Medical anthropologist and physician Paul Farmer is a founding director of Partners In Health, an international charity organization that provides direct health care services and undertakes research and advocacy activities on behalf of those who are sick and living in poverty.
Dr. Farmer’s work draws primarily on active clinical practice (he is an attending physician in infectious diseases and chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital (BWH) in Boston, and medical director of a charity hospital, the Clinique Bon Sauveur, in rural Haiti) and focuses on diseases that disproportionately afflict the poor.
Along with his colleagues at BWH, in the Program in Infectious Disease and Social Change at Harvard Medical School, and in Haiti, Peru, and Russia, Dr. Farmer has pioneered novel, community-based treatment strategies for AIDS and tuberculosis (including multidrug-resistant tuberculosis). Dr. Farmer and his colleagues have successfully challenged the policymakers and critics who claim that quality health care is impossible to deliver in resource-poor settings.
Paul Farmer and his organization, Partners In Health, were featured on the front page of the New York Times on Sunday, November 30, 2003, in a long and admiring piece about their work in combatting AIDS in Haiti.
A healer in Haiti: Dr. Paul Farmer believes people have the right to medical care no matter how rich or poor they are or where they live. The former Brooksville resident’s methods are being copied around the world. [2/22/04] – In January, the St. Petersburg Times visited former Hernando County resident Dr. Paul Farmer, who has provided health care in central Haiti for more than 20 years.
Dr. Farmer has written extensively about health and human rights, and about the role of social inequalities in the distribution and outcome of infectious diseases. He is the author of Pathologies of Power (University of California Press, 2003), Infections and Inequalities (University of California Press, 1998), The Uses of Haiti (Common Courage Press, 1994), and AIDS and Accusation (University of California Press, 1992). In addition, he is co-editor of Women, Poverty, and AIDS (Common Courage Press, 1996) and of The Global Impact of Drug-Resistant Tuberculosis (Harvard Medical School and Open Society Institute, 1999).
Following an interview with Paul Farmer: The floods have been devastating in low-lying areas of Haiti. What has the impact been in the Central Plateau?
Mudslides and flash flooding have been bigger problems than groundwater flooding. The road to Boucan Carre (a town where Zanmi Lasante operates a hospital and several social programs) was impassable last week. Impassable, at least, to the trucks carrying the building supplies for the housing proect. But the biggest problem for people in central Haiti is they can’t stay dry during the rainy season. The thatch huts just can’t keep the heavy rains out. These houses are just not worthy of the name and need to be replaced with tin and cement.
The arrival of U.S. Marines seemed to some people in America to be at least a short-term solution to the chaos of the revolt this winter. From what you’ve seen, have the Marines helped restore order?
In central Haiti there have been no Marines, and there are no Haitian policemen. Many of the latter were shot by the “rebels,” who are really the former military who came in across the border near us. And although I hear there are Chilean troops in Hinche (in the Central Plateau) the other cities and towns you visited are all pretty much in the hands of former Haitian military. They are the people who in the past stole our ambulances, took members of our staff hostage, etc. They’ve been pretty tame recently, but then again, who is there to stand up to them?
So at least the paramilitary aren’t setting up roadblocks and hassling your workers the way it did when it controlled the country in the early 1990s?
Actually, there have been numerous roadblocks since the beginning of March, and most of them have been paramilitary. The delivery of supplies has been interrupted on a number of occasions, and we have been unable to travel to places like Hinche or Port-au-Prince. We have taken steps to prevent staff from being harmed in any way. We remind our staff that they are not obliged to travel on the road when they feel unsafe. We listen to the radio, try to be prudent and do not travel at night.
Your treatment of AIDS and tuberculosis patients depends on residents delivering medication to fellow villagers, usually on foot. With the roadblocks and flooding, have these community health care workers been able to keep up with their deliveries?
Yes, the workers have done a great job. On this score, we have discovered that good community-based care can function even in times when roads are blocked. They’ve been keeping their neighbors alive.
We saw horrible deprivation among the people in the Central Plateau when we visited in January. Has that changed since the arrival of the Marines and the departure of Aristide?
There has been no visible improvement from the vantage point of the rural poor. The real crises in Haiti are humanitarian and political. As far as I know, the Marines are not involved in either the humanitarian crises – although certainly they helped bury those drowned last week – or the political ones. The humanitarian crisis will only be addressed by dealing with hunger, excess burden of disease, unsafe drinking water and dangerous roads. These were the problems that were to be addressed by the aid that was blocked by the U.S. administration for the three years preceding Aristide’s removal.
There was promise of restoring aid after the takeover. Has that happened? Has aid made its way to the Central Plateau or to the governmental department you work with most closely, the Ministry of Health?
