Originally: Remarks at Congressional Black Caucus Health Braintrust
Mildred T. Aristide
First Lady of the Republic of Haiti
Congressional Black Caucus Health Braintrust
March 5, 2003
First, I’d like to join Ron Dellums, Dr. Paul Farmer and the other panelists
in thanking the Congressional Black Caucus for organizing this important
forum. I’d like to also thank everyone here for their concern and commitment
to equity and justice in healthcare for all Haitians.
In the ideal world, today’s discussion on the health crisis in Haiti would be
all about healthcare. There should be dozens of Paul Farmers talking about
the impact of HIV/AIDS and Tuberculosis on the Haitian population, two
leading causes of adult deaths in Haiti. There should be teams of
pediatricians proposing strategies for universal vaccination campaigns
against the preventable childhood diseases which continue to kill Haitian
children. We should be questioning experts on the latest methods of water
purification, because unsafe water is still a leading cause of morbidity and
mortality in my country.
In short, a discussion about healthcare should be about just that:
healthcare. Unfortunately, we live in a less than ideal world, and so, such
is not the case. Before we can talk about the pressing health crisis that
Haiti faces, we must first talk about a series of issues so apparently
unrelated to healthcare — elections, OAS resolutions, multiparty democracy,
macro-economic governance measures — and I could go on.
We must because the provision of healthcare today in Haiti is inextricably
linked to these issues. Exactly 2 years ago, in the Spring of 2001, Haiti
and the Inter-American Development Bank finalized all the elements of four
loan agreements totaling $146 million. $22.2 million of that amount was for
the national healthcare system. The people of Haiti, through their duly
elected government, agreed to borrow this money at the terms set by the Bank
in order to extend the reach of the Ministry of Health so that the 60% of the
population living beyond the capital of Port-au-Prince would have greater
access to healthcare.
In order to activate these loans, the government of Haiti was told that it
had to pay the Bank $5 million in arrears. The government did so, knowing
that because these loans for healthcare, education, potable water and
secondary roads would respond to the needs of the people, this immediatepayment of so large a sum from the national reserves was justified.
But instead of releasing the loans, the loans were blocked. The healthcare
needs of 8 million people have become embroiled in a political fight fueled
by the political ambitions of a tiny minority coalition of opposition
political parties, and the push to impose on Haiti a notion of multiparty
democracy that does not reflect the electoral choices of the majority.
The New Partnership for Haiti Resolution, introduced by the CBC on April 18,
2002, demands that humanitarian assistance not be linked to a political
accord. It paved the road for Resolution 822 of the Organization of American
States which was adopted by unanimous consent in September of last year.
Resolution 822 officially de-links the humanitarian loans and assistance to a
political accord, calls for the normalization of Haiti’s relationship with
the international financial institutions, and it reaffirms the absolute
necessity for Haiti to adhere to the electoral process — the voice of the
majority — as it moves forward to resolve the political crisis. Exactly 6
months after Resolution 822, and a year and a half after the resignation of
the seven senators elected in May 2000, supposedly at the genesis of the
crisis, the loans still have not been released.
The requirement of a political accord has been replaced, or is now masked, by
another set of pre-requisite conditions, payment of arrears now totaling $21
million to the IDB alone, and approximately $60 million globally. In
addition, the elimination of subsidies on gasoline prices and other
macro-economic governance measures which they tell us are “really not that
onerous.” The gas subsidies were dropped at the end of last year, the price
of gas nearly doubled, and as predicted, the cost of living has skyrocketed.
The move has indeed proven onerous for the people of Haiti.
Before we can gain access to credit to invest in our healthcare system, we
are told that, at all cost, we must close the deficit in the national budget.
And a first step in closing the deficit is reducing government spending, in
part through lay-offs. On paper, a reasonable and rational goal for any
government. But in human terms, for a country like Haiti with a 70%
unemployment rate, losing a job condemns a person to unemployment with no
access to unemployment benefits or any other social safety nets. It reduces
drastically one’s chances of sending a child to school, and can very likely
leave a person homeless. Closing the government deficit gap, now, by
reducing government spending, with no social safety nets, is not so rational,
if indeed the purpose of government is to guarantee the welfare and wellbeing
of its citizens. If the government of Haiti does not employ its citizen,
fund its literacy campaign, build public schools in our rural countryside,
build public parks, and construct roads, who will?
