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No love in the time of Corona

A view from Haiti, a country that is poorly prepared to handle COVID-19.

In this article, Mats Lundahl discusses how COVID-19 could affect Haiti. Being one of the most disaster-prone countries in the world, the author describes how Haiti has struggled to handle previous crises and how the country identifies several risks in coping with COVID-19. With Haiti as an illustration, Lundahl points to potential problems that could happen in other countries with few resources.  

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Mats Lundahl

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This essay is dedicated to the memory of my dear brother-in-law, Lennart. COVID-19 took his life.

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So far, the corona pandemic has not hit the Caribbean nearly as strongly as it has hit Europe and North America. The worst affected country among the islands is the Dominican Republic, with almost 119,000 cases and 2,183 deaths as of 14 October 2020, or 10,939 cases and 201 deaths per 1 million inhabitants. Neighboring Haiti has so far escaped a major outbreak. The first two Haitian cases were confirmed on 19 March and the first death on 5 April. At the time of writing, mid-October 2020, the country has 8,887 confirmed cases and 230 deaths, or 777 cases and 20 deaths per 1 million inhabitants, if we are to believe the statistics. Unfortunately, I am inclined not to. Haiti is a country with a population that is spread across its entire territory and with few cities and villages. There is hence likely to be a considerable time lag in the reporting and a large number of cases will in all probability never enter the statistics. Bawon Samdi – the voodoo spirit who is the guardian of the churchyards – most of the time claims his victims silently. Unfortunately, Haiti is extremely ill prepared, should Bawon decide to launch an offensive.

Haiti is one of the most disaster-prone countries in the world. It is regularly ravaged between June and October by hurricanes that move from the southeast to the northwest, passing both the southern and the northern peninsula, leaving human casualties, wrecked homes and destroyed crops in their trail. Such is everyday life in Haiti. The country is situated in the center of the Caribbean hurricane belt, and the frequency of hurricanes has increased over the last decades. In 2008, four hurricanes and tropical storms struck within less than a month, and in 2016, Hurricane Matthew affected 2 million people in the southern peninsula and caused material damage that amounted to 30 percent of the country's GDP.

Haiti is decidedly not the best-known country of the Americas, but on 12 January 2010, it was abruptly thrown into the 24-hour news cycle around the world. Bawon had struck – violently. An earthquake of magnitude 7.0 on the Richter scale had hit the capital, Port-au-Prince, and much of the southern peninsula, killing up to 112 000 people, injuring 300 000 and putting 1.5 million into makeshift tent camps.

Haiti's plight, however, is not limited to hurricanes and earthquakes. This is the country that God chose to forget. In October 2010, when Haiti was in the immediate aftermath of the earthquake, an epidemic disease was discovered: cholera. Its origins were uncertain, but little by little, evidence accumulated that it had been introduced by the Nepalese contingent of the United Nations security forces present in Haiti at the time. After many subterfuges and a good deal of pressure from many quarters, the UN finally had to admit the facts and apologize. In the end, some 10,000 Haitians died as a result of the epidemic. Misery sought, and indeed got, company.

Ten years after the earthquake and the cholera epidemic Haiti runs the risk of yet another major catastrophe: a nation-wide spread of COVID-19. It would be strange if figures will remain lower than in the Dominican Republic. The 2010 cataclysm laid bare the endemic weaknesses of Haitian society. The earthquake was not man-made, but the consequences were. The weaknesses have not disappeared, and they bear directly on the consequences of the probable spread of the virus to large population segments. Haiti suffers from three structural weaknesses which are of relevance in the present context: the economy, the political situation and the infrastructure. We will deal with each one in order.

The Economy

The first weakness is the Haitian economy. GDP per capita is the lowest in the Western Hemisphere: 868 US dollars in 2018, and the extent of income inequality is frightening – one of the worst in the world. Half of the national income accrues to the richest 10 percent, while close to 60 percent of the population lives in poverty, trying to survive on less than 2.41 US dollars per person per day, and one-fourth lives in extreme poverty, less than 1.23 dollars. An estimated 4.6 million, of a total of 11.4 million, are deemed to be in need of humanitarian assistance. Without the remittances sent by Haitians residing abroad – the equivalent of one-third of GDP – the situation would have been catastrophic. The growth of the domestic economy has been sluggish in recent years, barely enough to keep an even pace with the growth of the population. The preliminary figure for 2019 is negative, and so is the forecast for 2020.

