IHSJ Issue: Haiti

Justice and Democracy in Haiti:

For those of us committed to justice in Haiti, the poorest country in the Western hemisphere and one of the poorest and hungriest countries in the world, many questions arise: Why is the situation in Haiti so bad? Is it a “failed state”? Why do powerful countries not help or allow Haiti to prosper?

As any Haitian will tell you—from the educated elites to the peasants of the Central Plateau where PIH has worked since its inception—it is impossible to understand present day Haiti without understanding the past. At the turn of the 19th century, Haiti was the property of France and generated more wealth than any other French holding. It is more accurate to call Haiti a slave plantation than a French colony because the indigenous people had long been dead, killed mostly by Columbus and the first wave of European explorers, and finished off by the brutal work conditions of sugar plantations. The island’s population of African-born slaves and their descendants successfully orchestrated a strategically brilliant revolution that defeated Napoleon’s army. On January 1, 1804, after a 12-year struggle that claimed the lives of more than 100,000 slaves, the Republic of Haiti became the first independent Black republic and the first nation born of a slave revolution.1 The protracted struggle destroyed much of the country’s colonial infrastructure, including its hospitals.2 Clean water, adequate sanitation, health care and stable food supplies were virtually eliminated.3

Slavery—with its oppressive twin, colonialism—built the powerful empires of England and France as well as massively enriched other European countries like Spain, Portugal and the Netherlands. As slavery was still part of the economic engine of the United States and thereby the first successful slave revolution a threat, Thomas Jefferson called for the isolation of Haiti in international relations. The United States, in collaboration with France, enforced a commercial embargo of Haiti in the early 1800s, which immediately crippled prospects for economic development by ensuring that the newly independent country was effectively prohibited from participating in the international economic community.4 In 1827, France sent 41 warships back to an independent Haiti demanding compensation from the Haitian people for stealing themselves, as French property, from the French. Without weaponry or money for another battle, the Haitian people began paying France a sum of 200 million francs (a sum the equivalent of US$21.7 billion today), a debt they were not able to repay until 1943. Such an extreme level of external debt was not seen again until 150 years later when newly independent African states began incurring massive “development” debt from financial institutions like the World Bank (WB) and International Monetary Fund (IMF).

Thus, Haiti started what should have been a glorious path as a bastion for liberty and human rights, with economic isolation and crushing debt. In the context of internal unrest and to protect American business in Haiti, the U.S. Marines invaded Haiti in July 1915 where they created and trained the Haitian Army and remained an occupying force until 1934.5 Armed popular resistance to the occupation began immediately following the invasion and continued for the next 29 years, though opposition and dissent were violently suppressed.6 During that time, a small minority of Haitian elites consolidated their political and economic control over Haiti and remained the dominant force in Haitian bringing François “Papa Doc” Duvalier to power in 1957.7 His son, Jean-Claude “Baby Doc” Duvalier, succeeded him in 1971. The Duvalier family ran a brutal dictatorship that lasted nearly 30 years. When Jean-Claude Duvalier fled Haiti in 1986, he left behind a country in economic and political ruin. The legacy of this regime continues to haunt Haiti today.

The nascent grassroots movement that brought the first democratically elected Haitian government and President Jean Bertrand Aristide to power was crushed by a United States C.I.A. backed coup d’état in 1991. The military dictatorship plundered the national treasury, while inflicting widespread violence and injustice on the general population.8 After three years of a brutal military regimen, President Aristide was reinstalled in 1994.9 He finished his term and democratically handed power to President René Préval. Aristide was elected again in 2000 in elections widely considered fair and transparent. However, run-off elections for several parliamentary seats, which may have been improperly conducted, served as a pretext for foreign involvement in the Haitian political process.10 Consequentially, the United States and the Inter-American Development Bank blocked all aid to the public sector of Haiti.11 Military force, covertly backed by the United States, France and Canada, was also used to destroy the Aristide government.12 President Aristide was removed from power against his will on February 29, 2004—he and his wife were taken to the Central African Republic on an unmarked U.S. military plane.13 The U.S. Marines entered Haiti that morning followed by the UN peacekeeping mission, MINUSTAH.

