Saturday, January 16, 2010

Is Haiti's Tragic Disaster Entirely Natural?

As a long time resident of the San Francisco Bay Area living near a major fault, I am quite conscious of the potentially devastating impact of "The Big One" forecast to to hit California at some unknown date in the future. A 1906 San Francisco earthquake, measuring about 7.9 on the Richter scale, caused widespread damage and claimed at least 700 lives. A similar sized earthquake centered in Kashmir, measuring about 7.6 on Richter scale, hit northern and western Pakistan in 2005 and claimed 75,000 lives.

Another big tremor struck the Bay Area in 1989 which I personally experienced. The 7.0 Loma Prieta shaker in 1989 caused 63 deaths. This week, a major earthquake, also measuring a magnitude of 7.0, struck near Port-au-Prince, Haiti. Early Red Cross estimates indicate that between 45,000 and 50,000 people have died. Haiti quake's aftermath is not entirely a natural disaster story. This is a story of abject poverty caused by years of corruption and mismanagement. It’s a story about shoddy construction, bad infrastructure and poor public services.

How poor is Haiti? The best way to answer this question is to describe dirt cookies consumed by a very large population in Haiti. These cookies are literally made from dirt with a small amount of flour and sugar mixed in to make them relatively palatable. While these dirt cookies do fill the hungry stomachs of the poor, there is very little nutrition in them. Why is Haiti so poor and underdeveloped? Well, it does have a history of oppression, slavery and colonialism. Post-independence Haiti has endured bad governance, corruption and foreign invasions. Others, like Barbados and Dominican Republic which shares the island Hispaniola with Haiti, have done much better than Haiti in spite of similar problems.

There are very few place where people are poorer or hungrier than Haiti, with the exception of Bangladesh and some states in India and Sub-Saharan Africa. In addition to Bangladesh and the nations of sub Saharan Africa, the Indian states of Gujarat, Chattisgarh, Bihar, Jharkhand and Madhya Pradesh are worse off than Haiti, according to India's State Hunger Index (ISHI) survey report. Gujarat is often projected as a success story by the right-wing Indian media. The economy of Gujarat is sustaining an overall growth rate of eight percentage points, but the incidence of rural poverty declined at the annual rate of 0.23 per cent, which is the worst Human Development Index (HDI) improvement record among all Indian states. From 1996 to 2006, Gujarat slipped one rank each in education and health indices to eight and tenth positions, respectively, as compared to 20 other states. In improvement in Infant Mortality Rate, it ranked 13th. The state ranked 14th in Child Mortality Rate, 13th in TMR, 17th in stunted children and ninth in underweight children. What it says is that economic growth alone can not solve the problems of poverty and malnutrition in Gujarat, or India, or the rest of the world. Economic growth has to be accompanied with progressive policies to uplift the most vulnerable populations in society.

Obviously, the first order of business for all of the peoples and the governments of the world is to provide emergency aid and comfort to the survivors of the monumental tragedy unfolding in Haiti. We should all donate time, money and other resources that each of us can to our Haitian brothers and sisters in humanity in their most difficult hour. Most major international relief organizations such as Red Cross, UNICF, Islamic Relief, Hidaya Foundation, Edhi Foundation and others have online portals for aiding Haitians in dire need of immediate assistance.

There are soldiers and rescuers helping the relief effort from across the world, including Pakistani soldiers wearing blue UN helmets deployed in Haiti. Relief supplies are flown in by the American military to the only airport with just on runway in Port-au-Prince.

Beyond immediate help, it's important for the world to find ways of alleviating the abject poverty, recurring hunger and deprivation of the Haitian people and other victims of poverty and hunger in South Asia and sub-Saharan Africa. Reducing poverty and hunger and improving governance in these parts of the world can help reduce their everyday suffering and prevent the repeat of at least the man-made contribution to massive tragedies resulting from natural disasters in the future.

Here is an interesting Op Ed by David Brooks in the New York Times discussing Haiti and the problems of reducing poverty in developing nations:

On Oct. 17, 1989, a major earthquake with a magnitude of 7.0 struck the Bay Area in Northern California. Sixty-three people were killed. This week, a major earthquake, also measuring a magnitude of 7.0, struck near Port-au-Prince, Haiti. The Red Cross estimates that between 45,000 and 50,000 people have died.

This is not a natural disaster story. This is a poverty story. It’s a story about poorly constructed buildings, bad infrastructure and terrible public services. On Thursday, President Obama told the people of Haiti: “You will not be forsaken; you will not be forgotten.” If he is going to remain faithful to that vow then he is going to have to use this tragedy as an occasion to rethink our approach to global poverty. He’s going to have to acknowledge a few difficult truths.

