The UN’s Shame and Haiti’s Suffering

It’s well known at this point that the United Nations brought cholera to Haiti. The worst cholera outbreak in recent global health records, in a country that hadn’t seen cholera in its recorded history. 9700 people died. The UN then spent six years attempting to avoid admitting to its role in the transmission. Finally, molecular epidemiology traced the outbreak to a detachment of peacekeeping forces recently arrived from Nepal. Due to their improper disposal of human waste – they dumped it in a river without appropriate treatment – it took just four days after their arrival for the first case of cholera to occur.

Cholera is now endemic in Haiti, with an average of 30,000 cases per year since 2010. This is a substantial increase over the average number of reported cases from 1910-2010, which was zero. Hurricane Matthew has pushed outbreak levels even higher.

In December 2016, the UN finally came clean. It released a 16-page report that concluded, “the preponderance of the evidence does lead to the conclusion that personnel associated with the [UN’s peacekeeping] facility were the most likely source.” Secretary General Ban Ki Moon then personally apologized to the people of Haiti, in three languages, “We apologize to the Haitian people. We simply did not do enough with regard to the cholera outbreak and spread in Haiti. We are profoundly sorry for our role.”

The report also outlined a new approach to fighting cholera in Haiti based on global best practices. It called for a $400 million plan to reduce the incidence of cholera in Haiti and establishing a fund to support people who had suffered as a result of the cholera epidemic. Global Health experts praised the plan, as did human rights activists.

Now, three months later, the fatal flaw in this redress effort becomes apparent. Despite the handsome apology, the UN continues to disclaim any legal responsibility for the cholera outbreak. As a result, victims can’t sue for compensation. And the fund to support victims hasn’t materialized. Neither has the grand new approach in improving cholera surveillance and treatment.

Why? There’s no money for it. There never was. The United Nations funds this kind of emergency activity by issuing a funding appeal that calls for targeted donations from UN member states. They issued a $400 million appeal for cholera in Haiti and established a multi-donor trust fund to administer the money, with the intention of splitting the funding 50/50 between the efforts to fight cholera and the support fund.

Thus far, the appeal has raised $8 million, primarily from France and South Korea. That’s 2% of its funding goal. UN officials in Haiti are now quietly trying to lower everyone’s expectations. Victims of the epidemic will have to continue struggling on their own, or with a tiny amount of additional support. David Nabarro, the UN advisor tasked with raising money for the fund, has said that “I have never found it so hard to raise money for an issue as I am finding it to raise money for this.”

The reason for the fundraising failure is unknown, but its consequences are clear. Cholera will remain endemic to Haiti.

The UN harmed Haiti once, and then turned away, indifferent. That indifference, it seems, has spread to the international community. Given the chance to support justice for cholera victims and break the hold of cholera on the nation, donor countries have instead turned away.

This isn’t just a compassion problem. It’s also a systems problem. Having to hold an appeal every time its wants to implement a major activity is no way to run a functioning international organization. If we want the UN to be able to do real work, it needs a real budget. The fact we’ve chosen not to provide one is a telling statement about how the world views the UN.

I know I said I would be updating here, and I’m not back to writing Blood and Milk full time. You’ll still find most of my content at This World Needs Brave. It turns out, though, that this blog is a hard habit to break.

Self-promotion down here:

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Leaving Haiti

The other day, the WHO asked aid groups in Haiti not to leave for at least 60 days. I found that kind of confusing, to be honest, because no aid agency is going to leave Haiti on purpose. Their humanitarian mission will make them want to stay – these groups do after all, want to help people. So will their competitiveness. Getting to open an office in a new country is exciting, and expands an NGO’s global reach.

NGOs will leave Haiti when they no longer have the funding to stay. They will do their best to stay – intense public fundraising appeals, unsolicited proposals to government donors, staff drawdowns, and salary cuts – but eventually there will be no money to remain in Haiti. Then, and only then, they’ll leave. (Except MSF. MSF leaves when the “emergency phase is over.” But as far as I know, only MSF does that.)