The majority of the Haitians live in the countryside, eking out a meager existence on a shrinking and increasingly impoverished land area. The mechanism is one of circular and cumulative causation. The trigger is the growth of the population. Haiti is a densely populated country which means that all the arable land, and much of the land that ought never to have been put into cultivation, is used for agricultural purposes. Then, when the population grows, the only mechanism of adjustment available is that of changing the crop mix. The latter consists of export crops, notably coffee, and food crops. The factor use of these two crops differs. Coffee, a perennial crop which grows on the mountainsides, uses relatively little labor. It grows wild and labor is used mainly during the harvest. Food crops need more workers per unit of land. They have to be sown or planted, weeded etc. and harvested, several times per year. When the population grows, the balance between the two types of crops is altered: food crops invade the steep hillsides of Haiti; the coffee trees, with their protecting canopies and soil-binding roots, are cut down; and when it rains, the soil is washed into the valleys below. The soil is eroded and lost. Once this takes place, food crops again encroach on coffee territory, since people have to eat, etc. The process feeds itself without any need of further population growth. But the population keeps growing. The end result of the loss of arable land is that the income per capita in the countryside shrinks and people are forced into the cities, notably Port-au-Prince.

It was precisely here that the 2010 problems began. People were pushed, not drawn, into Port-au-Prince, where very few formal, secure jobs existed. The vast majority of the migrants ended up in the amorphous informal sector where competition is extreme, and everyone has to fend for themselves. Today, the situation is identical. Haiti used to be an agricultural exporter, but this is more or less history. The loss of arable land has changed the country's factor proportions. Now, the abundant factor is unskilled labor. The main export sector is the apparel industry – women sewing – producing simple goods like t-shirts which are exported to the United States. It accounts for some 90 percent of Haiti's total exports. Hopes have been high with respect to the ability of the sector to create jobs, but so far, less than 60,000 people work there, and the apparel sector is a low-wage sector.

Migrants have been pouring into Port-au-Prince at an alarming rate. In 1950, the city housed some 150,000–200,000 inhabitants. In 2010, more than 2 million were living there, in chaotic conditions. When I came to Haiti for the first time in 1969, I could walk around in the city without problems. The downtown area presented an open and friendly atmosphere. This is no longer the case. The ocean view on Truman Boulevard these days is hidden behind ugly slums, and it is in no way the worst area. The slum areas frequently are beyond control, ruled by criminal gangs. The conditions prevailing there are likely to scare the wits out of almost anybody. When the earthquake struck, the capital housed around 40,000 inhabitants per square kilometer. The figure is not likely to be lower today. The vast majority of the population of the capital as well as those living in other parts of the country are left to their own devices. In 2012, no more than 4 percent of the population was covered by social insurance of some kind. Given the generalized poverty, this puts the Haitians in an extremely precarious situation. Haitian society is anything but resilient. It cannot afford to.

Politics

The second structural weakness of Haitian society is its dismal political tradition. Haiti does not have political parties the way we conceive of them in Sweden. Here, the parties elect their leaders. In Haiti, the leaders elect their parties. First comes the man who wants to be elected president, thereafter the effort to gather enough followers to make his election possible. Parties have no ideologies. They simply make promises, for whatever they are worth – most of the time nothing – and they are born and die as their leaders enter and leave politics.

The core of Haitian politics is that the participants in the game are in it, not because they have any ideas of how to make a better Haitian society, but to make personal gains. This unfortunate tradition was developed during the nineteenth century. When the plantation system collapsed, after 1809, and an independent peasant class was established, the non-working ruling elite found out that they could no longer squeeze any land rent out of the tillers, since land was plentiful and worth very little. The only way not to have to put in a good day's work themselves was to control the state and get access to the government vaults. All the way up to the beginning of the American occupation of Haiti, a series of corrupt kleptocrats ruled Haiti.

This dismal heritage has unfortunately been conserved up to the present. The latest two presidents have been a pop singer and a banana grower, both of whom lacked political experience when they came into power, after elections that brought few voters to the ballot box. In both cases, the voter participation was around 20 percent, and in each instance, the election process was marred by a number of dubious circumstances. The two elected presidents – Michel Martelly and Jovenel Moïse – have both been involved in corruption scandals and both have had to contend with a parliament ruled by the opposition. The 2019 parliamentary elections were postponed and Moïse is now ruling by decree. No budget has been voted, and hence, it is very difficult for Haiti to get assistance from international financial institutions. The opposition has a single goal: to depose the president. Under these circumstances, it is impossible to pursue or conduct any meaningful policies. The situation has been complicated by repeated street riots both in 2018 and 2019.