I don’t know that the aid has been released. Some has been sent to Port-au-Prince, but has it filtered into the Ministry yet? I doubt it.
If the living conditions haven’t improved and, as you often say, most of the disease that you treat is caused by poor living conditions, I guess the Zanmi Lasante hospitals and clinics are still overcrowded?
We are overwhelmed. We are seeing people from southern and northern Haiti, as well as from the area we seek to serve. The health crisis is far from over, and more bad weather will worsen it by polluting groundwater and triggering more flash flooding.
You were trying to address the overcrowding with an ambitious expansion program. Has this proceeded as planned?
Perhaps not as planned, but we have proceeded. On the day we were to open our office in Hinche, one of our vehicles was commandeered by paramilitary forces. They’re still around, but we opened the office anyway. And we are dedicating the Boucan Carre community hospital and microcredit bank on July 8, pretty much on time. We’re determined to continue our efforts to improve medical and educational services to the people of central Haiti, and this is not work we care to see politicized in any way.
You said the humanitarian process can be solved only with more international aid. How about long-term solutions to the political crisis?
It’s popular to say things like “The Haitians have to solve their own problems,” but it’s silly. The Haitians did not create slavery, chronic interference with their internal affairs, gunboat diplomacy, foreign occupations and a long history of trade and aid embargoes. The Haitians did not create unfair economic policies. These were created outside of Haiti. Erasing Haiti’s debt, restoring constitutional rule, ending arbitrary aid embargoes and sinking significant resources into public health, public education and public infrastructure would be central to addressing and indeed solving Haiti’s social problems. Haiti’s flooding is a result of the ecological disaster (deforestation) that’s been worsening over the past several decades, and that could be addressed, too. But exhorting peasants not to cut down trees for firewood is not the way to address deforestation. How else are they going to cook their food?
According to a recent New York Times story, the Bush administration has spent about $191-billion on wars in Middle East. At the same time, the U.S. government has cut back on the president’s pledge to dedicate $15-billion to fight AIDS. Do you ever think about what could be accomplished if some of the military funding had been redirected to health care?
I think about it every day. I never fail to think about it. The program for rebuilding Haiti, and for taking on the diseases of the poor globally, would cost peanuts compared to what it’s cost to finance the wars you mention. And of course I’m just talking about the financial costs. As a physician, I think every day about the human cost of war, too. I can’t imagine it’s possible to put a price tag on that. Dan DeWitt can be reached at 352 754-6116 or email@example.com.
Book: Paul Farmer, Pathologies of Power, Health, Human Rights, and the New War on the Poor, 0-520-24326-9, With a New Preface by the Author; California Series in Public Anthropology, 4; Foreword by Amartya Sen. Paperback 0-520-24326-9.
DESCRIPTION: Pathologies of Power uses harrowing stories of life–and death–in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.
Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.
From the Foreword: “Paul Farmer is a great doctor with massive experience working against the hardest of diseases in the most adverse circumstances, and, at the same time, he is a proficient and insightful anthropologist. Farmer’s knowledge of maladies such as AIDS and drug-resistant tuberculosis, which he fights on behalf of his indigent patients, is hard to match. But what is particularly relevant in appreciating the contribution of this powerful book is that Farmer is a visionary analyst who looks beyond the details of fragmentary explanations to seek an integrated understanding of a complex reality.”–Amartya Sen, Nobel Laureate, Economics.
ABOUT THE AUTHOR: Paul Farmer is Professor of Medical Anthropology at Harvard Medical School and Founding Director of Partners In Health. Among his books are Infections and Inequalities: The Modern Plagues (California, 1999), The Uses of Haiti (1994), and AIDS and Accusation: Haiti and the Geography of Blame (California, 1992). Farmer is the winner of a MacArthur Foundation “genius” award and the Margaret Mead Award for his contributions to public anthropology. He recently held the Blaise Pascal International Chair at the College de France. Amartya Sen, whose work challenges conventional market-driven economic paradigms, is the winner of the 1998 Nobel Prize in economics. He teaches at Trinity College, Cambridge University.
“Paul Farmer is a superb physician, a penetrating anthropologist, and a prophet of social justice. He combines an unflinching moral stance–that the poor deserve health care just as much as the rich do–with scientific expertise and boundless dedication. He has saved the lives of countless destitute patients in Haiti, Peru, and Russia, and he has shown that effective health services, even complex medical regimens, can be put in place in impoverished communities. . . . Farmer’s moral philosophy, anthropological insights, and medical successes are described in his trenchant and timely new book, Pathologies of Power.” Jeffrey Sachs, Natural History
Dr. Farmer is the recipient of the Duke University Humanitarian Award, the Margaret Mead Award from the American Anthropological Association, the American Medical Association’s Outstanding International Physician (Nathan Davis) Award, and the Heinz Humanitarian Award. In 1993, he was awarded a John D. and Catherine T. MacArthur Foundation “genius award” in recognition of his work. Dr. Farmer is the subject of Pulitzer Prizewinner Tracy Kidder’s Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World (Random House, 2003).
