—by Paul Farmer
This appeal is followed by “Haiti Struggles with Humanitarian Disaster in Aftermath of Deadly Storms,” transcript of an interview between Paul Farmer and Amy Goodman on Democracy Now!
First published in La Prensa San Diego, issue of September 12, 2008:
Below is a letter written by Paul Farmer, co-founder of Partners in Health (PIH), an international organization dedicated to healthcare for the poor. Paul Farmer is a renowned medical doctor who has worked for many years among the poor in Haiti. In a Sept. 6 letter, he describes the scene on the ground in flood-ravaged Haiti, saying “I have never seen anything as painful.”
When the alphabet attacked Haiti—it received Hurricanes Fay, Gustav, Hanna, and Ike, in rapid succession—an estimated 800,000 were affected by massive flooding and lethal mudslides. Farmer writes that international aid has been disastrously slow in entering so Partners in Health has taken on the task of providing what it can in the face of dire need. He has asked to spread the word to our readers and encourages all to give generously to support PIH in these efforts—the donation link follows Paul’s letter.
Iam writing from Mirebalais, the place where our organization was born, having just returned from Gonaïves—perhaps the city hit hardest by Hurricane Hanna, which, hard on the heels of Fay and Gustave, drenched the deforested mountains of Haiti and led to massive flooding and mudslides in Northern and Central Haiti. A friend of mine said this morning: “I am 61 years old, born and raised in Hinche. I have never seen it under water.” Gonaïves, with 300,000 souls, is in far worse shape, as you’ll see from the pictures here. The floodwaters in Hinche are dropping, but as of 5 p.m. last night, when we left Gonaïves, the city was still under water. And hurricanes Ike and Josephine are heading this way as I write.
The need is enormous. After 25 years spent working in Haiti and having grown up in Florida, I can honestly say that I have never seen anything as painful as what I just witnessed in Gonaïves—except in that very same city, four years ago. Again, you know that 2004 was an especially brutal year, and those who work with PIH know why: the coup in Haiti and what would become Hurricane Jeanne. Everyone knows that Katrina killed 1,500 in New Orleans and on the Gulf Coast, but very few outside of our circles know that what was then Tropical Storm Jeanne, which did not even make landfall in Haiti, killed an estimated 2,000 in Gonaïves alone.
We’re faced with another round of death and obliteration. Haiti’s naked mountains promise many more unnatural disasters. We know that a massive reforestation program and public works to keep cities safer are what’s needed in the medium and long terms. But there’s a lot we can do in the short term to help out with disaster relief.
None of us regard PIH as a disaster-relief organization. Together, we’ve built PIH—meaning the network of locally directed organizations working in 10 countries—to serve a different cause. We wanted to attack poverty and inequality and bring the fruits of modernity—healthcare, education, etcetera—to people marginalized by adverse social forces. It seemed likely, as reports came in this week, that many other institutions and organizations would be far better able to respond to the after-effects of storms and floods. I’d been told, as the American Airlines flight passed over flooded Gonaïves, that the city was cut off from outside help, but even as I heard this, I knew that our own colleagues were there, volunteering what meager resources we had on hand, and a few hours later I was there too. I was hoping that we’d find that the city was receiving the expert attention of organizations trained to do disaster relief. So imagine my surprise, yesterday, when I discovered that very little in the way of help had reached Gonaïves or the other flooded towns along the coast.
Although it’s not true that Gonaïves cannot be reached by vehicle, it is true that the city center is still under water, and that the road into the city is well and truly flooded. Between Pont Sonde—the only way to the coast, since the major bridge between Port-au-Prince and Gonaïves is out, as is that to the north—and the flooded city, we saw not a single first-aid station or proper temporary shelter. We saw, rather, people stranded on the tops of their houses or wading through waist-deep water; we saw thousands in an on-foot exodus south toward Saint-Marc.
We saw a couple of UN tanks rolling through the muddy water over these streets, some Cuban doctors, and two Red Cross vehicles (one of them stuck in mud at least 10 miles from the city), and heard and saw helicopters overhead. But for the most part the streets were full of debris, upside-down vehicles, and dazed residents looking to get out before the next rains. Our friend Deo from Burundi was there and said it reminded him of nothing so much as what he’d seen there, and in Rwanda, in 1994—long lines of people carrying little more than their children, goats, and balancing sodden bags and suitcases on their heads.
