Haiti, or humanitarian ethics under question

Jean François Mattei – French Red Cross Fund

J.-F. Mattei

J.-F. Mattei

The recent earthquake, or rather the succession of earthquakes in Nepal, confirms the fact: humanitarian action is increasingly subject to criticism. The charge of “humanitarian circus”, willingly uttered in the media – whether founded or exaggerated and therefore itself debatable – challenges the humanitarian community. The founding moment of this criticism is undoubtedly the 2004 tsunami in Southeast Asia. Between these two events, the 2010 earthquake in Haiti did not escape this “questioning” that Jean-François Mattei addresses here in terms of ethics. An ethic of action that intends to apply for other disasters, which will unfortunately occur. In short, by revisiting a paroxysmal crisis, the president of the French Red Cross Fund invites us to a “prospective view” about the current and future challenges of humanitarian action.

The earthquake that hit Haiti January 12th 2010 is peculiar for more than one reason. With a magnitude of 7.3 and an epicenter close to Port au Prince, it turned out to be of an extreme gravity: more than 200 000 deaths, just as many wounded, a large part of the capital destroyed and 1.5 million people deprived of a dwelling. But mostly, it hit a high vulnerability country from an economic and political point of view: numerous humanitarian organisations were on the spot for years to aid vulnerable populations in one of the poorest countries in the world suffering from a political instability that prevented active democracy from taking root after decades of dictatorship. Besides, the catastrophe occurred at the time that a presidential election campaign was just beginning, and all political transition periods are not then very compatible with strong decisions.

The earthquake that hit Haiti January 12th 2010 is peculiar for more than one reason. With a magnitude of 7.3 and an epicenter close to Port au Prince, it turned out to be of an extreme gravity: more than 200 000 deaths, just as many wounded, a large part of the capital destroyed and 1.5 million people deprived of a dwelling. But mostly, it hit a high vulnerability country from an economic and political point of view: numerous humanitarian organisations were on the spot for years to aid vulnerable populations in one of the poorest countries in the world suffering from a political instability that prevented active democracy from taking root after decades of dictatorship. Besides, the catastrophe occurred at the time that a presidential election campaign was just beginning, and all political transition periods are not then very compatible with strong decisions.

Haiti: symbol of the humanitarian action at the crossroads

As early as the emergency phase, the question of the next stage was a preoccupation for all minds. Designated by the International Federation of Red Cross and Red Crescent Societies (IFRC) alongside three other persons to follow the evolution of operations, I returned regularly to Haiti for four years. The aim was to proceed to field evaluations but also to meet international decision makers and politicians so as to appreciate the transition from promises to tangible acts.

In spite of difficult conditions inadequate for rapid action, the programs for production of drinking water, food distribution, organization of life in the camps but also of health centres and rehabilitation projects for damaged dwellings were rolling out at a satisfactory pace, notwithstanding the total absence of a political master plan. In particular, there existed no land survey, no urban planning, no joint zoning areas. Nonetheless, despite considerable efforts and tangible accomplishments appreciated by Haitians, we were aware of criticism, sometimes hurtful, expressed by Haitian personalities concerning humanitarian action. Like others(1)Revue Humanitaire, Haiti Dossier : « Exiting from humanitarian dependency ? », number 27, December 2010., I was able to see that a serious misunderstanding was setting in between Haitians and humanitarian organisations.

This recognition retained my attention because for quite some time I was questioning myself about the conditions of our interventions in Africa as in Asia, their legitimacy, the understanding that the beneficiaries had concerning these and the way in which these actions were perceived. I felt a more and more pronounced desire for emancipation arising. Of course the Haitians that we were helping always reserved us a warm welcome on the field. Nonetheless, something that I was at difficulty in discerning was going on. I thus met a certain number of personalities so as to ask them questions about Haiti, the Haitians and the way they felt about humanitarian action implemented after the earthquake(2)Rosny Desroches, Academic, former Minister of Education ; Gary Victor, writer and script writer ; Lyonel Trouillot, writer ; Michele Pierre-Louis, former Prime Minister of the Haitian government in 2008-2009 and presently President of the FOKAL foundation ; Frantz Duval, Chief editor of the “Nouvelliste”; His Grace Guire Poulard, archbishop of Port au Prince.. Without exception, they all comforted me in the idea that humanitarian action was at a crossroads and that ethics should play here a capital role(3)Jean-François Mattei, L’Humanitaire à l’épreuve de l’éthique, éditions Les liens qui libèrent, 2014..

