8 November 2010. A World to Win News Service. Unlike the earthquake that hit Haiti last January, the cholera outbreak was predictable and preventable. The danger is far greater because of the earthquake, but the disease might have struck even without that destruction. People have known for many years that this was possible unless serious sanitation measures were taken.
Already many thousands of people have fallen ill with acute diarrhoea and more than 540 have died of it. So far most of the confirmed cases have occurred in the Lower Artibonite river, in the rural Central Plateau region north of the capital. The river is believed to have recently become infected with the bacteria that causes the disease.
Just after the cholera epidemic struck, Hurricane Tomas made the Artibonite overflow. The floodwaters have further isolated some people from medical help, forced others to flee and may spread the contamination. There is fear that the disease may reach the crowded capital. Suspected cases have appeared in Cité Soleil, a huge shantytown that lies in the direction of the Artibonite Valley.
No one knows how rapidly this disease will spread. Even if efforts to contain it succeed, it is likely to become yet another affliction for Haiti's people for some time to come.
Most often cholera spreads through water contaminated by human excrement. There is a cruel irony to the fact that infected drinking water causes people to die of dehydration, the emptying of the water in their bodies due to a diarrhoea so intense it can kill in a few hours. The key to preventing or containing it is clean drinking water. It's that simple. That's what people are dying for lack of, in a world marked by unprecedented riches and scientific and technological progress.
The Artibonite region was not heavily damaged by the earthquake, although the situation there has been made more difficult by the influx of homeless people forced to return from the capital. The dangers created by the people's dependence on river water have been known for a long time. This beautiful river is central to people's lives. People live alongside it, bath in it, wash their clothes and themselves in it and drink it. They can't afford the fuel to boil water before they drink it. No matter how careful they try to be about sanitation and cleanliness, everything they do in their daily lives with the only plentiful water at hand can kill them and spread the disease.
Most people infected by the disease don't fall ill, although they can spread it anyway. Malnutrition can make them more vulnerable. Treatment should be simple: water with a little salt and sugar will keep the majority of people alive even without hospitalisation, and intravenous fluids can help almost all of the rest to survive. In some cases antibiotics are needed to save people, and they can help prevent the infection from spreading.
Cholera first appeared in the nineteenth century and has spread around the globe six times before. The current pandemic began in South Asia a half century ago and spread from there. Scientists believe that this disease can never be wholly eradicated, because the bacillus that causes it can live outside of human beings, but it can be contained and treated effectively, and recently a vaccine has been developed. Once a recurring curse in European cities like London, it was quickly eliminated by putting disinfectants in public water supplies and improving sewage, not only in the better-off countries, but even many others.
Cholera epidemics are often associated not just with poverty, but changes in how people live due to natural disasters, population displacements, unplanned rapid urbanization and especially the kinds of large-scale social breakdowns that make it impossible for communities to keep up their sanitary conditions.
For instance, one of the world's worst recent outbreaks hit Zimbabwe two years ago and is now spreading to neighbouring countries. It occurred when the rainy season coincided with the collapse of the urban water supply and sanitation systems amid an economic crisis due to UK and U.S. pressure on the Mugabe government. The trigger factor came when Zimbabwe could no longer obtain chlorine to purify piped water.
The question of whether people who get sick with cholera will live or die is also associated not only with poverty in a general way but other, not necessarily directly connected, particular social issues. For example, when asked if the percentage of Haitian cholera victims who have died is "standard", a doctor who formerly worked in Bangladesh said that he had treated thousands of patients for cholera there and had never lost a single one, even in one of the world's poorest countries. One reason cholera victims in Haiti need hospital treatment is that the amount of clean water they need to drink to avoid dying of dehydration, about 20 litres a day, just isn't available anywhere else. And what are people supposed to wash with to prevent spreading and catching the disease? What toilets can they use? They can and should take precautions, but on the whole there isn't much they can do in this context. The health crisis reflects a social crisis.
Some of the reasons why clean water is missing in Haiti were documented by several U.S. and Haitian-based groups, including Partners for Health, an organization that has been working in Haiti for decades. They issued a report entitled "Woch nan Soley: The Denial of the Right to Water in Haiti" two years before the cholera outbreak.
One detail in that report has suddenly claimed people's attention. In 1998, the Inter-American Development Bank decided to lend the Haitian government 54 million dollars to improve the water system nationally. Specific upgrading projects included the city of St. Marc and the surrounding Artibonite department where today's outbreak first occurred. Later the U.S. got the IADB to block this loan as part of a covert programme to destabilize the elected government of Jean-Bertrand Aristide. The U.S. first backed Aristide as a possible source of political stability in a period of tumultuous popular upheaval. Then, when he seemed to imperil some American interests, he was eventually kidnapped and sent into exile by a U.S. and UN-backed coup in 2004.
The continuing lack of any public spending on water since then has created a deteriorating situation where the only clean water available is provided by private companies, and most people can't afford to buy enough of it no matter how much they love their children. Even before the cholera outbreak, other kinds of infectious diarrhoea and gastrointestinal infections, highly preventable diseases that need not exist anywhere in today's world, became the leading cause of death of young children. Among the countries ranked by a world survey of "water poverty", Haiti ranked last long before the earthquake.