The first of those truths is that we don’t know how to use aid to reduce poverty. Over the past few decades, the world has spent trillions of dollars to generate growth in the developing world. The countries that have not received much aid, like China, have seen tremendous growth and tremendous poverty reductions. The countries that have received aid, like Haiti, have not.

In the recent anthology “What Works in Development?,” a group of economists try to sort out what we’ve learned. The picture is grim. There are no policy levers that consistently correlate to increased growth. There is nearly zero correlation between how a developing economy does one decade and how it does the next. There is no consistently proven way to reduce corruption. Even improving governing institutions doesn’t seem to produce the expected results.

The chastened tone of these essays is captured by the economist Abhijit Banerjee: “It is not clear to us that the best way to get growth is to do growth policy of any form. Perhaps making growth happen is ultimately beyond our control.”

The second hard truth is that micro-aid is vital but insufficient. Given the failures of macrodevelopment, aid organizations often focus on microprojects. More than 10,000 organizations perform missions of this sort in Haiti. By some estimates, Haiti has more nongovernmental organizations per capita than any other place on earth. They are doing the Lord’s work, especially these days, but even a blizzard of these efforts does not seem to add up to comprehensive change.

Third, it is time to put the thorny issue of culture at the center of efforts to tackle global poverty. Why is Haiti so poor? Well, it has a history of oppression, slavery and colonialism. But so does Barbados, and Barbados is doing pretty well. Haiti has endured ruthless dictators, corruption and foreign invasions. But so has the Dominican Republic, and the D.R. is in much better shape. Haiti and the Dominican Republic share the same island and the same basic environment, yet the border between the two societies offers one of the starkest contrasts on earth — with trees and progress on one side, and deforestation and poverty and early death on the other.

As Lawrence E. Harrison explained in his book “The Central Liberal Truth,” Haiti, like most of the world’s poorest nations, suffers from a complex web of progress-resistant cultural influences. There is the influence of the voodoo religion, which spreads the message that life is capricious and planning futile. There are high levels of social mistrust. Responsibility is often not internalized. Child-rearing practices often involve neglect in the early years and harsh retribution when kids hit 9 or 10.

We’re all supposed to politely respect each other’s cultures. But some cultures are more progress-resistant than others, and a horrible tragedy was just exacerbated by one of them.

Fourth, it’s time to promote locally led paternalism. In this country, we first tried to tackle poverty by throwing money at it, just as we did abroad. Then we tried microcommunity efforts, just as we did abroad. But the programs that really work involve intrusive paternalism.

These programs, like the Harlem Children’s Zone and the No Excuses schools, are led by people who figure they don’t understand all the factors that have contributed to poverty, but they don’t care. They are going to replace parts of the local culture with a highly demanding, highly intensive culture of achievement — involving everything from new child-rearing practices to stricter schools to better job performance.

It’s time to take that approach abroad, too. It’s time to find self-confident local leaders who will create No Excuses countercultures in places like Haiti, surrounding people — maybe just in a neighborhood or a school — with middle-class assumptions, an achievement ethos and tough, measurable demands.

The late political scientist Samuel P. Huntington used to acknowledge that cultural change is hard, but cultures do change after major traumas. This earthquake is certainly a trauma. The only question is whether the outside world continues with the same old, same old.

Related Links:

Aid, Trade, Investments and Remittances

Poverty in Pakistan

Haitian Dirt Cookies

The Underlying Tragedy

India State Hunger Index

Grinding Poverty in Resurgent India

Can Congress Deliver in India?

Food, Clothing and Shelter in India and Pakistan

What Works in Development? By Jessica Cohen, William Easterly


Riaz Haq said...

Here's a report about hunger at hospitals in India:

At the busy, charitable hospital run by the Rural Medicare Society (RMS) at Mehrauli, on the outskirts of the national capital, where Dhaka is employed, there are provisions for poorer patients. But this is not the case with most state-run or private medical facilities, where patients are left to their own devices when it comes to procuring prescribed medicines or getting their meals.

Unlike in most other countries, in-patients in India must bring along attendants, usually family members, to buy medicines, fetch meals, do the paperwork and help the nurses. These attendants can be seen sitting beside hospital beds or crowding around the corridors.------------

According to Dr. Aarti Vasisht, one of 28 doctors and surgeons working at the RMS hospital, providing patients with timely, balanced and nutritious meals is important because it has a direct bearing on recovery.