Two years of extreme violence ensued under the U.S. backed “transitional government”. Unrest and pro-Aristide protests often resulted in deaths among urban poor in the slums of Cité Soleil and Belair.14 Finally, after the utter failure of the international community to establish peace, elections in 2006 brought the current President, René Préval, to power again.

Interventionist political and economic policies imposed on Haiti by powerful countries have crippled the country’s ability to express self-determination and have resulted in Haiti’s progressive impoverishment. Today, Haitians continue to struggle under the crushing burden of insurmountable international debt, poor health care, lack of access to clean water, and the effects of the international food crisis.15

In understanding the history of Haiti and listening to our patients, friends and colleagues (90 percent of whom are the rural poor), PIH believes that health and dignity can only be achieved if we engage in a struggle for justice and democracy in Haiti. To this end, the IHSJ is involved in a number of advocacy initiatives to benefit Haiti from collaborating with other organizations to immediately eliminate Haiti’s debt, to investigating, documenting and publicizing the harmful effects of withholding loans to Haiti, to uncovering the role of outside influence in President Aristide’s removal in 2004. In addition, the IHSJ works to draw attention to the impoverishment of the public sector by highlighting PIH’s work in supporting the Haitian Ministry of Health at all levels.

For a greater understanding of Haiti and its place world, one of the best resources is Paul Farmer’s, Uses of Haiti.

Health in Haiti:

By almost any measure, the island nation of Haiti is one of the sickest and poorest places on our planet. A mere one and a half hour flight from Miami, FL, the health disparities between Haiti and the United States are staggering. In 2008, Haiti ranked 148th out of 179 nations surveyed in the UN’s Human Development Index, the lowest in the Western Hemisphere.16 At 61.3 years on average, Haitians have the lowest life expectancy in the Western Hemisphere compared with the composite average of 73.4 years for people living in Latin America and the rest of the Caribbean.17 Infant and maternal mortality rates in Haiti are equally appalling: 57 per 1000 live births and 630 per 100,000 live births respectively.18 This is compared to an average infant mortality rate of 20.2 per 1,000 live births and 89.2 maternal deaths per 100,000 live births respectively for the rest of Latin America and the Caribbean.19

Today, Haiti is also burdened by the highest HIV prevalence in the entire hemisphere, representing nearly 50 percent of the known HIV infections in the Caribbean.20 Tuberculosis remains endemic and is a significant cause of mortality.21 Malaria, nearly non-existent in many other Caribbean countries, remains a deadly problem in Haiti.22 In 1999 infectious diarrhea was found to be the second leading cause of death in Haiti.23 Even simple prevention measures, like childhood vaccinations, are woefully lacking.24

Despite the significant health concerns in Haiti, what remains perhaps even more shocking is the utter lack of public health, sanitation and health care infrastructure. Haiti lacks the financial, infrastructural and human resources to deliver crucial preventive health and medical services to its citizens. There are only three doctors, one nurse, and less than one dentist per 10,000 people,25 a paltry figure when compared to the 19 doctors, 18 nurses, and four dentists available per every 10,000 people in the neighboring Dominican Republic.26

On paper, Haiti has a well organized public health system. Nationwide, there are 371 health posts, 217 health centers, and 49 hospitals.27 However, the presence of a health post does not guarantee health services. Many do not function at all or are open just a few hours a day; few have supplies beyond basic vaccines and an unpredictable supply of medicines available only on a fee-for-service basis.28 Haiti spent 27.7 percent of its national budget on health in 2003, which amounts to just $36 per person as compared to $7,421 per person in the United States.29

Partners In Health and Zanmi Lasante:

With its genesis in the mountainous region of Haiti’s Central Plateau, Partners In Health (PIH) has a long-term commitment to providing health care to the people of Haiti in partnership with our sister organization, Zanmi Lasante (ZL). Over two decades ago, PIH’s co-founders Paul Farmer, Ophelia Dahl, Todd McCormick, Tom White and Jim Kim began working with Father Fritz Lafontant, an Episcopal priest who had established a small medical clinic in the rural village of Cange, Haiti. Cange was a deforested and rocky mountain top that was established as a settlement by peasants who had been displaced by the flooding of their lands when the Péligre dam was built in 1956. Together, as community health workers, social workers, and patients themselves, the community of Cange became the central agents of change in the work of Zanmi Lasante.