In other words, during the last 16 years that Haiti has been occupied by various combinations of UN and U.S. troops – and not just since the earthquake – most people's lives have gotten much worse. The U.S. responded to last January's catastrophe by setting up a commission led by former American President Bill Clinton to oversee the decisions of a regime brought in under the wing of the U.S. in the first place. Clinton is said to have some credibility in Haiti because his administration backed Aristide, but this even more direct American intervention has led to nothing positive for the people.
In March 2010, U.S. Secretary of State Hillary Clinton promised 1.15 billion dollars to reconstruct the country's infrastructure. Not a single penny of this has been delivered. (Associated Press, 4 November 2010). The excuse is that Clinton's State Department wants to be sure that the money won't be wasted or stolen. Given her husband's role in Haiti, this is ridiculous. Corruption may be rife there, but the responsibility lies at the top. The U.S. been the biggest corrupter, both by buying people and influence and indirectly because of what it has done to Haiti.
Most of the money promised by international organizations and other countries also never appeared.
Many plans were drawn up to put up housing, install solar power and building roads. But since then not even the rubble left by the earthquake has been cleared. Land ownership issues have contributed to a deadlock in which nothing has been done to restore even the impoverished infrastructure that once existed.
The U.S. and others have provided emergency humanitarian assistance. This and private charity has paid for emergency medical programmes, tents, a little food and a few other things to keep people from dropping dead in such large numbers as to cause violent social unrest (which the UN troops are still there to prevent) with possible global implications. But this situation is not sustainable. Ever since last January conscientious NGO workers and others have been saying that without a fundamental turn in the situation, further disaster was inevitable, including possibly cholera.
It is particularly damning that most of the suspected cholera cases in the crowded capital so far have appeared not among the homeless stuck in temporary camps but in Cité Soleil, where people are living under the same conditions as before the earthquake.
Cholera has not been present in Haiti or anywhere else in the Caribbean for many decades. Some people inside and outside the country have tried to blame the UN troops for the October outbreak, charging that the infection originated from Nepali UN soldiers who have a base near the Artibonite river. Pro-Aristide forces have especially focused on this idea (see the newspaper Haiti Liberté), although a few lesser government figures have found it convenient to repeat it. In protest rallies people have chanted, "Down with the occupation! Down with imported cholera!"
This slogan has gained popularity because the UN troops are hated for repressing protests and raping, brutalizing and even murdering people in the shantytowns. But no matter what tests may or may not reveal about the immediate trigger, Haiti has long been a country where cholera or something other epidemic was waiting to happen. Casting the blame on some underpaid mercenaries misses the bigger picture, especially the collapse of the Haitian economy and the social crisis brought about by U.S. imperialist domination.
In fact, the underlying problems can't even be reduced to particular criminal political decisions, even though as in Zimbabwe, the outbreak of this disease can sometimes be linked to specific imperialist acts of disregard for human life. More fundamentally, what we are seeing is the inexorable grinding of a system that cannot function any other way.
Haiti's plantation slaves played a significant role in the early accumulation of capital that led to the development of the capitalist system in France and elsewhere. Theirs was the world's first successful slave revolt. After a long period of contention over which major power would turn the country into a colony again, the U.S. won and has crushed Haiti for more than a century. U.S. troops invaded to protect American investments from a peasant rebellion. They occupied the country for almost two decades, and the U.S. kept direct control of the country's finances until 1947, a situation which exists in another form today.
Before the U.S. military went home it organized a Haitian army that was to be the main pillar of the country's economic, political and social life and the main instrument of U.S. domination. That military gave birth to the presidencies of the infamous tyrant "Papa Doc" Duvalier and his successor son, known as "Baby Doc". Washington kept the Duvaliers in power until 1986, until popular upheaval brought the regime down and eventually the U.S. had to let the Haitian army be disbanded. (See AWTWNS100118)
It has not been the U.S.'s wilful decision to keep the country undeveloped. It tried to bring about the kind of development in agriculture and industry that would make the country a greater source of profits. The opening up of the Haitian economy to the world market ruined its peasants (leading, among other things, to massive migration into Port au Prince and other cities, and an enormous number of immigrants abroad whose cheques are the main source of income for their families back home). But international capital has not flocked to exploit the Haitian people. In fact, despite drooling in American business publications about a "Bangladesh next door", efforts to encourage the establishment of low-wage factories for export products have not prospered. One important reason is the U.S.'s inability to set up the kind of politically stable regime foreign capital investment requires. This is largely a result of both the fact and the form of the U.S.'s own long-standing political domination, including the feelings this has created among the people.
Haiti is imprisoned in a criminally insane situation where people are dying of diseases other countries wiped out a century and a half ago. There is so much work crying out to be done to save the people, so many ditches to dig, pipes to be laid and homes, schools and hospitals to be built, even if rubble were the only building material and arms the only machinery. So many people are crying out for work and a chance to rescue themselves and their country. Yet nothing will be done if it doesn't profit some capitalist and especially U.S. imperialist capital.
For the imperialists and their Haitian henchmen, the people of Haiti are a big problem. But in reality they are the only possible solution. When revolution frees Haiti's people from imperialist political and military domination and the tyranny of the profit system, when a revolutionary regime can put the welfare of the people first and increasingly enable the people to become the conscious masters of all spheres of society, Haitians could rapidly free themselves from scourges like cholera as they take their first steps toward a world worthy of human potential.
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