Chaos and Cholera

This Tuesday, April 10, Rick Santorum, who had given Republican frontrunner Mitt Romney a serious run for his money, bowed out of the race, leaving the former Massachusetts governor the heir apparent, barring an unpredictable surge in Tea Party support for one of the two other remaining candidates.

Maybe Romney – considered a “moderate” – will no longer have to pitch toward the Tea Party wing of the Republican base, but he has already run on their major themes of lower taxes, unfettered free market, rights for corporations (who “are people, my friend”), and more importantly limited government.

With the Republican nominee all but assured, it is time that we ask what these policies really mean. Aside from the contest of “Obamacare” at the U.S. Supreme Court, what would a Tea Party state look like?

For this, we need look no further than Haiti, brought even closer to U.S. travelers this weekend when the world’s largest airline began service from the world’s busiest airport.

It has become cliché to call Haiti the “Republic of NGOs” – even before the earthquake, non-governmental organizations (NGOs) received nearly all foreign assistance. So the government has been unable to fulfill even the most basic functions. In the mid-1990s, World Bank researcher Alice Morton pointed out that 90 percent of the government’s revenues were being financed by foreign actors. Former UN mission chief Edmond Mulet put the figure in 2007 at 70 percent, largely owing to the reduction in funds sent to the government.

If Haiti had a tax base to speak of, it could finance things like schools, hospitals, and road repair on their own, and invest in other human development and national production. Without a tax base, not only was the Haitian government bankrupt, it was at the mercy of foreign donors and their priorities for Haiti. Right after the earthquake, former U.S. president Bill Clinton apologized for destroying Haitian rice production through policies he championed as president.

Two years later, how much has changed? Not much, says a report from the Center for Economic Policy Research: a whopping .02 percent of the billions in reconstruction aid contracts went to Haitian firms.

I can almost hear the angry retorts: what about corruption? Didn’t Haiti top the list of most corrupt countries in 2005?

Let’s take a look at this corruption. First, it is a “Corruption Perception” index, asking leaders of business for their perceptions on state corruption. It is difficult to imagine the reverse, with government or nonprofit agencies reporting on perceptions of corruption of Wall Street or that of a particular corporation. Congress stopped Obama from naming Elizabeth Warren to head an agency to help consumers who were defrauded by a mortgage industry allowed to be de-regulated.

Secondly, the state that was deemed “most corrupt” was installed after a 2004 coup engineered by the U.S. and France. True, President Aristide had his critics at home that were calling for his ouster. But every time the progressive movement declared independence from the bourgeois-led, USAID-funded “civil society” opposition, the former military stepped in to rout the country’s police stations and let out people in prison. Their leader, Guy Philippe, is currently a fugitive, running in no small part because he spelled out the larger U.S. plan of which he was apart.

Backing up in Haiti’s history, the leaders that received most U.S. support were the 29-year father-and-son Duvalier dictatorship. The Duvaliers had a secret police called thetonton makout – that even according to the International Monetary Fund’s own accounting siphoned off the loans.(1) The Duvaliers took at least $900 million in U.S. aid.

So when Haiti’s first democratically elected government came to power in 1991, it faced a USAID and World Bank that was concerned about the issue of corruption, not to mention the rise in a belief in neoliberalism, the belief shared by Tea Partiers and libertarians alike (and increasingly so-called “centrist” Democrats) that the market should be free from any kind of government interference. So the elected governments did not get this support from foreign agencies. This was the beginning of a gradual NGO-ization, and neoliberalization, of Haiti.

Whole books can (and have) been written about this – see for example DeWind and Kinley’s AIDing Migration – but briefly, neoliberalism rendered Haiti more vulnerable to the earthquake. I had the honor of putting together many Haitian and other scholars and activists’ analyses together in Tectonic Shifts.

Chapter 1 discusses how foreign imposition of the model to be later embraced by the Tea Party (no taxes, limited government, completely unfettered free market) rendered the death toll greater. Alex Dupuy pointed out that neoliberalism exploded the population of Port-au-Prince, from 736,000 in the mid-1980s to 3,000,000 today. With no government oversight, unplanned shantytowns sprang up to house the people looking for $1.75 per day minimum wage jobs sewing clothes for U.S. manufacturers. These neighborhoods lacked public services like water and sanitation, and with no government building code; Yolette Etienne pointed out that 86 percent of the housing destroyed in the quake was built in this stateless fashion and as cheaply as possible, since 1990.