Dr. Farmer received his Bachelor’s degree from Duke University and his M.D. and Ph.D. from Harvard University. He is the Presley Professor of Medical Anthropology in the Department of Social Medicine at Harvard Medical School.
AWARDS: C. Wright Mills Award Finalist, Society for the Study of Sociology
Biography: Dr. Paul Farmer, Physician, Medical Anthropologist, Writer, 1959- “If access to health care is considered a human right, who is considered human enough to have that right?”
RELATED WEB SITES: Read a recent Paul Farmer interview about Haiti’s current situation.
Medical Anthropologist and physician Paul Farmer has dedicated his life to treating some of the world’s poorest populations, in the process helping to raise the standard of health care in underdeveloped areas of the world. A founding director of Partners In Health ( 1987), an international charity organization that provides direct health care services and undertakes research and advocacy activities on behalf of those who are sick and living in poverty, Dr. Farmer and his colleagues have successfully challenged the policymakers and critics who claim that quality health care is impossible to deliver in resource-poor areas.
Paul Farmer began his lifelong commitment to Haiti in 1983 when still a student, working with villages in Haiti’s Central Plateau, determined to bring modern health care to the poorest people in the Western Hemisphere. Starting with a one-building clinic in the village of Cange, Farmer’s project has grown to a multiservice health complex that includes a primary school, an infirmary, a surgery wing, a training program for health outreach workers, a 104-bed hospital, a women’s clinic, and a pediatric care facility. It has become a model for health care for poor communities world wide.
Born in Massachusetts into a family of six children, Farmer grew up in Florida. He received a bachelor’s degree from Duke in 1982, and both an M.D. and Ph. D. in Anthropology from Harvard in 1990. He has written or co-written over 100 scholarly papers, as well as books including Infections and Inequalities ( 1998), and Pathologies of Power ( 2003).
In 2003 author Tracy Kidder wrote a best selling book about Farmer and his work, Mountains Beyond Mountains: the Quest of Dr. Paul Farmer, A Man Who Would Cure the World. This book brought international attention and support to Farmer’s work.
Among the numerous awards Dr. Farmer has received in the last decade is the Heinz Award for the Human Condition. Its citation reads, “To say that Dr. Paul Farmer is a life saver does not begin to describe the impact of his work. Dr. Farmer and his extraordinary organization have been a force in making the world confront the health care needs of those who historically have never had access to proper care. Because of his dedication and compassion, critical health care services are now being administered around the globe to people who previously would have been left untreated.”
Article: Who removed Aristide? – Paul Farmer reports from Haiti: On the night of 28 February, the Haitian president, Jean-Bertrand Aristide, was forced from power. He claimed he’d been kidnapped and didn’t know where he was being taken until, at the end of a 20-hour flight, he was told that he and his wife would be landing ‘in a French military base in the middle of Africa’. He found himself in the Central African Republic.
An understanding of the current crisis requires a sense of Haiti’s history. In the 18th century it became France’s most valuable colonial possession, and one of the most brutally efficient slave colonies there has ever been. Santo Domingo, as it was then called, was the leading port of call for slave ships: on the eve of the French Revolution, it was supplying two-thirds of all of Europe’s tropical produce. A third of new arrivals died within a few years.
Haitians are still living with the legacy of the slave trade and of the revolt that finally removed the French. The revolt began in 1791, and more than a decade of war followed; France’s largest expeditionary force, led by General Leclerc, Napoleon’s brother-in-law, was sent to put down the rebellion. As the French operation flagged, the slave general, Toussaint l’Ouverture, was invited to a parley. He was kidnapped and taken away to a prison in the Jura. In Avengers of the New World: The Story of the Haitian Revolution,* Laurent Dubois tells Toussaint’s story in a manner that reminds us of its similarities to the current situation:
‘Toussaint must not be free,’ Leclerc wrote to the colonial minister in Paris at the time, ‘and should be imprisoned in the interior of the Republic. May he never see Saint-Domingue again.’ ‘You cannot hold Toussaint far enough from the ocean or put him in a prison that is too strong,’ Leclerc reiterated a month later. He seemed to fear that the deported man might suddenly reappear. His very presence in the colony, he warned, would once again set it alight.