A speedy, determined relief effort could save the lives of tens of thousands of Haitians in Gonaïves and all along the flooded coast. The people of that city and others have been stranded without food or water or shelter for three days and it’s simply not true that they cannot be reached. When I called to say as much to friends working with the U.S. government and with disaster-relief organizations based in Port-au-Prince, it became clear that, as of yesterday, there’s not a lot of accurate information leaving Gon-aïves, although estimates of hundreds of deaths are not hyperbolic. We had no cell phone coverage there and had to wait until last night to call people in Port-au-Prince. One sympathetic American friend, following up on our distress calls about a lack of relief, told me this morning the retort she’d heard from an expert employed by a UN-affiliated health organization: “Three days without water is nothing. People in Southern Haiti affected by Gustave went ten days without water.”
No human can go ten days without water. Food, perhaps. But not water. So we can expect that the people you see in these photographs, which I took by borrowing the digital camera of a ZL employee from Gonaïves (whose family, like all those you see, lost everything), are at great risk of falling ill with water-borne illnesses. There is also a lot of dead livestock floating down the streets of the city. The stench is overwhelming.
We are familiar with a lot of the Haitian officials charged with responding to this tragedy, which is, agreed, widespread. They showed up in Gonaïves: the district health commissioner, who is from the city and felt lucky to have avoided drowning; the coordinator of the government’s disaster response; nurses and doctors we’ve known over the years. They are doing the best they can with scant supplies. They are tired, thirsty themselves, hoarse-throated. Even Haiti’s newly-appointed Prime Minister, on her first day on the job, showed up this morning in Mirebalais, keeping a promise she made many months ago, long before she was directly involved in politics. She now has to install a new government, perhaps this afternoon, and respond to multiple disasters at once. These people, who are trying to help their fellow Haitians, deserve our help.
This is an appeal to staff, family, friends, and readers. Our co-workers in Haiti are already contributing what services and supplies they can. We will withdraw from Gonaïves (as soon as we get the information we need regarding urgent supplies and as soon as we see more evidence of the mainstream disaster-relief organizations) to Saint-Marc and Petite Rivière de l’Artibonite, where we will run the hospitals and health centers with our colleagues in the Ministry of Health; we will help organize food and some clothing for people in Gonaïves and refugees being brought in today from Gonaïves.
Mirebalais is going to be under a good deal of stress. As many of you know, the city’s hospital is not really functioning (in January, local protests about the hospital led to its closing, with patients evacuated to Cange, Boucan Carre, and LaColline). To my knowledge, at least 15,000 are expected to arrive here today—and they will come with nothing. They’ll need water, food, and shelter immediately, and the Mayor of Mirebalais, with whom we met this morning, is looking for dry spaces for them (maybe schools, etc) but there’s no bedding or mosquito nets or cots that I know of.
A U.S. Coast Guard cutter is to arrive in Gonaïves tomorrow with water and supplies, but by report last night’s attempt to dock a UN vessel and distribute food was not successful because of “fear of crowd control” (this was from an American friend in Port-au-Prince, so I can’t confirm anything other than what I saw: no widespread distribution of water or food or tents or tarps or anything).
Since ZL is, like all the PIH sister organizations, nimble, we can do a lot by pooling small donations from friends and family members and helping ZL respond in real time to requests from those coordinating the relief efforts. We’ll need to source things like tetanus vaccine (withdrawn from Gonaïves some months ago because of concerns over quality of a certain batch; I don’t know the details), first-aid supplies, oral-rehydration packs, and of course food, cooking oil, and fuel. Again, I know that conventional disaster-relief organizations have greater experience in logistics, and I am expecting they’ll have kits prepared for precisely these needs, but as of today these supplies are conspicuous by their absence. Problems with “crowd control,” refugees, and short tempers will only increase as the days go by—especially if more rain falls, as is predicted.