The chest specialist added that many of her patients are being treated for tuberculosis and are on heavy medications. "These are people who need to be on special diets and must be provided timely, nutritious meals," she said.

Vasisht has been able to arrange free meals for her patients at the RMS hospital from the charitable Santhigiri Ashram, which has a mission of providing free or subsidised food and medical care for the needy.

"We hope to expand these services and reach other hospitals in the national capital, but this is not easy in a time of recession when the prices of food items have gone through the roof," said Swami Pranavsuddhan, director of the Santhigiri Ashram. "The good thing though is that this is a cause that people seem interested in supporting, and New Delhi is a city of wealthy people who believe that feeding the poor and needy can add positively to their karma."


"In India’s healthcare delivery system it is hard enough to get affordable medicines to most patients, and so the question of ensuring that they eat well is glossed over although everybody is aware of the problem,’’ she said.

The latest review of the National Rural Health Mission (NRHM), released last week, speaks of continuing difficulties in providing free drugs to patients and "the imperative of prescribing medicines from outside," when the government is committed to raising public spending on health from 0.9 percent of gross domestic product to two to three percent of GDP.

Many public hospitals, says NRHM – which has the stated goal of improving the availability of and access to quality healthcare for people, especially those residing in rural areas, the poor, women and children – now run commercial pharmacy shops within their premises.

What that means is that patients who do not have the cash to buy medicines with may have to do without them. The same goes for the hospital canteens from where patients are expected to buy food for themselves and their attendants.

In sharp contrast to the services at the RMS centre are the swish hospitals dotting the capital that cater to the health needs of the well-to-do and to a burgeoning medical tourism industry that attracts 450,000 foreign patients each year.

Hospitals such as the ‘Indraprastha Apollo,’ which ranks among the world’s biggest private health facilities, do not allow attendants and provide patients with meals prepared under the careful supervision of dieticians.

According to the study one million Indians die every year as a result of inadequate healthcare and that 700 million of India’s 1.1 billion people have no access to specialist care simply because 80 percent of specialists live in urban areas.

The NRHM also acknowledges that over 40 percent of hospitalised Indians borrow heavily or sell assets to cover medical expenses and that over 25 percent of hospitalised Indians fall below the poverty line because of hospital expenses.

Riaz Haq said...

Indian NGO Sathi's Findings as reported by Times of India:

The urban population of the coastal region, which includes the country’s commercial capital Mumbai, has the highest prevalence of calorie deficiency (43%) in Maharashtra.

Analysis also shows that undernutrition is prevalent across all religions.

only 30.7% of the people in Maharashtra are classified as Below Poverty Line (BPL). The official BPL designation excludes over 16 million people who are too poor to afford adequate food.

Calculations made using a per consumer unit calorie norm of 2400 in rural and 2100 in urban areas, reveals that the incidence of calorie-based poverty is 54.1% in rural areas and 39.5% in urban areas.

Going by the NSS norm of 2700 calories per consumer unit, then 68% of households in rural Maharashtra are not receiving adequate calories and should be considered ‘poor’.

According to Ram, Mohanty and Ram’s 2008 analysis, 65.4% of abject deprived households25 in Maharashtra do not have BPL cards.

In contrast to the millions of households in abject poverty that cannot access BPL cards, 12.7% of non-poor households posses BPL cards. Specifically, BPL cards are owned by 15% of families owning more than five acres of agricultural land, 5% who own a television and refrigerator and 7% with a motorized vehicle.

Undernourished children are more susceptible to illnesses such as diarrhoea and acute respiratory infections and are less likely to survive them. In cases where they do survive, they are further weakened and susceptible to future illness.

Only 12% of schools investigated were providing cooked midday meals. Among the schools distributing food, most only provided cooked rice without any other supplements such as cooked dal and vegetables. This study also found that not a single school was providing the stipulated 300 calories and 8 to 12 grams protein.

ICDS feeding centres (i.e. Anganwadi centres) often do not weigh the children regularly or properly. Other research (both government and independent) suggests that a much larger portion of children are malnourished than that reported by ICDS.

Grade III and IV malnourishment is grossly underreported by the ICDS. Workers often lack the skills and equipment necessarily to accurate weigh and classify children. ICDS employees tend to underreport severe malnutrition in order to mask program failures.

Riaz Haq said...

Here's an excerpt from an interesting opinion by Jeffrey Sachs published in Christian Science Monitor:

Those who contend that foreign aid does not work - and cannot work - are mistaken. These skeptics make a career of promoting pessimism by pointing to the many undoubted failures of past aid efforts. But the fact remains that we can help ensure the successful economic development of the poorest countries. We can help them escape from poverty. It's in our national interest to do so.

