Haiti and Cholera: An Ongoing Failure of Imagination and Responsibility

The rainy season recently began on the island nation of Haiti and health officials there expect it to result in a strong uptick in confirmed cases of cholera, rising to a likely total of 45,000 this year. Flooding will spread contaminated water that citizens will use for hydration and hygiene and thereafter a share of those people will fall catastrophically ill. Since the onset of this tragic epidemic in October 2010, traced to poor sanitation at a United Nations (UN) Nepalese Peacekeepers camp along the Artibonite River, more than 8,500 Haitians have died from cholera and 700,000 have been sickened. Apart from the fact that international community agents brought the disease to the nation that had never before had to address it, itself a travesty, this year also looks set to see a continuing reduction in aid needed to address this heartrending scenario. This fact implies, plainly, many Haitians will die needlessly because the leaders of assisting nations will prove unwilling to ensure their survival.

While those who contract cholera fall grievously ill rapidly, the disease is eminently treatable, assuming that those afflicted receive suitable medical care quickly, including obtaining clean water and rehydrating salts. Nonetheless, the number of clinics in Haiti equipped to treat the infection has fallen from 120 in 2010-2011 to 40 currently. Nongovernmental aid organizations, which first arrived in the aftermath of the nation’s devastating earthquake in January 2010, are steadily leaving Haiti due to major international organizations and donor nations reducing or ending their funding and the country’s government is ill equipped to undertake this responsibility alone. In short, a clear and present health danger exists today in Haiti, the means to address it are well known and it will sicken or kill thousands. Nonetheless, the international community is not taking necessary steps to redress these realities and is, in fact, making matters worse by its choices.

Meanwhile, Haiti’s people are suffering from these conditions, and the United Nations—which has refused to acknowledge that its peacekeepers imported cholera to the nation for fear, reportedly, of accepting legal liability—has calculated that the cost of the clean water, sewage treatment and health systems the nation now requires totals at least $2.2 billion. But international support for such improvements has been tepid to date. Indeed, the global community now seems prepared neither to invest adequately in the infrastructure necessary to address Haiti’s long term health needs nor to provide the resources required to overcome its current disease epidemic.

The obvious question is how aid officials and international leaders could allow this scenario to unfold. Analysts have, so far as I can discern, advanced three reasons to “explain” these decisions. First, some commentators have blamed the United Nations and argued that its pleas for help for Haiti are being treated with relative disdain because of its association with the nation’s cholera outbreak. But surely decision-makers are more mature than this argument suggests and can see past the messenger to the message and the dire need it represents? Punishing innocent Haitians for a United Nations action with which those citizens had nothing to do and for which they had no responsibility makes no sense.

Some experts offer a second rationale for global inaction to help Haiti in the face of its continuing cholera (and longer-term health infrastructure) crisis. These authors suggest that those providing aid are suffering “donor fatigue,” as they have given substantial sums to help, but conditions in the country, including the public health emergency under consideration here, remain stubbornly present. The result, in this view, is a slow enervation of donor interest and will. This argument is perhaps more credible on its face than the “Blame the UN” claim, but not much more plausible, as it also implicitly suggests that there is something “wrong” with the Haitian people since their circumstances are proving vexingly difficult to improve. This contention also raises the unsettling question of whether donors have the right to “tire” of addressing morally compelling concerns and simply abandon them, irrespective of the consequences of their choice.

A few conservative United States political leaders have argued that their nation must in principle reduce its efforts abroad of all sorts, including development aid, on grounds the nation should not be so engaged and can ill afford such support in any case. I dismiss this contention on its face since the sums involved are not large, the notion that the U.S. can isolate itself from its globalized posture is simply not tenable and, in the case of cholera in Haiti, the moral case for engagement is strong and the treatment is extremely effective when made available.

What I find most striking about this situation is the lack of political will evident in the U.S. and international community’s stance concerning Haiti’s cholera outbreak. While such behavior has been evident in America’s posture toward other nations before, it is troubling how consistently Haiti seems to have borne the brunt of unfinished initiatives and poorly implemented assistance efforts. No one can argue the needs or suffering are not real. Nonetheless, the United States and other donor nations are apparently prepared to stand by and watch thousands more Haitians die because to assist implies ongoing efforts to address a difficult challenge that cannot be “fixed” readily.

At a deeper level, this episode reflects a failure of moral and empathetic imagination. Jonathan Jones has defined the moral imagination, a concept that originated with the philosopher Edmund Burke, as

a uniquely human ability to conceive of fellow humanity as moral beings and as persons, not as objects whose value rests in utility or usefulness. It is a process by which a self “creates” metaphor from images recorded by the senses and stored in memory, which are then occupied to find and suppose moral correspondences in experience. An intuitive ability to perceive ethical truths and abiding law in the midst of chaotic experience, the moral imagination should be an aspiration to a proper ordering of the soul and, consequently, of the commonwealth (http://www.firstthings.com/blogs/firstthoughts/2009/07/defining-moral- imagination/).

The international community’s disposition to leave Haiti troubled and bereft as its people confront a disease imported to their nation reflects the failure of too many leaders to think more broadly and deeply than the merely useful, and to value the Haitian nation and people for their own sake. We live in a deeply utilitarian moment and this episode symbolizes in a clear way the consequences of such a calculus for human suffering, deprivation and death.

This turn for Haiti also points up a trend among Western nations toward an ever more encompassing individualism, particularly in our nation. As this cultural disposition deepens it becomes increasingly difficult to call upon the population to exercise the empathy required to imagine themselves in the place of those suffering and to accord them standing and dignity for that reason alone. In surveys and polls Americans evidence a disquieting lack of interest and understanding of nations and cultures other than their own. This situation is daily exacerbated by a growing propensity to individualism and to a calculus that demands that the value of all be measured solely in terms of narrowly defined utility.

The international community can only act when its member states are united and willing to accept responsibility for their collective action. In the present case, the United States and other donor nations are showing themselves unwilling to persevere and to remain engaged together to address a clear moral imperative. The result will yield additional needless suffering and death for the Haitian people. It also surely represents a stain on those countries, including our own, willing to countenance this outcome. The current international regime can ill afford any further degradation of commitment to the health and well-being of all of the world’s peoples. To put the matter bluntly, our nation’s position and that of its partners in slowly abandoning Haiti’s residents to the cholera visited on them is empathetically heedless, practically feckless and morally indefensible. Our present course must be reversed.