Toussaint died of exposure and tuberculosis in 1803. Every Haitian schoolchild knows his last words by heart: ‘In overthrowing me, you have cut down in San Domingo only the trunk of the tree of black liberty. It will spring up again by the roots for they are numerous and deep.’
In November 1803 the former slaves won what proved to be the war’s final battle, and on 1 January 1804 declared the independent republic of Haiti. It was Latin America’s first independent country and the only nation ever born of a slave revolt. The Haitian Revolution, Dubois writes, was ‘a dramatic challenge to the world as it then was. Slavery was at the heart of the thriving system of merchant capitalism that was profiting Europe, devastating Africa, and propelling the rapid expansion of the Americas.’ Independent Haiti had few friends. Virtually all the world’s powers sided with France against the self-proclaimed Black Republic, which declared itself a haven not only for runaway slaves but also for indigenous people from the rest of the Americas (the true natives of Haiti had succumbed to infectious disease and Spanish slavery well before the arrival of the French). Hemmed in by slave colonies, Haiti had only one non-colonised neighbour, the slaveholding United States, which refused to recognise its independence.
Haiti’s leaders were desperate for recognition, since the island’s only source of revenue was the sugar, coffee, cotton and other tropical produce it had to sell. In 1825, under threat of another French invasion and the restoration of slavery, Haitian officials signed the document which was to prove the beginning of the end for any hope of autonomy. The French king agreed to recognise Haiti’s independence only if the new republic paid France an indemnity of 150 million francs and reduced its import and export taxes by half. The ‘debt’ that Haiti recognised was incurred by the slaves when they deprived the French owners not only of land and equipment but of their human ‘property’.
The impact of the debt repayments – which continued until after World War Two – was devastating. In the words of the Haitian anthropologist Jean Price-Mars, ‘the incompetence and frivolity of its leaders’ had ‘turned a country whose revenues and outflows had been balanced up to then into a nation burdened with debt and trapped in financial obligations that could never be satisfied.’ ‘Imposing an indemnity on the victorious slaves was equivalent to making them pay with money that which they had already paid with their blood,’ the abolitionist Victor Schoelcher argued.
By the late 19th century, the United States had eclipsed France as a force in Haitian affairs. A US military occupation (1915-34) brought back corvée labour and introduced bombing from the air, while officials in Washington created the institutions that Haitians would have to live with: the army, above all, which now claims to have the country ‘in its hands’, was created by an act of the US Congress. Demobilised by Aristide in 1995, it never knew a non-Haitian enemy. It had plenty of internal enemies, however. Military-backed governments, dictatorships, chronic instability, repression, the heavy hand of Washington over all: this state of affairs continued throughout the 20th century.
I learned about Haiti’s history while working on medical projects on the country’s central plateau. When I first travelled there in 1983, the Duvalier family dictatorship had been in place for a quarter of a century. There was no dissent. The Duvaliers and their military dealt ruthlessly with any opposition, while the judiciary and the rest of the world looked the other way. Haiti was already known as the poorest country in the Western world, and those who ran it argued that force was required to police deep poverty.
By the mid-1980s, the hunger, despair and disease were beyond management. Baby Doc Duvalier, named ‘president for life’ at 19, fled in 1986. A first attempt at democratic elections, in 1987, led to massacres at polling stations. An army general declared himself in charge. In September 1988, the mayor of Port-au-Prince – a former military officer – paid a gang to set fire to a Catholic church as mass was being said. It was packed with people, 12 of whom died. At the altar was Father Jean-Bertrand Aristide, the nemesis of the dictatorship and the army. Aristide was a proponent of liberation theology, with its injunction that the Church proclaim ‘a preferential option for the poor’, but liberation theology had its adversaries: members of Reagan’s brains trust, meeting in 1980, declared it less Christian than Communist. ‘US policy,’ they said, ‘must begin to counter (not react against) . . . the “liberation theology” clergy.’
Aristide’s elevation from slum priest to presidential candidate took place against a background of right-wing death squads and threatened military coups. He rose quickly in the eyes of Haitians, but his stock plummeted in the United States. The New York Times, which relies heavily on informants who can speak English or French, had few kind words for him. ‘He’s a cross between the Ayatollah and Fidel,’ one Haitian businessman was quoted as saying. ‘If it comes to a choice between the ultra-left and the ultra-right, I’m ready to form an alliance with the ultra-right.’ Haitians knew, however, that Aristide would win any democratic election, and on 16 December 1990, he got 67 per cent of the vote in a field of 12 candidates. No run-off was required.