A recent concrete example. Two Saturdays ago President Aristide inaugurateda health clinic constructed in downtown Port-au-Prince with the cooperation
of the Canadian government. The Government of Haiti and the President
expressed their great appreciation to the Canadians for this assistance with
the construction, which cost approximately $400,000. But I know that this
sentiment of appreciation was immediately followed by a great sense of
concern and urgency: where will the government find the funds needed from the
national treasury to staff this new clinic and buy the medications required
to deliver the healthcare so urgently needed? In short, without access to
additional funds, how do we expand desperately needed health coverage while
we reduce the government budget?
Some argue that the gap can be filled and is indeed being filled by
non-governmental organizations. Indeed, in Haiti’s Global Fund project on
AIDS, the NGO community, working in partnership with the public sector, plays
an important role. However, with the deep appreciation that I have for much
of the important work performed by NGO’s, funding NGO’s exclusively is not
the right strategy. As many NGO’s will tell you, the government’s role in
the provision of social service is central and cannot be delegated. Only the
Ministry of Health is mandated to provide national health coverage; Haiti’s
highly privatized education system has failed to school 45% of the school age
population, and only the Ministry of Public Works will build the roads
linking our isolated countryside. The national infrastructure must be
strengthened, if indeed the work of NGO’s is to have any impact. These are
the responsibilities of the state, all states, rich and poor, because the
right to healthcare and education are the human rights of all individuals and
should not be treated like commodities for sale on the open market.
Yes, economic reform by the government is needed; it is underway, it must
happen. The Haitian government must work hard to combat the legacy of
corruption left behind by the 31-year Duvalier dictatorship. But as this
reform goes forward, the international community — which turned a blind eye
to years of pillage and theft during the Duvalier dictatorship — should not
sit on the sidelines exacting more from the government while the people
suffer. Even the IDB was forced to acknowledge that the major factor behind
economic stagnation in Haiti is not inflation or government spending, but the
withholding of both foreign grants and loans of up to $500 million,
associated with the international community’s response to the political
In 1995, the amount of international aid that Haiti received (bilateral, from
the international banks and from the United Nations system) was $430 million.
By 2001 the total dropped to $120 million, with the bulk of this money going
to non-governmental organizations, and not the government. Before the onset
of this crisis, Haiti averaged $75 million annually in loans from the IDB,
today that number is zero. This, in a country that the world is so quick to
label the poorest in the Western Hemisphere. A country living with thehorrific health indicators that Dr. Farmer just described to us.
Something is wrong. Something is terribly wrong.
What is wrong, they tell us it is the government — that it has not done
enough to guarantee security, to fight impunity, to combat corruption, to
fight drug trafficking and to create political stability. Yet as they speak,
the international community continues to withhold assistance — technical and
monetary — targeted at precisely these areas. As one member of the OAS
recently described it, Haiti has been thrown in the water, hands bound, and
asked to swim.
An embargo on the lawful purchase of side arms and other standard police
equipment has kept an already undermanned police force, under-equipped.
Right now Haiti is experiencing an assault on its young democracy that is
being largely ignored by the international press. In fact, when the assaults
first began, they were even denied by representatives of the international
community in Haiti and by mainstream human rights organizations. Heavily
armed commandos dressed in army fatigues, declaring themselves to be former
members of the military and now aligned to the opposition, are attacking
police stations and killing police officers.