The first step out of rural poverty almost always involves a boost in food production to end cycles of famine. Asia's ascent from poverty in the last 40 years began with a "green revolution." Food yields doubled or tripled. The Rockefeller Foundation helped with the development and propagation of high-yield seeds, and US aid enabled India and other countries to provide subsidized fertilizer and seeds to impoverished farmers. Once farmers could earn an income, they could move on to small-business development.

A second step out of poverty is an improvement in health conditions, led by improved nutrition, cleaner drinking water, and more basic health services. In the Asian success stories, child mortality dropped sharply, which, in turn, led to smaller families because poor parents gained confidence that their children would survive to adulthood.

The third step is the move from economic isolation to international trade. Chile, for instance, has become the chief source of off-season fruit in the US during the past 20 years by creating highly efficient supply chains. China and India have boomed as exporters of manufacturing goods and services, respectively. In all three, trade linkages were a matter of improved connectivity - roads, power, telecommunications, the Internet, and transport containerization.

Today, the skeptics like to claim that Africa is too far behind, too corrupt, to become a China or India. They are mistaken. An African green revolution, health revolution, and connectivity revolution are all within reach. Engineers and scientists have already developed the needed tools. The Millennium Villages project, which I and a group of colleagues developed, is now rapidly expanding in 10 countries in Africa and is showing that this triple transformation - in improved agriculture, health, and connectivity - is feasible.

Improved seed varieties, fertilizers, irrigation, and trucks have all helped convert famine into bumper crops in just one or two productive growing seasons.

Malaria is under control. Farmers have access to capital to make the change from subsistence to cash crops. Children are being treated for worms and receive a midday meal to help keep them healthy and in school.

Riaz Haq said...

It's not just Haiti, it seems that the poor India are also resorting to eating dirt to survive, according to BBC:

"We live on a day-to-day basis," Suraj says, as the faint sound of hammering echoes across the village. "What we earn is what we spend on our families in a day."

In Ganne, just off the main road about an hour south of the city of Allahabad, this is a simple fact of life.

It is home to members of a poor tribal community, who live in small huts clustered around a series of shallow quarries.

Inside one of the huts sits a little girl called Poonam. She is three years old, and in the early stages of kidney failure.

Like many children in Ganne she has become used to eating bits of dried mud and silica, which she finds in the quarry. Tiny children chew on the mud simply because they are hungry - but it is making them ill.

When reports first emerged of children eating mud here local officials delivered more food and warned the villagers not to speak to outsiders. But Poonam's father, Bhulli, is close to despair.

Riaz Haq said...

Here's an IRIN critique of recovery and reconstruction effort after Pakistan's 2005 quake:

ISLAMABAD, 13 May 2010 (IRIN) - The devastating 7.6 magnitude earthquake that struck northwestern Pakistan in October 2005 led to the establishment of a government body tasked with coordinating the emergency response, early recovery and reconstruction of homes and infrastructure in an area spanning 30,000sqkm of mountainous terrain.

The Earthquake Relief and Rehabilitation Authority (ERRA) has been credited with overseeing the biggest post-disaster reconstruction effort in history: Its owner-driven rural housing programme to rebuild some 435,000 homes in nine districts of Khyber Pakhtunkhwa and Pakistan-administered Kashmir has become a benchmark. [See “Building back better” in quake zone]

However, amid the chaotic scenes that inevitably followed such a large-scale and widely scattered disaster, it took some time for ERRA to formulate and implement its policies.

“[At the beginning] there wasn’t enough information in the field. There wasn’t enough capacity in the field and people were starting to build quickly before advice,” Maggie Stephenson, technical adviser at UN HABITAT, which was involved in designing ERRA’s housing programme from the outset, told IRIN.

Stephenson praised the Pakistan government’s overall response to the disaster, particularly the army, but noted that the current ERRA model for rural housing reconstruction took years to develop and was not without mistakes.

“There was only a very simple and single housing standard at the beginning and it really had to be widened and tested. There was extremely rigorous testing from the World Bank and others. Every local [construction] technique that now seems obvious had a lot of documentation, empirical testing and so on,” Stephenson said.

“We’re conscious that we wouldn’t want people to go through some of the things we went through. We want some of the hurdles also to be documented so that we can avoid them next time,” she added.

Kamran Shariff, humanitarian affairs officer for the UN Office for the Coordination of Humanitarian Affairs (OCHA), said that coming from “zero capacity” ERRA had done a “pretty good job” in harmonizing all the stakeholders involved in the disaster, but he also lamented the amount of time and money needed to arrive at best practices.

