Waiting for Helicopters? Cholera, Prejudice and the Right to Water in Haiti

“Where you stand,” goes an old Haitian proverb, “depends on where you sit.” This article, the second in a series, will examine aid workers’ stereotypes and prejudices about residents of displacement camps in post-earthquake Haiti, stemming from acute disconnect between NGOs and the people they are there to work with. We explore how these misperceptions have perpetuated deliberate decisions to deny water and sanitation services to desperate survivors.

The context is complicated by the transnational flow of both bacteria and aid dollars. Scientists have shown that the cholera pathogen came to Haiti in the bodies of foreign UN troops whose military base was dumping its sewage into a nearby river. The imported disease has claimed more than 7,000 lives and continues to ravage communities across Haiti. Two and a half years since the 2010 earthquake, the country still faces a severe dearth of water and sanitation services, further fueling the epidemic. The crisis is playing out among the nearly 400,000 internally displaced people (IDPs) still living in makeshift camps under tarps or torn tents, an ideal environment for cholera. The situation raises serious questions: why, with billions of dollars in post-earthquake aid and hundreds of humanitarian NGOs in the country, do so many people still lack the most basic of services? What factors are guiding NGOs’ decisions to provide or withhold them?

The first article of this series described how NGOs in Haiti decided to relax humanitarian standards for provision of water and sanitation and to deliberately withhold these essential services in IDP camps, in the middle of the epidemic. By spring of 2011, the WASH cluster (the UN-run group of NGOs coordinating water and sanitation response) had decided to terminate water provision. It had also decided to abandon the international minimum requirement of 20 people per toilet, instead setting a goal of 100 people per toilet. Predictably, cholera surged, as it has done again in the rainy season of 2012. What were NGO officials’ underlying perceptions and attitudes that could lead them to such decisions? Here, we describe more results from a study I conducted in 2011, based on 52 interviews with officials from NGOs and residents of displacement camps.

“Everyone Stopped Waiting for Aid”

Stopping in the middle of an interview, one camp resident and mother of three looked me squarely in the eye and asked: “Who would like to live under a tent for one year with the heat, sun, and rain falling, water passing under your tent soaking all your clothes? …Do you think anybody would like to live this kind of life?”

People in camp after camp used nearly the same words in describing day-to-day life. While IDP camps have been the main locale for earthquake-affected Haitians to rebuild their lives and communities, this rebuilding has been fraught with suffering. The majority of camp residents I interviewed said they were skeptical they’d ever receive more services from non-governmental organizations (NGOs), but they stayed in the camps because the scraps of tents and the fragile communities of interdependence that had emerged were their last resort – their only option for survival. “As of six months ago people stopped waiting for aid and left,” said one camp resident in early 2011. “Those that are here are those who can’t return home, who don’t have anything.”

During the rainy season, most of the homes I sat in leaked water through the makeshift roof and gushed water through muddy gaps between ground and plastic. Many had to be re-hoisted, re-tied, re-sewed, re-hammered after every storm. Although families kept the areas outside their homes tidy, nearby drainage ditches brought all manners of trash and debris as daily gifts. In the majority of camps, respondents stated they had nowhere else to go, and an International Organization for Migration (IOM, a coordinating agency) survey of more than 15,000 camp dwellers concluded the same, stating “94 per cent of people living in camps would leave if they had alternative accommodation.” Part of the difficulty is that 80% of camp residents were renting homes before the earthquake, which made return extremely difficult given the massive post-earthquake surge in rental prices and the bleak job market.[i]

But how did NGO officials perceive the situation?

“Waiting for Houses, Cars, Helicopters”

In their interviews, foreign officials from NGOs and IOM expressed the belief that Haitians could handle the camp conditions and were simply waiting for handouts. Many officials stated that they viewed signs of day-to-day survival in the camps – such as women selling coffee on the street and families scrounging up building materials from friends – as proof that life was back to normal. Where these efforts may have provided the coffee vendor with enough money to purchase some water for her kids or bought the family an extra week before their shelter collapsed for the fourth time, many NGO officials touted them as “coping mechanisms” which indicated that camp residents were doing fine on their own. One official evoked the racist hypothesis that Haitians were “genetically strong” given the “horrendous conditions” such as “slavery and torture” they had endured over centuries. “You or I would not survive one month in one of those camps,” she said.