Advocating for Health as a Public Good and Human Right:

In 2002, PIH/ZL was chosen as a sub-recipient of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. It was the first significant money that the global community had offered for the treatment of these diseases. That year, PIH made a strategic decision that forever changed the scope of our work; we recognized that working to build, rebuild, support and staff health care clinics had to be done through the public sector in order for health to truly become a human right in Haiti. The work started with the refurbishing, staffing and stocking of one small public clinic in the town of Lascahobas, Haiti.

Today, PIH and ZL have revitalized ten public health clinics, centers and hospitals, trained and supported staff, and provided essential supplies, medicines and equipment in two states in Haiti—the Central and Artibonite departments now reach a combined catchment area of nearly one and a half million people.

Our model in Haiti contributed to PIH’s invitation from the governments of Rwanda, Lesotho and Malawi to engage in partnership to not only provide health care but also strengthen the public sector. The IHSJ uses these examples in its advocacy with partners on issues such as the health system strengthening and increased funding for global health.

Advocating for Change in Haiti

IDB Report

Read the entire June 2008 article

Report indicts U.S. government and Inter-American Development Bank for violations of the rights to clean water and health in Haiti

By Tom Spoth

In 1998, the Inter-American Development Bank (IDB) awarded US$54 million in loans to the Haitian government to improve the country’s patchwork, crumbling public-water system. The money was intended to bring clean water to people who for many years had been denied this basic human right, with devastating consequences for public health. Ten years later, however, this desperately needed money has not produced a single improvement to Haiti’s water supply in the city designated to be one of the first recipients.

A new report from Partners In Health and three other groups reveals the United States government’s clandestine efforts to ensure that political considerations (namely the desire to destabilize Haiti’s elected government at that time, led by President Jean-Bertrand Aristide) took precedence over the rights of some of the planet’s poorest and most vulnerable people.

In the 10 years since the loans were approved, the Haitian water system has actually gotten worse. In 2002, a water-poverty index released by the British-based Centre for Ecology and Hydrology ranked Haiti dead last out of 147 countries surveyed.

On June 23, Partners In Health—along with its Haitian sister organization Zanmi Lasante, the Center for Human Rights and Global Justice, and the Robert F. Kennedy Memorial Center—released the 87-page report “Wòch nan Soley: The Denial of the Right to Water in Haiti” in New York City.

“We have to stand up for what's right,” Loune Viaud, director of operations at Zanmi Lasante, said at the press conference. “What is right is for the IDB and the international community to stop playing with the lives of innocent people.”

Viaud and the rest of the investigative team worked for six years to bring the story of the IDB loans to light. During that time, Haiti’s water system continued to deteriorate. The report states that:

  • Public water systems are rarely available throughout the year and close to 70 percent of the population lacks direct access to potable water at all times.
  • The percentage of the population without access to safe drinking water has increased by at least seven percent from 1990 to 2005.
  • Infectious diarrhea was the second leading cause of death in Haiti in 1999, and gastrointestinal infection was the leading cause of mortality for young children. These preventable diseases result primarily from unsafe drinking water and poor sanitation.

The failure to address Haiti’s crippling public-health problems is the latest in a long line of oppressive policies toward the country. Haiti, the only nation to be born from a successful slave revolution, has been hamstrung by crushing foreign debt for virtually its entire existence. It took Haiti more than 100 years to pay off a debt of 150 million francs (equivalent to US$21 billion today) imposed by France in 1825 to “compensate” for the value of lost property, including the former slaves themselves. More recently, impoverished Haiti has been forced to pay US$1 million a week toward settling a US$1.54 billion debt piled up mainly by the dictatorial Duvalier regime, which did nothing to improve the lives of average Haitians.