Over 20 years ago, someone explained to me that “wet poverty is worse than dry poverty.” I wasn’t then sure what that meant, but had a pretty good idea of the misery endured by those living through the rainy season in houses that, as the Haitians say, “can fool the sun but not the rain.” I’ve repeated the maxim often enough to merit teasing from my students, but the Haitians find it neither amusing nor over-used. Trying to sleep in wet clothes, on a muddy floor, is high on the list of degradingly uncomfortable activities. It’s better to simply give up and wait until daylight.
Surveying the devastation in Gonaïves, and the wretched population on roofs or wading through the streets or carrying bundles out of the city, we knew that these floods and the lack of effective response are not so much about the unruly forces of nature. Many of you on the Haiti team recall that we’ve long been based in a squatter settlement formed by the floodwaters of the Artibonite; that we spent years rebuilding lean-tos and shacks that didn’t even fool the sun; you’ll remember our co-worker’s mother swept away in a flash flood; or you’ve been part of a team of health workers watching helplessly as an ambulance is swept downstream before their eyes.
The world is waking up to these threats, but Haitians have long been pulling all-nighters as rainstorms keep them up rather than lull them to sleep. Please give generously to ZL’s efforts to intervene immediately, and share this with friends and family who might give even small amounts via the PIH website:
—Dr. Paul Farmer
first published in La Prensa San Diego, issue of September 12, 2008:
Haiti Struggles with Humanitarian Disaster in Aftermath of Deadly Storms
An interview between Paul Farmer and Amy Goodman:
(First published in Democracy Now/ War and Peace Report of 10 September, 2008)
Amy Goodman: In Haiti, a humanitarian disaster is unfolding after the impoverished country was hit by four major storms and hurricanes in less than a month.
As many as 1,000 people have died. An estimated one million Haitians have been left homeless. Rescue groups say they have no access to many interior villages across the southern region or to Gonaives, Haiti’s third-largest city, which has been cut off after a bridge collapsed. Much of Gonaives remains under water. At least 80 percent of the estimated 300,000 residents have been displaced or otherwise affected by the flooding. The city’s population has been stranded for days without food or drinking water. Many are making do sleeping on rooftops, with their animals and furniture, waiting for the water level to drop. Throughout Haiti, bridges, roads, clinics and homes have been washed away.
Dr. Paul Farmer is the co-founder of Partners in Health, a group that provides free medical care in central Haiti. After visiting Gonaives over the weekend, he wrote an urgent appeal for aid supplies to be delivered to Haiti immediately. Dr. Farmer wrote: “After 25 years spent working in Haiti and having grown up in Florida, I can honestly say that I have never seen anything as painful as what I just witnessed in Gonaives.”
Dr. Farmer is renowned in the world of global healthcare, a professor of medical anthropology at Harvard Medical School and the author of several books. He joins us now from Boston, just back from Haiti.
Welcome to Democracy Now!, Paul Farmer.
Dr. Paul Farmer: Thank you, Amy. Good to be back.
Amy Goodman: It’s good to have you with us. Why don’t you just describe what is happening in Gonaives and how you made it in there?
Dr. Paul Farmer: Well, the situation is perhaps most grave in Gonaives, but unfortunately, the entire country has been affected by these storms—southern Haiti, northern Haiti and even central Haiti, where we’ve never seen flooding before.
As for getting into Gonaives, you know, just—I had heard, even from the air where one could see approaching Port-au-Prince, that the city was under water. I had heard that the—it was not possible to get there. But we just went there in a jeep. Now, Saturday night—there are three main ways into Gonaives: from the north, the south and from the central area of Haiti, where we work. We also work close to Gonaives, a little bit further south on the coast in a town called St. Marc, also badly affected by the storm. But Saturday night, Sunday morning, the way that we got in, the bridge through central—from central Haiti also collapsed. So, although it’s more difficult than ever to get into Gonaives, I’m confident that a determined relief effort could reach all of those people stranded there, since we’re not really specialists in disaster relief and we didn’t have much trouble getting there. In fact, my colleagues there today tell me they intend to go back to Gonaives, and whether that’s by using a small boat or just getting through the—past the collapsed bridge with four-wheel drive vehicles, we’ll see. But I think that what is clear is that people can get into Gonaives with water and food and temporary shelter.