Infrastructure

The third structural weakness of Haiti is directly connected to the dismal political situation. In 2010, as a result of the extreme congestion in Port-au-Prince, the social service functions had become extremely strained, with a huge excess demand in all areas, and the authorities failed to deliver. Only 30 percent of the inhabitants in the capital had access to municipal water, no more that 50 percent had access to toilets and only half the waste of the metropolitan area was collected and transported to a temporary dump. The sewerage system was virtually non-existent. Surface waterways were often clogged with solid waste which led to floods in the rainy season. Building standards were low and lax and construction and inspection faulty, with many houses on steeply sloping mountainsides and in densely packed slum areas. According to the mayor of Port-au-Prince, 60 percent of the buildings in the capital were unsafe even under normal circumstances.

The earthquake hit a completely run-down city. Both international organizations and independent observers had for long denounced the neglect of the Haitian authorities with respect to natural disasters and called for improvements. As things stood at the time, Haiti did not have any disaster management system whatsoever. The country could not cope even with minor calamities, let alone major ones. With the exception of the declaration of a state of emergency and requests to the international community for money and on-the-ground assistance, there was no response. The president immediately went into hiding, dodging his responsibility as the leader of the nation at the most difficult moment in the country's modern history. Little by little, the truth about Haiti and Port-au-Prince made it into the world media. The ordinary people had to take their fate into their own hands, drag out their dead from under the rubble, bury them and proceed to reconstruct their homes as best as they could.

The reconstruction after the earthquake has been slow. Tens of thousands of people are still living in tent camps, and from 2010 to 2020, a completely new, makeshift slum area, Caanan – what was originally a tent camp – has grown up outside Port-au-Prince, with 300,000 inhabitants lacking most necessities. This is today Haiti's third biggest city.

Haiti in the Year of the Corona Virus

The Caribbean has so far not experienced a major COVID-19 outbreak, but given developments in the rest of the world, it could only be a matter of time. Haiti's confirmed cases and deaths are statistics that only reveal the tip of an iceberg of unknown size. The virus has yet barely hit the slums, but what will happen if it starts to spread in Cité Soleil, on the outskirts of Port-au-Prince, with half a million people, some of whom are living up to ten persons in a single room? There is very little to do about that. Recommendations about social distancing are impossible to implement efficiently. The tap taps, the small trucks that transport people inside cities, and which are always terribly overcrowded, continue to circulate – by necessity – as it is the only way, except for walking, for regular people to move around, get to work and take care of their necessities. The common Haitians do not buy their food in stores, but in outdoor markets or from curb-side vendors, and they have to go there on a regular, usually daily, basis. The sellers are dependent on getting an income every day, or they will not survive, and closing down these markets could bring starvation. Haiti already has 52,800 children below the age of 5 who are affected by acute malnutrition – the highest rate of child malnutrition in the Western Hemisphere – and in an emergency this can easily increase. The situation is further complicated by the fact that Haiti is not self-sufficient in food but dependent on imports, made increasingly difficult by the disruption of transportation, which will of course lead to price increases, and food price rises may in the worst case trigger street riots, like in 2007–08, following price increases in the world market. Wholesale looting of stores is not a far-fetched scenario.

The 2017 census in the Dominican Republic registered more than 750,000 people of Haitian origin in the country, in all probability an underestimate. The real figure is likely to be higher than a million. This is a very vulnerable group, with no social security whatsoever. As of 15 April 2020, more than 140,000 of them had lost their jobs as a result to the measures undertaken to combat the corona pandemic, which means that many will decide to leave the country. This is, however, not the only cause of the flow of people from the Dominican Republic to Haiti. In 2013, the requirements for Dominican nationality were changed – retroactively – in such a way as to make 200,000 people of Haitian extraction risk deportation. Some 10,000 are deported each month. Between 12 and 19 April, 13,200 people were reported to have crossed the border from the Dominican Republic to Haiti, and presumably several thousands more did so clandestinely. The number is likely to increase in the near future, and with that also the risk of increased spread of COVID-19 in Haiti.

The threat of deportation comes from other quarters as well. President Donald Trump in the United States thinks that Haiti is a "shithole country" and wants to deport the more than 56,000 Haitians who were granted Temporary Protected Status (TPS) after the 2010 earthquake. The issue is stuck in the American judicial system for the time being. The Haitians are allowed to remain in the US until 4 January 2021. What will happen thereafter is uncertain. In the worst case, there will be mass deportations from the most COVID 19-infested country in the world, in a situation when the virus is still active, with all that this may imply. (The US is today continually deporting Haitians that do not enjoy TPS, in spite of the pandemic).

What Response?