The cholera epidemic is an even clearer example of the ills of an under-resourced public sector. In addition to the pending rainy season, which experts predict will trigger another spike in cases, a 6,000-word lead story in the New York Times brought this conversation back to the fore. Writing in response to what some called “the blame game,” commentators pointed out that the problem isn’t simply one of resources failing to materialize or detailed what their NGO was doing in response.

This is one of many cases of people talking past one another, as they can both be right. NGOs individually can be doing a good job, but as the Times’ Sontag cited noted anthropologist and physician Paul Farmer, Bill Clinton’s assistant UN Special Envoy: “In the future, historians will look back and say, ‘Wow, that’s unfortunate.’ This unfolded right under the noses of all those NGOs. And they will ask, ‘Why didn’t they try harder? Why didn’t they throw the kitchen sink at cholera in Haiti?’”

Why indeed?

The answer is structural.

I conducted two studies of Haiti’s IDP camps, a sample of one in eight in the Port-au-Prince metro area, over 100 camps, one before and one after the outbreak of cholera. Among other indicators, progress on water and sanitation was slow. As of August 2010, seven months after the earthquake, 40.5 percent of camps lacked water and 30.3 percent lacked toilets. Just over a quarter (26 percent) of camps had latrines that hadn’t been cleaned at all since January 10, and one toilet was on average shared by 273 people, while the Sphere Minimum Standards say that toilets should be shared by no more than twenty.

Colleagues Chevalier Smail at the State University of Haiti and Tania Levey at CUNY helped explore statistical significance on a range of variables. Two in particular are relevant here: municipality and the presence of an NGO camp management agency.

Where a camp physically sits, in what jurisdiction, is statistically significant. The percentage of camps with water was greater in the central cities (73.9%), compared to 50.0 percent of camps in Cité Soleil and 26.1 percent of camps in the peripheral locations. Among camps in central areas, 18.2 percent were without toilets, compared to 28.6% of camps in Cité Soleil and 53.8% of camps in distant locations.

The takeaway here is twofold: camps that were located in far-flung areas had fewer services because they are harder to service – longer and more expensive transit. They are also out of people’s way. This is one reason why people prefer not to be relocated to far-flung areas if they have a choice. Cité Soleil is another issue: car rental companies and aid agencies’ policies place restrictions on aid workers’ movement in poorest and neediest areas that happen to not coincidentally be sites of greater violence.

More dramatic is the issue of NGOs acting as camp management agencies. The percentage of camps with water is more than double (88.5%) in camps with an NGO management agency than those without (40.0%). Only 9.7 percent of NGO-managed camps lacked toilets whereas the statistic was 40.4 percent for non-NGO managed camps. Both are statistically significant.

There are a couple of lessons to glean. First, thankfully, camp management agencies are doing their job. However, the question remains as to why NGOs acted as camp management agencies in only a small minority of camps (20-30 percent per the IOM’s official database, varying as a result of the total number of camps going down).

Even more telling is the progress after cholera struck in October 2010. Research assistants went back to the same 106 camps in January 2011 to identify progress since the 175 million in new pledges to combat the disease.

In short, there was very little progress: 25.8 instead of 30.3 percent of camps were still without a toilet, and 37.6 percent instead of 40.5 percent still lacked water. That is, thousands of deaths and over a hundred million dollars later, only four percent of camps had water and toilets newly installed.

Why this continued lack of progress?

While there are many theories, the answer is simple: no one forced NGOs to do more, to work in more areas. They are private structures accountable only to donors (individuals as well as USAID), not to the Haitian government or beneficiaries.

Where the four percent increase was concentrated is instructive. In Cité Soleil, the Haitian government – the national directorate for water and sanitation (DINEPA) in tandem with the local government – set a policy of 100% coverage of water and sanitation services within Cité Soleil camps. It was still the NGOs that did the work. But they worked under a framework established and coordinated by the government.

It worked. As of January, 2011, research assistants noted that all Cité Soleil camps had water and only one lacked a toilet (I was later informed that this too was solved).

The lesson here is an example of what difference an adequately-funded, empowered government can do. And, unfortunately, why NGOs can never replace governments. Left to themselves and their reward structures, only one additional camp got water out of over 100.

Undoubtedly, NGOs can do good work. But NGOs’ work has limits, and they can never be expected, or attempt, to replace responsible governments. This said, foreign donors only sent 1% of emergency aid to the Haitian government.