Two rented helicopters are hardly enough to patrol Haiti’s coastline for drug
traffickers. Yet Haiti is deploying much effort with limited resources
available to it, to stop the flow of drugs primarily destined for this
country. And indeed since President Aristide took office, the flow of drugs
from Haiti to the United States has dropped. The judicial system, imbued
with decades of corrupt practices, will not change overnight. Long term and
sustained efforts to train magistrates and judicial personnel, construct
adequate courthouses — as are underway — must be expanded. The successful
prosecution of the coup regime’s military high command for one of many
horrific massacres perpetrated during the coup and the imprisonment of police
officers accused of a brutal act of multiple murders, proves that it is
Much is possible since the foundation of democracy was established with
Haiti’s first free and fair elections in 1990. But it is a process that must
be supported and strengthened. Now is not the time for the international
community to turn its back on Haiti. A repressive army has been demobilized,
a civilian police force created. An unparalleled level of free speech exists
in Haiti and is unrestricted by any government censure.
Schools are being built in communities that have never benefited from the
public school system. For the first time in Haiti’s history we have a public
school lunch program. Just last month the executive submitted to Parliament
a bill increasing the minimum wage. Roads and bridges are linkingcommunities long isolated from regional markets. Literacy is a national
priority and the government seeks to significantly reverse the 55% illiteracy
rate in this year leading up to the bicentennial of our independence.
These efforts are being sustained by the revenues collected from the national
treasury by a government committed to investing in its people.
I have, inevitably strayed from the topic of the health crisis facing Haiti
today — just as the international financial institutions, charged with the
mandate of bringing development assistance to the poorest people of this
earth — have strayed from their mandate to do so. The false images of the
so-called political crisis and insecurity in Haiti have been allowed to
obfuscate the true human crisis in health, nutrition and literacy that
The challenge of poverty in Haiti and globally are great. 1.5 billion people
in the world living on less than a dollar a day, the developed world far from
meeting its commitment to set aside .07% of its GNP for foreign development
assistance, and the gap between the rich and the poor growing. Perhaps it is
frustration with these growing challenges that lead some to demonize the
victims of this global poverty, rather than combat the poverty itself.
It is a sad commentary on the vision of the international financial
institutions, that at a recent public meeting on Haiti, a high-level bank
official described Haiti’s Central Plateau as a “lunar landscape”. With no
peasants tilling the soil, this Bank official chose to blame the situation
not on the lack of irrigation systems, erosion, or access to seeds and
farming tools, but on insecurity; attributable of course to the government’s
insufficient efforts in this area.
This rush to ignore the root causes of misery in Haiti and to tie every event
to the “political crisis” is being echoed by so-called political leaders in
the opposition. It is not new. Exactly 110 years ago in Jackson Park,
Chicago, former U.S. Ambassador to Haiti, Frederick Douglass, had the
following to say about Haiti: “The fault is not with the ignorant many, but
with the educated and ambitious few. Too proud to work, and not disposed to
go into commerce, they make politics a business of their country. No
president, however virtuous, wise and patriotic, ever suits them when they
themselves happen to be out of power.”
The vast majority of the people of Haiti voted for President Aristide to make
“the business of their country” the task of feeding the people, providing
healthcare, potable water, education, land reform, and roads. This is the
will of the people that must guide Haiti. Yet those desperate to
short-circuit the electoral process seek to by-pass this most fundamental
element of democracy, the voice of the people.
I left Haiti yesterday afternoon as the country was awakening from a second
day of carnival and preparing to fill the streets for a final night of
dancing, music and revelry. Up to one million people, thousands from the
diaspora community, on the parade route in downtown Port-au-Prince, in open
defiance to the exaggerated and false images of “violence and insecurity”
painted by international press reports. A powerful demonstration of the true
unity and peace that is in the hearts of the majority of Haitians.
We appreciate very much the efforts of several numbers of the House and
Senate in coming to Haiti during the past six weeks to see this true side of
our country. The bill granting favorable trade status to Haiti and President
Bush’s pledge of increased funding for Haiti in its fight against AIDS were
some of the important issues raised. These are significant initiatives for
which we are grateful.
President Aristide sends his warm greetings. As we prepare to celebrate next
month the 200th anniversary of the death of our founding father Toussaint
Louverture and the bicentennial of our independence in 2004, we urge you to
come to Haiti and to continue to support the people of Haiti.
Thank you very much.