IOM officials suggested that a large percentage of displaced people actually had the means to return to their former homes, but remained in camps waiting for NGOs to bestow miracles. They were “waiting for houses, cars, helicopters,” complained one, and “visas to Canada” quipped another. One senior IOM official enthusiastically but incorrectly asserted that only 30% of IDPs were renting homes before the quake, that the majority had land they could return to. Another high-level IOM official, somehow missing the fact that the job market was devastated and rental costs drastically inflated, commented, “We have to be careful because if they had the money to rent before, why now they don’t have it?” Suspicion often won out, with worries that camp residents were systematically conning the system. Many officials I interviewed expressed a fear that camps would persist indefinitely. Since no one has offered residents an alternative, this could be a realistic fear, but one officials responded to by retracting services so people would disperse, rather than pushing more vehemently for comprehensive housing solutions.

Officials actually worried about overprovision of services as a “pull factor” into camps. Services “are like a magnet to keep people there,” said one aid worker. Another went as far as saying, “In truth, if you scratch the surface, people find a way to obtain new lodging.” Many officials I interviewed expressed the same opinion, and a few all but stopped short of explicitly labeling camp residents conniving and conspiratorial. This is alarming for a number of reasons. For one, it paints the camps as some sort of cornucopia of services, when in reality most residents continue to struggle for the most basic of needs. It also minimizes the experiences of earthquake survivors living outside camps in conditions desperate enough that they might move to a camp just for a bucket of water every once in a while. In allowing “pull factor” mentality to dilute their commitment to providing services, NGOs could keep water and sanitation out of reach of both camp residents and their desperate neighbors.

In an unfortunately common case of reverse psychology, a management-level official argued that WASH services were sufficient in the camps since “people didn’t riot and there wasn’t mass outbreak of diarrheal disease.” When my research partner raised an eyebrow and brought up cholera, he responded, “Well, that one didn’t happen in the camps, and it hasn’t wiped out camps either.” Although the official admitted that he hadn’t talked to any camp residents, he said, “I think they’re pretty pleased.” Meanwhile, not only have cases been documented in which entire camps dispersed specifically due to cholera, but this should hardly be the minimum qualifier for concern.[ii] Another like-minded IOM official’s observation that “When you go to a camp during daytime almost no one is there,” led him to conclude, “they all take back their work they had before.” Although they do not represent the majority, it is telling that such opinions openly exist among key decision-makers in the WASH response who are clearly placing their presumptions above real knowledge of camp conditions.

Mistrust and the idea that camp residents are doing fine have made it all the easier to neglect humanitarian standards and human rights. It’s another iteration of how the resilience of a people can be used against them. If they’re somehow surviving, the logic goes, they can take more, and make do with less.

Esaie Jean Jules of the Solino Neighborhood Assembly, a grassroots group involved in cholera response, didn’t mince words in putting the pieces together: “One measure NGOs have taken to get people to leave the camps is to take away provision of water and sanitation,” he said this past April. “It’s been almost six months since anyone has come to de-sludge the latrines, but people are still using them. People don’t have access to any other option. There are almost 2,000 people, all who lost their homes in the earthquake, in one of the camps in Solino. They share 4 toilets. There’s no dignity in that, and when it comes to cholera, it’s a danger.”

“An Agenda, a Plan, a Program”

There are reasons why NGO officials don’t really take to heart the experiences of those living in displacement camps. There’s very little dedicated time and space for honest contact and discussion between the two parties. As if in a war zone, NGO rules often restrict their employees from walking on the street, barricading them in offices or air-conditioned SUVs. This is based largely on perceptions rather than reality: Haiti actually has among the lowest homicide rates in the region. Camp residents, in their interviews, often decried these measures as a sign of disrespect and distrust.

Camp residents also told me they have little to no input in the decisions made regarding their own camps. I used a checklist to ask camp committee leaders about their involvement in many steps of the project process. Of these, the only actual role residents were usually allowed in sanitation projects was cleaning the toilets and determining where toilets would be placed. While this seems more like NGOs pawning off the most undesirable or mundane tasks onto camp residents, aid workers described this to us as community “participation.” More active aspects of the project process, such as deciding how to carry out the project or follow-up, designing a system for maintenance, or even deciding how many toilets and what kind, were not up for input by camp residents. While NGO officials described meetings they held to discuss these issues, camp residents countered that they had little actual say in these meetings. They were “obliged” to take whatever they got, however they got it. They had opinions on the way toilets were being installed and maintained in their own camps, and on the system as a whole. They wanted information on how and why the system worked the way it did. But, beyond informing the NGO representative – assuming such a representative showed up, understood them, and relayed the message – camp residents had little means to convey their opinions.

