Haiti Case Study - The Department of Global Health and Social ...

law 11 . In 2006, Rene Préval again was elected president and remained so until 2011.
President Préval is the first Haitian president to be democratically elected to a second term.
24. Though elected more than once, President Aristide’s rule was marred with political
challenge which has created barriers for Haiti’s foreign investment and development.
Concern over corruption and Aristide’s leftist policies led the donor community, and the US in
particular, to refuse money to his government and funnel it instead to largely foreign based
NGOs 12 .
25. This lack of stable, credible governance and finance, as well as a lack of trust between
Haitian leadership and powers beyond its borders, led to the government’s inability to
perform basic functions, like issuing birth and death certificates and land deeds, regulating
industry and providing and enforcing building codes, much less providing health and
education services 13 . In addition, environmental vulnerabilities went unaddressed, most
notably deforestation for the purposes of charcoal production, which is Haitians main source
of fuel. Only an estimated 2% of Haiti’s forests remain and this has led to a fragile
environment with landslides and devastating floods wracking Haiti’s hurricane vulnerable and
erosion prone coastline 14 . In 2001, Haiti remained the least water secure nation in the
world 15 . Haiti is a fragile state indeed and one frequently affected by and vulnerable to crisis.
A CRISIS-AFFECTED FRAGILE STATE
26. In July 2010, Active Learning Network for Accountability and Performance in
Humanitarian Action (ALNAP), in partnership with the UN Evaluation Group, published a
Haiti Context Analysis report whose purpose was to “provide a useful contextual background
for operational reflection [and to] serve as a sound and shared foundation for evaluative
efforts going forward” 16 . The project team found that this report provides a solid summary for
understanding the historical, political, and social context of Haiti as a fragile state prior to the
earthquake.
27. The ALNAP report summarizes Haiti’s political and social context as follows:
“Haiti has endured political instability, chronic challenges in governance and the highest
levels of poverty in the Western Hemisphere. According to several indexes measuring
states’ fragility, Haiti performs particularly poorly ranking twelfth out of 177 countries in
the Failed States Index and 129th of 141 countries according to the Index of State
Weakness in the Developing World…”
“The rapid urbanisation has a negative impact on the local environment and the country’s
natural resources. In 2007 45.6 per cent of the population lived in urban centres that have
more than doubled in size since 1982. As a result vulnerable populations live in highdensity
and often appalling living conditions in slums, triggering public health and other
problems.”
28. In light of this political and social context, the ALNAP report concludes that “the country
is highly vulnerable to disasters such as floods, landslides, storms, hurricanes, tsunamis and
earthquakes. Between 2001 and March 2007, disasters resulted in 18,441 deaths, 4,708
injuries and 132,000 homeless; some 6.4 million people were affected and damage was
estimated at USD4.6 billion”.
THE HEALTH SYSTEM
29. Prior to the earthquake, Haiti’s population suffered from some of the worst health
outcomes in the Western Hemisphere, worsening with eruptions of political strife, divestment
of aid to the public sector, embargoes and coups. 17 Comparing Haitian health outcomes to
those of the Dominican Republic, its only neighbour, is particularly illustrative of Haiti’s plight.
Life expectancy in Haiti is 63 years compared to 72 in the Dominican Republic. 76 children
per 1,000 live births will die before their fifth birthday in Haiti, compared with 24 in the
6