The United States might not have been able to prevent Aristide’s landslide victory, but there was plenty they could do to undermine him. The most effective method, adopted by the first Bush administration, was to fund both the opposition – their poor showing at the polls was no reason, it appears, to cut off aid to them – and the military. Declassified records now make it clear that the CIA and other US groups helped to create and fund a paramilitary group called FRAPH, which rose to prominence after a military coup that ousted Aristide in September 1991. Thousands of civilians were killed and hundreds of thousands fled overseas or across the border into the Dominican Republic. For the next three years Haiti was run by military-civilian juntas as ruthless as the Duvaliers.
In October 1994, under Clinton, the US military intervened and restored Aristide to power, with a little over a year of his term left to run. Although authorised by the UN, the restoration was basically a US operation. Then, seven weeks after Aristide’s return, Republicans took control of the Congress, and influential Republicans have worked ever since to block aid to Haiti or burden it with preconditions.
The aid coming through official channels was never very substantial: the US gave Haiti, per capita, one tenth of what it distributed in Kosovo. It is true that, as former US ambassadors and the Bush administration have recently claimed, hundreds of millions of dollars flowed into Haiti – but not to the elected government. A great deal of it went to the anti-Aristide opposition. A lot also went to pay for the UN occupation, and Halliburton support services. There was little effort to rebuild schools, the healthcare infrastructure, roads, ports, telecommunications or airports.
During his few months in office, Aristide, in part because of the abolition of the Haitian army, became in 1996 the first elected civilian to see another elected civilian – René Préval – succeed him as president of Latin America’s oldest republic. Préval in turn became Haiti’s first president ever to serve out his term, not a day more or less. In November 2000, Aristide was again elected by a landslide. But problems had already arisen. In the local and parliamentary elections in May, eight parliamentary seats were disputed and when the political opposition cried foul, the US froze international aid. The Inter-American Development Bank (IDB), for example, had approved four loans, for health, education, drinking water and road improvement. Haitian and American sources have confirmed to me that the US asked the bank to block the loans until the electoral disputes had been worked out. Since seven of the senators in question resigned in 2001, and the other’s term expired shortly thereafter, that should have been the end of the aid freeze, yet it continued throughout Aristide’s tenure.
The State Department later claimed that the freeze was decided on by a consensus of the members of the Organisation of American States in something called the Declaration of Quebec City. The declaration is dated 22 April 2001, and the letter from the US representative asking that the loans not be disbursed was dated 8 April. To quote the conclusion of one of the few journalists to find this scandal worthy of inquiry, ‘it would seem that the effort became concerted after it was made.’
International financial institutions engaged in discriminatory and probably illegal practices towards Haiti. According to the London-based Haiti Support Group,
Haiti’s debt to international financial institutions and foreign governments has grown from $302 million in 1980 to $1.134 billion today. About 40 per cent of this debt stems from loans to the brutal Duvalier dictators, who invested precious little of it in the country. This is known as ‘odious debt’ because it was used to oppress the people, and, according to international law, this debt need not be repaid.
Yet in order to meet the renewed demands of the IDB, the cash-strapped Haitian government was required to pay ever-expanding arrears on its debts, many of them linked to loans paid out to the Duvalier dictatorship and to the military regimes that ruled Haiti with great brutality from 1986 to 1990. In July 2003, Haiti sent more than 90 per cent of all its foreign reserves to Washington to pay off these arrears. As of today, less than $4 million of the four blocked loans – which totalled $146 million – has reached Haiti in spite of many assurances from the IDB.
Even so it was not until last month that one could read in a US daily newspaper that the aid freeze might have contributed to the overthrow of the penniless Haitian government. On 7 March, the Boston Globe wrote:
Today, Haiti’s government, which serves eight million people, has an annual budget of about $300 million – less than that of Cambridge, a city of just over 100,000. And as Haitians attempt to form a new government, many say its success will largely depend on how much and how soon aid will flow to the country . . . Many of Aristide’s supporters, in Haiti and abroad, angrily contend that the international community, particularly the United States, abandoned the fledgling democracy when it needed aid the most. Many believe that Aristide himself was the target of the de facto economic sanctions, just as Haiti was beginning to put its finances back in order.
That the US and France undermined Aristide is not a fringe opinion. The Caribbean Community (CARICOM) and the African Union have called for a formal investigation into his removal. ‘Most people around the world believe that Aristide’s departure was at best facilitated, at worst coerced by the US and France,’ Gayle Smith, a member of the National Security Council staff under Clinton, recently said.
Why such animus towards Haiti’s leader? Taking up the question of the historic French debt, Aristide declared that France ‘extorted this money from Haiti by force and . . . should give it back to us so that we can build primary schools, primary healthcare, water systems and roads.’ He did the maths, adding in interest and adjusting for inflation, to calculate that France owes Haiti $21,685,135,571.48 and counting. This figure was scoffed at by some of the French, who saw the whole affair as a farce mounted by their disgruntled former subjects; others, it’s increasingly clear, were insulted or angered when the point was pressed in diplomatic and legal circles.