What can Haiti do to cope with the corona pandemic? On 20 March, a state of emergency was declared, and the country officially sealed off its borders, airports and harbors as well as ground transports from the neighboring Dominican Republic. There are four official border crossings, all under surveillance, but as anybody who has ever traveled in the border area is painfully aware of, the border is completely permeable. You can cross virtually anywhere.

A state of emergency was announced, with a curfew between 8 PM and 5 AM. Meetings of more than 10 people were discouraged. Schools, churches and voodoo peristyles were closed. The textile factories were also closed at the beginning of the epidemic in the country but were reopened after a month at 30 percent capacity, to ensure that social distance can be upheld. Given that Haiti is a poor country, most people cannot afford not to work, resulting in an unpalatable trade-off: between having an income and a higher risk of contamination on the one hand, and unemployment and increased malnutrition on the other. Staying at home is an option only for the well-to-do. The Haitian schools were reopened in August.

The Haitian health care system is close to dismal, even in regular times. In spite of the overwhelming needs of the country, the share of the health sector in the government budget was reduced from 17 percent in 2004 to 4 percent in 2017–18, and between 2012–13 and 2017–18, investments in the health sector were reduced by almost 94 percent. In 2017–18, more money was put into the Senate and the Chamber of Deputies than into health. At the same time President Moïse began the resurrection of the Haitian army, which had been abolished in 1995 and had served no other purpose than the oppression of the Haitian population.

All this amounts to almost total neglect. The country is in no shape whatsoever to handle a pandemic. Hospitals and clinics are scarce. Where do sick peasants go? The answer is simple: nowhere. They stay at home trying to fight it out. And what if they are infected by the virus? Haiti has only around 65 ventilators, 20 of which are not in working conditions, and some 125 intensive care beds, for a population of 11 million. Oxygen facilities are lacking, and the country has a single laboratory capable of handling COVID-19 tests. Only 85 percent of the Hôpital de l'Université d'État d'Haïti, the main unit to receive poor people, which had to be rebuilt after the 2010 earthquake, is finished, and the hospital has reported inadequate preparation and lack of supplies to cope with COVID-19 cases, which made some of the staff refuse to work.

Hygienic prescriptions are not easily upheld, especially not in the tightly crowded urban slums where clean water and soap are scarce or completely absent commodities. People have been recommended to use masks, but how and where do you get them? Not even the medical personnel itself is to be trusted. In Gonaïves, ambulance drivers and emergency medical personnel on strike, claiming 40 months of salaries in arrears, on 28 April, vandalized a center built to receive COVID-19 patients, destroying tents and equipment and turning beds and furniture upside down.

The only advantage that Haiti has is that half of the population is under 25 years of age and hence hopefully able to survive an infection. A complicating factor is that Haitians distrust their authorities – for good reasons – and hence tend to disobey their recommendations, especially since the corona pandemic is still perceived as something that has only affected foreign, far-away countries. This could easily prove fatal in the long run.

In the midst of this, law and order is difficult to uphold. Criminal gangs involved in the transit traffic of drugs, related to certain politicians and businessmen, rule many slum areas and are killing each other in shoot-outs. The UN force that was stationed in Haiti to assist with the maintenance of order left the country in 2019, after fifteen years. The responsibility now falls exclusively on the Haitian National Police, a mere 15,000 officers in the entire country, but the police corps is not trustworthy. During protest actions against pay and working conditions demonstrating policemen have been opening fire against members of the newly resurrected army and burnt cars outside ministries and other government buildings. Haiti is well on its way to become a failed state where the government cannot control the territory and has lost its monopoly of the legitimate use of force. It cannot provide social services on a decent level and it has visible problems when it comes to making collective decisions. Its relations with the political opposition are completely blocked.

What will the consequences of the corona pandemic be for the average Haitian? The writing is on the wall in other countries. The risk of recession and loss of jobs is acute also in Haiti. This is extremely serious because of the already low living standard. At the same time, the macroeconomic indicators point in the wrong direction. The value of the gourde vis-à-vis the US dollar has deteriorated severely, which makes imports, e.g. of food, difficult and the inflation rate is almost 20 percent. The majority of Haitians have only small or no savings at all to fall back upon. If the authorities fail to respond adequately to the needs imposed by the virus pandemic, social instability may become generalized.