Massive debt has precluded spending on desperately needed infrastructure projects. In 2003, for example, Haiti’s debt service was US$57.4 million; the Haitian government’s combined budget for education, health care, environment, and transportation was US$39.21 million. Meanwhile, the Haitian people continued to endure crushing poverty, which has been exacerbated by the failure to disburse the IDB loans. The report contains a telling comparison: In order to purchase the World Health Organization’s minimum standard of 20 liters of water per day, a Haitian family of four would have to spend approximately 12 percent of its annual income – the equivalent of asking a U.S. family living at the poverty level (US$20,444 per year) to pay nearly US$2,500 per year for water.

In Port-de-Paix, the Haitian city that was supposed to be one of the first beneficiaries of IDB loans, the private sector provides 80 percent of drinking water, and 86.7 percent of residents surveyed reported that they are “always” or “sometimes” unable to pay for water. Eighty percent indicated that water quantity had either declined or stayed the same in the five years before the survey was conducted, and 88.9 percent said water quality had gotten worse or not improved.

A household survey conducted by PIH documented the devastating impact on public health. Fifteen percent of the surveyed households reported probable recent cases of typhoid. One-third of respondents suffered from symptoms of gastrointestinal infection, the leading cause of death for Haitian children under the age of five.

“I’ve been working in Haiti for more than a decade,” commented Evan Lyon of PIH, “so I have long been aware of the connection between lack of access to clean water and preventable disease. But surveying households in Port-de-Paix opened my eyes to how essential clean water is to all facets of life, from cooking and washing, to growing food and the ability of children to attend school. At one household, we perched on rickety chairs in front of the house, ankle-deep in water, and the family was literally bailing filthy water out of their yard while I asked them questions. When we tested water at the local hospital we discovered it was just as contaminated as the water that makes people sick in the first place. The hospital's water comes from the same dirty sources.”

Although initial bids have been taken for the Port-de-Paix project, as of May 2008, no ground had been broken. Several attempts to obtain updates from the IDB’s Public Information Center were unsuccessful.

By failing to distribute loans and grants to Haiti, the IDB violated its own charter, which strictly prohibits the bank from letting politics influence its decisions. Internal documents from the U.S. Treasury Department and the office of the U.S. Executive Director at the IDB, obtained through Freedom of Information Act requests, show that officials actively used American influence to block the loans in an attempt to destabilize the government led by President Aristide, who was ultimately overthrown in 2004.

International law protects the human right to water, according to the United Nations’ Committee on Economic, Social and Cultural Rights as well as other international covenants and declarations. If one accepts the notion of water as a fundamental right, then the U.S. government’s actions can be construed as a direct violation of its international human-rights obligations.

“I bet most of the people in this city do not think about this as a right,” Viaud said. “It is taken for granted every day. Just imagine one day without water, here in New York City. It would be a disaster -- in the news around the world. It would be outrageous.”

The report’s authors recommend a “rights-based” approach to water projects in Haiti going forward: All initiatives should focus on accountability and sustainability, and should involve Haitians living in the communities where projects will be implemented in the process.

“Wòch nan Soley: The Denial of the Right to Water in Haiti” will be launched in Port-de-Paix at a later date. French and Kreyol versions will be available soon.

Debt Relief

Historical Context

As discussed in previous sections, Haiti’s international debt can be traced back to its birth as a nation. At the end of the nineteenth century, debt repayments to France for its freedom devoured nearly 80 percent of Haiti’s budget, thus restricting its ability to develop agricultural systems and other basic infrastructure required for modern development.30

The Duvalier family dictatorship, from 1957-1986, further exacerbated Haiti’s debt crisis. Cumulatively, the Duvaliers racked up some US$900 million of debt in multinational and bilateral loans, a significant portion of which went toward their own individual spending purposes.31 Almost half of Haiti’s current debt was incurred during the 29-year reign of the Duvaliers.