That means there is no point in appealing to the NGOs to stay. The WHO is aiming its pleas in the wrong direction. It’s not, in the end, the NGOs’ choice. We need to donate the money to keep them there, and push our governments to do the same. Whether or not the NGOs stay in Haiti is up to us.


Photo credit: Zedworks

Chosen because – that’s how you leave, right? On a jet plane?

Three bad ideas for helping Haiti

plane over Haiti

In the rush to engage on Haiti, a lot of well-meaning groups are jumping in to help. Some are brand new, and some have never worked on a disaster like this before. Most of these groups are going to be useless. Some will actually do harm to themselves or others. A tiny minority will have a positive impact. I wish those odds were better, but they’re not.

I’ve seen three bad ideas for helping in Haiti floating around recently. I don’t want to single anyone out for criticism – after all, everyone is trying to do good here. But in this case, the culture of nice may be letting bad programs hurt people. I need to say something.

Bad idea #1 – 50,000 Shoes The idea is to donate 50,000 shoes in 50 days for Haiti. They are asking for a $5 donation for each pair of shoes. The problem with this idea is that it’s based on an assumption – that lots and lots of shoes are what Haitians need right now. What if they need clothes? Or food? Or water purifiers? Should they sell their new shoes and use the money to buy those things? Has anyone done an assessment to find out if shoes are needed? To decide what kind of shoes are needed?

The shoes could end up wasted and useless, absorbing people’s donations without providing any benefit. They could clog supply lines that also bring in desperately needed medicines. They could keep the local shoe suppliers from rebounding after the earthquake, and if badly chosen for the Haitian climate they can give people disgusting fungus.

This is almost a good idea. The time-delimited fundraising with easy to remember numbers will drive people to donate, and they’ve got celebrity endorsements that are raising their profile.

How it could be a good idea – call it $500,000 in 50 days instead of 50,000 shoes. That would double their fundraising goal (since they are trying to provide $250,000 of shoes) but I think they could pull it off, considering their level of media attention. Then they could make a high profile donation, including a ceremony with one of those oversize checks on poster board to Partners in Health.

Bad idea #2 – Flight to Crisis Volunteer doctors and nurses are banding together to charter a flight to Haiti and help with medical care. It’s brave, it’s scrappy, and it shows amazing initiative. It’s also a horrible idea. The people don’t seem to have any plan from bringing in their own supplies and haven’t set up a place to stay in Haiti. They don’t have a hospital to work out of or any background in responding to this kind of disaster. This is exactly the kind of misguided effort I was afraid we’d see, because Haiti is close enough to the US to make it possible. For more information on why this is such a bad idea, read this account of another group of health care providers that chartered a plane.

[Edited to add: please see comments below for a response from Flight to Crisis. They are better organized than their page makes them look.]

How it could be a good idea – in about three months, when rebuilding gets serious and Haitians have time to think, this group could choose a Haitian hospital to partner with. They could fundraise to help it rebuild, and donate supplies and equipment. They could visit the hospital quarterly to train the providers there as needed, and make sure that the equipment is in good shape and well maintained.

Bad Idea #3 – The Global Volunteer Network Haiti Project This project, which volunteers pay to support, is seeking people to volunteer for the following projects: working with children, teaching, health/medical efforts, building and construction, counseling, and business development. They say that volunteer trips can run from one week long to six months. This list seems designed to please volunteers, not meet the needs of people in Haiti. You already know that I am not a supporter of trips where you pay to volunteer.

This, however, is even worse than usual. This isn’t just useless feel-goodery for rich people. This will hurt people in Haiti. Traumatized children should not be making emotional attachments to volunteers who will be gone in six months. Volunteer labor for building and construction will keep Haitians from getting paid jobs to do the work themselves. And no outsider volunteer has any business providing counseling; counseling needs a background in local culture and context that a visitor won’t have.