One camp resident summed up the sentiments the majority of residents expressed to me: “[NGO officials] come with an agenda, a plan, a program. They can always find people who are clients for them who help execute the plan. But they don’t meet with the majority of the committee to identify needs.”

“The Meetings Are Almost Always in English…”

If displaced people have little say in programs being run in their camps, they have even less at the level of aid coordination and management. I asked if camp residents knew about the cluster system, the UN-run meetings where NGOs made decisions regarding not only water and sanitation but also provision of all basic post-quake services. None of the camp residents interviewed from any of the 16 camps knew what the cluster system was. The vast majority of residents reported that they do not receive information about how the UN and NGOs make decisions regarding them.

From our observations, the classic cluster meeting, for at least a year after the earthquake, looked like this: 20 to 30 people crowded around a few tables, some 80% from the US or Europe, speaking in a mix of English and French, communicating through powerpoint presentations and humanitarian aid jargon. The clusters’ exclusion of local people and groups drew criticism in the weeks following the earthquake, as it has after previous disasters elsewhere in the world. [iii] Yet this exclusion was so consistent, and the meetings so culturally comfortable to them, that aid workers came to see it as the norm. Several agency officials, in fact, explained that the cluster was not designed for camp residents to be present, that clusters were meetings for NGOs to speak with each other. A few wondered aloud how camp residents could be invited to participate given that the meetings could turn unwieldy, and some argued that the camp residents are in fact represented, since the NGOs speak on their behalf. Only three respondents stated that lack of participation was a real concern for them.

The result is that displaced people are simply not present to express the challenges they face and to advocate for solutions of their own creation. This exclusion was replicated at a number of other levels in post-earthquake decision-making and planning (more on this in the next article).

For most NGO officials, suspicion and misperceptions are not due to ill intentions – many work long hours and aspire to help those in need – but to the extreme disconnect between their institutions and Haitians’ reality on the ground. This, combined with the fact that management-level officials can hold prejudiced, sometimes downright racist beliefs, inevitably spills over into agencies’ decision-making in the form of denial of services and exclusion.

NGOs may claim that they cannot continue providing services indefinitely. Notwithstanding the fact that many are still sitting on (some even making interest on) the funds they raised for Haiti, this is understandable in the long term. But instead of responding by abandoning the people they’ve assumed responsibility for, they could step up in their role as advocates, pushing for long-term reconstruction and housing policies, for the changes in foreign policy that Haitians are demanding, and for the international community’s follow-through on its pledges. Some groups, such as Doctors without Borders and Partners in Health, have been doing this all along.

What are the solutions that Haitians are asking for? And how can NGOs adopt models that are driven by these demands? The next article will take a look at some of the inspiring examples of community engagement that Haitian grassroots groups are promoting, as well as the exceptional international NGOs that have followed their lead. We also look at how the dynamics I describe here are the continuation of historic trends that often implicate our government, here in the US – down to the reason why cholera was able to gain a foothold in Haiti in the first place.

Sign these petitions telling the UN to take responsibility for introducing cholera into Haiti and to help stop the epidemic: Just Foreign Policy Petition & Baseball in the Time of Cholera Petition.

Respondents’ names are not given as interviews for the study were conducted anonymously. Esaie Jean Jules was interviewed separately by Alexis Erkert. The study described was part of a Master’s thesis at the Harvard School of Public Health. For a copy of the full paper, contact [email protected]. Special thanks to Professor Stephen Marks and Silvan Vesenbeckh at the Harvard School of Public Health, Professor Mark Schuller at the City University of New York, and Ben Depp for sharing his remarkable photography.

[i] Financial Edge. (2011, April 29). Where’s The Next Housing Bubble? and Sasser, B. (2011, March 18). Haiti’s housing bubble, more pressing to some than election or Aristide. Christian Science Monitor .

[ii] Schuller, M. (2011). “Met Ko Veye Ko”: Foreign Responsibility in the Failure to Protect Against Cholera and Other Man-made Disasters. Retrieved April 17, 2011 from IJDH.

[iii] Lindsay, R. (2010, March 29). Haiti’s Excluded. Retrieved April 17, 2011 from The Nation.