After the return of President of Jean-Bertrand Aristide to Haiti in 1994, in order to rebuild the nation, Haiti took out a series of loans from international financial institutions that came with a strict set of conditions, including requirements to privatize state-owned enterprises, cut spending on social services and liberalize trade policies.32 At the same time, Haiti was working to repay its Duvalier-era debts to various international financial institutions.

In order to whittle down its debt burden, by 2003 the Haitian government was spending between US$50-80 million annually in payments to various international financial institutions.33 From 1991 to 2007, Haiti spent a total of US$631 million in payments to creditors and that number continues to grow.34 The requirement to continually pay off its debilitating debt has left the Haitian government incapable of supporting the basic needs of its population. The Haitian government has been unable to funnel its limited resources into social infrastructure, such as health facilities, water and sanitation, and education.

In 2003, for example, Haiti’s debt service was US$57.4 million, whereas the Haitian government’s combined budget for education, health care, environment and transportation was US$39.21 million. In 2005-06, Haiti’s US$25 million health budget was less than half the amount spent on debt repayments. Haiti’s public debt as of end-September 2008 amounted to 36 percent of GDP, most of which is owed to external creditors. The majority of Haiti’s external debt is owed to a handful of institutions—41 percent to the Inter-American Development Bank (IDB), 27 percent to the World Bank and 24 percent to bilateral creditors.

Present Actions

(For additional information, see the Jubilee USA Haiti action page.)

In keeping with its historical position, the International Monetary Fund (IMF) responded to the January 2010 earthquake by announcing its intent to give Haiti a $100 million loan. The IMF vote to approve this loan, almost doubling Haiti's debt to the institution, stood in direct opposition to its verbal commitment to cancellation.35

On February 5th, US Treasury Secretary Timothy Geithner announced his support of debt cancellation and grants, not loans, for Haiti. At the G7 meeting in Canada, finance ministers also voiced support. These announcements are a major step forward for both Haiti and the debt cancellation movement, but must be followed by concrete action.

The United States Congress is quickly working to turn these commitments into reality. On March 5th, the US Senate approved the Haiti Recovery Act (S2961) which calls for debt relief and funds for reconstruction. The House of Representative's sister bill, (HR4573), has passed subcommittee. HR4573 calls for the U.S. to:

  1. cancel immediately and completely all debts owed by Haiti to these institutions;
  2. suspend Haiti’s debt service payments to the institutions until such time as the debts are canceled completely; and
  3. provide additional assistance to Haiti in the form of grants so that Haiti does not accumulate additional debts.

 

Citations

1: The definitive account of the Haitian revolution is The Black Jacobins, written in 1933 by Trinidadian C.L.R. James as a means to transfer the spirit of the Haitian revolution to the Africans who were beginning their struggles for independence. The importance of Haiti to the abolition of the slave trade is well documented Adam Hochschild’s book Bury the Chains and Laurent Dubois’ book The Avengers of the New World. The independence of Haiti (France’s richest colony at the time) was not well received by the “developed world.”

2: See Paul Farmer, The Uses of Haiti 63-64 (2005).

3: See, e.g., Ary Bordes, Évolution des sciences de la santé et de l'hygiène publique en Haïti (1980); David Patrick Geggus, Yellow fever in the 1790s : the British Army in Occupied Saint Dominigue (1979).

4: See Dubois, supra note 3.

5: It is widely accepted that protecting U.S. business interests played a large role in the U.S. decision to occupy Haiti. The Haitian American Sugar Company was among the most prominent business interests. See, e.g., Mary Renda, Taking Haiti: Military Occupation and the Culture of U.S. Imperialism, 1915-1940 (2001); Hans Schmidt, U. S. occupation of Haiti (1915-1934) (1995).

