Commentary

Rebuilding a Stronger Haiti

in Program

By Sarah Kornblet – In late May, the Senate Foreign Relations Committee passed a bill authorizing $2 billion in reconstruction funds for Haiti over the next 2 years. The ”Haiti Empowerment, Assistance, and Rebuilding Act of 2010,” co-sponsored by Sens. John Kerry [D-MA] and Bob Corker [R-TN], aims to rebuild Haiti, with the hope of making the country stronger than before. The bill is only a first step, and as it makes its way through the legislative process, has already been pared down in terms of funding. While there are numerous other bills aimed at helping Haiti floating around Congress, this legislation usefully calls for the direction of a Senior Haiti Coordinator, housed in the Department of State, to coordinate all US policies on Haiti. The bill also puts USAID in charge of developing a multi-year “Haiti Rebuilding and Development Strategy,” including strict reporting, monitoring, and evaluation requirements, a good first step in a longer-term solution.

This bill is part of a much larger outpouring of monetary aid to Haiti that, in the past 5 months, has demonstrated reflexive generosity and our hopes that this small country in the Caribbean, the poorest in our region, can rebuild a more stable society. While disaster response continues to improve in terms of delivery of services on the ground, what comes after – the rebuilding – is still a challenge. This Haiti bill, and the $2 billion that comes with it, is a chance to start going beyond reconstructing buildings and houses, and to remake a broken system so the next disaster is not so devastating for the country’s already burdened population.

As many of us witnessed on TV in the days following the earthquake, without hospitals or health care facilities, relief crews were forced to make the best out of a bad situation. Too many injured people waited too long for treatment, despite herculean efforts. The exact number of amputees is still unknown, but they number close to 100,000. Another hundred thousand people are now severely disabled. These cases have overwhelmed Haiti’s already overburdened health system. Prior to the earthquake, over half of Haiti’s population lived on less than $1 per day. An estimated 120,000 people have HIV/AIDS, and 50,000 kids live in orphanages. Because Haiti lacked basic infrastructure, the rebuilding process has been overwhelming for donor governments, NGOs, and most importantly, Haitians themselves. We are already seeing signs of wavering and impatience on the ground. This is why it is vital to work directly with the Haitian government and assist in building security on the ground. It is equally important for trained professionals to assist Haiti in developing strong infrastructure in individual sectors, but not to lose sight of the whole picture.

According to the World Health Organization (WHO), before the earthquake, HIV/AIDS, respiratory infections, meningitis, diarrheal diseases, and perinatal conditions — all mostly preventable — accounted for almost half of all deaths. Just as shocking are the under-5 and maternal mortality rates (112 per 1,000 and 680 per 100,000, respectively). Access to clean water and sanitation always has been a huge problem in Haiti, and is doubly so now. For example, in 2006, only half of the rural population had access to improved drinking water, and less than 30% of both urban and rural populations had sustainable access to improved sanitation. In the aftermath of the earthquake, those percentages have plummeted. The lack of basic public health infrastructure is at the core of Haiti’s problems, and makes post-earthquake recovery even more of a challenge.

Beyond the Senate bill, a broader effort is underway to bring international aid more in line with general anti-poverty programs, which in countries like Haiti means development and better health care systems. The United Nations International Strategy for Disaster Reduction (UNISDR) has recommended dedicating 10% of all humanitarian aid to development. Haiti presents a prime opportunity to put into practice what the international aid community has acknowledged: efforts to reduce disaster risk must be integrated into development and poverty reduction policies. To help Haiti survive the next disaster, which will most likely hit before ultimate development goals can be reached, it is vital to build a solid foundation for community resilience.

This includes not only providing citizens with access to clean water and sanitation, but also reliable health services to respond to a new generation of amputees, the increasing burden of chronic diseases, and a host of existing problems on the ground in Haiti. The key is translating cost-effective interventions for the immediate needs of people so that funds authorized in this bill can be stretched and used for sustainable development projects. Some efforts may be as simple as facilitating South-South partnerships: for example, while artificial limbs in the US can cost $1,000 to $2,000 per limb, technology in India and Africa enables production for under $200.

Good governance and community buy-in are fundamental to this process, but so is the willingness of donors to look beyond the disaster and see the potential for creating something better. Efforts on the ground (and from Washington) must include recognizing the uniqueness of the island. We need investments in long-term solutions to reduce poverty and empower the people. US and Haitian health experts recognize improving overall health status – particularly maternal-child health – could reduce susceptibility to crises and build human capital for economic growth. The question is, how patient can we be in building good governance and community-buy in, rather than trying to fix all of Haiti’s broken health services at once?

The Kerry-Corker bill is a step in what will certainly be a much longer up-hill climb. The bill makes important statements regarding the essential need to support the government of Haiti and include the local people in policy decisions – things NGOs and donors have not always been able to (or wanted to) do in the past. It discusses the need to expand access to basic shelter, health care, clean water, and sanitation. All these points make for a development plan and an improved Haiti 10 years down the road. What Haiti needs now, along with stronger Congressional action, is vision, determination, and follow-through.

Photo Credit: Fred W. Baker III, http://www.defense.gov/PhotoEssays/PhotoEssaySS.aspx?ID=1535


Sarah A. Kornblet is a Research Fellow with the Global Health Security Program at the Stimson Center.

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