Amy Goodman: Well, can you talk, though—just describe the picture of what you saw. What are people saying inside? And where is the Haitian government in all of this?
Dr. Paul Farmer: Well, I’ll take those as two different or three different questions. What I saw was something I had never seen before, except in that same city four years ago, when Tropical Storm Jeanne brushed the northern Haitian coast, never making landfall there, and killing 2,000 people in Gonaives, which is—was the same time, more or less, as Katrina. And it was the city—the downtown of the city, the central area of the city, in water, and I saw huge numbers of people in the streets, but they were all people from Gonaives. Very few—this is Friday—on Saturday, very few people from disaster relief organizations had really reached there.
As for the Haitian government, they were there. Their officials were there. And you may recall that over past few months Haiti has not had a government, because the prime minister was—lost his job because of the food insecurity issue, again, which Haitian governments have little to do with. So it was actually not until Saturday, when the new Haitian government was installed. And on that day, Saturday, we met with the new prime minister. And she spent her first day on the job working on disaster relief. The problem is, the Haitian government and the Haitian state have been so hollowed out over the last several years that they really don’t have the resources that they need. But the people in charge of responding, the doctors and disaster relief employees and the volunteers, they were there in the city doing what they could with what they had. The problem is, they just don’t have anything.
And so, that leads to the third part of your question: how do the people feel? Well, you know, they’re angry, and they’re upset, and they’re frightened. And they’ve lost their property. And many of them have lost family members. And they’re still stranded on top of these ramshackle buildings. And in one house, for example, there were about a hundred people crowded into one single-family dwelling on top of the roof and, you know, in the dryer parts of the house. And you could see that all over the center of the city. So, again, getting food and water and medicines to the people inside that area and also to those who have been pushed further south towards places like the ones in which we work or into the center of Haiti is going to be an urgent—it is an urgent, has been urgent, and also feasible.
Amy Goodman: Dr. Paul Farmer, can you talk about why Haiti has been so hard hit? Is this just the force of these storms and hurricanes? In the headlines, we read about Cuba, that suffered billions of damages to their buildings, but very few people have died, about four. What specifically in Haiti now, aside from perhaps being ground zero, like deforestation?
Dr. Paul Farmer: Well, you’re right to signal the difference between those two places, because I have little doubt that Cuba was harder hit by Ike than Haiti and may have been harder hit just in general by these storms. But they have a fairly well-coordinated—a very well-coordinated disaster relief system that allows them to move hundreds of thousands, sometimes millions, of people on fairly short notice into shelters. Haiti doesn’t have that. So that’s one area.
A second is, as you mentioned, deforestation. The force of these storms is felt principally in flash flooding that occurs because the highlands get hit and then there’s no trees to protect against erosion, and the rivers from the mountains swell and sweep away bridges and people and homes.
And then there are other actions. For example, from what I understand about the early Sunday morning bridge collapse—this is the bridge that I got out on Saturday—what I heard this morning is that a flash flood that hit the UN military base in the city of Mirebalais swept over a dozen containers into the river, and the containers hit the bridge and took it down. And so, you have this sort of chaos in Haiti that I don’t think you have in other areas.
And you also have the ecological disaster that underpins the entire process. And again, the chaos and the ecological disasters are caused by humans and not the wrath of God. So, ostensibly, we could respond to them. It’s going to take a long time, but in the short term, disaster relief is, of course, what people are asking for.
Amy Goodman: Dr. Farmer, before we talk about what exactly people need, on that issue of deforestation, I don’t think many people in the United States are that familiar with how it takes place. Can you talk about the economy of this country and why people cut down trees on the mountains, on the hills?
Dr. Paul Farmer: There is a deep history of deforestation, which has to do with the slave plantations from long ago. In the mountains, the deforestation is now occurring principally because people, the poor who live in them, don’t have cooking fuel. They can’t, you know, cook a pot of rice without charcoal. And the charcoal comes from trees.