Ethics are not that well known in the humanitarian community. Considered to be too distant from field realities, they are often confused with morals and deontology if not philosophy and thus belong to the realm of “Academics”. Nonetheless, ethics have their own history. After the atrocities of World War II, , the emergence of a new ethical conscience expressed the will for a radical change in behaviour, inspired by the concern of respecting in all circumstances, the equal dignity of each human being. Immediately put to trial by the medical and scientific revolution that emerged in the second half of the twentieth century, its practical efficiency has been widely demonstrated. By imposing itself concretely, it built its identity and affirmed the specificity of its field of thought around four founding principles: Autonomy, Well-doing, Non wrongdoing, Justice(4)Tom Beauchamp, James Childress, Principles of Biomedical Ethics (fifth edition), New York/Oxford, Oxford University Press; 2001.. It now imposes itself in numerous fields of activity confronted with change.

It appeared important to me to analyze the different aspects of humanitarian action in Haiti after the 2010 earthquake, through the prism of ethics to try and understand the reasons of the Haitian misunderstanding and propose a new approach to the relationship with local populations.

Between criticism and realities

Two groups of criticisms emerge, substantiated each time by precise examples. At first, humanitarian organisations decided and acted on their own without associating Haitians and ignoring their will for autonomy.

All those with whom I spoke underlined the failure of the Haitian State while deeply regretting it. Besides, the importance of the catastrophe was such that Haitians were animated by the pressing desire to refound their country and to turn the page to start at zero again. And the State was not able to respond to this enthusiasm. It was not able to mobilise energies and motivate the will of Haitians. It had the duty of planning, just as it should have organised co-operation between international and Haitian organisations, which it did not do. The population thus understood that only the international organisations that counted and took action, giving a feeling of invasion. From a certain point of view, Haiti had become the “Republic of the NGOs”, creating an uneasiness fed by the “intellectuals”. Refusing to be passive victims, the Haitians wanted to be stakeholders in the reconstruction of their country and not only spectators of the cacophony of an international humanitarian wave.

In fact, in the absence of political decisions, international humanitarian organisations found themselves left alone and it occurred sometimes that they did not necessarily make the most judicious choices. Of course the Haitian associative fabric could not act as a substitute to the State nor take over, as it did not have the capacity to mobilise funds by itself nor did it possess the required capacities. Humanitarian organisations thus managed on their own and local organisations found themselves weakened when they could have hoped to progress and end up reinforced by the trial. There is a strong regret that the international organisations did not share with and listen to Haitians in respectful partnerships: “Without any doubt this was difficult, as it was necessary to act quickly…but they should have done it…” resumes one of my speakers.

The arguments exposed rest upon a well thought out belief. They underline the fact that one must always be distrustful when a compassionate logic replaces a structuring logic, as, in the end, humanitarian aid can create the needs for its permanence. Engaged as it was, prolonged assistance appeared demotivating, giving the impression of excluding Haitians, while Haiti has not been a colony any more since the beginning of the nineteenth century! The claim for autonomy is strong, reminding one that Haitians are citizens, thus free and responsible persons. In fact the regret constantly expressed by Haitians is to have been left aside in the definition of operations and strategic choices. Their arms and their strength have of course been used but it was forgotten that they knew the country and could also have a few ideas about the best way to act.

When René Depestre, poet and writer, laureate of the Renaudot Prize(5)Prestigious French literary prize created in 1926 (editor’s note). in 1988, expresses himself he puts forward that “humanitarianism of the last century” is finished. For him, the first country to have gained its independance in suffering in 1804 has not totally put an end neither to its colonial past nor to its neo-colonial present. The earthquake must be the opportunity for a new departure. Haitians don’t have to wait for humanitarian organisations, the United Nations, the G20, the IMF to think and act in their place(6)Le Nouvel Observateur, « Reinventing Haiti », 2/18/10. The conclusion of each of my discussions is always the same: “It will be necessary for Humanitarians to stay for long in Haiti but on the basis of a progressive emancipation of local humanitarian organisations”. This points to two ideas that impose themselves today in the humanitarian debate, the notion of transition and the will for national sovereignty. These two ideas are linked and rejoin the more and more frequently expressed need for ethics. The victims need to choose what they consider to be good for them whereas they are not always asked to do so. Respect for the ethical principles of autonomy and well-doing obviously impose themselves.

Secondly, by lack of co-operation with Haitians, humanitarian action has not been able to avoid wrongdoing while wanting to do good. Several criticisms arose to underline that while wishing to do good the Humanitarians had sometimes been responsible for nuisances and even wrongdoing towards Haitians.

First example: the massive hiring of Haitian managers by humanitarian organisations with salaries far higher than those of Haitian civil service contributed in giving work to many Haitians, permitting entire families to live. But this has also been accused of having emptied the Haitian civil service of its substance and even the recruitment of several classes of civil servants by attracting them at the end of their training. This reproach has been repeated like a leitmotiv: “Your aid at the time has diverted the competent human resources that the State needed to redress itself!” In fact, thinking applied for the short term and not for the more distant future.

Second example: the rental of numerous quality villas and apartments by the humanitarians in a largely destroyed city contributed towards soaring rates for rents to the point of rendering access to housing much more difficult for Haitians themselves. One can understand that such situations are discouraging for Haitians wanting to find a dwelling and contribute to exasperation towards Humanitarians.

Third example: the maintaining of free medical consultations in the humanitarian health centres beyond the emergency period led, in fact, to unfair competition for doctors and paramedical professions working in the private sector. It is regrettable that the lack of coordination with Haitians did not prevent this unfortunate episode. In fact, had we even thought of the problem, obsessed as we were by the immense need for care?

Fourth example: the efficiency of the drinking water production chain by humanitarians nearly provoked the disappearance of resellers of drinking water pouches installed at all intersections. Likewise, numerous small businesses selling water made safe for drinking by different processes found here. The person responsible of a small store advertising on the store front “Miracle water: top quality drinking water processed by inverted osmosis” explained this to me, torn between revolt and desolation. The goal of humanitarians was to improve water distribution and not to damage an activity generating revenue for people lacking resources. They did not take into account the destroying effect of free goods and services when a whole economy is asking to revive. Taking decisions with Haitians would have authorised solutions respectful of their activities.

The fifth example concerns the emergency adoption of Haitian children considered, often wrongly, as deprived of all family, giving way to excesses and illicit trading(7)Hervé Boéchat, The management of international adoptions, Revue Humanitaire, number 27, December 2010.. Between the hopes of candidates for adoption in France and the pictures of forlorn children, apparently alone in the middle of ruins, the temptation to go fast was great. It became difficult to oppose true scandals. Professionals in contact with children at their arrival in France have testified that these children have often been “embarked” hastily and that, under cover of a status of “presumed orphan”, numerous uprootings occurred. Now therefore, adoptions cannot be made within the time scale of emergency, as the risks of abuse and illegal trade are then multiplied, always at the detriment of the children. The risk of “wrongdoing” is then high. At the opposite, it must be underlined how much the Child Protection Services in the French Antilles, associated with the French Red Cross, tried to organise a “first stage welcome” so as to try and untangle the true from the false, to establish with precision the situation of each one and act to the best of the child’s interests.

The case of the cholera epidemic undoubtedly constitutes a considerable ill. Amongst the Haitian people, the “cholera resentment” is enormous. Thousands of people died, whereas there has never been cholera in Haiti. Amalgamation was made in minds between all these “foreigners”. Nonetheless, the conditions of wrongdoing differ sensibly from all the examples already mentioned. One can only stress that the least of strategies would now be to target the eradication of cholera to ensure the return to the previous sanitary state. This ambition does not seem out of reach if the decision is taken to make it a real priority and if the necessary means are granted and applied. If this were not the case, one could speak of an absolute wrongdoing.

And ethics in all that?

The main goal of the ethical approach is to put the victims at the heart of the actions that concern them. Analysis of mistakes shows that they could have been avoided by referring to simple reasoning based on ethical principles, mainly those of autonomy and non wrongdoing.

The principle of autonomy that should have been recognised for Haitians has obviously not been a major concern for humanitarian organisations, not more than for the donors nor for anybody. It’s true that the situation turned out to be delicate. How, in a “gasping” country, to have the will to respect the autonomy of a deliquescent State? How to avoid burying in its ruins the Haitian people’s pride and overcome anti colonial resentment? Bruno Frappat writes it very well: “Let’s not only offer to Haitians the charity of our heart-broken glances or the gift of our money, let’s offer them the grace of recognising and admiring their dignity(8)“Haiti, Life lesson”, La Croix, 1/23/10..” Compassion, yes; solidarity, yes; but not that thinly veiled despise wrapped in condescending sympathy that tends to present Haitians as condemned to misery by their fault. Rony Brauman says so very well, “The Haitians know the way we look at them. And that way of looking –which is often a judgement – can have effects there too(9)“Debates”, Le Monde, 1/21/10..” The facial encounter described by Levinas(10)Emmanuel Levinas, Ethics and Infinity (Le Livre de Poche), 1984. takes here its full meaning. Besides, there exist in Haiti a remarkable dynamism and creativity capable of inventing the most adequate solutions(11)Michèle Oriol, Henri Rouillé d’Orfeuil, Agnès Chamayou (under the direction of), Local innovations and sustainable development in Haiti, Publications of the State University of Haiti, 2014., as long as one is willing to seize them.

The principle of non wrongdoing has not always been respected with the required attention. The reactivity of humanitarians is such that mistakes have been rapidly rectified in numerous cases, but how preferable it would have been not to commit them and to anticipate. The situations that we have evoked are significant. There are others. It would thus have been necessary to ask questions about the relocalisation of people living in camps. This poses a major problem of ethics. Isn’t one here an accomplice to wrongdoing? No long-term solution was proposed to the majority of the 200 000 people living in a shanty town before the earthquake. It is for this reason that villages built of wood and sheet-metal sprung up here or there, for instance on the road called “La Piste”, an old runway next to the airport. Even often, following forced expulsions from urban areas some groups directed themselves towards a place called “Promised Land”, composed of zones named “Canaan” or “Jerusalem” (this is not invented!). In fact this Promised Land intended for the organisation of informal housing is made up of hillsides with slopes that render them inaccessible to begin with. But necessity spells its law and the process is well run in. By stages, in cavities dug up without any security concern, appear parpen walls, rapidly topped with a corrugated iron roof. And besides there is no access, no water distribution, no evacuation of waste, no sanitation. And also all the risks linked to trickling, flooding and landslides, especially close to ravines. The ethical stake is sizeable and the attitude adopted heavy with consequences. The most appropriate behaviour seems to be not to accept this kind of dehumanising solution and to make it known. And nonetheless it is out of the question to abandon vulnerable people, notably women and children, in such distress. Aid must then be accompanied by a powerful plea that finds its full meaning by expressing that one cannot stay at that! One undergoes the painful feeling of being on the razor’s edge, recalling that there is no ethical choice without strong moral tension.

All these examples are sufficient to explain the feeling that humanitarian actors often experience of stumbling on intricate obstacles, making it impossible to go ahead. Luckily, some intuitions have sometimes permitted to find solutions in conformity with what ethics can wish for. It is this way that certain teams, that of the French Red Cross but others also, have established integrated rehabilitation and reconstruction programs in certain neighbourhoods, linking up with inhabitants regrouped and organised in committees. This has permitted to develop “cash for work” activities so that each person can participate and earn enough to support a family. It is this way that certain neighbourhoods were rid of their rubbles, temporary shelters put up and dwellings rehabilitated. It seems to me that these programs represent good examples of a deeply ethical attitude. Inhabitants are consulted and informed of projects that humanitarians wish to propose then they ask questions and talk it over between themselves. Lastly, they indicate their consent, ask to be associated and participate. After that the project becomes theirs. I believe that this type of neighbourhood rehabilitation programmes is the example to be opposed to situations not well engaged because non ethical. Autonomy is respected, as well as well-doing because they have been able to choose what they considered the best for themselves. Non wrongdoing is also taken into consideration as they refused what did not agree to them and finally justice is a security guarantee as each inhabitant of the neighborhoods receives from the committee itself an equitable share of work days so that the right of all to earn a bit of money is also respected.

Ethics, a guide for future action

In 2013, the producer, Raoul Peck, in a prosecuting documentary, established a very biased indictment, thus quite unfair, on the calamitous management of the post catastrophe period by the international community(12)Assistance mortelle, movie by Raoul Peck, http://www.arte.tv/guide/fr/043970-000/assistancemortelle. I bear testimony to this, aid revealed itself essential and very efficient until it met its limits imposed by the disability of the State. However, and this is the very crux of my thinking, I realize that the methods of humanitarian intervention need to be rethought. Times have changed. Even inside the IFRC, where relations between national members are natural, the cooperation modes were probably not the best possible in view of the future. Questions are numerous: How to achieve true resilience when totally dependant on foreign aid? How to take in hand all that is done today by the “Westerners”? How to self-appropriate action when everything comes from international aid? How to exit from this state of dependency so as to achieve autonomy? Answers have to be found if one wishes to build the humanitarian action of tomorrow.

The ethical approach is, I am convinced, one of these responses. That is why I propose to call upon ethical questioning as an Ariane’s thread to accompany humanitarian action in the process of change it is going through. In my opinion it is a requirement if we want to build a guide for action that designs the new unity of the humanitarian world. Ethics will usher humanitarianism into modernity, very simply because it is about time to place the victims, or the beneficiaries, at the center of all actions that are engaged for them and to respect their full autonomy.

Translated from the French by Philip Wade

Biography

Jean-François Mattei is the Honorary president of the French Red Cross (2004-2013) and former member of the Executive Board of the International Federation of Red Cross and Red Crescent Societies. He is now president of the French Red Cross Fund and attached to the UMR (Joint Research Unit) 7268 ADES (biocultural anthropology, law, ethics and health), Aix-Marseilles University / EFS / CNRS. He is member of the Institute de France and the National Academy of Medicine. Last book published : L’Humanitaire à l’épreuve de l’éthique, éditions Les liens qui libèrent, 2014.

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1. Revue Humanitaire, Haiti Dossier : « Exiting from humanitarian dependency ? », number 27, December 2010.
2. Rosny Desroches, Academic, former Minister of Education ; Gary Victor, writer and script writer ; Lyonel Trouillot, writer ; Michele Pierre-Louis, former Prime Minister of the Haitian government in 2008-2009 and presently President of the FOKAL foundation ; Frantz Duval, Chief editor of the “Nouvelliste”; His Grace Guire Poulard, archbishop of Port au Prince.
3. Jean-François Mattei, L’Humanitaire à l’épreuve de l’éthique, éditions Les liens qui libèrent, 2014.
4. Tom Beauchamp, James Childress, Principles of Biomedical Ethics (fifth edition), New York/Oxford, Oxford University Press; 2001.
5. Prestigious French literary prize created in 1926 (editor’s note).
6. Le Nouvel Observateur, « Reinventing Haiti », 2/18/10
7. Hervé Boéchat, The management of international adoptions, Revue Humanitaire, number 27, December 2010.
8. “Haiti, Life lesson”, La Croix, 1/23/10.
9. “Debates”, Le Monde, 1/21/10.
10. Emmanuel Levinas, Ethics and Infinity (Le Livre de Poche), 1984.
11. Michèle Oriol, Henri Rouillé d’Orfeuil, Agnès Chamayou (under the direction of), Local innovations and sustainable development in Haiti, Publications of the State University of Haiti, 2014.
12. Assistance mortelle, movie by Raoul Peck, http://www.arte.tv/guide/fr/043970-000/assistancemortelle