Playing the blame game in Haiti
I’m not a big fan of Deborah Sontag’s massive 6,000-word NYT story about cholera in Haiti: it seems to me that if you’re going to be writing about something at that kind of length, you ought at some point to zoom back out and look at the big picture. Instead, Sontag seems to miss the forest for the trees, or at least the woods.
There’s no doubt that Haiti’s cholera epidemic was massive and tragic, and that the response to it could have been better, in an ideal world. But Sontag barely attempts to address the question of why the response was suboptimal. And insofar as she does, she waves vaguely at “financial concerns”, as though the main weakness in the response was that the amount of money spent was insufficient, and that the main way in which the response could have been improved was simply by increasing it.
Rather, Sontag spends a huge amount of effort tracking down, on the one hand, purely anecdotal stories of individual Haitians who were exposed to the disease, and on the other hand, the detailed story of whether and how the outbreak could be traced back to a group of Nepalese peacekeepers on the island. (Incidentally, although the article does include a handful of pro-forma links to the home pages of various NGOs mentioned in the article, it does not link to the key study on the origins of the outbreak, despite explicitly saying that the study was “published in the C.D.C.’s Emerging Infectious Diseases journal”.)
It’s standard journalistic practice, of course, to lead with an anecdote which illustrates the bigger story you’re writing about. But this story does much more than lead with an anecdote — it refers back to it at great length, and adds in many others as well, as if the best way to understand the response to the Haitian cholera epidemic is to talk to lots of Haitians who either got the disease or know someone who did. (Which is most of the country, in truth.)
One problem is that when Sontag quotes an official UN report (also not linked to) as saying that “the introduction of this cholera strain as a result of environmental contamination with feces could not have been the source of such an outbreak without simultaneous water and sanitation and health care system deficiencies,” she treats that statement as an attempt by the UN to avoid blame, rather than an important truth about the woeful state of Haiti’s infrastructure even before the earthquake hit.
And when she says that in the immediate aftermath of the outbreak, two smallish NGOs — Doctors Without Borders and the Cuban medical brigades — were handling 80% of the cholera cases, that’s meant as — and is — an indictment of what she calls the “health cluster”. That cluster, which includes the CDC and Partners In Health, did in fact respond relatively slowly to the outbreak, but elsewhere in the article Sontag presents PIH as the good guys, pushing for a maximalist response to the emergency.
The obvious — and true — conclusion is that this story does not lend itself easily to good-guy/bad-guy distinctions and dichotomies. But that doesn’t stop Sontag from trying. The victims, of course, are the innocent; meanwhile, the guilty, in this telling, would seem to include the CDC, the UN, and especially the Nepalese peacekeepers. And that does a huge disservice to all of those organizations.
The cost of responding to the cholera response has totaled some $230 million to date; to put that number in context, it’s roughly half the country’s total annual exports. And the cholera response is just one small part of the much larger international response to the 2010 earthquake. The biggest problem in Haiti isn’t a lack of money; it’s the problems inherent in trying to spend so much money in an economy which is in large part incapable of absorbing it, as Janet Reitman showed in a fantastic Rolling Stone article last year.
This is not exactly news within what’s known as the Republic of NGOs. But it seems to be news to Sontag, who never so much as broaches the subject. The biggest weakness with her article is that she makes it sound as though things would have been much better if more money had been spent, and that the optimal outcome was foiled by penny-pinching bureaucrats who mainly wanted to minimize their outlays.
In reality, there’s almost nobody in Haiti with an interest in minimizing outlays. And on top of that, a huge amount of the necessary cholera response was the kind of thing which had to be done anyway, as part of the broader post-earthquake crisis response: the construction of a sanitation infrastructure with sewerage systems and access to clean water. All Haitians need that regardless of whether there’s a cholera outbreak or not. If the money’s going to get spent in any case, the marginal extra cost of spending it quickly is unlikely to cause a cholera-eradication expenditure to be vetoed.
So the story of cholera in Haiti is a fantastic opportunity to delve into the complexities of aid and disaster response in Haiti, and how even the best and most well-intentioned organizations, like Partners In Health, find themselves stymied through no real fault of their own.
It’s an article of faith in the US that if there’s a problem somewhere in the world, then the application of sufficient cash will solve that problem. Haiti is the most salient counterexample to that article of faith that the world has. And yet somehow Deborah Sontag went to Haiti and came back with 6,000 words which seem to say that the problem in Haiti was that there wasn’t enough money, and that it wasn’t spent fast enough. She doesn’t even dwell on the central irony in her piece, which is that it was precisely the disaster-responders — the Nepalese peacekeepers — who seem to have triggered the cholera outbreak in the first place.
Would it have been better had there been no peacekeepers at all? Of course not. But failed states like Haiti are hard to fix. And that’s the central problem with the way the NYT is treating the country — as though it’s a fixable problem, as opposed to a much more intractable one. Victims can be identified, and cholera epidemics traced back to a single source. But when the NYT runs this story under a headline blaming “Global Failures”, that implies a baseline of success which is frankly impossible to achieve.