How it could be a good idea – It’s almost impossible to rescue this one, but short-term volunteers could offer brief, targeted English or French classes to Haitians who needed them. They could cover technical topics that local teachers might not be able to offer. Not in a week. There really isn’t anything useful you can do in a week. But two months might work. It really wouldn’t qualify as disaster response – or rebuilding – but it would at least be useful.

For more information on how to help in Haiti, take a look at my Aid Watch post.

Photo credit: simminch

Me, in other locations

I’m writing less often for Blood & Milk because I am writing in other places now. Some recent stuff that might interest you:

The Lancet is Off-Base About Aid Agencies – at UN Dispatch

Nobody Wants Your Old Shoes – How Not to Help Haiti – at Aid Watch

Teaching Americans What Haiti Needs
– The New York Times (I didn’t write that one, I’m just quoted)

Should We Be Vacationing in Haiti Right Now? – at UN Dispatch

Haiti – Some Thoughts and Some Links

Rescuers in Haiti

Right now, the immediate emergency stage is already over, barring severe earthquake aftershocks. Tales From the Hood has some great posts up on Haiti and disaster relief. One excellent point:

The first phase of an emergency response is carried out by ordinary citizens in their own neighborhoods. Now, a day after the earthquake, the most nimble international aid agencies are just getting “feet dry” on Hispanola…All of those agencies will make dramatic statements about their life-saving relief work. But remember: At this moment people are being dug out and pulled alive from the rubble by their neighbors, husbands, mothers, and cousins…

I have a post at UN Dispatch on the health impact of an earthquake. Here’s the fast version – after the initial injuries are over, you need clean water, good toilets, and decent housing as fast as possible to prevent typhoid, dengue, and malaria.

Tales From the Hood, Aid Watch, and Good Intentions are Not Enough all have suggestions for who to give to for Haiti. My own suggestion is this – the single most important thing you can do when choosing where to donate is to pick an organization with a history in Haiti. That will make all the different in the speed and quality of their work.

I gave my own Haiti donations to two groups: Partners in Health (PiH), and Architecture for Humanity. PiH, founded by Paul Farmer, has an excellent reputation and a long history in Haiti. It’s also big enough to absorb as many donations as it gets. Architecture for Humanity has longstanding ties to Haiti, and strong relationships in country. They will be focused on the rebuilding effort, which is very important. Experience with the Tsunami showed that it’s easy to waste funds on building new structures that are culturally and environmentally wrong. I trust Architecture for Humanity to help make sure that Haiti builds back better.

Edited to add one more thing – Haiti doesn’t need donated goods right now. It’s difficult and expensive to ship donated stuff, and most donations will not be appropriate for Haiti. Now is the time to give cash.

Photo credit: American Red Cross

Things I don’t believe in #10 – Donating stuff instead of money (June 2008)

Pile of used clothes

Note: August is looking like a crazy and stressful month for me, with no time to blog here. To make sure no one gets bored and abandons me, I am going to re-run some of my favorite posts from the past.

Give money. Don’t send food, bottled water, clothing or useful-seeming stuff. Give money.

Your old stuff costs money to ship. It is almost always cheaper to just buy it in country, and doing it that way benefits the local economy. It’s also more respectful to survivors of humanitarian emergencies, and allows relief agencies to procure exactly what is needed instead of struggling to find a use for randomly selected used junk. Disaster News Network talks about the used clothes problem in “The Trouble with Trousers.” which features a really depressing anecdote about Hurricane Hugo.

Your food costs money to ship, too. It is probably not food anyone in the recipient area would recognize. How exactly will the people of Burma know what to do with canned refried beans or artichoke hearts? Sending donated American food doesn’t drive income to local farmers or help local retailers start selling again. Buying in-country gets food people will actually understand how to cook and supports the local economy.