Still, Aristide kept up the pressure. The figure of $21 billion was repeated again and again. The number 21 appeared all over the place in Haiti, along with the word ‘restitution’. On 1 January this year, during the bicentennial celebrations, Aristide announced he would replace a 21-gun salute with a list of the 21 things that had been done in spite of the embargo and that would be done when restitution was made. The crowd went wild. The French press by and large dismissed his comments as silly, despite the legal merits of his case. Many Haitians saw Aristide as a modern Toussaint l’Ouverture, a comparison that Aristide did not discourage. ‘Toussaint was undone by foreign powers,’ Madison Smartt Bell wrote in Harper’s in January, ‘and Aristide also had suffered plenty of vexation from outside interference.’
It’s usually easy to tell, in even the briefest conversation about Aristide, how your interlocutor feels about him. Opinion in Haiti is almost always referred to as ‘polarised’ in the US press, but this isn’t true in every sense. Elections and polls, even recent ones, show that the poor majority still support Aristide. It’s the middle classes and the traditional political elites who disagree about him, as well as people like me: non-Haitians who, for whatever reasons, concern themselves with that country’s affairs.
Between the coup that followed Aristide’s inauguration and his return to Haiti, the coverage in the US was of the same character as today’s. On 22 September 1994, the New York Times ran a front-page piece called ‘The Mouse that Roared’. From it, we get a keen sense of Aristide as irritant:
The Clinton crowd has had to work hard to justify him to lawmakers who were unnerved by the October 1993 closed-door CIA briefing to Congress, in which the intelligence agency offered information – later proven false – that Father Aristide had received psychiatric treatment at a Montreal hospital in 1980. Senator Jesse Helms, Republican of North Carolina, left the briefing and branded him a ‘psychopath’ – a slur it has been hard for Father Aristide to get over.
It would be convenient for the traditional Haitian elites and their allies abroad if Aristide, who has been forced to preside over unimaginable penury, had been abandoned by his own people. But Gallup polls in 2002, the results of which were never disseminated, showed that, despite his faults, he is far and away Haiti’s most popular and trusted politician. So what is to be done about the people who, to the horror of the Republican right, keep voting for him?
The protégés of Jesse Helms have had more say in Aristide’s fate than the Haitian electorate have. Although US officials stated initially that he had been ‘taken to the country of his choice’ at the end of February, Aristide’s claim that he had no idea where he was going seems more plausible. He had never been to the Central African Republic before. About the size of Texas and with a population of only three million, it is subject to French military and economic interests. A BBC story in March 2003 reported that the capital, Bangui, was the world’s most dangerous city, while the US advises its citizens not to travel to the country; the US embassy was closed two years ago.
On the tarmac, Aristide thanked the Africans for their hospitality, and then said: ‘I declare in overthrowing me they have uprooted the trunk of the tree of peace, but it will grow back because the roots are l’Ouverturian.’
The Bush administration appears to have put two men in charge of Latin American diplomacy, and they’ve been at it for a long time. As the ’special presidential envoy to the western hemisphere’, Otto Reich is the top US diplomat in the region, even though he has never survived a House or Senate hearing; he was given the post by Bush during a Congressional recess. In the 1990s, Reich was a lobbyist for industry (one beneficiary of his work: Lockheed Martin, who have been selling fighter planes to Chile); before that he had a long record of government service.
During the civil war in Nicaragua, according to William Finnegan in a New Yorker profile, Reich
headed a Contra-support programme that operated out of an outfit called the Office of Public Diplomacy. The office arranged speeches and recommended books to school libraries, but also leaked false stories to the press – that, for instance, the Sandinista government was receiving Soviet MiG fighters, or was involved in drug trafficking . . . The office employed army psychological-warfare specialists, and worked closely with Lieutenant-Colonel Oliver North, at the National Security Council.
During the course of the Iran-Contra investigation, the US comptroller general concluded that Reich’s office had ‘engaged in prohibited, covert propaganda activities’. But by then Reich had been named US ambassador to Venezuela, where he laid the groundwork for future efforts to destabilise President Chávez. Not all this activity is covert: less than a year ago, Reich was on record welcoming a coup against Chávez, and urging the State Department and opinion makers to support the ‘new government’. The only problem was that the Venezuelan majority failed to fall into step, and Chávez remained.