Now, I work in those areas and know that people understand that this is, you know, a short-term gamble. They understand, in my experience, that this is going to be bad for the prospects for their country and their own little bits of land. But, again, they’ve been pushed into a corner, where they have no option other than to cook with charcoal. And, you know, that’s not going to slow down until there is a very aggressive attempt to provide alternative fuels to the rural poor and, at the same time, to link reforestation with some meaningful job creation and assistance, so we can lessen the poverty and food insecurity in Haiti. And that’s really the basic reason why people are cutting down trees.
Amy Goodman: This disaster also comes in the wake of a major food crisis.
Dr. Paul Farmer: That’s right. And it’s really, you know, adding insult to injury. Haitians were already hungry and living on the edge, and sometimes dying on the edge, before these four storms hit, and since, it’s affected so much of the country. You mentioned over a million refugees out of maybe nine million people. It’s going to make the work that we all know needs to happen to decrease poverty and to lessen food insecurity—it’s going to make it all that more difficult. It may also wake up people to the gravity of the situation so that we can have the kind of assistance that we need.
I work with an organization called Partners in Health, as you mentioned, and although we’re not a disaster relief organization, we’ve found ourselves in the position of providing emergency relief to people on the coast and in central Haiti. And we’re considering this part of our short-term response, but it’s going to be linked to ongoing, long-term investments in infrastructure and reforestation, which we’ve been doing successfully in the center of Haiti. And I think the reason we’ve been successful at it is because we’ve been creating alternatives, including alternative employment for people, so that they don’t have to cut down trees, sometimes even cutting down trees for a living to sell charcoal.
Amy Goodman: We’re going to break, and we’re going to come back to Dr. Paul Farmer, professor of medical anthropology at Harvard Medical School, founder of Partners in Health, which is based in Haiti and in different countries around the world. He’s just back from Gonaives, one of the hardest hit but by no means the only city in Haiti that has been affected by storm after hurricane after storm after hurricane. It’s believed more than a thousand people have died, more than a million displaced. Stay with us.
Amy Goodman: Dr. Paul Farmer is our guest, professor of medical anthropology at Harvard Medical School. He’s actually just up from Haiti, back in Boston. He is cofounder of Partners in Health and associate chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital in Boston. He’s written many books, including Infections and Inequalities and From Outrage to Courage: Women Taking Action for Health and Justice. And Partners in Health has clinics all over the world, the first one in Haiti.
Dr. Farmer, can you talk about water-borne diseases now, as Gonaives is under water and you point out that all of Haiti is in mass crisis now?
Dr. Paul Farmer: I think that the first wave of medical complications of these storms is already being registered. And the biggest problem will be, in addition to just thirst, dehydration, hunger, is going to be water-borne disease. And, you know, it’s an obvious mechanism, I’m sure, to everybody who listens to this show, and that is that when impure water is the only thing people have to drink, they’re going to drink it. And that’s going to cause dysentery. You know, even that’s how cholera outbreaks occur, is because of, you know, fecal oral contamination. The water is contaminated by human and animal waste.
And, you know, in Gonaives, for example, and in all these other towns on the way and in St. Marc, the water is standing in the streets. And one of the things that really struck me, in looking at this long line of people, this exodus out of the city on foot, alone, was that they were all thirsty, that they—that was what they asked us for was water. Now, we hadn’t come on that day bearing water, because we assumed that there would be a more conventional disaster relief organization having addressed this already, and that was not the case, alas. So, you know, thirst is the first thing, and then these water-borne diseases.
Amy Goodman: In reading the calls for help, Haitian President Rene Preval said in an interview with the Miami Herald, “We need a flood of helicopters, because there’s a lot of food coming into Port-au-Prince that can’t reach the provinces.” And then we read that the US Navy’s USS Kearsarge arrived in the waters off Haiti Monday to support USAID’s efforts to assist the devastation, but the helicopters couldn’t find a suitable place for supplies to be unloaded, according to the Associated Press.
Dr. Paul Farmer: Well, I think that the president is right to say that we need to use helicopters in addition to boats and, as I said, jeeps, because the trucks, the big trucks, can’t get into Gonaives, I’m pretty sure. That must be—that’s true, with the bridge collapses that we mentioned. But I saw the helicopters overhead. And even though it’s not in his terrain, and I’m not a pilot, you know, it seems difficult to believe that you can’t land a helicopter somewhere in that area that isn’t cut off. So, you know, I would just echo that we need to use air, sea and land as best we can to get food and water out of Port-au-Prince or just out of—off ships into that city.