6: Also of note, the Haitian Army was established in a treaty approved by the U.S. Congress in 1915. With no meaningful foreign threats to defend against, the Haitian Army has been an instrument of oppression against the Haitian people, acting behind various governments or acting independently, ever since. The military was officially disbanded (but not disarmed) by President Aristide in 1994, only to re-form in 2003 during the build up to the coup d’état against President Aristide on February 29, 2004. The re-formed Army had the audacity to demand “back-pay” for the 10 years they were disbanded—which the Latortue government paid in 2004. The Haitian Army remains an influential force in Haiti. See, e.g., DeWayne Wickham, Payoffs to Haiti’s Renegade Soldiers Won’t Buy Peace, USA TODAY, Jan. 3, 2005, available at http://www.usatoday.com/news/opinion/columnist/wickham/2005-01-03-haiti-wickham_x.htm.

7: While the elections in 1957 were probably corrupt (many believe the Haitian Army assisted in vote rigging), François Duvalier initially had significant popular support. This was based largely on a noiriste political appeal to the Afro-Haitian majority. A lighter-skinned mulatto class has controlled Haiti politically and economically throughout the nation’s history. This minority rule only strengthened after U.S. occupation, laying the groundwork for Duvalier’s rise. The brutality and terror regime of Duvalier’s Tonton Makout, devastating corruption, and U.S. support for the Duvalier regime as a “bulwark against Latin American Communism” have all been well documented. An estimated 30,000 Haitians were killed during the Duvalier regime. See BERNARD DIEDERICH, PAPA DOC AND THE TONTON MACOUTES (2005); ELIZABETH ABBOTT, HAITI: THE DUVALIERS AND THEIR LEGACY (1991).

8: Marie Clark, Enslaved by Debt, in LET HAITI LIVE: UNJUST US POLICIES TOWARDS ITS OLDEST NEIGHBOR 173 (Melinda Miles & Eugenia Charles, eds., 2004).

9: S.C. Res. 940, U.N. Doc. S/RES/940 (Jul. 31, 1994).

10: The presidential election in November 2000 was claimed by Aristide’s opposition to be unfair due to disputed percentage calculations for seven senate runoff elections. See Stephen Lendman, The Sorrow of Haiti, COUNTER PUNCH, Oct. 18, 2005, available at http://www.counterpunch.org/lendman10182005.html.

11: Foreign aid donors suspended at least $500 million in aid to Haiti. See, e.g., P. Farmer, M. Smith Fawzi & P. Nevil, Unjust Embargo of Aid for Haiti, 361 THE LANCET 420 (2003); Farah Stockman & Susan Milligan, Before Fall of Aristide, Haiti Hit by Aid Cutoff, THE BOSTON GLOBE (Mar. 7, 2004), available at http://www.boston.com/news/nation/articles/2004/03/07/before_fall_of_aristide_haiti_hit_by_aid_cutoff/.

12: IRI

13: Randall Robinson, An Unbroken Agony: Haiti, From Revolution to the Kidnapping of a President (2007).

14: See International Crisis Group, Crisis Group Latin America/Caribbean Report N°10, A New Chance for Haiti? (Nov. 18, 2004).

15: Joia Mukherjee and Donna Barry, “Feeding Haiti” Boston Globe. May 5, 2008. Access at: http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2008/05/05/feeding_haiti/

16: The Human Development Index is a single statistic which serves as a frame of reference for both social and economic development. It combines indicators of life expectancy, educational attainment and income. UN DEVELOPMENT PROGRAM (UNDP), HUMAN DEVELOPMENT REPORT 2007/2008 (2007), available at http://hdr.undp.org/en/humandev/hdi.

17: Pan American Health Organization, Health Situation in the Americas: Basic Indicators (2008). Access at: http://www.paho.org/english/dd/ais/BI_2008_ENG.pdf.

18: Ibid., at 8.

19: Ibid.

20: The prevalence of HIV for adults ages 15-49 in Haiti was 3.8 percent. The next national prevalence in the Americas and Caribbean is the Bahamas, at 3.3 percent. The population of persons living with HIV in Haiti is estimated at 170,000, or 58% of the 290,000 in the Caribbean at large. UNAIDS, “2006 Report on the global AIDS epidemic.” http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/

21: TB prevalence in Haiti in 2005 was 405 cases per 100,000 population. This compares (all per 100,000 population) to 3 in the U.S., 116 in the Dominican Republic, 10 in Jamaica, and 11 in Cuba. World Health Organization (WHO). “World Health Statistics 2007.” France. 2007. http://www.who.int/whosis/whostat2007/en/index.html

22: In 2005, PAHO noted 21,778 reported cases of malaria in Haiti – representing 73% of reported cases in the Latin Caribbean. (The Dominican Republic, sharing the eastern 2/3rds of Hispanola, had just 3,837 reported cases.) “Health Situation in the Americas: Basic Indicators.” Pan American Health Organization (Regional Office of the World Health Organization). 2007. http://www.paho.org/english/dd/ais/BI_2007_ENG.pdf. Considering a number of factors, such as the lack of access to trained health workers (discussed above), inadequate laboratory and diagnostic capacity, and an under-funded public health reporting infrastructure, the number of actual cases may be significantly higher.

23: Pan American Health Organization (Regional Office of the World Health Organization), Health Situation Analysis and Trends Summary: General Situation and Trends (1999), available at http://www.paho.org/english/dd/ais/cp_332.htm.

24: UNICEF reports the following percentages of one-year-old children in Haiti as vaccinated against the respective diseases: Tuberculosis, 75 percent; Polio, 52 percent; Measles, 58 percent. In the Dominican Republic, by comparison: Tuberculosis, 95 percent; Polio, 85 percent; Measles, 99 percent. Jamaica: Tuberculosis, 90 percent; Polio, 86 percent; Measles, 87 percent. Cuba: Tuberculosis, 99 percent; Polio, 89 percent; Measles, 99 percent. UNICEF. “The State of the World’s Children 2008: Child Survival.” p. 123. New York. 2007.

25: World Health Organization, World Health Statistics 2007: Core Health Indicators— Haiti (2007), available at http://www.who.int/whosis/database/core/core_select_process.cfm?country=hti&indicators=healthpersonnel.

26: World Health Organization, World Health Statistics 2007: Core Health Indicators—Dominican Republic (2007), available at http://www.who.int/whosis/database/core/core_select_process.cfm.

27: PAHO, Basic Country Health Profiles for the Americas, Haiti. Available at http://www.paho.org/English/DD/AIS/cp_332.htm

28: For example, in 2002 the health center in the town of Lascahobas where both of this chapter’s authors have worked was open only until noon most days and saw a maximum of 20 people each day (in a commune of over 55,000). Based on a public-private partnership with the non-profit charity organization Partners In Health, this health center is now a hospital and often sees over 400 patients a day with vastly expanded primary healthcare and specialty services available. Walton, et al, Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons from Rural Haiti, Journal of Public Health Policy, 25(2): 137-158.

29: This is calculated at the international dollar rate. If this measure is considered at the average exchange rate in $US per capita government expenditure on health is just 10 dollars. WHO, World Health Report, 2006. Available at: http://www.who.int/whr/2006/whr06_en.pdf

30: FARMER, supra note 5, at 77; see also Peter Hallward, Damming the Flood. Haiti, Aristide, and the Politics of Containment 12 (2007).

31: See Mats Lundhal, The Haitian Economy: Man, Land and Markets 33 (1983); Jubilee USA Network/Institute for Justice and Democracy in Haiti, supra note 9.

32: Clark, supra note 21, at 174. In 2000-2001, Haiti was forced to cut social spending from 3 percent of Gross Domestic Product to 2 percent. See Schuller, supra note 18.

33: See, e.g., José De Côrdoba, Impoverished Haiti Pins Hopes for Future on a Very Old Debt, WALL ST. J. (Jan. 2, 2004), available at http://www.odiousdebts.org/odiousdebts/index.cfm?DSP=content&ContentID=9636; Mark Schuller, Jubilee USA Network, Break the Chains of Haiti’s Debt (2006), available at http://www.jubileeusa.org/fileadmin/user_upload/Resources/Policy_Archive/haitireport06.pdf.

34: Schuller, supra note 18.

35: Information from the Jubilee USA Haiti page: http://www.jubileeusa.org/jubilee-act/haiti-debt-cancellation-resolution/resources-on-haitis-debt.html