Last month, the Bush administration sent Roger Noriega to Haiti to ‘work out’ the crisis. Not everyone knew who he was: Noriega’s career has been spent in the shadows of Congressional committees. For the better part of a decade, he worked for Helms and his allies, and it’s no secret he has had Aristide in his sights for years. US Haiti policy is determined by a small number of people who were prominent in either Reagan’s or George H.W. Bush’s cabinets. Most are back in government today after an eight-year vacation in conservative think tanks or lobbying firms. Elliot Abrams, convicted of withholding information from Congress during the Iran-Contra hearings, serves on the National Security Council; Reagan’s national security adviser John Poindexter until recently headed the Pentagon’s new counterterrorism unit; John Negroponte, former ambassador to Honduras, is now ambassador to the UN. Jeanne Kirkpatrick is on the board of the International Republican Institute, a body which has been actively supporting the opposition in Haiti (my sources suggest that it backed the demobilised army personnel who provided the opposition’s muscle at the beginning of the year, though it denies this).
The players on the Haitian side fall into one of two categories: first, Haiti’s business elite, including those who own the media, and then the former military and paramilitaries – the people who were involved in the 1991-94 coup. Some have been in jail since then for murder, drug trafficking and crimes against humanity. Today, every single one of them is out.
Among those released by the rebels is the former general Prosper Avril, a leader of the notorious Presidential Guard under both Duvaliers. Avril seized power in September 1988, and was deposed in March 1990. A US District Court found that his regime engaged in a ’systematic pattern of egregious human rights abuses’. It also found him personally responsible for enough ‘torture and cruel, inhuman or degrading treatment’ to award six of his victims a total of $41 million in compensation. The victims included opposition politicians, union leaders, scholars, even a doctor trying to practise community medicine. Avril’s repression was not subtle: three torture victims were paraded on national television with their faces grotesquely swollen, their limbs bruised and their clothing covered with blood. He suspended 37 articles of the constitution, and declared a state of siege.
The US started protecting Avril shortly after the 1994 restitution of Aristide. In November that year, the then secretary of state, Warren Christopher, relayed to the US ambassador intelligence reports that the Red Star Organisation, under Avril’s leadership, was planning a ‘harassment and assassination campaign directed at . . . Aristide supporters’. This information was not passed on to the Haitian authorities. In December, the Haitian police, acting on their own information, sought to arrest Avril at his home. Immediately after the police arrived, US soldiers turned up and tried to dissuade them from making the arrest. By the time they got in, Avril had fled to the neighbouring residence of the Colombian ambassador. Police searching Avril’s house found military uniforms, illegal police radios and a cache of weapons.
He escaped to Israel but later returned to Haiti, where his international and potential military support deterred further attempts to arrest him. He founded a political party, which has never fielded candidates in an election but was invited by the IRI to participate in developing an opposition to Aristide. In May 2001, after US troops had withdrawn from Haiti, the police finally seized the opportunity to execute Avril’s arrest warrant. The successful arrest was greeted with applause by the vast majority of Haitians and by human rights and justice groups in Haiti, the US and Europe. Amnesty International asserted that the arrest ‘could mark a step forward by the Haitian justice system in its struggle against impunity’: ‘the gravity of the human rights violations committed during General Avril’s period in power, from his 1988 coup d’état to his departure in March 1990, cannot,’ Amnesty said, ‘be ignored.’ France’s Committee to Prosecute Duvalier concluded that ‘the general must be tried.’ On 9 December 2003, the magistrate investigating the Piatre Massacre in 1990, when several peasants lost their lives, formally charged Avril with responsibility. He was in prison awaiting the end of the pre-trial proceedings when he was freed on 2 March – a few days after Aristide was deposed.
The rebel leader Guy Philippe received training, during the last coup, at a US military facility in Ecuador. When the army was demobilised, Philippe was incorporated into the new police force, serving as police chief in the Port-au-Prince suburb of Delmas and in the second city, Cap-Haïtien. During his tenure, the UN International Civilian Mission learned, dozens of suspected gang members were summarily ex ecuted, most of them by police under the command of Philippe’s deputy. The US embassy has also implicated Philippe in drug smuggling during his police career. Crimes committed in large part by ex-military policemen, are often pinned on Aristide, even though he sought to prevent coup-happy human rights abusers from ending up in these posts.
