Editorial

The Crisis in Haiti:
Who can provide the best response?
The response to complex emergencies is not the same as the response to natural disasters. Just as each situation is unique, each type of agency —humanitarian and development— has a specialized service to offer. What (and who) works best in one situation is not necessarily the same in another.

Haiti’s long history of crises—natural disasters and chronic humanitarian and political situations—has had a major impact on the health of this island nation of 8.4 million. According to the Pan American Health Organization’s Epidemiological Bulletin, Vol. 24, No. 1, by 2000, infant mortality had increased to 80.3/1,000 live births, a rise associated with increased poverty, deficiencies in the health system and the impact of the AIDS epidemic. Other major health concerns include vector-borne diseases such as malaria, which is endemic in Haiti, diseases preventable by immunization such as measles, intestinal infectious diseases and nutritional and metabolic diseases. Malnutrition ranks eighth among the causes of general mortality and 76% of the cases are in children under 5.

Although both natural disasters and complex emergencies wreak havoc on a country’s health care system, a natural disaster can ultimately strengthen a country’s management capacity as a result of experience gained and an influx of national and external assistance. This was the case in several countries affected by Hurricane Mitch in late 1998, where financial support was used not only for immediate repairs to infrastructure, but to also build better disaster prevention and response mechanisms. Nicaragua is a good case in point. In the last five years, the country has built up its health disaster program at a much faster pace than it was able to do in the previous twenty years, so much so that it recently led the process to create an inter-country disaster preparedness and prevention plan for the health sector in Central America.

Complex emergencies, where public institutions have received little or no support, do not offer the same opportunities. In Haiti, almost nothing remains from previous humanitarian and military interventions. The United Nations has called for a long-term international presence of some 20 years as Haiti recovers from this series of reverses. "We cannot continue,”said the U.N. Special Adviser to Haiti to the Security Council, “with the stop-start cycle that has characterized relations between the international community and Haiti. Since 1994, 10 separate and joint missions by the United Nations and the Organization of American States (OAS) would spend a year or two, without necessarily involving local people in their work, and there would be no continuity after the missions left.”

There is a great deal of goodwill among the Caribbean Community, the countries of the Western Hemisphere and the international community to change the way support is provided to countries in a chronic state of crisis such as Haiti. However, if humanitarian or security programs and institutions act in isolation during the post-conflict period, progress may be short-lived.

What triggered the latest international humanitarian response in Haiti was not the downward spiral in the state of health, but rather the sudden increase in violence—duly recorded by the arrival of the international press corps in Port-au-Prince. At that point, the international community focused its response primarily on security. Fortunately, a military intervention aided in peacekeeping and the transition government, the international community and NGOs were than free to look at humanitarian issues.

Humanitarian programs are needed and will be needed for a good while in Haiti to deal with the most immediate needs brought on by the crisis. But they will have little or no role in strengthening the government or addressing the roots of the crisis. Humanitarian agencies and workers are tremendously adept at providing a quick and agile response to crises, but they must work hand-in-hand with the development community. Some best practices that were noted in previous crises include:

• Avoid having humanitarian programs deal with the overall post-conflict situation. “Humanitarians” should focus on what they are good at: rehabilitation, preparedness for the next disaster, logistics and quick fixes.
• Avoid having the development community begin its full involvement only when humanitarian programs are winding down. “Developers” must be fully involved from the beginning, working in tandem with humanitarian agencies. Later, bilateral, UN or NGO cooperation should take the lead in medium-term reconstruction efforts.
• Avoid cutting off aid in areas such as security, policing, justice and the political process too soon, as has been the case. No stable development or economic program can be carried out without a minimum level of security. Development programs are among the strongest contributors to good governance and stability.

In situations of chronic crisis, strictly humanitarian agencies and programs should be the first to complete their post-crisis contribution, followed by support to the security, judicial and political aspects of the crisis (disaster preparedness agencies, however, should remain for several years). Development programs should be the last to withdraw from countries in crisis such as Haiti.

In natural disasters, good humanitarian programs can resolve most problems. However, they cannot have the same impact in post-conflict situations that result from serious structural and long-term political problems. These situations require everyone to be on board, contributing to the areas for which they are best equipped. The overall process will be best led by professionals and agencies that have traditionally been in charge of medium and long-term development. Humanitarians, with their ability to operate quickly in crisis mode, are the best suited to deal with security and logistic issues and to concentrate on preparedness or readiness when crises are imminent.

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