organisation and coordination processes (IASC, 2012). But based on the same aim to standardise, centralise and control the response, mixing reflection on needs and competition for access to funding, hopes of tangible improvements are, at this stage, thin.

32It is therefore legitimate to ask how much leeway (independent assessment, evaluating constraints and action) such a system allows and whether this system exists for itself or to respond to real needs.

33Two years after the onset of the cholera epidemic, and despite the Haitian Prime Minister having declared it under control,26 several thousands of cases were still recorded in 2012. In November 2012, MSF’s cholera treatment structures were still receiving 250 new cases per week.27

  • 28  Trenton, D. "Haiti, DR Hope to Eliminate Cholera with $2.2 Billion Plan with International Groups. (...)
  • 29  In the city of Port-au-Prince, MSF provides care for 62% of the sick.

34An ambitious plan to eradicate cholera within 10 years has recently been announced.28 This MSPP plan, with the backing of CDC Atlanta, PAHO and UNICEF, will require the mobilisation of USD 2.2 billion, the first millions of which are yet to be found. Yet another empty promise, at a time when caring for the sick is yet to be integrated into the range of services offered by the medical structures of the MSPP.29

35Haiti has experienced a one-off situation, suffering two large-scale disasters in quick succession. This context obviously has its own characteristics, such as the weakness of the state as a provider of basic public services to its citizens or the historic deficit in terms of reputation of the United Nations as such. The fact remains that it would be irresponsible to hide behind the later exception and shy away from questioning the coordination system and the real capacity for aid that it offers, in addition to its propensity to promise more than it can deliver...

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Bibliography

CAFOD, Christian Aid, Progressio and Tearfund (2011) Building Back Better: An imperative for Haiti. A Parliamentary briefing paper http://www.christianaid.org.uk/images/building-back-better.pdf (Accessed on May 16, 2013).

Center for Economic and Policy Research (CEPR) (2012) Evaluation of Donor Response to Haiti Earthquake Shows "Building Back Better" Nothing But a Slogan http://www.cepr.net/index.php/blogs/relief-and-reconstruction-watch/evaluation-of-donor-response-to-haiti-earthquake-shows-building-back-better-nothing-but-a-slogan (Accessed on May 16, 2013).

Dara (2011) Focus on Haiti. Build Back Better ?(Madrid) http://daraint.org/wp-content/uploads/2012/02/HRI2011-FocusOnHaiti.pdf (Accessed on May 16, 2013).

Inter-Agency Sharing Committee (IASC) (2012) The IASC Transformative Agenda 2012 http://www.humanitarianinfo.org/iasc/pageloader.aspx?page=content-documents-default&mainbodyID=22&publish=0 (Accessed on May 16, 2012).

Johnston J. and K. Bhatt (2011) Not Doing Enough: Unnecessary Sickness and Death from Cholera in Haiti (Washington D.C: Center for Economic and Policy Research – CEPR) http://www.cepr.net/documents/publications/not-doing-enough-2011-08.pdf (Accessed on May 16, 2013).

Merlin (2010) Is Haiti’s Health System any better? (London) http://www.who.int/workforcealliance/knowledge/merlinhaiti_2011report.pdf  (Accessed on May 16, 2013).

MIT Press (2010) Build Back Better. Strategies for Societal Renewal in Haiti. Special Edition for the 2010 Annual Meeting of the Clinton Global Initiative (Boston: MIT Press) http://www.mitpressjournals.org/userimages/ContentEditor/1285251880968/INNOVATIONS-CGI-2010.pdf (Accessed on May 16, 2013).  

Oxfam International (2010) Haiti: A Once-in-a-Century Chance for Change http://www.oxfam.org/sites/www.oxfam.org/files/bp136-haiti-once-in-a-century-220310-summary.pdf (Accessed on May 16, 2013).

United Nations Office of the Special Envoy for Haiti (2012) International Assistance to Haiti Key Facts as of December 2012 http://www.haitispecialenvoy.org/download/International_Assistance/1-overall-key-facts.pdf (Accessed on May 16, 2013).

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Notes

1  Reuters (2010) ‘PREVIEW-Haiti, donors face huge task to 'build back better’ http://www.reuters.com/article/2010/03/28/quake-haiti-donors-idUSN2822043320100328 (Accessed on May 16, 2013).

2  The figures themselves are subject to much controversy. According to the Haitian government at the time, the death toll amounted to 316,000. This figure is contested and reduced by some to a range between 46,000 and 85,000. See BBC (2011) ‘Report challenges Haiti earthquake death toll’ http://www.bbc.co.uk/news/world-us-canada-13606720 (Accessed on May 16, 2013).

3  According to the PAHO, 40% of Haitians had no physical access to a healthcare service before the earthquake, while the financial barrier prevented the majority of the rest from using existing services.