Philippe fled Haiti in October 2000, when the authorities discovered him plotting a coup with a clique of fellow police chiefs. Since then, the Haitian government has accused him of masterminding terrorist attacks in July and December 2001, as well as lethal hit-and-run raids against police stations on Haiti’s central plateau. (Over the last two years, four of our ambulances have been stolen, and members of our medical staff have been held hostage.) Last month, Philippe’s men bragged to the US press that they had executed Aristide supporters in Cap-Haïtien and Port-au-Prince, and many have indeed been reported missing. ‘I am the chief, the military chief. The country is in my hands,’ Philippe boasted on 2 March, which triggered the following response from Oscar Arias, the Nobel Peace laureate and former president of Costa Rica: ‘Nothing could more clearly prove why Haiti does not need an army than the boasting of rebel leader Guy Philippe last week in Port-au-Prince. The Haitian army was abolished nine years ago during a period of democratic transition, precisely to prevent the country from falling back into the hands of military men.’ Philippe told the Associated Press that he would use his new powers to arrest Haiti’s prime minister, Yvon Neptune, and proceeded to lead a mob in an attack on Neptune’s house. Philippe has been quoted as saying that the man he most admires is Pinochet.
The list goes on. Louis-Jodel Chamblain was a sergeant in the Haitian army until 1989 or 1990. He reappeared on the scene in 1993 as the second in command of the FRAPH. (Emmanuel ‘Toto’ Constant, its leader, is now living as a free man in Queens, New York.) Among the FRAPH’s victims was Guy Malary, the justice minister, ambushed and machine-gunned with his bodyguard and a driver. In September 1995, Chamblain was one of seven senior military and FRAPH leaders convicted in absentia and sentenced to forced labour for life for their involvement in the September 1993 execution of Antoine Izméry, a well-known pro-democracy activist. In late 1994 or early 1995, he went into voluntary exile in the Dominican Republic.
As for the traditional political elite, some have wanted to live in the National Palace ever since the time it was occupied by Papa Doc. Others may appear more marginal but they have done their share of harm. When, the other day, Vladimir Jeanty was shown destroying artwork on public display in Port-au-Prince, he was described as a ‘pastor from the Party of God’. In fact he is another perennial presidential candidate, delighted to have the chance to burn precious artefacts linked with voodoo and other aspects of Haitian culture – and to do so in full view of the international press.
US-born André Apaid, known in the US press as ‘the leader of the civil society movement to oust Aristide’, is the founder of a TV station and owner of a garment manufacturing firm (a subsidiary of Alpha Industries) that was prominently featured in news reports about Disney’s sweatshop suppliers. Aristide’s relentless push to raise the minimum wage above 72 gourdes a day – about £1 – cut into the massive profits of the offshore assembly industry. The US Congress has proposed building new garment factories in Haiti and encouraging American companies to contract out more sweatshop labour – good news for Apaid.
At the other end of the social spectrum from Apaid are the chimères, the groups described in the foreign press as armed thugs working for the Aristide government. But who are the chimères? Residents of Haiti’s slums, long excluded from civil society, they ‘were indeed chimeras’, Madison Smartt Bell wrote. ‘Ill fortune left them as unrealised shadows . . . These were the people Aristide had originally been out to salvage.’
The salvage operation came to an end last month as ‘rebels’ continued to ‘take cities’. I work in these ‘cities’ and I saw the rebels’ modus operandi. They came in, shot the police – who usually numbered no more than two or three – and left. Only a similarly equipped counterforce could have stopped them. The beleaguered government appealed for help in the Security Council, but this was delayed by the Bush administration – delayed long enough for the government to fall, or be pushed out.
Did the US and France have a hand in Aristide’s removal? Were he and his wife being held against their will? Most of Aristide’s claims, initially disputed by US officials from Noriega to Donald Rumsfeld, are now acknowledged to be true. His enemies’ claims that Aristide met with officials in Antigua – Aristide said they were not allowed to move from their seats – were undermined by reports from Antigua itself. Noriega acknowledged during a House hearing that Aristide did not know of his destination until less than an hour before landing in the Central African Republic. Even CAR officials acknowledge that no Haitian authorities were involved in the choice of destination.
Many more questions remain unanswered. We know that US funds overtly financed the opposition, but did they also fund, even indirectly, the rebellion, which featured high-powered US weapons only a year after twenty thousand such weapons were promised to the Dominican Republic? Senator Christopher Dodd is urging an investigation of US training sessions for six hundred ‘rebels’ in the Dominican Republic, and wants to find out ‘how the IRI spent $1.2 million of taxpayers’ money’ in Haiti. Answering these and related questions would take an intrepid investigative reporter, rather than a physician like myself, working, with some trepidation, in central Haiti. It would need a reporter willing to take on hard questions about US policies in Latin America. But about the return of the military, there can be little doubt. In his first public statement the man sworn in as Haiti’s new prime minister announced that Aristide’s order to replace the military with a civilian police force violated Haiti’s constitution; he promised to name a commission to examine the issues surrounding its restoration.
Another Interview. with Paul Farmers’ Partners in Health.