“In rural housing they have gone through lots and lots of trial and error. The initial houses that were made were based on inputs by consultants who had no idea of local needs. So they wasted a lot of time - and I’m sure money and effort - in coming up with a design that was cost-effective and earthquake-resistant as well. And they ended up re-inventing the wheel and coming up with a design very close to the traditional house designs of that area,” Shariff told IRIN.

“So it has taken lots and lots of time - nearly half a decade - and that has caused lots of frustration.”

Too many layers of bureaucracy

Another critique of the reconstruction effort has been that there were too many layers of bureaucracy and that “parallel structures” slowed the process down.

“What people in Pakistan are doing is to get the best of ERRA’s model and trying to replicate that without the complexity associated with the bureaucratic procedures. ERRA’s approach is considered too process-oriented, too time-consuming, too much bureaucracy. That’s the biggest hurdle in replicating ERRA’s model. [But] they are not able to do it in Pakistan - Baluchistan is one example,” Shariff said, referring to the October 2008 earthquake in this province.

“I was there coordinating the humanitarian response. There they [the government] just gave them the money. No standards, nothing. You could build a house or go spend the money,” he said.

Riaz Haq said...

Northern Pakistan hit by 6.2 quake on Sept 17, 2009, according to Pakistan's Dawn newspaper:

ISLAMABAD, Sept 17: High-intensity tremors jolted vast areas of Khyber Pakhtunkhwa, Punjab, Azad Kashmir and Islamabad a little before midnight on Friday, triggering panic among people.

According to seismic department, the magnitude of the quake was 6.3 on the Richter scale and its epicentre was somewhere in Hindukush mountains. The tremors lasted 14 to 15 seconds.

The tremors were felt in Gilgit, Chitral, Skardu, Abbottabad, Swat, Muzaffarabad, Mirpur, Mansehra, Peshawar, Kohat, Nowshera, Islamabad, Lahore, Faisalabad, Gujranwala and Sarai Alamgir.

No loss of life was reported from any part of the country.

Reports from India indicate tremors were felt in Indian occupied Kashmir and as far as Delhi.

Riaz Haq said...

Much of Haiti still looks like the earthquake struck yesterday, according to the Daily Mail. Here's what happened with all of the aid and NGOs:

Many of them quickly ran into trouble - and then went to the UN for help. Often those without experience found the environment too tough to manage, so they became 'part of the caseload' and had to be shipped home. Harassed UN officials were forced to direct their energies towards rescuing those who were supposed to be helping.
This was an extreme example of a wider problem identified by Linda Polman, the author of The Crisis Caravan: What's Wrong With Humanitarian Aid.
She describes a new phenomenon flourishing in the market free-for-all of the aid sector which she calls MONGOs, or My Own NGOs. She cites cases of doctors who arrive on their own in countries such as Sierra Leone, inspired by the scenes of suffering they have watched on television, only to pull out when they run out of money.
Patients are abandoned with no aftercare, sometimes with infected post-operative wounds.
In the aftermath of the Asian tsunami in 2004, the UN tried to develop what is known as its 'cluster system' to co-ordinate the efforts of individual agencies. It has certainly resulted in some significant improvements, but in Haiti the system has been creaking at the seams.

Imogen Wall says coordination there often comes down to 'hundreds of organisations, not all of whom speak English, meeting in a shack with a tin roof down by the airport . . . and then it starts raining', so no one can hear anything anyway.

She says that at one stage the 'health cluster' included no fewer than 600 different NGOs. And the UN has no power at all to compel aid agencies to join the cluster system. In theory, NGOs have to register with the Haitian government, but in practice that does not always happen - not least because the government has itself been in such a mess since the earthquake.

The result is a very patchy provision of assistance. The good camps work well. Actor Sean Penn, who has earned widespread admiration for his dedication to Haiti's cause, has established a well-run camp in the old Portau-Prince golf club; it has good security, professional camp manage-ment and an efficient water and sanitation system provided by Oxfam. But it is known as 'the VIP camp' because it is so atypical of the way most earthquake victims live.
On the outskirts of the desperately poor Cite Soleil district of Port-au-Prince I visited an informal camp that is home to 300 families. They receive a weekly delivery of water from a Norwegian NGO and they have access to just three latrines between them.
That is pretty much it. There is no real security, and in camps like this rape and violent crime are a constant threat. I asked a group of women at the camp water tank what they thought of the foreign aid agencies. 'We have no opinion,' said one woman, 'because we haven't had any aid.'

The Haiti experience has been an object lesson in the limits to what aid can achieve.