4  Source Ministère de la Santé Publique et de la Population – Haïti (MSPP) (Ministry of Public Health and Population).

5  MSF (2010) International Activity Report http://www.msf.org/international-activity-report-2010-haiti-year-crisis (Accessed on May 16, 2013)

6  This gave him the opportunity to recycle the ‘Build Back Better’ slogan, which he had already used as special envoy to Haiti after the 2008 cyclones. See Clinton B. in MIT Press (2010).

7  This figure excludes the reduction of the country’s debt. Data available in: United Nations Office of the Special Envoy for Haiti (2012).

8  In September 2012, only 52.3% of this sum had actually been disbursed.

9  Approximate figure provided by the United Nations Office of the Special Envoy for Haiti

10 See the recommendations of the NGOs in CAFOD, Christian Aid, Progressio and Tearfund (2011).

11  February 2010 figure.

12  Report cited and commented on by the Center for Economic and Policy Research (CEPR) (2012) Evaluation of Donor Response to Haiti Earthquake Shows "Building Back Better" Nothing But a Slogan http://www.cepr.net/index.php/blogs/relief-and-reconstruction-watch/evaluation-of-donor-response-to-haiti-earthquake-shows-building-back-better-nothing-but-a-slogan (Accessed on May 16, 2013).

13  Whose webpage for ‘Projects and Operations’ in Haiti gives ‘No records found’. Accessed 30/11/2012 http://web.worldbank.org/external/projects/main?pagePK=217672&piPK=64625826&theSitePK=2748750&menuPK=2805029&category=regcountries&regioncode=&countrycode=HT

14  370,000 people are still living in tents according to OCHA figures (September 2012).

15  Pierre Salignon, Director-General of Doctors of the World, interviewed in the magazine Là-Bas (January 2011) http://www.labas-mag.fr/wp-content/uploads/2012/01/LB0016pages1.pdf (Accessed on May 16, 2013).

16  Such as the Clinton Bush Haiti Fund or Canada.

17  For example, see the comments by William H. Frist published in the Washington Times (2012) Helping Haiti build back better - A hand up, not handouts http://www.washingtontimes.com/news/2012/jul/13/helping-haiti-build-back-better/ (Accessed on May 16, 2013).

18  To return to the origins of the introduction of the reform of the previous system initiated in 2005, see the 2005 ‘Humanitarian Response Review’.

19  Source of the Haitian Health Ministry (MSPP). These figures are approximate, as it is very likely that many cases have never been recorded.

20  More than 614,000 cases listed by the MSPP in November 2012

21  The Huffington Post (2010) ‘Major Aid Organizations "Duped Donors" and "Failed Haiti" Group Charges’, http://www.huffingtonpost.com/georgianne-nienaber/major-aid-organizations-d_b_785847.html (Accessed on May 16, 2013)

22  The French Red Cross says it immediately opened its first cholera treatment centre on 25 January 2011. Save the Children announced the opening of its first centre on 4 January 2011.

23  Some have done their utmost, but often by confining their response to the areas where they were already deployed.

24  In reference to the United Nations inter-agency website aiming to exchange information in order to improve humanitarian coordination in emergencies: http://www.oneresponse.info.

25  A subgroup (mini cluster) involving the largest NGOs active in the health domain was created. It met separately with a view to working more efficiently. But even in these conditions it was difficult to deal with medical questions and problems relating to the health system. Differences in involvement (primary healthcare, hospital care) and philosophies between the various organisations (integrated in the MSPP, private healthcare) as well as different policies and modus operandi account for this phenomenon. All in all, close to seven subgroups were created in the health domain. Actual participation represents the equivalent of a full-time job for the coordinators of some organisations.

26  Statement by the Prime Minister on 26/9/2012 cited by newspaper Française Nouvelles, ‘Haïti PM, dit épidémie de choléra sous contrôle’ http://www.francaisenouvelles.com/haiti-pm-dit-epidemie-de-cholera-sous-controle/ (Accessed on May 16, 2013).

27 MSF (2012) ‘Haiti: Cholera remains major public health problem’ http://www.msf.org/article/haiti-cholera-remains-major-public-health-problem (Accessed on May 16, 2013).

28  Trenton, D. "Haiti, DR Hope to Eliminate Cholera with $2.2 Billion Plan with International Groups." The Washington Post, 28 Nov. 2012. Web. 30 Nov. 2012

29  In the city of Port-au-Prince, MSF provides care for 62% of the sick.

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References

Electronic reference

Jean-Marc Biquet, « Haiti: Between Emergency and Reconstruction », International Development Policy | Revue internationale de politique de développement [Online], 4.3 | 2013, Online since 30 January 2014, connection on 19 September 2017. URL : http://poldev.revues.org/1600 ; DOI : 10.4000/poldev.1600

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About the author

Jean-Marc Biquet

Research Officer, Unité de Recherche sur les Enjeux et Pratiques Humanitaires(UREPH) - http://www.msf-ureph.ch/, Médecins Sans Frontières, Switzerland.

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Copyright

Creative Commons Attribution-NonCommercial 3.0 Unported License.

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