This isn’t a “blame game,” nor is it rocket science. Just social science. This is the lesson that humanitarians – and individuals considering donating to a relief effort – should be learning from the cholera outbreak in Haiti: that NGOs have their place, but so do governments. And as much as possible our aid should build the capacity of governments.

One solution might be considered a “tax” (this is a bad word, code word for “big government”) – call it simply a “coordination fee” or “administrative fee:” whenever USAID and other bilateral donors give to NGOs we should reserve a portion to the responsible ministry and local government to be able to coordinate, oversee, and evaluate the projects.

There are other solutions that also accomplish a shared goal of decentralization so that people don’t die in an earthquake just because they had to get a baby’s birth certificate. While waiting for Port-au-Prince’s political class to sort out the issue of filling the Prime Minister’s spot, there are 565 local administrative divisions in Haiti, called sections communales, or communal sections.

For example, if USAID gave each local neighborhood council $1000 to repair a bridge, build a grain stockage, dig a well, or buy school materials, social control – the fact that everyone knows their neighbors in rural Haiti, that people’s cousins, church members, neighbors, etc. would demand accountability – would ensure that these projects are carried out. Despite all, if a local leader walks off, USAID would only be out $1000 – the cost of a per diem for many aid agencies. Collectively the figure is about half a million dollars, less than USAID spends on administration.

If incentives to succeed and build capacity are put in place, successful local governments could get $5000, $10,000, and then $25,000. For $25,000 a school can be built and equipped, for example. Even if all of these local governments succeed – and isn’t this everyone’s goal? – the figure is just over 23 million ($23,165,000 to be precise). This is less than the budget to communicate the importance of having clean drinking water (without providing it, of course). Then they could have the “absorptive capacity” to become regular partners with donors or NGOs.

Haiti’s cholera outbreak requires more than an outpouring of compassion and hopefully requisite funding. It requires new thinking and a clear look at the problems of the privatized system.

In other words, it requires that we take a look at knee-jerk prejudices about the evils of “big government.” Would we only heed it, Haiti offers a warning system for policies increasingly embraced by U.S. politicians.

True, there are important differences in the two country’s histories, specifically about imperialism, colonialism, and slavery – and the direction of resource flows as a result.

But we have the opportunity to ask ourselves what kind of society we want to live in. Do we want local school boards that have to close schools and force students into unsafe conditions? Do we want city governments unable to repair potholes or respond to the ever-increasing boarded up houses? This is already happening as a consequence of fiery rhetoric about the evils of taxation and big government, compounded by the financial crisis wrought by a banking system allowed to get out of control.

Or do we want to be able to have a healthy and well educated population able to compete on a level playing field in an increasingly global economy, with corporations choosing to locate to cities because of their livability? As in Haiti, the long term solution is for a country to invest in its people.

What we are learning in Haiti we should be able to apply to our own society, learning lessons while we still have some ability to turn our own economy around.

Mark Schuller is Assistant Professor of African American Studies and Anthropology at York College (CUNY) and affiliate at the Faculté d’Ethnologie, l’Université d’État d’Haïti. Supported by the National Science Foundation and others, Schuller’s research on globalization, NGOs, gender, and disasters in Haiti has been published in twenty book chapters and peer-reviewed articles as well as public media. He is the author of forthcoming Killing with Kindness: Haiti, International aid, and NGOs (Rutgers, 2012) and co-editor of four volumes, including Tectonic Shifts: Haiti Since the Earthquake (Kumarian, 2012). He is co-director / co-producer of documentary Poto Mitan: Haitian Women, Pillars of the Global Economy (Documentary Educational Resources, 2009). He chairs the Society for Applied Anthropology’s Human Rights and Social Justice Committee and is active in many solidarity efforts.

Support from the National Science Foundation made this research possible. Tania Levey at York College, the City University of New York, helped in the analysis of the quantitative data. Gratefully acknowledged are my students and colleagues at the Faculté d’Ethnologie, l’Université d’État d’Haïti.


(1)    See James Ferguson, 1987. Papa Doc, Baby Doc: Haiti and the Duvaliers, page70.


Mark Schuller is Associate Professor of Anthropology and Nonprofit and NGO Studies at Northern Illinois University and affiliate at the Faculté d’Ethnologie, l’Université d’État d’Haïti. He is the author or co-editor of seven books, including Humanitarian Aftershocks in Haiti. Schuller is co-director / co-producer of documentary Poto Mitan: Haitian Women, Pillars of the Global Economy (2009), and active in several solidarity efforts.