Unjust embargo deepens Haiti’s health crisis
By Paul Farmer and Mary C. Smith Fawzi, Boston Globe 12/30/2002
N HAITI’S central plateau, lack of resources and medical personnel combined
with a growing burden of disease are responsible for increasingly desperate
social conditions. The causes of worsening conditions are many, but the
connection between unnecessary suffering and an aid embargo led by the
United States is undeniable.
US-sponsored embargoes against Haiti have a long history. From 1804-62, the
United States, a major slave-owning economy, simply refused to recognize the
existence of Haiti. According to a US senator from South Carolina speaking
on the Senate floor in 1824, ”the peace and safety of a large portion of
our union forbids us even to discuss” it. The United States occupied Haiti
militarily from 1915-34, and since that time has supported a number of
undemocratic governments. Under the Duvalier dictatorships, generous aid,
primarily from the United States, flowed steadily, as it did during the
military juntas later convicted of war crimes after the violent overthrow of
Haiti’s first democratically elected president, the Rev. Jean-Bertrand
During the early 1990s, the UN imposed a trade embargo in order to push
forward the restoration of Aristide. When in 1994 he returned to office and
a devastated country, $500 million in development aid was promised by the
United States and multilateral organizations. This aid might have helped
resuscitate the hemisphere’s poorest country, but it has been withheld.
The lack of development aid has been a burden, but even more troubling has
been the embargo on humanitarian assistance and loans. For example, loans
totaling $146 million (for health sector improvement, education reform,
potable water enhancement, and road rehabilitation) already approved through
the Inter-American Development Bank have been blocked by the United States
in response to alleged irregularities during May 2000 legislative elections.
After the presidential election of November 2000 (widely recognized as free
and fair), the funds were to be released, but the Bush administration used
its veto power to continue to block release of funds on the grounds that
Haiti has not demonstrated an adequate commitment to governing the country
in a democratic manner – objections not heard during the long years of
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This policy persists despite a September resolution by the Organization of
American States stating that the Haitian government has taken the
appropriate steps to foster democracy and that normal relations with
international financial institutions should be reinstated.
Putting legal arguments aside for the moment, what are the health
implications of withholding $500 million in development assistance and
blocking $146 million in loans to improve health, education, and water
During the past two years, at our 80-bed hospital in rural Haiti, we have
seen demonstrable declines in the public health infrastructure and the
health status of the populations surrounding our clinic. With a staff of 10
Haitian physicians and a large corps of community health workers, our
organization, Zanmi Lasante, runs one of the largest charity hospitals in
Haiti. Our support comes largely from private donors and foundations, and we
see ourselves as disinterested observers of the events above given that we
have never received significant government assistance or funding from the
Inter-American Development Bank or the US government.
Over the past year, our general ambulatory clinic has seen an enormous
increase in demand. We are staffed to receive no more than 25,000 visits per
year, but will this year see an estimated 160,000 patients.
Meanwhile, neighboring clinics and hospitals have seen a decrease in patient
load. While several neighboring facilities remain open, they sell or
prescribe medications at prices that are beyond the reach of the population,
over 80 percent of which live in poverty. We have noted a spike in trauma
cases due in large part to road accidents (there is no money to maintain the
rural road network). Malaria remains a major contributor to anemia and
death, exacerbated by lack of access to care. Polio, previously believed
eradicated from the Western hemisphere, has again resurfaced on the island.
Other infectious disease outbreaks – anthrax, meningitis, and drug-resistant
tuberculosis – have also occurred. The degree to which these pathogens
spread will be determined largely by the capacity of the public-health
system to respond.
The story is no different beyond our hospital’s expanding catchment area.
For example, there has been a significant decrease in Haitians’ access to
potable water, particularly in Port-au-Prince ($54 million of the $146
million that has been blocked was intended for improving water treatment).
This situation recalls the years of military rule in the early 1990s, when
the population with access to potable water in Port-au-Prince declined from
53 percent (1990) to 35 percent (1994). It should come as no surprise that
during the past several years, Haiti’s life expectancy has continued to
Can this decline in life expectancy be attributed directly to the embargo?
This question is difficult to answer, but it is clear enough that our
affluent and powerful country is failing once more to help the Haitian
people achieve decent conditions for themselves and their families. It is
also clear that aggressive humanitarian aid could have an immediate and
salutary impact if it can be channeled through institutions with national
Increasingly, however, aid has been decreased or funneled to nongovernment
organizations that, like our own, are often limited to serving local
populations of no more than some tens of thousands of people. UN agencies
and other multilateral organizations need to play a critical role in
providing humanitarian assistance to vulnerable populations in Haiti to
mitigate the effects of the aid embargo currently imposed by the United
In the 19 years that Zanmi Lasante has been working in Haiti, we have seen
US aid flow smoothly and generously during the years of Duvalier
dictatorship and the military juntas that followed. The current embargo has
been enforced during the tenure of a democratically elected government, a
situation inconsistent, in our view, with the articulated US policy and the
views of the American people, and is on the face of it immoral.
Such policies are both unjust and a cause of great harm to the Haitian
population, particularly to those living in poverty.
Dr. Paul Farmer is medical director of Zanmi Lasante and a professor at
Harvard Medical School. Mary C. Smith Fawzi is an epidemiologist with Zanmi
Lasante and an instructor at Harvard Medical School.