Here’s another example – some people wanted to send their old tents to China to house earthquake survivors. A sweet idea – provide quick, free housing. But every different kind of tent would have different set-up instructions, and how many people save their tent instructions once they’ve learned how to do it? It would take a huge time investment in figuring out each type of tent, and then training for the people in China who had to set up the tents. All of this time translates to a delay in providing housing, and it’s time used by paid staff, which means it is also squandered money.

Interaction, the coalition of disaster-relief NGOs, has a nice piece about why cash donations are most effective. They mention needs-based procurement, efficient delivery, lower costs, economic support, and cultural and environmental appropriateness as advantages of cash. World Volunteer Web has a good explanation too, breaking down the myths about post-disaster aid.

Usually people end these kinds of articles with links to the three or so places who will take your old clothes and possessions for international donation. I am not going to do it. Don’t waste everyone’s effort that way. Give your old stuff to Goodwill, the Salvation Army, or St. Vincent de Paul; they’ll make the best use of it. They’ll sell your things locally and use the money for their charitable purposes.

Giving stuff instead of money is easy for you, it’s cheaper for you, and it’s quick. It is not quick, easy, or affordable for the NGOs who are actually trying to help people.

If you want to help, give money.

[Picture of old clothes in Haiti from Flickr by Vanessa Bertozzi]

May 2008 – What’s the difference between relief and development?

Palestinian Refugees

Note: August is looking like a crazy and stressful month for me, with no time to blog here. To make sure no one gets bored and abandons me, I am going to re-run some of my favorite posts from the past.

May 2008 – What’s the difference between relief and development?

The simplest breakdown goes like this:

Humanitarian relief programs are focused on rapid start-up, and rapid impact. Implementers of humanitarian programs need to gear up as fast as possible, and start providing necessary assistance as fast as possible. Their primary focus is not building local capacity, sustainability, or monitoring and evaluation. Their primary focus is getting help to people in need. They end when the emergency ends. Relief can come from the outside, and it is a response to some kind of breakdown or disaster.

Development programs are focused on achieving long-term change of some kind, with the intent of improving people’s lives and the lives of their descendants. They involve rigorous planning and ongoing operational research. They are rooted in local capacity building, because they are aimed at change which continues after the project ends. Even if it has outside support, development in the end has to come from inside.

In practice, however, it’s not that simple. (it never is, is it?) Sometimes the emergency doesn’t end. Situations that look like short-term humanitarian emergencies can go on for years, or even decades. Somalia, for example, Afghanistan, or Sudan. Programs designed to provide immediate assistance become a way of life for people in crisis. It would be nice if those programs could be converted into development programs, but it’s very hard to turn a relief program into a development program. The skill sets for the staff are different, for one thing. Building latrines and building community capacity can be a long, long way apart. You can hire new staff, though, or retrain your people. The other hurdle – usually the big one – is that relief programs and development programs have different donors.

Relief programs are generally funded by private donations and specific government donors. The US government, for example, funds emergency relief through the USAID Office of Foreign Disaster Relief. Development programs are far less popular with private donors, and they’re funded by a different set of government agencies. If you want to change the focus of your program, you have to get different different donors. Which mostly you can’t do. Donors don’t like to take over each other’s programs, you won’t be familiar with the new donor’s procedures and evaluation requirements, and development donors plan their financial priorities a long time in advance. They often won’t have money to pick up your newly transformed relief project.

Everyone’s perfect ideal for relief is to give aid that empowers the communities who receive it. Immediate assistance that also builds skills and improves quality of life for the long term. You could, for example, truck in water to a community struck by drought. Then you could dig wells and turn the wells over to local management. You could train a local engineering association or the Ministry of Water on well-digging and irrigation management and safe drinking water. We just need a funding structure that makes it happen.

Photo Credit: Castielli
Chosen because the Palestinian refugee camps are a classic example of emergency relief that has been going on far, far too long.