The Haitian government, however, does not have the resources necessary to handle a country-wide epidemic. Its taxation capacity is extremely low. The health care system is extremely dependent on private funding and foreign assistance. In 2013 (no later figures seem to exist), 64 percent of the Haitian health budget came from international sources. The country has to rely completely on foreign aid to handle the situation. The IMF has dedicated 111 million US dollars to Haiti to combat COVID-19, the World Bank has authorized a 20 million grant to Haiti and the United States has contributed 16.1 million. Local businessmen and NGOs are raising funds. However, the remittances from Haitians living abroad will shrink as their countries of residence increasingly go into recession as a result of the pandemic.

Conclusions

The Haitian experience illustrates a fundamental fact. When a natural catastrophe or a pandemic hits a country, there is very little you can do ex post unless you are prepared ex ante. Haiti is an extreme case, but being so, it has the virtue of bringing out fundamental facts – completely in the nude. It serves to highlight the moral issue of honesty versus lip service and it stresses the importance of having a functioning economy and society. In the end, it is the total resources of a country and the way these are used under normal circumstances that determine what will happen when the catastrophe is a fact.

I have argued that Haiti suffers from three fundamental weaknesses that are likely to affect the response to the corona pandemic. The economy is weak, making Haiti the poorest country in the Western Hemisphere. It has been so for very many years and it will continue to be so in the foreseeable future. This means that resources are extremely scarce even in normal times and when disaster hits, as it does in Haiti with frightening regularity, there is no buffer that can be used to mitigate the effects. The country is completely dependent on foreign aid for emergency resources.

The second weakness is different. It is political, and hence possible to remedy through the action of the government and the opposition. Unfortunately, however, Haiti has never had decent governments. At best, they have been mediocre, but not more than so; at worst, they have been dismal. The story of Haitian politics is the story of the creation and conservation of a predatory state, ruled by a series of corrupt kleptocrats who have assumed that the population is there for the benefit of the government and not vice versa. The gap between the rulers and the ruled has always been wide, and the citizens tend to conceive of the government mainly as a man in uniform or a tax collector.

The unfortunate political tradition means that Haiti is as far from being a welfare state as you can possibly imagine. Since there are no publicly financed and administered security nets, everyone effectively has to fend for him- or herself. Haitian society displays very little resilience, and this inexorably shows up in emergency situations. The 2010 earthquake showed the world a completely helpless country. Many of the effects could have been, if not avoided, at least dampened, if the governments that ruled Haiti during the decades which preceded the calamity had been intent on building a strong infrastructure and as efficient a system of social service as possible instead of stuffing the available money into private pockets. That would also have facilitated the access to foreign assistance, i.e. it would have increased the government resources. Instead, Haiti has entered the road that leads to a failed state.

The corona pandemic has so far not taken a heavy toll in Haiti. The number of reported cases and deaths compares very favorably with the world average, the Nordic countries (except Iceland) and neighboring Dominican Republic. As stated at the outset, the real figures are, however, likely to be higher than the reported. In mid-October, 48,000 tests had been carried out per 1 million Dominicans but only 2,500 per 1 million Haitians.  Possibly the young age of the Haitian population has served to keep the death rate down. The median age is believed to be 24 years against 28 in the Dominican Republic. Whatever the causes, however, it is far too early to claim that the danger has passed. Europe seems to be entering a second outbreak phase, and the same could happen in the Caribbean, albeit with some time lag. If that should happen, there is not likely to be any a quick fix. If the virus spreads across the country, the consequences will be potentially disastrous. Large numbers of people will be sick and die for want of an adequate health infrastructure. The 2010 earthquake offered a window of opportunity to the decision makers – a chance to make amends for the sins of the past. But the Haitian post-2010 governments learned nothing from what happened – because they deliberately chose not to. They have displayed no love for their people in the time of corona. Or rather, they should have done so long ago, before the pandemic. But the only thing they have shown is neglect. As long as the Haitian state continues to be predatory, the world will continue to witness man-made catastrophes in the country.

References

Lundahl, Mats (1979), Peasants and Poverty: A Study of Haiti. London: Croom Helm

Lundahl, Mats (1983), The Haitian Economy: Man. Land and Markets. London and Canberra: Croom Helm

Lundahl, Mats (1992), Politics or Markets? Essays on Haitian Underdevelopment. London and New York: Routledge

Lundahl, Mats (2011), Poverty in Haiti: Essays on Underdevelopment and Post Disaster Prospects. Houndmills, Basingstoke and New York: Palgrave Macmillan

Lundahl, Mats (2013), The Political Economy of Disaster: Destitution, Plunder and Earthquake in Haiti. London and New York: Routledge

Add the following reference:  Worldometer Coronavirus Update (Live),  https://www.worldometers.info/coronavirus/

The Author

Mats Lundahl is Professor Emeritus of Development Economics at the Stockholm School of Economics. 

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