Amy Goodman: You sent out an urgent appeal. What exactly can people do?
Dr. Paul Farmer: Well, that was an appeal to my coworkers and supporters of Partners in Health. And what we’re looking for are the means to obtain water, food, temporary shelter. I just spoke to one of my Haitian colleagues, and she said, “Don’t forget boats.” And that’s for central Haiti, which is up in the hills, and so you’d think it wouldn’t be flooded. But in order to move people across some of these streams and also to reach other villages that are half underwater, you’re going need boats. She mentioned also the obvious things: soap, you know, and in medical supplies.
The problem we’ve had is that people do want to help, and yet it’s very difficult to move, for example, clothes—I don’t know if I mentioned clothes—small shipments of things. You know, how would you get them from the United States to Haiti? You get them there by container by sea. It takes too long. And one needs to put these kind of things together in a single package so that you don’t have a huge number of small shipments.
So we’re looking for financial assistance for our disaster relief efforts. We’re also trying to coordinate our efforts with the Haitian authorities in central and coastal Haiti. That’s an important thing for people to keep in mind, is that there is a government human infrastructure to do this work, and coordinating with them is really critical. We’re trying to update our own supporters on pih.org on what’s going on every day, without putting too much pressure on our Haitian colleagues who are working so valiantly to respond to the urgent needs of those afflicted.
Amy Goodman: Explain what life straws are.
Dr. Paul Farmer: I’m not the best person, Amy, to do it, but my understanding is that there are a number of devices that can be used to filter impure water so that people can take this dirty water and run it through a straw or other filters and have something that is at least safe or safer to drink. And we’ve also been looking at filtration devices. We’ve been doing this for many years, of course. But we’ve been trying to get some of those into Haiti.
Amy Goodman: And finally, Dr. Paul Farmer, you’ve written extensively about the history, the political history, of Haiti and, more recent, the coups against President Aristide, who still has not been able to come back to Haiti, remains in South Africa—the first US-backed coup against him ’91 to ’94, the second one in 2000. Can you talk about how that affects the people today?
Dr. Paul Farmer: Well, I mean, I think we’re—you know, we’re seeing the results in terms of a weak and hollowed-out—
Amy Goodman: 2004.
Dr. Paul Farmer:—public sector. Right. And we’re seeing—between 2004 and now, we’re seeing the results of that. There are plenty of Haitians of good will who would like to help and are helping their neighbors and citizens of their country, but without an infrastructure and without a stable government, it’s very difficult to build up this capacity. And so, in my view and the view of many Haitians, you know, letting democracy flourish in Haiti is really part of the recipe for avoiding future disasters. You know, we have to stop destabilizing democracy, and any other country that’s doing that also needs to stop, in order to have a long-term strategy that will remain in place for decades. And, you know, you can imagine how difficult it’s going to be to have a reforestation effort really take root without broad-based social support. And there is broad-based social support for democracy in Haiti. And so, we should respect that and do everything we can. I’m speaking as an American now, and the American people should do everything they can to support democracy in Haiti.
Amy Goodman: How has the US destabilized Haiti?
Dr. Paul Farmer: Well, over the—you know, we have the two oldest countries in the hemisphere. And so, between 1804 and now, we have not often been a very—government-to-government, often—not often been a very positive force. There have been many mechanisms used to destabilize Haiti: media campaigns, support for armed groups like the Haitian military. The modern Haitian military was really founded by a US act of Congress during the American occupation of Haiti. And although that army was demobilized under the democratic governments, you know, the leftovers and the weapons remain. So, you know, we need to side with those who believe that every Haitian adult should be able to vote and choose the kind of governments that they want.
Amy Goodman: I want to thank you for being with us, Dr. Paul Farmer. Are you headed back to Haiti?
Dr. Paul Farmer: I am.
Amy Goodman: Dr. Paul Farmer, professor of medical anthropology at Harvard Medical School, cofounder of Partners in Health. The updates are on the website pih.org.
First published in Democracy Now/ War and Peace Report of 10 September, 2008: