--- Page 1 --- D MH NFOR ION GPO S. HRG. 111-755 HAITI: FROM RESCUE TO RECOVERY AND RECONSTRUCIION HEARING BEFORE THE COMMITTEE ON FOREIGN RELATIONS UNITED STATES SENATE ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION JANUARY 28, 2010 Printed for the use of the Committee on Foreign Relations Available via the World Wide Web: http//www.gpoaccess.govicongress/index.html U.S. GOVERNMENT PRINTING OFFICE 62-792 PDF WASHINGTON : 2010 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore. gpo. gov Phone: toll free (866) 512- 1800; DC area (202) 512- 1800 Fax: (202)512-2104 Mail: Stop IDCC, Washington, DC 20402-0001 --- Page 2 --- COMMITTEE ON FOREIGN RELATIONS JOHN F. KERRY, Massachusetts, Chairman CHRISTOPHER J. DODD, Connecticut RICHARD G. LUGAR, Indiana RUSSELL D. FEINGOLD, Wisconsin BOB CORKER, Tennessee BARBARA BOXER, California JOHNNY ISAKSON, Georgia ROBERT MENENDEZ, New Jersey JAMES E. RISCH, Idaho BENJAMIN L. CARDIN, Maryland JIM DEMINT, South Carolina ROBERT P. CASEY, JR., Pennsylvania JOHN BARRASSO, Wyoming JIM WEBB, Virginia ROGER F. WICKER, Mississippi JEANNE SHAHEEN, New Hampshire JAMES M. INHOFE, Oklahoma EDWARD E. KAUFMAN, Delaware KIRSTEN E. GILLIBRAND, New York DAVID McKean, Staff Director KENNETH A. MYERS, JR., Republican Staff Director (II) --- Page 3 --- CONTENTS Page Dobbins, Hon. James, director, International Security and Defense Policy Center, National Security Research Division, RAND Corp., Washington, DC : Prepared statement Response to question submitted for the record by Senator Robert P. Casey, Jr. Farmer, Dr. Paul, U.N. Deputy Special Envoy for Haiti, Boston, MA Prepared statement Francois, M. Rony, M.D., incoming director of public health, State of Georgia, Atlanta, GA Prepared statement Kerry, Hon. John F., U.S. Senator from Massachusetts, opening statement Lugar, Hon. Richard G., U.S. Senator from Indiana, opening statement ADDITIONAL PREPARED STATEMENTS SUBMITTED FOR THE RECORD Christopher J. Dodd, U.S. Senator from Connecticut Kirsten E. Gillibrand, U.S. Senator from New York U.N. Human Settlements Programme, UN-HABITAT, submitted by Christopher W. Williams, Washington, DC National Haitian America Elected Officials (NHAEON), submitted by State Representative Marie St. Fleur, Boston, MA International Housing Coalition (IHC), Washington, DC Habitat for Humanity International submitted by Chris Vincent, director, congressional relations/international affairs, Washington, DC InterAction, A United Voice for Global Change (III) Dodd, U.S. Senator from Connecticut Kirsten E. Gillibrand, U.S. Senator from New York U.N. Human Settlements Programme, UN-HABITAT, submitted by Christopher W. Williams, Washington, DC National Haitian America Elected Officials (NHAEON), submitted by State Representative Marie St. Fleur, Boston, MA International Housing Coalition (IHC), Washington, DC Habitat for Humanity International submitted by Chris Vincent, director, congressional relations/international affairs, Washington, DC InterAction, A United Voice for Global Change (III) --- Page 4 --- --- Page 5 --- HAITI: FROM RESCUE TO RECOVERY AND RECONSTRUCTION THURSDAY, JANUARY 28, 2010 U.S. SENATE, COMMITTEE ON FOREIGN RELATIONS, Washington, DC. The committee met, pursuant to notice, at 9:18 a.m., in room SD-419, Dirksen Senate Office Building, Hon. John F. Kerry (chairman ofthe committee) presiding. Present: Senators Kerry, Dodd, Cardin, Casey, Shaheen, Lugar, and Corker. OPENING STATEMENT OF HON. JOHN F. KERRY, U.S. SENATOR FROM MASSACHUSETTS The CHAIRMAN. The hearing will come to order. We're going to start the hearing, and I think Dr. Farmer is not very far away. Let me just say I apologize to all for the need to shift, but five votes have been scheduled seriatim, starting at 10:30. And sO, had we begun this hearing as it had been scheduled, at 10 o'clock, we literally would not have had a hearing. So, I appreciate everybody's ability to move this and advance it. And I think what we will try to do is compress the hearing intowe actually have a grace period of about 15 minutes beyond the 10:30, SO we have until about 10:45 or sO, and that ought to give us an opportunity to be able to get through both the testimony and the questions adequately. I wish we weren't pressed, but the is, we are. reality Needless to say, today Haiti is reeling in the aftermath of what may well be the worst humanitarian catastrophe that the Americas have ever seen. Well over 100,000 dead, and more dying every day. An estimated 1 million Haitians are displaced. Large parts of Portau-Prince and several outlying cities are flattened. An already weakened infrastructure has basically collapsed. The numbers simply don't explain the horrors that millions of Haitians are living through. Instead, we begin to understand Haiti's tragedy through stories and images: a tent city next to a crumbled Presidential Palace; a Haitian child dividing one rationed meal among eight members of his family; a 70-year-old woman rescued from the cathedral in Port-au-Prince 7 days after the earthquake, too weak to stand, but strong enough to sing church hymns as she was carried out on a stretcher; and only just this morning, the photographs of the young 15- or 16-year-old girl out alive, just a little more than 2 weeks after the earthquake. being pulled (1) Haiti's tragedy through stories and images: a tent city next to a crumbled Presidential Palace; a Haitian child dividing one rationed meal among eight members of his family; a 70-year-old woman rescued from the cathedral in Port-au-Prince 7 days after the earthquake, too weak to stand, but strong enough to sing church hymns as she was carried out on a stretcher; and only just this morning, the photographs of the young 15- or 16-year-old girl out alive, just a little more than 2 weeks after the earthquake. being pulled (1) --- Page 6 --- It's impossible not to be moved by the suffering, but also the resilience and the dignity of the Haitian people. by It's our duty, as neighbors, and, frankly, as fellow human to respond to this tragedy. And that responsibility does not beings, end with the rescue. We need to help Haiti to rebuild in a way that leaves Haiti better off and better prepared were any future natural disaster to strike. Since the quake, America and the world have rushed in with as much assistance as Haiti's infrastructure has permitted, quickly deploying search-and-rescue teams, food, water, medical equipment, shelter, and several thousand troops. We're also well aware of the suffering and the heartbreak that has affected the hardworking Haitian-American community. Indeed, my home State of Massachusetts is home to the third-largest Haitian community in the United States, and we must do what we can to help. There's been a tremendous outpouring of generosity from Americans and from the international community. People have opened their wallets and their homes. We've been working very closelymy staff, myself-with dozens of families in Massachusetts to expedite the adoptions of Haitian orphans that were already before the earthquake. underway We're also working to make sure that our government's relief efforts provide for the thousands of Haitian children who were orphaned or displaced by the earthquake, within the safeguards of the formal process that protect the children from trafficking. I want to commend Dr. Shah, Secretary Clinton, and countless other Americans inside government and out who have made an impressive, even remarkable effort that all of us can be proud of. I'd particularly like to honor U.S. diplomat Victoria who lost her life, then to recognize the enormous loss suffered DeLong, by the United Nations. The U.N. has made a massive contribution in Haiti over the years. And when the earthquake struck, they lost many outstanding people on the ground. We offer our profound gratitude and our condolences to the U.N. and to the families of the deceased. We've also felt that tragedy personally in Massachusetts, with the loss of Britney Gengel. And I know, personally, the agony that her parents, Leonard and Cheryl Ann, have gone through, first in trying to find out what her fate might be, and now in trying to recover their daughter's body. The task before all of us remains far from over. First, we must continue the enormous ongoing effort to meet Haitians' immediate need for food, water, shelter, electricity, and emergency medical care. So far, thanks to U.N. peacekeepers and U.S. forces, the security situation has allowed these efforts to proceed in general calm. Second, we need to use this humanitarian crisis to begin reversing the poverty and environmental degradation that plagued Haiti long before this tragedy. We cannot be satisfied to simply restore Haiti to the unsustainable conditions of the past. On January 11, Haiti was already the poorest country in the Western Hemisphere. Even before the quake, there were 380,000 orphans in Haiti. Most Haitians lived on less that a dollar a day. One in eight children died before their fifth birthday, and 40 per- . peacekeepers and U.S. forces, the security situation has allowed these efforts to proceed in general calm. Second, we need to use this humanitarian crisis to begin reversing the poverty and environmental degradation that plagued Haiti long before this tragedy. We cannot be satisfied to simply restore Haiti to the unsustainable conditions of the past. On January 11, Haiti was already the poorest country in the Western Hemisphere. Even before the quake, there were 380,000 orphans in Haiti. Most Haitians lived on less that a dollar a day. One in eight children died before their fifth birthday, and 40 per- --- Page 7 --- cent were not enrolled in school. A hundred and twenty thousand Haitians are HIV-positive, and rural Haitians have been plagued by malnutrition. So, we need to help Haitians build a sustainable foundationphysical, social, economic-for a stronger and more stable society. This is a chance for Haitians to re-imagine their country as they rebuild it. We must use every opportunity to help Haiti improve its living standards. Haiti has duty-free, quota-free access to the U.S. market, a large pool of low-cost labor, and a large, hardworking North American diaspora sending money home. Haiti was actually making steps toward recovery when the earthquake struck. And violent crime was declining. Haiti's progress will be more sustainable if its government takes a serious look at longer term challenges, such as environmental devastation and runaway population growth. Third, Haiti's recovery must belong to the Haitian people. They may need our help today, but they must be empowered to build their own future down the road. President René Préval and Prime Minister Jean-Max Bellerive need to lead the national recovery, and civil society and democratic institutions must be protected and nurtured. Haiti's long-term success depends on a government that can inspire its people, work with the private sector, attract investment, and marshal resources to provide basic services, and rule of law. security, Some have said that Haiti is a lost cause. Based on all I know of the Haitian people-and I've learned a lot more in recent daysIc couldn't disagree more. Even in the darkest hours after the earthquake, Haitians who were poor to begin with and then lost everything, reached out to help each other. They searched for missing neighbors. Strangers provided comfort and shelter and shared their meager food. Looting and violence here and there may make headlines, but it is the Haitians' determination and decency in the face of disaster that will make the country's future. Schools may have collapsed, but Haitian commitment to education will not. Elisabeth Débrosse Préval, an economist and the President's wife, urged Haitian people to stand up again and move forward. As they do, American will be there to help. We are fortunate to have with us today three very witnesses with deep knowledge of Haiti and the challenge impressive that we and the Haitian people face. Paul Farmer is the U.N. deputy special envoy for Haiti. I'm proud to call Paul a friend. He's been a vital source of insight and information for me directly and through my daughter, Vanessa, who was Paul's student at Harvard Medical School and continues to work closely with him. James Dobbins, no stranger to this committee, is director of international security and defense policy at RAND. And he has written extensively on Haiti and on the challenges of reconstruction. And finally, Dr. Rony Francois, who emigrated from Haiti to Florida in 1979 to study medicine, can speak directly to the enor- . deputy special envoy for Haiti. I'm proud to call Paul a friend. He's been a vital source of insight and information for me directly and through my daughter, Vanessa, who was Paul's student at Harvard Medical School and continues to work closely with him. James Dobbins, no stranger to this committee, is director of international security and defense policy at RAND. And he has written extensively on Haiti and on the challenges of reconstruction. And finally, Dr. Rony Francois, who emigrated from Haiti to Florida in 1979 to study medicine, can speak directly to the enor- --- Page 8 --- mous challenge- -public health challenges-that Haiti faces. He is the incoming director of public health for the State of Georgia. And we welcome all of you and thank you for being here today. Let me turn to Senator Lugar, and then we'll welcome your testimonies. OPENING STATEMENT OF HON. RICHARD G. LUGAR, U.S. SENATOR FROM INDIANA Senator LUGAR. Well, thank you, Mr. Chairman. And I'd like to thank you again for calling this important hearing on the rescue, recovery, and longer term reconstruction efforts in Haiti. The unimaginable devastation caused by the earthquake and the ongoing aftershocks since January 12, 2010, is, as you pointed out, one of the worst natural disasters to confront the Western Hemisphere in modern history. Nearly 3 million people have been affected, and authorities estimate that more than 150,000 people have perished. My thoughts, and those of all of us in this hearing, are with those who have suffered loss. The crisis situation in Haiti has the potential to destabilize security in the Caribbean. The social instability in Haiti represents a critical concern for the Dominican Republic and could have farreaching implications if deteriorating conditions induce a mass exodus of Haitians by land and sea. Immediate action by the United States to provide assistance to Haiti was clearly warranted. The heroic emergency efforts of American relief workers and the international teams of first responders are deeply inspiring. I commend the administration and many of my Senate colleagues who have worked to advance policies and legislation that will hasten Haiti's recovery. Last week, I called on the Secretary of Homeland Security to grant 18 months of Temporary Protective Status for Haitian immigrants already residing in our country and to grant visa parole for orphans in the midst of adoption proceedings with American ents. The Secretary's quick action on both provisions will ensure parthat many vulnerable children are united with loving families and that all people of Haitian descent in the United States are in a position to contribute to Haiti's recovery. A senior economist at the World Bank has projected that Temporary Protective Status could generate an additional $360 million in remittances sent to Haiti in 2010-on top of the more than $1 billion transferred each year since 2006. I am working with Senator Dodd on a bill that would encourage the IMF to provide debt relief to Haiti and ensure that IMF gold sale surpluses are used for low-income countries, including Haiti. The legislation also would explore ways to invigorate economic activity in the country by adjusting United States-Haiti trade agreements. Despite strong support from the United States, sustained international participation in Haiti is vital for its recovery. It is especially important that the international community provide governance assistance to the Haitian people. The failure and corruption of past Haitian governments contributed greatly to the stress felt by the Haitian people before the . I am working with Senator Dodd on a bill that would encourage the IMF to provide debt relief to Haiti and ensure that IMF gold sale surpluses are used for low-income countries, including Haiti. The legislation also would explore ways to invigorate economic activity in the country by adjusting United States-Haiti trade agreements. Despite strong support from the United States, sustained international participation in Haiti is vital for its recovery. It is especially important that the international community provide governance assistance to the Haitian people. The failure and corruption of past Haitian governments contributed greatly to the stress felt by the Haitian people before the --- Page 9 --- earthquake, and the limitations of the current government constrain the prospects for recovery. These harsh realities, compounded by the significant loss of life that has weakened the government and other institutions in Haiti, compel the international community to consider creative measures. Because of the devastation, Haiti's condition approximates that of a failed state. We should consider an enhanced role for the United Nations in the daily operations of the Haitian Government until the country is stable and less dislocated. This would include the provision of food and shelter, reconstruction activities, budgetary affairs, security, and other aspects of governance vital to the Haitian people. The United Nations has the credibility and capacity to perform this role. The relationship between the United Nations and Haitian Government should be a consensual, cooperative arrangement that preserves Haitian participation in decisions, while ensuring that the resources and expertise of the international community are brought to bear on the daily problems of Haiti. If the U.N. plays an increased security and recovery role, I believe that Haitians would more quickly gather their bearings and begin to rebuild their lives and their country. A top priority must be developing and implementing a plan to resettle temporarily the millions of internally displaced people, for whom Port-au-Prince has little to offer. Adequate food, water, and shelter must be delivered in earnest to these resettlement areas. I would also encourage the Obama administration to coordinate Haitian-American volunteers into HTAs-Hometown Associations-small groups of volunteers in the United States who are linked with their former hometowns and institutions in Haiti. Members of HTAs can serve as interpreters, support the resettlement of refugees, and provide assistance to Haitians temporary who are evacuated to the United States for medical treatment not available on the island. The Haitian-American community is eager to be involved in the recovery of Haiti, but much greater coordination is required to put their skills to full use. Our government should explore ways to partner with NGOs and existing social networking platforms like Facebook and Twitter to facilitate this coordination. Organizing HTAs will increase our ability to leverage the flow of the more than $1 billion remitted from the United States. I look forward to the insights of our very distinguished panel of witnesses and innovative recommendations on strategies for moving Haiti forward. I thank you, Mr. Chairman. The CHAIRMAN. Thank you very much, Senator Lugar. I want to welcome Senator Shaheen here today on the occasion of her 29th birthday. (Laughter.] Senator SHAHEEN. Thirty. The CHAIRMAN. Thirty. Thanks for being truthful, we appreciate that. [Laughter.] And, again, delighted to welcome all the members of our panel. Dr. Farmer, we have such admiration for the work you've been engaging in with Partners in Health, in Haiti, in Africa, and elsewhere, and for your leadership, and for all of you who have been CHAIRMAN. Thank you very much, Senator Lugar. I want to welcome Senator Shaheen here today on the occasion of her 29th birthday. (Laughter.] Senator SHAHEEN. Thirty. The CHAIRMAN. Thirty. Thanks for being truthful, we appreciate that. [Laughter.] And, again, delighted to welcome all the members of our panel. Dr. Farmer, we have such admiration for the work you've been engaging in with Partners in Health, in Haiti, in Africa, and elsewhere, and for your leadership, and for all of you who have been --- Page 10 --- contributing to this dialogue on Haiti. So, we look forward to your testimony this morning. We'll begin with Dr. Farmer, then Mr. Dobbins, and then Mr. Francois. STATEMENT OF DR. PAUL FARMER, U.N. DEPUTY SPECIAL ENVOY FOR HAITI, BOSTON, MA Dr. FARMER. Thank you, Mr. Chairman. And thank you for having me back here and-to testify. I'm speaking, as you mentioned, as the U.N. Deputy Special Envoy for Haiti-and President Clinton, as you know, is the special envoy-but also as a physician and teacher from Harvard who has worked for over 25 years in rural Haiti. Today, my hope is to do justice, not by chronicling the events of the last 2 weeks, which are already well known to you, but by attesting to the possibility of hope for the country and of the importance of meaningful investment and sustainable development in Haiti. That said, I will not pretend that hope is not, at times, difficult to muster. As I was coming here into this city, I asked my colleagues, including Dr. Kerry, "What would it be like to look around you and see every Federal building collapsed-the White House, the House-the Dirksen Building, all of them?" And that's of course what we've seen in Haiti. And as I was flying up here from Port-au-Prince to Montreal, headed to a conference on coordinating donor responses to this massive earthquake, I did the painful math in my head and counted close to 50 colleagues, friends, and family members who had lost their lives in the space of a minute. The afternoon of the earthquake, several of my colleagues from Partners in Health in the U.N. were, ironically, in Port-au-Prince for a meeting about disaster risk reduction. Partners in Health, through its Haitian sister organization, provides health care to the rural poor. This meeting was in Port-au-Prince, as I said. By focusing on training and employing local talent, we have grown a great deal over the years. We are currently serving a population of well over 1.2 million, and count 5,000 employees, most of them community health workers. Of course, not all of our colleagues survived, but the vast majority of our colleagues did survive and have spent the last 2 weeks working day and night to relieve the staggering suffering of the wounded and displaced. President Clinton, our colleagues, and I have been in the cities of Port-au-Prince, Jacmel, Leogane, as well as in the less effective Central Plateau in Artibonite Valley. Everywhere, we have seen great acts ofbravery and solidarity. In addition to the heroism of friends and colleagues, I would like to note for the record the dignity and patience of the long-suffering Haitian people. During a visit last week to Haiti's largest teaching hospital, which shares a campus with the ruins of the nursing and medical schools, President Clinton remarked that no other in the world would be SO patient and calm in the face of SO people much suffering. This observation, though accurate, must not be misunderstood. People in Haiti are afraid, not only for their and futures, but, quite simply, for their safety. options . In addition to the heroism of friends and colleagues, I would like to note for the record the dignity and patience of the long-suffering Haitian people. During a visit last week to Haiti's largest teaching hospital, which shares a campus with the ruins of the nursing and medical schools, President Clinton remarked that no other in the world would be SO patient and calm in the face of SO people much suffering. This observation, though accurate, must not be misunderstood. People in Haiti are afraid, not only for their and futures, but, quite simply, for their safety. options --- Page 11 --- A few nights ago, we sat in empty medical wards. Hearing of impending aftershocks, the patients bolted outside with their IVs dangling from their arms. They refused, as have SO many, to sleep inside the building, any building, but instead found tarpaulins and sheets, and lay down in the open courtyard near the hospital. This scene has repeated itself throughout the country and is a reminder of the logistics challenges facing all those who would be involved in the provision of shelter, clean water, and health care. The relief efforts focused now on addressing the initial wave of devastation of the earthquake will soon turn to a new set of concerns. Hastily cobbled-together camps are at risk of outbreaks of cholera and other waterborne disease. The Haitian Government has wisely proposed avoiding huge camps, which would be difficult to manage. But, we must hasten our efforts to get tents, tarpaulins, and latrines or composting toilets to Haiti. beIt is humbling to see the relief effort be SO slow, in large part cause the delivery of services was so weak before the quake. Now, we must do much more to get food and water to people every day for some time to come. Creating safe schools and safe hospitals, even makeshift ones, is a known need in rebuilding society. And storm-resistant housing must also be a carefully considered priority, since there is little time before the rainy season. Students need to be back in school. The planting season cannot be missed, and requires fertilizer, seeds, and tools. of How will we fund such settlements, ongoing relief, the sewing seeds, the reconstruction that must follow? Major pledges have been made by the United States, Canada, Japan, Spain, Brazil, the European Union, the Inter-American Development Bank, the World Bank, and others. Indeed, most countries have responded to Haiti's plight. Even in faraway and once afflicted Rwanda, a group of community health workers making less than $200 a month have been able to pull together $7,000 in donation for their colleagues in Haiti. This is but a small portion of the billions needed, but hard to surpass as an eloquent testimony of human solidarity. I will make two points, Mr. Chairman. Even when such resources are available, the task before us will be extremely difficult. Medical jargon can be helpful here. Today, Haiti is facing what we would term in medicine an acute-on-chronic problem. Before January 12, the country was already facing long-term challenges in public health and education, and an unemployment rate of over 70 percent, and a majority of its population living on less than $2 a day. Food and water and security were already large problems. Does this catastrophe present a chance for all of us to have a sounder, more solidarity-based relationship with Haiti, or is it yet to be another chapter in a long jeremiad of suffering and the abuse of power? In my last testimony here, at Senator Lugar's invitation in 2003, I expressed concern that the latter possibility was likely- -Senator Dodd was there, as well-was likely, given the policies at our time. Today, I would like to conclude that we are opening up the possibility for a very different way of interacting with Haiti. That said, let me say that I have in my life attended only two donor conferences, both about Haiti. The last one was in Montreal; Haiti, or is it yet to be another chapter in a long jeremiad of suffering and the abuse of power? In my last testimony here, at Senator Lugar's invitation in 2003, I expressed concern that the latter possibility was likely- -Senator Dodd was there, as well-was likely, given the policies at our time. Today, I would like to conclude that we are opening up the possibility for a very different way of interacting with Haiti. That said, let me say that I have in my life attended only two donor conferences, both about Haiti. The last one was in Montreal; --- Page 12 --- I just came from Port-au-Prince to Montreal to here. The first one was in Washington, less than a year ago. The results are noteworthy and worrisome. Despite $402 million pledge to support the Haitian Government's economic recovery program-this was after the 2008 hurricanes, which destroyed 15 percent of the country's GDP-it was estimated that-by my coworkers at the mere U.N.-that a $61 million had been disbursed. In the Office of the Special Envoy, we've been tracking the disbursement of pledges. Eightyfive percent of the pledges made a year ago are undisbursed. Many of us worry that if past is prologue, Haitians themselves will be blamed for this torpor. But, as we have argued before, there are serious problems in the aid machinery, and these have contributed to the delivery challenges on the ground. The aid machinery currently at work in Haiti keeps too much for overhead for its operations and still relies overmuch on NGOs or contractors who do not observe the ground rules we would need to follow to build Haiti back better. The fact that there are more NGOs per capita in Haiti than in any other country in this hemisphere is, in part, a reflection of need, but also, in part, a reflection of overreliance on NGOs, quite divorced from public health and public education sectors. Haiti will need the contractors and mission groups and NGOs. And indeed, I speak on behalf of a very large health NGO. But, we need to create new ground rules, including a demand to create local jobs for Haitians and on building an infrastructure that 1S crucial to creating sustainable economic growth and, ultimately, reducing Haiti's dependence on aid. In other words, what we need is a way of building back better that strengthens governance, but also strengthens the Haitian economy to provide for the needs of its people, especially the vast majority of Haitians who are desperately poor. There is an opportunity not only to build Haiti back better, but to build a more functional and beneficial aid structure. Over the past two decades, U.S. aid policies have see-sawed between embargos and efforts to bypass government, including elected ones not to Washington's taste. In building back Haiti, a credible body that has been working in Haiti, such as the Inter-American Development, Bank, could help house a recovery fund. We need to commit funds and also to disburse them. To quote Jeff Sachs, "Haiti does not need a pledging session, it needs a bank account to fund its survival and reconstruction." Such an account could be managed, as the chairman just noted, with partners such as the U.N. and, of course, Haitian leadership, and would work openly and directly with partners to design and implement recovery plans coordinated at central and local levels. The effort must include a comprehensive post-disaster needs assessment, which should be supported by the United States and other partners. Might such plans work? In some of the darkest moments of the last 2 weeks, when the incapacity and lack of coordination of institutions on the ground was repeatedly revealed to me, I thought often of Rwanda and what happened there in 1994. As a and teacher at Harvard, I've been lucky to work with Partners physician in Health, the Clinton Foundation, and the Government of Rwanda in with partners to design and implement recovery plans coordinated at central and local levels. The effort must include a comprehensive post-disaster needs assessment, which should be supported by the United States and other partners. Might such plans work? In some of the darkest moments of the last 2 weeks, when the incapacity and lack of coordination of institutions on the ground was repeatedly revealed to me, I thought often of Rwanda and what happened there in 1994. As a and teacher at Harvard, I've been lucky to work with Partners physician in Health, the Clinton Foundation, and the Government of Rwanda in --- Page 13 --- rebuilding health infrastructure in three of the last four districts that lacked central hospitals. They are now all built. As in rural Haiti, this has been a very positive experience. It has resulted in thousands ofjobs for Rwandans, and has created broadly accessible health care infrastructure, all with a modest pricetag, compared to traditional aid contractors. If such progress can be made in Rwanda, which boasts strong leadership, but in 1994 was the poorest country on the face of this Earth, then one hopes it can be made elsewhere. Our mission must be-and I will close, because I've gone overto note that if there's any silver lining to this cloud, it is that we can push job creation. It is a strange irony that supporters of economic assistance to Haiti are now obliged to shill for cash-for-work programs for the quaint notion that people should be paid for their labor. Let us be honest; it is absurd to argue that voluntarism and foodfor-work programs will create sustainable jobs. But, if we set the ground rules on reconstruction correctly, we will be able to create sustainable jobs. As a doctor, I can tell you that bad infrastructure and thoughtless policy are visible in the bodies of the poor,just as are the benefits of good policy and well-designed infrastructure. In my almost 30 years in Haiti, I have witnessed many political interventions and multiple coups. They have been unpleasant, even if their effects pale in the shadow ofwhat we are now experiencing. Many people look at Haiti in despair, as the chairman noted. They say that aid is wasted, that there is no hope for this country. I would answer them by saying that this is not true. If we focus the reconstruction efforts appropriately, we can achieve long-term benefits for Haiti. Putting Haitians back to work and offering them the dignity that comes with having a job and its basic protections is exactly what brought our country out of the Great Depression. Thank you very much. [The prepared statement of Dr. Farmer follows:] PREPARED STATEMENT OF DR. PAULFARMER, U.N. DEPUTY SPECIAL ENVOY FOR HAITI, BOSTON, MA Thank you for inviting me to testify today before the Senate Committee on Clin- Foreign Relations. I speak as the U.N. Députy Special also Envoy, for Haiti-President and teacher from ton, Harvard as you who know, has worked is the Special for over Envoy-and 25 years in rural as Haiti. a physician Today, my hope is to do justice to Haiti not by chronicling the events of the past 2 weeks, which are well known to you, but also by attesting to the possibility of hope for the country, in Haiti. and of the importance of meaningful investment and sustainable development That said, Iwill not pretend that hope is not at times difficult to muster. As I was flying from Port-au-Prince to Montreal on Monday, headed to a math conference on coordinating responses to the massive earthquake, I did the painful who in my head and counted close to 50 colleagues, friends, and family members had lost their lives in the space of a minute. from Partners In The afternoon of the earthquake, several of my colleagues for a about disaster Health and the U.N., were, ironically, in Port-au-Prince meeting risk reduction. Partners In Health, through its Haitian sister organization, local provides talent, health care to the rural poor. By focusing on training and employing we have grown a great deal over the years. We are currently serving a population of well over 1.2 million and count about 5,000 employees, most of them community health Of course, workers. not all our colleagues survived. But the vast majority of them did survive, and they have spent the last 2 weeks working day and night to relieve the staggering suffering of the wounded and displaced. President Clinton, our col- Prince meeting risk reduction. Partners In Health, through its Haitian sister organization, local provides talent, health care to the rural poor. By focusing on training and employing we have grown a great deal over the years. We are currently serving a population of well over 1.2 million and count about 5,000 employees, most of them community health Of course, workers. not all our colleagues survived. But the vast majority of them did survive, and they have spent the last 2 weeks working day and night to relieve the staggering suffering of the wounded and displaced. President Clinton, our col- --- Page 14 --- leagues, and I have been in the cities of Port-au-Prince, Jacmel, and well as the less-affected Central Plateau and Artibonite Valley. Léogâne, we have as seen acts of great bravery and solidarity. Everywhere In addition to the heroism of friends and colleagues, I would like to note for the record the dignity and patience of the long-suffering Haitian a last week to Haiti's largest teaching hospital, which shares a people. with During the visit of the nursing and medical schools, President Clinton remarked campus that no other ruins in the world would be so patient and calm in the face of so much suffering. people This observation, though accurate, must not be misunderstood. People in Haiti are not only for their options and futures, but still quite simply for their safety. afraid A few nights ago, we sat in empty wards: hearing of impending the bolted outside with their IVs dangling from their arms. They aftershocks, refused, as sO many, to inside the fatentr sleep building-any building-but instead found and sheets, and lay down in the open courtyard. tarpaulins logistics This scene has itself throughout the country and is a reminder of the challenges fetiee all those who would be involved in the provision of shelter, clean water, and health care. The relief efforts, focused now on the initial wave of devastation from the earthquake, will soon turn to a addressing new set of concerns. Hastily cobbled-together camps are at risk of outbreaks of cholera and other waterborne disease. The Haitian Government has wisely proposed avoiding camps, which will be difficult to manage, but we must hasten our efforts to huge tents, the relief tarpaulins, efforts be and latrines or composting toilets to Haiti. It is humbling to see get before the quake. Now SO slow-in large part because delivery of services was so weak for some time to we must do more to food and water to people every day come. Creating safe and safe hospitals, even a PE.R ones, is known need in rebuilding, a society, and storm-resistant makeshift must also be a carefully considered priority since there is little time before housing the rainy season. Students need to be back in school; the planting season cannot be missed and requires fertilizer, seeds, and tools. How will we fund such settlements, ongoing relief, the sowing of seeds, and the reconstruction that must follow? Major pledges have been made by the United States, Canada, Japan, Brazil, the European Union, the Inter-American Development Bank, the Rena Bank, and others.1 Indeed, most countries have responded. health Even in far away and once-afflicted Rwanda, a of community workers making less than $200/month have been able to together in donations for their in $7,000 uifu needed, but hard to colleagues Haiti. This is but a small portion of the billions Even ifa surpass as an eloquent testimony of human solidarity. ficult. Medical adequate resources are available, the task before us will be extremely diffacing what we jargon, would though term "acute at times arcane, can be helpful here. Today, Haiti is country was already facing huge long-term on chronic" problems. Before January 12, the cation, the unemployment rate over 70 percent, challenges and a majority in public of its health and eduliving on less than $2 a day.2.3 Food and water insecurity were already population huge was lems.4 Does this catastrophe create a chance for all of us to have a sounder, prob- more solidarity-based jeremiad of relationship with Haiti? Or is it to be yet another chapter in a suffering and abuse of power? In my last testimony here, in 2003, I expressed concern that the latter possibility was likely given our policies at that time. 12, the cation, the unemployment rate over 70 percent, challenges and a majority in public of its health and eduliving on less than $2 a day.2.3 Food and water insecurity were already population huge was lems.4 Does this catastrophe create a chance for all of us to have a sounder, prob- more solidarity-based jeremiad of relationship with Haiti? Or is it to be yet another chapter in a suffering and abuse of power? In my last testimony here, in 2003, I expressed concern that the latter possibility was likely given our policies at that time. Today I will spend my time focusing on the potential for an entirely reconsidered relationship between the two oldest independent countries in the Americas: Haiti and my own. Let me offer, as one example of the difficult relations between Haiti and the international community (and an echo of the 19th century machinations I discussed in my last testimony before this committee), the donor conference I attended here in Washington last April. It was one of only two donor conferences I have ever attended, the second being in Montreal earlier this week. The results of the first are noteworthy Government's and worrisome: despite $402 million pledged to support the Haitian Economic Recovery Program, when the country was to from a series of natural disasters resulting in a 15-percent reduction trying of GDP, recover estimated that a mere $61 million have been disbursed.5 In the Office of the it is Envoy, we have been tracking the disbursement of pledges, and as of Special we estimate that 85 percent ofthe pledges made last year remain undisbursed. yesterday for Many this of us worry that, if past is prologue, Haitians themselves will be blamed torpor. But as we have argued before, there are serious problems in the aid machinery, and these have contributed to the "delivery challenges" the The aid machinery currently at work in Haiti keeps too much overhead on for ground.6 its ations and still relies overmuch on NGOs or contractors who do not observe ground rules we would oRRe are need to follow to build Haiti back better. The fact that there more NGOs per capita in Haiti than in any other country in the hemisphere --- Page 15 --- is in part a reflection of need, but also in part a reflection of overreliance on NGOs divorced from the public health and education sectors.7 Haiti will continue to need the contractors, and the NGOs and mission groups, but more importantly we will need to create new ground rules-including a focus on creating local jobs for Haitians, and on building the infrastructure that is crucial to creating sustainable economic growth and ultimately reducing Haiti's dependence on In aid. other words, what we need is a way of "building back better" that strengthens governance but also strengthens the Haitian economy to provide for the needs of its people, especially the vast majority of Haitians who are desperately poor. There is an opportunity not only to build Haiti back better, but to build a more functional and beneficial aid structure. Debt forgiveness is needed to ease the financial drain which would otherwise hinder economic recovery and growth. Over the past two decades, U.S. aid policies have seesawed between embargoes and efforts to bypass governments, including elected ones not to Washington's taste.8 In building back Haiti, a credible body that has been working in Haiti such as the Inter-American Development Bank could help to house a recovery fund. We need to commit funds and also to disburse them. To quote Jeff Sachs, "Haiti does not need a pledging session; it needs a bank account to fund its survival and reconstruc- the tion."s A Such an account should be managed in collaboration with partners, U.N., and, of course, Haitian leadership, which would work directly and openly with to design and implement recovery plans coordinated at central and local mtten The effort must include a comprehensive post-disaster needs assessment, which should be supported by In the U.S. Development Bank could help to house a recovery fund. We need to commit funds and also to disburse them. To quote Jeff Sachs, "Haiti does not need a pledging session; it needs a bank account to fund its survival and reconstruc- the tion."s A Such an account should be managed in collaboration with partners, U.N., and, of course, Haitian leadership, which would work directly and openly with to design and implement recovery plans coordinated at central and local mtten The effort must include a comprehensive post-disaster needs assessment, which should be supported by In the U.S. of and the other darkest partners. moments of the last 2 weeks, when Might the such incapacity plans work? and lack of some coordination of institutions on the ground was revealed repeatedly, I have thought often of Rwanda and what happened there in 1994. As a physician and teacher at Harvard, I have been lucky to work with the Clinton Foundation, Partners In Health, and the Government of Rwanda on rebuilding health infrastructure in three of the last four districts that lacked central hospitals. As in rural Haiti, this has been a very positive experience. It has resulted in thousands of jobs for Rwandans, and has created a broadly accessible health care infrastructure-all with a modest price tag compared to traditional aid contractors.10 If such progress can be made in Rwanda, which boasts strong leadership but in 1994 was the poorest country in the world,11 then one hopes it can be made elsewhere. In part because of this positive experience of working together with the Clinton Clinton Foundation in Rwanda (and in Malawi and Lesotho), I joined President for 6 months ago as his deputy in the U.N. role he originated. As Special Envoy Haiti, President Clinton has focused his attention not only on holding donors to the financial pledges they made, but also on reducing the risk of disasters and on job creation through the massive public works that are necessary to reforest Haiti, protect watersheds, and improve agricultural yield-the backbone of the Haitian economy. Private investment in Haitian businesses, especially small- and mediumsized ones, is critical to rendering Haiti free of any dependence on aid-the goal of Rwanda by 2020, a goal likely to be met.12 Haiti also has, he noted, great potential as a tourist attraction but lacks the infrastructure to welcome the millions of people who should see Haiti's natural beauty and historic treasures like King Henri Christophe's This has been Citadel. our mission: to build back better from the 2008 storms. We believe that these efforts were beginning to bear fruit. We had scheduled a meeting last week in the Hotel Montana to bring in another round of investors and also to discuss job creation. As many of you know, this hotel is no longer standing, and the most need inside it perished on January 12. But the need for such investments, and for public works that would create hundreds of thousands ofj jobs, remains. If there is any silver lining to this cloud, it is that we can push job creation. It is a strange irony that supporters of economic assistance to Haiti are now obliged be to shill for "cash for work" programs-for the quaint notion that people that voluntarism should paid for their labor. Let us at least be honest: It is absurd to argue and food-for-work programs will create sustainable jobs. But if we set the ground rules on reconstruction correctly, we will be able to create sustainable jobs. In other words, if we focus the reconstruction efforts appropriately, we can of achieve long-term benefits for Haiti. The UNDP is helping to organize programs this kind, which should be supported and extended around the country. Putting Haitians back to work and offering them the dignity that comes with having a job and its basic protections is exactly what brought our country out of the Great Depression. --- Page 16 --- This was always the right thing to do, and aid programs persistently fail to get it right. So here is our chance: If even half of the pledges made in Montreal or other such meetings are linked tightly to local job creation, it is possible to imagine a Haiti building back better with fewer ofthe social tensions that inevitably arise as half a million homeless people are integrated into new communities. of that Haiti needs and deserves a Marshall Plan-not the "containment" aspects policy, unless we are explicit about containing the ill effects of poverty, but the SOcial-justice elements-but we need to be honest about the differences between postwar Europe and Haiti in 2010. it right. So here is our chance: If even half of the pledges made in Montreal or other such meetings are linked tightly to local job creation, it is possible to imagine a Haiti building back better with fewer ofthe social tensions that inevitably arise as half a million homeless people are integrated into new communities. of that Haiti needs and deserves a Marshall Plan-not the "containment" aspects policy, unless we are explicit about containing the ill effects of poverty, but the SOcial-justice elements-but we need to be honest about the differences between postwar Europe and Haiti in 2010. Part of the problem, I've argued, is the way in bandits" which aid is delivered nowas compared to in 1946-well before the term "beltway was coined. We need a reconstruction fund that is large, managed transparently, creates jobs for Haitians, and grows the Haitian economy. We need a reconstruction far different plan that uses a pro-poor, rights-based approach based on something interactions from the charity and failed development approaches that have marred between Haiti and much of the rest of the world for the better part of two centuries. Our country can be a big part of this effort. Debt relief is important. but only the beginning. Any group looking to do this work must share the goals of the Haitian busipeople: social and economic rights, reflected, for example, in job creation, local ness development, watershed protection (and alternatives to charcoal for cooking), access to quality health care, and equity. Considering all these who goals hold together orients our strategic choices. Fretu example, cash transfers to women, the purse strings in Haiti and are arbiters of household spending, will have signifi- lessons cant impact. This is a chance to learn and move forward with and build ventilation on to learned in adversity- to build hurricane-resistant houses good water improve air quality from stove smoke; to build communities around clean sources; to reforest the terrain to protect from erosion and to nurture the fertility shelof the land for this agriculturally dominant country. It is the chance to create ter, grow the local economy. and incomes, and invest in improved health. This will do much to decrease the risk of another calamity, and to decrease the vulnerability of the poor-especially as we face the second wave of problems, including epidemic disease born of the earthquake. visiAs a doctor, I can tell you that bad infrastructure and thoughtless policy are ble in the bodies of the poor,. just as are the benefits of good policy and well-designed infrastructure. In my almost 30years in Haiti I have witnessed many political interventions and multiple coups. They have been unpleasant, even if their effects pale dein the shadow of what we are now experiencing. Many people look at Haiti and I would spair. They say that aid is wasted, that there is no hope for this country. in the answer them with the positive experience of building Haitian-led Central Plateau and Artibonite Valley regions that have created jobs for peorilonsaee who would otherwise have no steady work. I advance this model not because E is associated with our efforts, but because job creation is the surest way to amends speed the cash flow that is essential now. It is also the fastest way to make HP our past actions toward Haiti, which have not always been honorable. Sitting before you, I am at my core optimistic about the possibilities before us and The the potential of our support to help rescue and transform our poorest neighbor. has been response from citizens of the United States to the recent events in Haiti overwhelming and encouraging. There is the promise of solidarity by, our Haiti-and leadership to make long-term commitments to the kinds of investments needed in to For fulfilling two centuries, them. the Haitian people have struggled for basic human and economic rights, the right to health care, the right to education, the right to work, the right to dignity and independence. These goals, which Haitians share with people all over the world, should direct our policies of aid and rebuilding. in written As I wrote with colleagues in a recent op-ed-which is available that Haiti my itself will testimony-as physicians working in Haiti, we know firsthand envisioned soon be the casualty if we do not help build back better in the way by Haitians themselves. 1Walker, P. "Haiti Earthquake Aid Pledged by, Country." Guardian.co.uk 26 January 2010. Available at: Hoietarstarraaazn1boyoitain-heatineteaiR try-donations *Flintoff, Corey. aid and rebuilding. in written As I wrote with colleagues in a recent op-ed-which is available that Haiti my itself will testimony-as physicians working in Haiti, we know firsthand envisioned soon be the casualty if we do not help build back better in the way by Haitians themselves. 1Walker, P. "Haiti Earthquake Aid Pledged by, Country." Guardian.co.uk 26 January 2010. Available at: Hoietarstarraaazn1boyoitain-heatineteaiR try-donations *Flintoff, Corey. (accessed "In January Haiti, A 27,2010). Low-WageJob Is Better Than None," All Things Considered, June 14, 2009. Available at: HputamamiedilmpPanpNNeM0oHci0ESi (accessed 3In 2006, January27, the World 2010). Bank estimated that 78 percent of Haiti's 9 million people lived on less than $2 per day. See Haiti at a Glance, World Bank, Development Data Group (DECDG). (accessed Avail- Januable at: SRamlsissismtXSS-ERNHNONS-armRenANiPF ary 26, 2010). --- Page 17 --- 4For an overview of Haiti's water insecurity Satterthwaite and delays in AM international et al. Woch commitments nan soley: to address this crisis, see Varma MK, Robert 251 Klasing Memorial Center for Human The denial Center of the for Human right to Rights water and in Haiti. Global Justice at F. NYU Kennedy School of Law, Partners In Health, Rights, and Zanmi Lasante, 2008. Available at: http://www. .chrgj. Paranpaaouctsaaiy .pdf (accessed 5This estimate January of 27, disbursements, 2010). was prepared in January 2010 in an internal memorandum U.N. of the U.N. Office of the Special Envoy For Haiti. President Clinton, in his capacity Special Envoy, frequently appealed to donors to fulfill their commitments. See Helprin 5 "Bill Clinton Chides Nations Over Help to Haiti." Associated Press, September 9, 2009. Available at: http://www. newsvine. .com/ Atantdhseamersdimpartdimean-amnnammerbipt haiti 6Farmer, (accessed P. January "Challenging 27, 2010). Orthodoxies: The Road Ahead for Health and Human Rights." Health and Human Rights: "Bill An International Tells Diaspora: Journal 'Haiti 2008; Needs 10(1): You 5-19. Now, >> Miami Herald, August 7Daniel, Clinton, 9, 2009. ACtiR. at: apbmbore.dralotitfahoalsamusmsmms (accessed "Farmer January P, Smith 27, Fawzi 2010). MC, and Nevil P. "Unjust Embargo of Aid for Haiti." The Lancet 2003;361:4 9Sachs, J. 420 "After 423. the Earthquake, How To Rebuild Haiti From Scratch." Washington Post, 17 January 2010. Available at: http://www. E0E31AnanMatmtmionn Appbotosobumi 10Republic of Rwanda, (accessed Ministry January of Health, 27, 2010). and Partners In Health. "African Rural Healthcare: An Evaluation of the South Kayonza, Rwanda Project" (2005-2011). Programme Report, 1United Ministry Nations ofHealth, Development 2006. Programme. "Human Development Report: 1997." New York: Oxford University Press, 1997. 146-148. Available at: MopMarr-4papmoewdansr 1997 en indicatorsl.pdf (accessed January 27, 2010). Ministry of Finance and Economic Plan12] Republic of Rwanda. "Rwanda Vision 2020." Kigali: ning, Republic of Rwanda, 2020.pdf 2002. (accessed Available January at: htg.7mmr.edfaor-reddecument-20itbrary 27, 2010). impantantt2Mbcs0son (From the Miami Herald, Jan. 23, 2010] TALES FROM THE FRONT (By Drs. apmoewdansr 1997 en indicatorsl.pdf (accessed January 27, 2010). Ministry of Finance and Economic Plan12] Republic of Rwanda. "Rwanda Vision 2020." Kigali: ning, Republic of Rwanda, 2020.pdf 2002. (accessed Available January at: htg.7mmr.edfaor-reddecument-20itbrary 27, 2010). impantantt2Mbcs0son (From the Miami Herald, Jan. 23, 2010] TALES FROM THE FRONT (By Drs. Paul Farmer, Louise Ivers and Claire Pierre) The vocabulary of clinical medicine is large and arcane, but a couple of concepts In the are useful in diagnosing what is happening in Haiti and in setting there a path. must also coming weeks, there will be scores of prescriptions for Haiti, but terms be diagnoses, too. What is going on right now would be described in clinical with serious as an "acute-on-chronie" picture: Haiti's majority has long been dealing problems and to this has been added the acute injury of a massive earthquake affecting much of the country, most notably its most heavily populated areas. If any kind of chronology can be imposed on a disaster of this magnitude, we are moving into the next phase, where rescue and relief operations continue-miracu. lous rescues of those trapped are still occurring, with one young girl and her brother pulled from rubble the other day and now recovering at the largest urban hospitaland are complemented by slowly coordinated efforts to bring food, drink, shelter, and basic medical services to the millions affected by the quake. Some of the aid is starting to move, as repeat visits to Port-au-Prince's local general hospital reveal: In the space of less than a week, the hospital, run by staff, has been assisted by scores of surgical and medical volunteers and has moved from no functioning operating rooms to a dozen that are busy all day, every day and throughout the night, too. and interest in Haiti such that for the This disaster has brought together goodwill trauma first time in the country's history, there may soon be enough surgeons and specialists. There are, of course, many kinds of trauma, and even those who escaped unscathed physically have lost friends and loved ones, to say nothing of material possessions. Across the country, as people continue to search for missing family members and friends, a kind of numbness is giving way to grief. Rescue workers and medical personnel and ad hoc logisticians, most of them Haitians, will need a break, as some of them have been working nonstop for over a week. together goodwill trauma first time in the country's history, there may soon be enough surgeons and specialists. There are, of course, many kinds of trauma, and even those who escaped unscathed physically have lost friends and loved ones, to say nothing of material possessions. Across the country, as people continue to search for missing family members and friends, a kind of numbness is giving way to grief. Rescue workers and medical personnel and ad hoc logisticians, most of them Haitians, will need a break, as some of them have been working nonstop for over a week. One of our collaborators is still in the clothes in which she escaped with her life from her home. SENSE OF CALM Everywhere here you see Haitians helping each other. Despite reports President of violence, Clinton, what strikes many of us is the overall sense of calm: Former --- Page 18 --- after bringing surgical supplies to the general hospital, noted that no other people in the world would be so patient and calm in the face of'so much suffering. School, A young Haitian colleague, already on the faculty of Harvard Medical is organizing scores of volunteers from every class. People have opened their homes and yards, which are covered with makeshift shelters: The chronic problem of housin Haiti is now worsened by the acute problem of half a million newly homeless. "ao addition to cross-class cooperation, it is clear that the Haitian diaspora, which scattered across North America and Europe (and even Rwanda, where a small group One of Haitians is busy raising funds) has a lot to offer beyond material assistance. New ICU doctor, Dr. Ernest Benjamin, wrote to his home institution in FeATESt to say that "at last this is starting to look like a functioning hospital." Haitian He and other Haitian professionals living in the United Statesphysicians and nurses are a powerful force there-have much to offer a large-scale rebuilding effort ifit is coordinated with efforts to rebuild national institutions, Another helpful notion from medicine is the pledge to "do no harm." Knowing what not to do is not the same thing as knowing what to do-who can be sure of what to do when nothing of this scale has been registered before?-but it is important nonetheless to learn from years of international aid to Haiti. will be First, long-term lack of coordination of relief and reconstruction efforts costly. Competition between self-described donor nations is worse than unhelpful. Even now, there is bedlam as medical teams arrive with excellent skills and intention, but insufficient coordination. The many clinicians now in the country need to work together as a team. the 1994 One potential model of recovery for Haiti is the nation of Rwanda. After which ingenocide, Rwanda was overwhelmed by the international helping vultures, class, consultcluded, in addition to many people of good will, a flock of trauma ants and carpetbaggers. Under the strong leadership of the nascent government, including now-President Paul Kagame, leaders insisted that recovery and reconstruction aid be coordinated by the central and district governments. A number of nongovernmental organizations left Rwanda, but most would argue the decisions made then have helped to create a new model of collaboration between public and and private actors, and contributed to Rwanda's remarkable post-genocide stability growth. The Government of Rwanda has made a generous fmancial gift to the people of Haiti. Second, neglecting the immediate-term needs in favor of the long view is a mistake. People need food, water, shelter and sanitation in the days and months to come, to complement the emergency medical care that has been dispatched. Third, those who wish to help in the next few days would be wise to hold off on most in-kind donations. Some of these will surely be needed soon, but the best thing to do right now is to send cash to organizations that have deep connections to needs Haiti and can draw on local knowledge and local hands to respond to the immediate of the injured, homeless, and sick. RESETTLEMENT EFFORTS Fourth, we must do no harm in resettlement efforts. Housing will be an enormous challenge, and will require the best minds on the planet. We need to avoid creating intermediate-term camps that become slums. Haitians United States Fifth, we must make sure that deportation of from the and Prescriptions elsewhere stops. for Haiti will be bountiful from outside, but we must ensure that the prescriptions are correct. Haiti needs a different kind of assistance, one them- built on solidarity and respect and rooted in what the Haitian people want for selves. Assistance offered now must develop food sovereignty for Haiti and investment in the rural area, now seeing an influx of those displaced from the for capital. the reThe next few weeks will reveal some sense of the long-term prognosis construction of Haiti. There is already talk of a $12 billion rebuilding tab. The CHAIRMAN. Thank you very much, Dr. Farmer. Mr. Dobbins. STATEMENT OF HON. JAMES DOBBINS, DIRECTOR, INTERNATIONAL SECURITY AND DEFENSE POLICY CENTER, NATIONAL SECURITY RESEARCH DIVISION, RAND CORP., WASHINGTON, DC Ambassador DOBBINS. Thank you, Mr. Chairman. food sovereignty for Haiti and investment in the rural area, now seeing an influx of those displaced from the for capital. the reThe next few weeks will reveal some sense of the long-term prognosis construction of Haiti. There is already talk of a $12 billion rebuilding tab. The CHAIRMAN. Thank you very much, Dr. Farmer. Mr. Dobbins. STATEMENT OF HON. JAMES DOBBINS, DIRECTOR, INTERNATIONAL SECURITY AND DEFENSE POLICY CENTER, NATIONAL SECURITY RESEARCH DIVISION, RAND CORP., WASHINGTON, DC Ambassador DOBBINS. Thank you, Mr. Chairman. --- Page 19 --- The history of prior American and international interventions in Haiti must instill a sense of caution regarding the prospects for working any real transformation there. Yet, as a candidate for assistance, Haiti has many advantages over other fragile states, including some in which the state-building process has yielded quite positive results. Most of the-most of those sorts of states are surrounded by conflict-prone and predatory neighbors. Haiti, in contrast, sits in the midst of a zone of relative peaceof peace and relative prosperity. All of Haiti's neighbors are much richer, and none have any interest in destabilizing Haiti or inhibiting its development. Neither is Haiti divided by competing ethnic or religious groups. Haitians have a strong sense of national identity and no serious sectarian divides. Haiti also has a large and relatively prosperous diaspora, many of whom are located at no great distance and enjoy frequent contact with their families on island. So, Haiti does have certain inherent advantages. În addition to these inherent advantages, I think there are three relatively new conditions that suggest that, this time around, we may do better than we have the last few. First of all, the final departure of President Aristide in 2004 has greatly diminished partisan rancor in both Port-au-Prince and Washington. At a moment when Bill Clinton and George W. Bush are campaigning together for relief to Haiti, one may hope that this American divide, which SO hobbled American efforts to help Haiti in the past, has definitively closed. Second, the outpouring of sympathy for Haiti as a result of the recent earthquake seems likely to yield a substantial increase in American and international aid levels. More money means more assistance, but it also means more leverage to promote change. Finally, the very immensity of the recent disaster has administered a shock to the Haitian political structure that can help ease resistance to reform and undermine longstanding barriers to progress within Haiti. My own experience with Haiti dates back to the American intervention of 1994. This was one of five such nation-building ations with which I became associated, including Somalia, early oper- in the decade, then Bosnia and Kosovo, and, finally, Afghanistan, on behalf of the Bush administration, And since leaving I've had an opportunity to reflect not only on that American office, but also on a dozen or more U.N. and other operations experience, with which the United States was not closely associated. And so, I'd like to offer a number of proposed guidelines for assistance to Haiti that's based on that broad experience of the last 60 years in these kinds of missions in fragile island states. First, security is an essential prerequisite for reform, as it is for private investment. In the absence of security, any positive changes will be washed away. So, the bad news is that an international security presence in Haiti is going to be required for a long time. The good news is that Haiti is not a particularly difficult society to secure. Contrary to the popular image, the Haitian population 1s neither heavily armed nor inclined to violence. One has only to regard the patience with which the people of Port-au-Prince has awaited succor over the last 2 weeks to recognize its essentially peaceful character. Haiti is no Somalia, Iraq, or Afghanistan. is for private investment. In the absence of security, any positive changes will be washed away. So, the bad news is that an international security presence in Haiti is going to be required for a long time. The good news is that Haiti is not a particularly difficult society to secure. Contrary to the popular image, the Haitian population 1s neither heavily armed nor inclined to violence. One has only to regard the patience with which the people of Port-au-Prince has awaited succor over the last 2 weeks to recognize its essentially peaceful character. Haiti is no Somalia, Iraq, or Afghanistan. --- Page 20 --- American troops, therefore, are unlikely to be required once the immediate emergency passes. I think the United Nations should be able to secure Haiti successfully with the modest reinforcements that have already been authorized. I do think that the United States should consider increasing the assignment of American police officers to the U.N. police there. We have a unique attribute to draw on, which is contingent a number of Haitian-Ameriean police officers, in big cities like Miami and New York and elsewhere, who, I think, can offer a valuable contribution to the U.N. police force, which is helping to secure Haiti. Second lesson drawn from these past operations is that stabilization and reconstruction operations take time. The 1994 Americanled intervention was a case in point. That operation was almost entirely successful in its own terms, but those terms were much too narrow. In launching the intervention, President Clinton to restore a freely elected President and then to keep American promised troops in Haiti only long enough to organize new elections and inaugurate a new President. And he promised to do this all within 2 years. This, his administration proceeded to do, hitting every benchmark, achieving every target, and suffering almost no casualties. But, 2 years was too short a time to fix a society as troubled as Haiti's, and the 1994 intervention accomplished little of lasting value. Recent post-conflict stabilization and reconstruction operations have lasted-have been lasting 8 to 10 years. The current operation began in 2004, but I think, as the result of the earthquake, we basically have to set the clock back to zero and assume that a U.N. peacekeeping force is going to be required there, probably for another decade at least. Third, in a post-conflict environment, economic development and political reform programs need to be evaluated not just on their tential to promote growth and social justice, but on their poto ease tensions in the society and promote reconciliation capacity among long-hostile groups. This means that programs to relieve poverty, create jobs will be a necessary part of a larger aid effort, even if their immediate impact is sometimes rather ephemeral. Fourth, assistance should be focused on building a more competent and efficient state. This is probably my most important message. Haiti's vulnerability to natural disaster is not just a matter of weak building codes and poor infrastructure, but, more fundamentally, the result of having an exceptionally weak state, one that cannot provide even minimal public services- -security, power, water, health, and education-to the majority of its population. Large amounts of American aid and other donor money are to flow into Haiti in the coming weeks, and the temptation will going be to spend most of it, as Dr. Farmer suggested, on American and foreign NGOs that can deliver essential services with fair reliability and good accountability. But, this sort of aid leaves no lasting local capacity to sustain those services. A second priority will be on bricks and mortar. But, this too will leave the underlying Haitian institutions unaltered. Aid, therefore, also needs to be directed on a priority basis toward enhancing Haiti's capacity to govern itself. This means pro- of American aid and other donor money are to flow into Haiti in the coming weeks, and the temptation will going be to spend most of it, as Dr. Farmer suggested, on American and foreign NGOs that can deliver essential services with fair reliability and good accountability. But, this sort of aid leaves no lasting local capacity to sustain those services. A second priority will be on bricks and mortar. But, this too will leave the underlying Haitian institutions unaltered. Aid, therefore, also needs to be directed on a priority basis toward enhancing Haiti's capacity to govern itself. This means pro- --- Page 21 --- viding Haitian Government the wherewithal to hire well-qualified staff at competitive wages and programs to further train such staff and provide them information systems and other support services needed to maximize their efficiency. Fifth, Haiti needs to be built from the bottom up as well as the top down. It's notj just Port-au-Prince; it's the rural populations. It's not just the government ministries in Port-au-Prince; it's creating the capacity of the Haitian Government to actually penetrate and deliver services at the local level, and also to promote the development of local leadership, local mayors, local councils, and provide them the wherewithal to assist their constituents. Sixth, the U.S. Government needs to organize itself for a sustained, high-intensity effort. I would suggest that the President and the Secretary of State should invest a single individual with the authority and responsibility for Haiti, comparable to that which Ambassador Richard Holbrooke currently exercises for Afghanistan. Congress should authorize and appropriate new money for Haiti, not in the usual categories of development assistance, security assistance, counternarcotics assistance, refugee assistance, et cetera, but in a single account, unencumbered by earmarks and special limitations, and then work, through the consultative and oversight processes, with whomever the administration designates as its point person, to make sure this money is carefully targeted and well Seventh, spent. it's important the international program for reform of Haitian institutions not bear a "Made in Washington" imprint. I believe that the United States should work to establish conditions for assistance, and to insist those conditions are met through institutions like the United Nations and the World Bank. We should help those institutions target the reforms that are feasible and essential, and to set the conditions which will use the leverage that assistance provides to get those reforms effectuated. And the United States should work quietly behind the scenes to use its political influence to make sure that the Haitian institutions do, indeed, adopt those reforms and embrace them. And the United States, of course, should be contributing directly and substantially to both U.N. and World Bank efforts. I would suggest the division of labor would be the United Nations continuing to take the lead in reforming the security sector, including police, courts, and prisons, in supporting elections and promoting political reform, while the World Bank takes the lead in supporting economic and social reforms. Finally, there are a couple of things that the United States is uniquely positioned to do by reason of its proximity. These involve trade and immigration. Senator Kerry, you already mentioned the very generous preferential access Haiti has to the United States market. This is a time-limited access, and I would suggest we, on that as well as on the peacekeeping force, essentially set the clock back to zero and assume that that access begins as of today rather than as of when it actually went into effect. And second, I do suggest, as I think Senator Lugar was suggesting, that the United States should consider a temporary in- things that the United States is uniquely positioned to do by reason of its proximity. These involve trade and immigration. Senator Kerry, you already mentioned the very generous preferential access Haiti has to the United States market. This is a time-limited access, and I would suggest we, on that as well as on the peacekeeping force, essentially set the clock back to zero and assume that that access begins as of today rather than as of when it actually went into effect. And second, I do suggest, as I think Senator Lugar was suggesting, that the United States should consider a temporary in- --- Page 22 --- crease in family unification immigration to the United States. Haitian society may be economically dysfunctional, but Haitian immigrants have, quite the contrary, proved to be exceptionally hardworking, family-oriented, law-abiding contributors to our society, even as they are one of the largest sources of support for those they leave behind in Haiti. Every dollar they remit to relatives in Haiti is another dollar that does not need to come from the U.S. taxpayer. Thank you. [The prepared statement of Ambassador Dobbins follows:] PREPARED STATEMENT OF HON. JAMES DOBBINS, DIRECTOR, INTERNATIONAL SECURITY AND DEFENSE POLICY CENTER, NATIONAL SECURITY RESEARCH DIVISION, RAND CORP., WASHINGTON, DC In considering how best to help Haiti recover from the January 12 earthquake, relief it is important torecognize that one now has an international disaster mission. of a reconstruction oERe ation superimposed on top preexisting when American and then-United earlier of these two operations began in Knreties Nations troops assumed responsibility for security in Haiti. but Of the two operations, humanitarian relief is clearly the more urgent, One post inconflict stabilization and reconstruction is ultimately the more important. tends to restore Haiti, the other to transform mission it. is to leave behind a society better The ultimate aim of any post conflict domestic able to look after itself. Usually this means the ability to manage In political Haiti's case, the competition in ways that do not spill over into violent conflict. deal with the sort of natobjective must also be to improve that society's capacity to ural disaster that, given this country's location, will continue to strike with some regularity. In trying to help fix a failed or failing state, one must begin by analyzing the sources of fragility. The earthquake demonstrated the weakness of Haiti's infrastructure. It also highlighted the weakness of its governing institutions. This is the true source of Haiti's vulnerability to conflict and to natural disaster. In Haiti's case, state-building, rather than nation-building is the more apt description of our mission. The history of prior American and international interventions in Haiti must instill a sense of caution regarding the prospects for any transformation. Yet as a candidate for such assistance, Haiti has many advantages over other fragile states, including ones where the nation- or state-building process has yielded positive results. Most of those states were surrounded by conflict prone and predatory neighbors. Haiti sits in the midst of a zone of peace and relative prosperity. All ofi its neighbors its are much richer, and none have any interest in destabilizing Haiti or inhibiting, Haidevelopment. Neither is Haiti divided by competing ethnic or religious groups. tians have a strong sense of national identity, and no serious of sectarian whom divides. Haiti also has a large and relatively prosperous diaspora, many are located at no great distance and enjoy frequent contact with their families on the island. So Haiti does have certain inherent advantages. In addition, there are three newer factors which provide some hope that future efforts to help Haiti can yield more enduring results than those of the past. diminished First, the final departure of ex-President Aristide in 2004 has greatly when Bill partisan rancor in both Port-au-Prince and Washington. At a moment Clinton and George W. Bush are campaigning together for relief to Haiti, one Haiti may hope that this American divide, which so hobbled American efforts to help in the Second, past, has the definitively outpouring closed. of sympathy for Haiti as a result of the recent earthquake seems likely to yield a substantial increase in American and international aid levels. More money means more assistance and also more leverage to promote change. Finally, the very immensity of the recent disaster has administered a shock to the Haitian political structure that can help ease resistance to reform and undermine longstanding My personal barriers experience to progress. with Haiti dates back to the American intervention of 1994. This was one of five such nation-building operations with which I became associated, beginning with Somalia earlier in that decade, and ending with Afghanistan in the aftermath of 9/11. Since leaving government, we at RAND have issued a series of studies looking at the results of post conflict stabilization and reconstruc- number tion missions across each of these American-led interventions, plus a larger ensity of the recent disaster has administered a shock to the Haitian political structure that can help ease resistance to reform and undermine longstanding My personal barriers experience to progress. with Haiti dates back to the American intervention of 1994. This was one of five such nation-building operations with which I became associated, beginning with Somalia earlier in that decade, and ending with Afghanistan in the aftermath of 9/11. Since leaving government, we at RAND have issued a series of studies looking at the results of post conflict stabilization and reconstruc- number tion missions across each of these American-led interventions, plus a larger --- Page 23 --- of U.N.-led operations. Based on this body of work, I offer the following suggested guidelines for future aid to Haiti. as it is to private investment. First, security is an essential prerequisite to reform, will eventually be washed away. In the absence of security, any positive changes to the Fortunately, Haiti is not a difficult society to secure. Contrary, popular image, the Haitian population is neither heavily armed, nor inclined to violence. One has only to regard the patience with which the people of Port-au-Prince has awaited Haiti is succor over the past 2 weeks to recognize its essentially peaceful nature. no Somalia, Iraq. or Afghanistan. The comparative docility of the population is, in fact, one reason why very small numbers of armed men have on occasion been able to threaten the state and overturn governments. In 2004, for instance, Aristide was driven out of office by, an insurgency numbering in the very low hundreds, equipped with nothing but small arms. American troops are, therefore, unlikely to be required once the immediate humanitarian emergency passes. Securing Haiti should be well within the capability of the current U.N. peacekeeping, force, modestly strengthened as it is being to help cope with the new, post-earthquake challenges. Nevertheless, the United States can and should help the U.N. in this task by, assigning an increased number the of United American police to the U.N. international police contingent. In doing so, States should draw, in particular, on Creole-speaking Haitian-American policemen from places like Miami and reconstruction New York. take time. The 1994 AmericanSecond, stabilization and operations That was almost led international intervention was a case in point. operation In entirely successful in its own terms, but those terms were much too narrow. elected launching the intervention, President Clinton promised to restore a freely President and then to keep American troops in Haiti only long enough to organize new elections, inaugurate a new President, Parliament and local officials. He ised to do this all within the space of 2 years. This his administration THEESE do, hitting every benchmark, achieving every target, and suffering almost no troubled casualties in the process. But 2 years was too short a time to. fix a society as value. as Haiti's. In the end the 1994 intervention accomplished little of lasting have been Recent post-conflict stabilization and reconstruction operations has lasting since 8 to 10 years. The current effort in Haiti began in 2004, but the country this suffered' devastating flood damage and now the earthquake. The clock on operation therefore needs to be set back to zero hour, and the U.N. Security Council should plan on keeping a peacekeeping force in Haiti for another 8 to 10 years. Third, in a post-conflict environment, economic development and political reform and programs need to be evaluated not just on their potential to promote growth social justice, but for their capacity to ease tensions in the society and promote reconciliation between long hostile groups. In Haiti, these competing groups are not ethnic or religious but rather economic and social. Programs that might exacerbate such tensions should be scrapped or adjusted, in favor of those that draw competing groups into collaboration, even where the immediate economic payoff of such pro- will may be less. This means that programs to relieve poverty and create jobs Em a necessary part of larger aid effort, even if their immediate impact the is ephemeral, for without anof visible signs of progress, significant elements of population may be inclined to block longer term, larger payoff efforts at reform. Fourth, assistance should be focused on building a more competent and efficient state. Haiti's vulnerability to natural disaster is not just a matter of weak building codes and poor infrastructure, but more fundamentally the result of having an exceptionally weak state that cannot provide even minimal public services- Haiti -security, is, for power, water, health and education-to the vast majority of its people. Em a necessary part of larger aid effort, even if their immediate impact the is ephemeral, for without anof visible signs of progress, significant elements of population may be inclined to block longer term, larger payoff efforts at reform. Fourth, assistance should be focused on building a more competent and efficient state. Haiti's vulnerability to natural disaster is not just a matter of weak building codes and poor infrastructure, but more fundamentally the result of having an exceptionally weak state that cannot provide even minimal public services- Haiti -security, is, for power, water, health and education-to the vast majority of its people. free instance, the only state in the entire Western Hemisphere that does not provide primary education to most of its children. countries themselves The urgency ofthe immediate crisis requires that donor provide people with food, water, medicine and shelter, bypassing the Haitian state. As we move beyond this emergency relief phase, the next priority will be to repair the country's most basic infastrgcturt-lo-pislk, schools, roads, electricity, telephones the old, and government buildings. But these institutions should not be rebuilt on inefficient, corrupt foundations. Rather the scale of this disaster offers the opportunity to accelerate long planned, oft delayed reforms in each of these sectors. ton in The port of Port-au-Prince has, for instance, long had the highest cost this the lowest wage rate. We should help fend the hemisphere but not with despite the same having grossly inefficient management and distorted cost strucport, ture. The same goes for the education ministry, the electric company, the telephone monopoly, the health ministry and the court system. Repair or replace the buildings, by all means, but also insist upon fundamental reforms in the management of these institutions. --- Page 24 --- Large amounts of American and other donor money will flow into Haiti in weeks. The temptation will be to spend most of it on American and coming NGOS that can deliver essential services with fair reliability and good foreign which Western legislators insist upon. But this sort of aid leaves behind accountability, no local capacity to sustain those services. The second priority will be on bricks lasting and mortar construction. This too will leave the underlying Haitian institutions Haiti's unaltered. Such aid should, thus, be oriented to the extent possible on enhancing wherewithal capacity to govern. This means providing the Haitian Government the to hire well qualified staff at competitive and to ther train such staff and provide them the information wages, systems and programs other support furservice needed to maximize their efficiency. Fifth, the Haitian state should be built from the bottom up as well as the down. This means assistance to mayors and local councils, and which top allow key government agencies to establish a presence beyond Port-au-Prince, funding will For decades the population has moved off the land and into the big cities, the capital. This exodus has now, as a result of the earthquake, been particularly reversed. Assistance efforts should be designed to help those who have left the find a livelihood in the countryside, rather than return to the shanty towns from city whence to the have fled. Sixth, the U.S. Government needs to organize itself for a sustained effort to promote these reforms. The President and Secretary of State high-intensity should invest a single individual with authority and responsibility for Haiti comparable to that Ambassador Richard Holbrook currently exercises for Afghanistan. should authorize and appropriate new money for Haiti not in the usual Congress of development assistance, security assistance, counternarcotics assistance, categories refugee assistance, etc., but in a single account unencumbered by earmarks and tations, and then work through the consultative and oversight processes special with whom- limicarefully ever the administration designates as its point person to ensure that this money is targeted and well spent. tions Seventh, not bear it is important that the international program to reform Haitian instituwill carry with a it made-in-Washington significant leverage imprint. to promote Large-scale change, but international this assistance to be exerted in a carefully calibrated manner, Candidate programs for pressure reform needs to be carefully chosen, local champions identified and empowered, local opponents need co-opted, World politicians lobbied and the public informed. The United Nations the Bank, the two major international institutions most heavily and should be out in front, choosing and designing the necessary reforms engaged and in Haiti tioning assistance on their achievement. Seventh, not bear it is important that the international program to reform Haitian instituwill carry with a it made-in-Washington significant leverage imprint. to promote Large-scale change, but international this assistance to be exerted in a carefully calibrated manner, Candidate programs for pressure reform needs to be carefully chosen, local champions identified and empowered, local opponents need co-opted, World politicians lobbied and the public informed. The United Nations the Bank, the two major international institutions most heavily and should be out in front, choosing and designing the necessary reforms engaged and in Haiti tioning assistance on their achievement. The United Nations should continue condi- lead in reforming the security sector, to include police, courts and and in to porting elections and promoting political reform. The World Bank prisons, should assume supleadership throughout the economic and social sphere, the needed and setting the conditions for assistance. The United identifying States should key changes work in concert with the other key donors, particularly Canada, France and the European Union, fine their forming a small core group to quietly help the U.N. and the World Bank dereform objectives and then working largely behind the scenes to these objectives are achieved. The United States should contribute directly ensure U.N. and World Bank funds for Haiti, and should make sure that its own bilateral to grams, and those of other donors contribute to, rather than undercut the reform programs set out by these institutions. proFinally, there are a couple of things that the United States is uniquely positioned to do by reason ofi its proximity to Haiti. These involve trade and In 2006 Congress passed legislation providing Haiti uniquely immigration. generous but timelimited access to the U.S. market. As with the U.N. the clock on this access should be set back to zero, recognizing peacekeeping that the mission, time more than away whatever had been accomplished since these earthquake preferences has originally went ethst effect. The United States should also consider temporarily raising its annual for Haitian immigration. Haitian society may be economically dysfunctional, quota Haitian immigrants have, quite to the contrary, proved to be hard-working, but oriented, law-abiding contributors to our society, even as they are one ofthe familysources of support for those they leave behind in Haiti. Every dollar that largest to relatives in Haiti is another dollar that does not need to come from the they U.S. remit taxpayer. Expanding legal Haitian immigration thus seems a classic win-win proposition. of The current crisis, though tragic, offers the chance to boost Haiti out of decades poverty and misrule. . Haitian society may be economically dysfunctional, quota Haitian immigrants have, quite to the contrary, proved to be hard-working, but oriented, law-abiding contributors to our society, even as they are one ofthe familysources of support for those they leave behind in Haiti. Every dollar that largest to relatives in Haiti is another dollar that does not need to come from the they U.S. remit taxpayer. Expanding legal Haitian immigration thus seems a classic win-win proposition. of The current crisis, though tragic, offers the chance to boost Haiti out of decades poverty and misrule. A successful strategy for doing SO will require several elements: care in the design, sustained U.S. commitment, effective international coordination, and, above all, a focus on strengthening Haiti's governing institutions. --- Page 25 --- The CHAIRMAN. Thank you very much, Mr. Dobbins, for some very thoughtful suggestions. Dr. Francois. STATEMENT OF M. RONY FRANCOIS, M.D., INCOMING DIRECTOR OF PUBLIC HEALTH, STATE OF GEORGIA, ATLANTA, GA Dr. FRANCOIS. Good morning, Chairman Kerry, Ranking Member Lugar, and members of the committee. My name is Dr. Rony Francois. I'm a physician and a doctor of public health by training. I'm also the immediate past secretary of health for the State of Florida, as well as the immediate past director of public health for the State of Louisiana. Effective I will be the director of public health for the State of Georgia. Monday, I want to thank the committee for inviting me to testify on the topic of "Haiti: From Rescue to Recovery and Reconstruction." My testimony will focus on the following: extent of the damages, immediate relief needs, some intermediate goals, and the long-term path to recovery and development. Extent of the damages. An earthquake of 7.0 magnitude is a challenge for any country, but when it occurs in one of the world's most fragile countries, its intensity seems potentiated as it finds a destructive and sinister synergy in the vast landscape of feeble structures. The estimated mortality is about 200,000. There are about 4,000 missing Americans. The number of injured approaches 1 million. The number of people affected is approximately 3 million. The economic damage is difficult to quantify. My mother- and father-in-law lost everything in Haiti. Fortunately, they were in the United States with me when the devastation occurred. Immediate relief needs. With the great number of people affected, the critical needs are food and water, medical care, temporary shelters, security, and sanitation. In terms of diet, the most vulnerable groups are the newborns and young infants, who require age-appropriate formula. However, tensions in the capital city and also the countryside continue to grow, as many families do not have access to food and other basic goods. The escalation of frustration is already inducing violence, and if resources are not more strategically distributed throughout the country, the security situation on the ground could rapidly deteriorate. Medical teams must also remain vigilant about wound infections, sepsis, malaria, tetanus, respiratory infections, and typhoid, as thousands more could die if conditions are not closely monitored and immediate steps are not taken to mitigate risks. Intermediate goals. In light of over 50 aftershocks of a magnitude of 4.5 or greater, a thorough assessment of the structural integrity of the remaining homes and buildings is absolutely critical for the future safety of the population. Before entering the United States and earning his doctorate degree in structural engineering, specializing in foundations and water resources, my brother, Carl, worked as an engineer in Portau-Prince. And building codes at that time did not exist, and construction practices were geared to withstand hurricane wind forces, and not earthquakes. are not closely monitored and immediate steps are not taken to mitigate risks. Intermediate goals. In light of over 50 aftershocks of a magnitude of 4.5 or greater, a thorough assessment of the structural integrity of the remaining homes and buildings is absolutely critical for the future safety of the population. Before entering the United States and earning his doctorate degree in structural engineering, specializing in foundations and water resources, my brother, Carl, worked as an engineer in Portau-Prince. And building codes at that time did not exist, and construction practices were geared to withstand hurricane wind forces, and not earthquakes. --- Page 26 --- In order to forecast the magnitude and, hence, the cost of debris rubble removal and disposal, it is appropriate to compare this recovery effort to the models and lessons learned after the September 11, 2001, destruction at the World Trade Centers, after Hurricane Ivan's aftermath in Pensacola, FL, and after Hurricane Katrina's devastation of the Gulf Coast States, where recovery is still ongoing today. The materials collected during this cleanup can be recycled or transported as fill for reclamation land along the coast of the bay of Port-au-Prince. Assuring proper drainage of rainwater will be a massive undertaking with the Mountain T'Hopital's steep watershed and the drastic reduction of previous areas with tree-cutting practices and anarchistic construction. The existing system was already obsolete and undersized and did not seem to rely on accurate hydrological data. In addition, with the earthquake's underground stresses generated from the wave propagation, it must be anticipated that the majority of structures and pipes-mostly concrete-have sustained irreversible damage. The waterworks and sewer infrastructures, gauged against current environmental standards, were already inadequate. Construction from scratch might be considered. The source of water supply might be adjusted after evaluation of the Cul-de-Sac Plain aquifer capacity and inventory of other reserves through groundwater hydrology. Another viable option is to tap into the bay of Port-au-Prince readily available sea saltwater through a desalination process. Long-term reconstruction and development. Decentralization away from Port-au-Prince must be a priority goal of future development efforts. The earthquake has already triggered an exodus of the population to various parts of Haiti. In order for that migration to become permanent, investments must be made in agriculture, food security, local jobs, tourism infrastructure, security, roads, and airports. Access to rudimentary medical care must also be decentralized with a network of community health centers across the country. Public health must become the foundation of this new health system and foster the widespread training and use of health moters of agents-or agents of health. proImprovements in literacy should also remain central to any development efforts. I would like to share with the committee a few of the recommendations of the Haiti Advisory Group, created by executive order on July 14, 2004, by former Florida Governor Jeb Bush. The advisory group consisted of 17 prominent Haitian-Americans with significant experience in Haitian issues. The advisory group formulated a set of25 recommendations to the Governor and the State of Florida. These prophetic recommendations, which are still very relevant today, included a wide range of problematic issues that fall in the following categories: security recommendations, economic development recommendations, disaster preparedness, environmental rehabilitation. Although Florida was the main partner of these projects, I would propose that these recommendations be adopted by the United by executive order on July 14, 2004, by former Florida Governor Jeb Bush. The advisory group consisted of 17 prominent Haitian-Americans with significant experience in Haitian issues. The advisory group formulated a set of25 recommendations to the Governor and the State of Florida. These prophetic recommendations, which are still very relevant today, included a wide range of problematic issues that fall in the following categories: security recommendations, economic development recommendations, disaster preparedness, environmental rehabilitation. Although Florida was the main partner of these projects, I would propose that these recommendations be adopted by the United --- Page 27 --- Nations. Examples include creation of a dedicated professional exchange and training program with the Government of Haiti. This would allow volunteers, utilizing their vast experience and skills, to travel to Haiti to provide in-country technical assistance and training. The objective of a professional exchange and training program would be to provide Haitian participants with the knowledge, skills, and resources they need to work more effectively in their respective fields and to build greater capacity within Haitian institutions. For example, Haiti produces only about 80 physicians each But, that number would steeply decline, since many of the medical year. schools were destroyed. What will happen to medical students already enrolled? How will they complete their studies? Will opportunities to study aboard be made available? A sharp increase of injured and a sharp decrease in doctors creates a formula for an intractable disaster. The international community should utilize its great and experience in law enforcement, corrections, and public expertise safety to assist the growth and professionalization of the Haitian National Police. The United Nations could sponsor a Haiti Trade Mission and Matchmaker Fair in which representatives of Haitian businesses can travel abroad to meet their counterparts. Promotion of investment in Haiti, as well as networking and identification of export opportunities of Haitian products, would be primary goals. The United Nations should begin now to assist Haiti's Minister of Commerce, Industry, and Tourism in its plan to create a targeted tourism marketing campaign to attract Haitian-Americans and other visitors to their country as tourists in order to rediscover its natural beauty and historical attractions. Haiti's infrastructure is now exponentially more vulnerable to hurricane-induced disasters like mudslides and flooding. Hurricane season begins June 1, and immediate action must be taken to mitigate potential risks. The United Nations should employ its welldeveloped expertise and experience with natural disasters to provide technical assistance to the Republic of Haiti's Directorate of Civil Protection in order for this agency to develop appropriate disaster management and infrastructure and training. In closing, I extend fervent prayers to all of those who are affected by the earthquake, as well as to the first responders who came from near and far. I also want to acknowledge the magnanimous generosity of those who have contributed to the relief efforts in Haiti. As we move forward, the United States and the international community must assure that investments made in rebuilding Haiti are actually carried out through community-based organizations, faith-based entities, nongovernmental agencies, and nonprofit nizations. orgaMy personal hope is that a new generation of leaders will emerge from these ashes to selflessly lead Haiti onto a new path of prosperity through integrity, hard work, transparency, perseverance, and true democracy. Thank you. [The prepared statement of Dr. Francois follows:] far. I also want to acknowledge the magnanimous generosity of those who have contributed to the relief efforts in Haiti. As we move forward, the United States and the international community must assure that investments made in rebuilding Haiti are actually carried out through community-based organizations, faith-based entities, nongovernmental agencies, and nonprofit nizations. orgaMy personal hope is that a new generation of leaders will emerge from these ashes to selflessly lead Haiti onto a new path of prosperity through integrity, hard work, transparency, perseverance, and true democracy. Thank you. [The prepared statement of Dr. Francois follows:] --- Page 28 --- PREPARED STATEMENT OF M. RONY FRONCOIS, M.D., MSPH, PH.D., INCOMING DIRECTOR OF PUBLIC HEALTH, STATE OF GEORGIA, ATLANTA, GA Good morning Chairman Kerry, Ranking Member Lugar and members of the committee. My name is Dr. Rony Francois. I am a physician and a doctor of Public Health by training. I am also the immediate past-Secretary of Health for the State of Florida as well as the immediate past-Director of Public Health for the State of Louisiana. Effective Monday, I will be the Director of Public Health for the State of I Georgia. want to thank the committee for inviting me to testify on the topic of "Haiti: From Rescue to Recovery and Reconstruction." My testimony will focus on the following: (1) Extent of the damages; (2) the immediate relief needs; (3) some intermediate goals; and (4) the long-term path to recovery and development. EXTENT OF THE DAMAGES An earthquake of 7.0 magnitude is a challenge for any country. But when it OCcurs in one of the world's most fragile countries, its intensity seems potentiated as it finds a destructive and sinister synergy in the vast landscape of feeble structures. The estimated mortality is about 200,000. There are about 4,000 missing Americans. The number of injured approaches 1 million. The number of people affected is approximately 3 million. The economic damage is difficult to quantify. My mother and father-in-law lost everything in Haiti. Fortunately, they were in the United States with me when the devastation occurred. IMMEDIATE RELIEF NEEDS With the great number of people affected, the critical needs are food and water, medical care, temporary shelters, security and sanitation. In terms of diet, the most vulnerable groups are the newborns and young infants who require age-appropriate formula. However, tensions in the capital city and also the countryside continue to grow as many families do not have access to food and other basic goods. The escalation of frustration is already inducing violence and if resources are not more strategically distributed throughout the country, the security situation on the ground could rapidly Medical deteriorate. teams must also remain vigilant about wound infections, sepsis, malaria, tetanus, respiratory infections, and typhoid as thousands more could die if conditions are not closely monitored and immediate steps are not taken to mitigate risks. INTERMEDIATE GOALS In light of over 50 aftershocks of a magnitude of 4.5 or greater, a thorough assessment of the structural integrity of remaining homes and buildings is absolutely critical for the future safety of the population. Before entering the United States and earning his doctorate degree in structural enginterins-pedaliding in foundations and and water resources-my brother worked as an engineer in Port-au-Prince building codes at that time did not exist and construction practices were geared to withstand hurricane wind forces and not earthquakes. In order to forecast the magnitude and hence the cost of debris/rubble removal lesand disposal, it is appropriate to compare this recovery effort to the models and sons learned after the September 11, 2001, destruction at the World Trade Centers, after Hurricane Ivan's aftermath in Pensacola, FL, and after Hurricane Katrina's devastation of the Gulf Coast States-where recovery is still ongoing today. The materials collected during this cleanup can be recycled or transported as fill for reclamation land along the coast of the Bay of Port-au-Prince. with the Assuring proper drainage of rainwater will be a massive undertaking Mountain THopital's steep watershed and the drastic reduction of pervious areas with tree-cutting practices and anarchistic construction. The existing system was already obsolete and undersized and did not seem to rely on accurate hydrological data. In addition, with the earthquake's underground stresses generated from the wave propagation, it must be anticipated that the majority of structures and pipes (mostly concrete) have sustained irreversible damage. The waterworks and sewer infrastructures gauged against current Environmental Engineering standards vere already inadequate. Construction from scratch might be The considered. source of the water supply might be adjusted after evaluation of the Cul-deSac Plain aquifer capacity and inventory of other reserves through groundwater areas with tree-cutting practices and anarchistic construction. The existing system was already obsolete and undersized and did not seem to rely on accurate hydrological data. In addition, with the earthquake's underground stresses generated from the wave propagation, it must be anticipated that the majority of structures and pipes (mostly concrete) have sustained irreversible damage. The waterworks and sewer infrastructures gauged against current Environmental Engineering standards vere already inadequate. Construction from scratch might be The considered. source of the water supply might be adjusted after evaluation of the Cul-deSac Plain aquifer capacity and inventory of other reserves through groundwater --- Page 29 --- hydrology. Another very viable option is to tap in the Bay of Port-au-Prince available sea saltwater through a desalination process. readily LONG-TERM RECONSTRUCTION AND DEVELOPMENT Decentralization away from Port-au-Prince must be a primary goal of future development efforts. The earthquake has already triggered an exodus of the lation to various parts of Haiti. In order for that migration to become permanent, popuinvestments must be made in agriculture, food security, local jobs, tourism structure, security, roads, and airports. infraAccess to rudimentary medical care must also be decentralized with a network of community health centers across the country. Public health must become the foundation of this new health system and foster the widespread training and use of health promoters or agents of health. Improvements in literacy should also remain central to any development efforts. I would like to share with the committee a few of the recommendations of the Haiti Advisory Group created by Executive order on July 14, 2004, by former Florida Governor, Jeb Bush. The Advisory Group consisted of 17 prominent HaitianAmerican members with significant experience in Haitian issues. The Advisory Group formulated a set of 25 recommendations to the Governor and the State of Florida. These prophetic recommendations, which are still very relevant cluded a wide range of problematic issues that fall into the following categories: today, inSecurity Recommendations Economic Development Recommendations Disaster Preparedness/Environmental Rehabilitation Although Florida was the main for these projects, I would propose that these recommendations be adopted EU the United Nations. Examples include: Creation of a dedicated Professional Exchange and Training Program with the Government of Haiti. This would allow volunteers, utilizing their vast experience and skills, to travel to Haiti to provide in-country technical assistance/ training. The objective of the professional exchange and training would be to provide Haitian participants with the knowledge, skills, program and resources they need to work more effectively in their respective fields and to build greater capacity within Haitian institutions. number For example, will Haiti produces only about 80 physicians each year, but that steeply decline since many of the medical schools were destroyed. What will happen to medical-students already enrolled? How will their studies? Will opportunities to study abroad be made available? they complete A increase of injured and a sharp decrease in doctors creates a formula for an sharp intractable disaster. The international community should utilize its great expertise and in law enforcement, corrections, and public safety to assist the growth experience and professionalization of the Haitian National Police (HNP). The United Nations could sponsor a Haiti Trade Mission and Matchmaker Fair in which representatives of Haitian businesses can travel abroad to meet with counterparts. Promotion of investment in Haiti, as well as networking and identification United of export opportunities for Haitian products would be primary goals. The Nations should begin now to assist Haiti's Ministry of Commerce, Industry & Tourism in its plan to create a targeted tourism campaign to attract Haitian-Americans, and other visitors to their country marketing as tourists in order to rediscover its natural beauty and historical attractions. Haiti's infrastructure is now exponentially more vulnerable to hurricane induced disasters like mud-slides and flooding. Hurricane season begins June 1 and immediate action must be taken to mitigate potential risks. The United Nations should employ its well-developed expertise and experience with natural disasters to provide technical assistance to the Republic of Haiti's Directorate of Civil Protection, in order for this agency to develop appropriate disaster management infrastructure and training. In closing, I extend fervent prayers to all of those who are affected by the earthquake as well as the first responders who have come from near and far. I also want to acknowledge the magnanimous generosity of those who have contributed to relief efforts in Haiti. As we move forward, the United States and the international the community must assure that investments made in rebuilding Haiti are carried out through community-based organizations, faith-based actually mental agencies, and nonprofit organizations. My personal hope entities, is that a nongovern- new eration of leaders will emerge from these ashes to selflessly lead Haiti onto a gen- new extend fervent prayers to all of those who are affected by the earthquake as well as the first responders who have come from near and far. I also want to acknowledge the magnanimous generosity of those who have contributed to relief efforts in Haiti. As we move forward, the United States and the international the community must assure that investments made in rebuilding Haiti are carried out through community-based organizations, faith-based actually mental agencies, and nonprofit organizations. My personal hope entities, is that a nongovern- new eration of leaders will emerge from these ashes to selflessly lead Haiti onto a gen- new --- Page 30 --- path true democracy. of prosperity through integrity, hard work, transparency, perseverance, and The CHAIRMAN. Thank you very much, Dr. Francois. In fact, thank you-thank you, all of you, for helping to really out the magnitude of the challenge here and put a lot of ideas lay on the table about things we need to think about. We-in the timeframe that we have, I think, if we do 7-minute rounds, then every Senator ought to have an opportunity to be able ask questions. And if we could ask you to keep the answers tightobviously encompass everything that you want to, but we want to try to cover a broad swath here, if we can. On a personal note, let me just say, Dr. Farmer, speaking as a dad, I want to thank you for the example and the opportunity that you have shown my, daughter, who I know just values enormously the relationship and what she's learned working with you. And I want to thank you for that. Let me begin by asking-I want to come back to the framework that you raised, Dr. Farmer, about the rules of the road, and I think it's very important to look at that. But, let me just ask you very quickly, any of you, about an immediate challenge. There's a lot of concern about the access to food in Haiti, and whether or not there are adequate levels and if the food is being appropriately distributed. And WFP has requested emergency funds to feed 2 million people over the next 15 days, essentially flooding food into the arena. Can you speak, very quickly, to this question of the adequacy of food and assess the current food distribution efforts? Dr. Farmer. Dr. FARMER. Thank you, Mr. Senator. In the short term, it's difficult to think of an alternative to WFP, which has the procurement capacity. I mean, it's hard to find other groups that might have that kind of procurement capacity, other than the ones noted by my colleagues testifying here today, which is remittances, cash transfers to households; that will also work to allow people to buy their own food. At the same time, the rules of the road-I would go back to those even for a group as august as WFP. For example, how can we focus on local procurement of foodstuffs SO that food insecurity in Haiti is not heightened by the huge, but necessary, influx of food from abroad right now? And Ijust could, you know, give one small example from our own work in central Haiti, which I've shared with my colleagues at WFP. We have-the proper treatment, not surprisingly, for malnutrition for children is something called food, and we grow peanuts-mostly, but it can be other grains as well-peanuts locally, and make what is essentially peanut butter, which is a ready-touse therapeutic food, you know, and is enriched with vitamins, right there in local food-processing plants in central Haiti. And we've gotten the WFP to support that. And sO, if we ramp up production of an endeavor like that in a moment like this, if we the right kind of peanuts, multivitamins, other things that get are needed to enrich this paste, we'll have done several things at once: One, we'll have responded to the acute need, which is extreme. I mean, it's very upsetting, to put it frankly, how hungry people are is a ready-touse therapeutic food, you know, and is enriched with vitamins, right there in local food-processing plants in central Haiti. And we've gotten the WFP to support that. And sO, if we ramp up production of an endeavor like that in a moment like this, if we the right kind of peanuts, multivitamins, other things that get are needed to enrich this paste, we'll have done several things at once: One, we'll have responded to the acute need, which is extreme. I mean, it's very upsetting, to put it frankly, how hungry people are --- Page 31 --- right now. Number two, we'll have bought local produce from local farmers. Number three, we'll have created jobs in processing plants. And, you know, it's not unthinkable that a processing plant like that could be scaled up to respond to needs elsewhere-in other of the country, certainly, but also other parts of the world. Eart I think the rules of the road still should include, what's your plan for local job creation? How can we link our very needed shortterm interventions to long-term interventions that will not leave Haitians dependent? The CHAIRMAN. So, that raises the question, How do you get from here to there? I mean, as I listen to you say, it'd be great to ramp up the production, it'd be great to, you know, engage the local community. Who's going to do this? I mean, one of the things that has struck me as I talk to various groups on the ground-and we've been dealing with various, sort of, hotspots-is, Who's going toWho's coordinating this overall effort? Who's going to call the shots and say, "You got to get the debris out of here, and here's where the debris is going to go, and here's the rebuild, and know, you begin to organize all of that. There are a lot here"-you of free actors floating around. Can you speak to this question of who's to both direct and enforce these rules of the road? And how do going we get the kind of coordination necessary to make sure that we are shifting to a Haitian solution as fast as possible? Dr. FARMER. I'm sure that my colleagues have thoughts on this, as well, but I would say the way that we do this is actually write it into the rules of the road for our-as a condition for some of our aid-not a condition on the recipients, but, rather, the condition on the donors. Some of the problem-if you go from, say, the Marshall Plan, which you've talked about, you know, many times over the last few years-if you go from the Marshall Plan to some of the legislation written by the Senate, 1961 to now, you'll see, you know, the rise of a class of contractors, again, who can provide useful services that are difficult to obtain in settings like Haiti or the places Mr. Dobbins mentioned. That's true. But, I think if we shift the rules formally and say, "This aid is dependent on our reforming ourselves, in a way"-so, I think part of it is really in your hands. On the ground, what I saw-you know, and Iit's very possible-and I've been writing a little bit about this from Haiti-to bemoan the lack of coordination. But, what I'm seeing is going from this chaos, as you might imagine the first nights afterward, to a little bit more coordination and a little bit more coordination, et cetera. So, the U.N. is trying to coordinate along lines of the health cluster, and that structure is emerging right now. And I think it's probably the necessary structure. And then, finally, on the district level-I mean, most of this stuff is happening in Port-au-Prince, as you know, but on the district level there are 10 districts in Haiti, 10 "departments," called. There need-needs to be a really locally driven process they're there. And this may not be the most popular thing to say, but in 1995, when Rwanda laid down the law, saying, "Ifyou, as an NGO, wish to work here, you have to follow the following rules. You have to fit into our development plans. You know, it's estimated by finally, on the district level-I mean, most of this stuff is happening in Port-au-Prince, as you know, but on the district level there are 10 districts in Haiti, 10 "departments," called. There need-needs to be a really locally driven process they're there. And this may not be the most popular thing to say, but in 1995, when Rwanda laid down the law, saying, "Ifyou, as an NGO, wish to work here, you have to follow the following rules. You have to fit into our development plans. You know, it's estimated by --- Page 32 --- some that half of the NGOs left Rwanda in a huff. And there were all sorts of critiques of Rwanda at the time. But, I think, in retrospect, many would argue that they really were right to push forward a tough line on this. So, I-you know, in summaryThe CHAIRMAN. Right. Dr. FARMER [continuing). I think part of it's going to be in your hands, and part of it is going to be in the hands of the U.N., and part ofit's going to be in the hands of the local government. The CHAIRMAN. Mr. Dobbins, you've been on the institutional side of this. What are your thoughts about the rules? Ambassador DOBBINS. I think it's useful to make a distinction here between the relief phase. Now, if there's one thing that the international community and the United States does well, it's disaster relief in these kinds of situations. It looks messy when 1,000 different autonomous organizations, NGOs, governments, and international institutions all show up, but it works, and it works remarkably well. And it is working in Haiti. That doesn't really require fixing, in my view. It requires resources, but people are erous, and it is the best-resourced thing the international commu- gennity does. You then have the question of moving beyond relief to recovery, and driving that recovery toward institutional reforms that will make future relief operations less necessary. That does require more hierarchical structure. I think the United States needs to help design such an effort, and it needs to help drive such an effort, but it shouldn't, itself, be the flag on which that effort 1S put. The CHAIRMAN. Fair enough. Ambassador DOBBINS. As you suggested, I think the U.N. needs to coordinate and become the flag under which political reform and reform of the security sector takes place. And I think the World Bank is the logical focus for planning and conditioning assistance across the economic and social spectrum. The CHAIRMAN. Thank you, sir. Senator Lugar. Senator LUGAR. Thank you, Mr. Chairman. Following up on the chairman's thought about who is in charge and how the government is to proceed, I would like to ask for comments by citing a very interesting poll that appeared in your this morning's Miami Herald, with the headline "Haitan-Americans Dissatisfied With Haiti's Response to Disaster. This poll, conducted in both Creole and English, found 63 percent of the 400 Haitian-Americans surveyed disapproved of how Haitian President Rene Préval's government has responded to the earthquake. The unhappiness runs SO deep that a majority of Haitian-Americans support the United Nations and the international community taking over Haiti's day-to-day operations, at least until Haiti recovers from the catastrophe. Interestingly enough, an overwhelming majority of those surveyed were happy with the United States Government's response. In fact, 96 percent approved what we had been doing. Additionally, 88 percent approved of the United Nations response. Furthermore two-thirds of the Haitian-Americans polled are SO concerned for Haitian-Americans surveyed disapproved of how Haitian President Rene Préval's government has responded to the earthquake. The unhappiness runs SO deep that a majority of Haitian-Americans support the United Nations and the international community taking over Haiti's day-to-day operations, at least until Haiti recovers from the catastrophe. Interestingly enough, an overwhelming majority of those surveyed were happy with the United States Government's response. In fact, 96 percent approved what we had been doing. Additionally, 88 percent approved of the United Nations response. Furthermore two-thirds of the Haitian-Americans polled are SO concerned for --- Page 33 --- Haiti; they'd be willing to move back there temporarily in order to assist with the reconstruction. I cite these figures to first make the point that Haitian-Americans have never expressed this level of satisfaction for any U.S. response to the many unfortunate afflictions the country has faced in the past. Second, not only are Haitian-Americans receptive to a strong U.S. role in the response to the earthquake, they are also largely in favor of sustained U.N. participation. Though these Hattian-Americans do not see it as immaterial as to which takes charge, they do believe that one or the other had better party do SO. The respondents to the poll also assert that President Préval is not a good communicator, and that he has not addressed the nation since the earthquake occurred. Public relations may not be his forte. But, the fact remains that he is Haiti's leader, and the Haitian Government has to be reconstructed in some form, even if the United Nations and the United States take effective control of reconstruction efforts. My statements are all in preface for asking for your judgments on Haiti's political future. What is going to occur? The common thought is that this earthquake has been a disaster. Futhermore, going forward, most believe that it will continue to be a disaster, because of the Haitian Government's lack of political sophistication, capacity to effectively respond to the crisis, and ability to strike any sort of rapport with the Haitian people. As T've noted, we even have Haitian-Americans saying, in essence, that "We're SO concerned we're prepared even to move back to Haiti temporarily in fairly large numbers for a while to try to bring some relief to the process." I believe all of this reflects the lack of almost any confidence on behalf of a majority of observers regarding the Haitian Government's ability to effectively respond to this crisis. Do any of you have any thoughts about the question of effective future governance there? Yes, Doctor. Dr. FRANCOIS. Senator Lugar, essentially my thought again, is about the analogy of how we respond to a tragedy or a hurricane here in the United States. What happens is that, whether it's Florida or Louisiana, we may ask the Federal Government for help. And, likewise, Haiti is now in dire needs of an international response. What's different is that the infrastructure and the that are in place in probably every State, is that you have an infra- plans structure where the Federal Government can come in and insert itself to support that response. That sort of framework is totally absent. In 2006, as secretary of health for Florida, we made a public health mission trip to engage the leadership about And you can tell, from the lack of the response, that preparedness. we were not taken up on that-on that offer. So, essentially, I think that, because of that lack of existing infrastructure, you really need the-a coordination of-for example, from the United Nations, to sort of lead that response, because it's certainly nonexistent on the ground. That makes it more difficult, because the folks coming in don't really know the terrain, which, absent. In 2006, as secretary of health for Florida, we made a public health mission trip to engage the leadership about And you can tell, from the lack of the response, that preparedness. we were not taken up on that-on that offer. So, essentially, I think that, because of that lack of existing infrastructure, you really need the-a coordination of-for example, from the United Nations, to sort of lead that response, because it's certainly nonexistent on the ground. That makes it more difficult, because the folks coming in don't really know the terrain, which, --- Page 34 --- again, that knowledge could have been facilitated by existing plans on the ground, which, again, are nonexistent. Ambassador DOBBINS. Senator, I suspect the Haitian-American community wouldn't object if Haiti became the 51st State, but I don't think, probably, the rest of our-or your constituencies are going to support that. So, I don't think we have any option but to try to rebuild a Haitian state structure, one that's more resilient, more capable than what we have today or had a year ago. And therefore, I do believe that state-building is the core-the core mission of the post-relief phase. Dr. FARMER. Thank you, Senator. You quoted the Miami Herald today, but in the Washington Post today there is something, I think, of equal note. It says, "Haiti Government gets minimal aid. Less than a penny on each U.S. dollar is sent to leadership." And that's almost certainly true. None of this money that's pouring into Haiti is going to the government. And I just want to-just a few vignettes of, again, whether that would be an effective way or not. I don't know; it's not my area of expertise. But, just a few examples from the last 2 weeks in Haiti. I mean, before the hurricane, looking at the budgets of money going to, for example, the U.N. for, you know, the U.N. presence there, the budget for IT, information technology, was larger than the combined budget, I believe, of the Ministries of Health and Ministry of Education, together. During the Gonaives hurricane, when we were told that the roads were blocked and that the city was inaccessible and there was no one there, that was not true. The roads were not blocked and the director of public health was at his post, but he had no tools to do anything. And I was with-on-right after the recent earthquake, with the Minister of Communication. She did not have a phone. You know, I gave her my phone. I mean, these kind of absurdities go on and on. The university hospital, the general hospital, when we there, late at night, we found-at 10 o'clock at night, we found the got director of the hospital and director of nursing, who had, herself, just had a grandchild the day before and had lost the family and home. They were there at work. But, they have to have the tools of the trade. And as it's true in medicine, SO it must be in all of the other arenas of engagement. So, I would say that, in addition to appropriate skepticism about the capacity of the now devastated government to implement some of these necessary interventions, we also need a healthy dose of skepticism regarding, as I said earlier, the way our aid has been funneled SO exclusively to the nongovernmental sector. Senator LUGAR. So, the recommendation is more aid to these ernment officials to give them a chance to respond, in addition gov- to continued assistance to NGOs and the rest of those on the ground there. Dr. FARMER. Thank you. The CHAIRMAN, Senator Dodd. Senator DODD. Well, thank you very much, Mr. Chairman. And I'm going to ask consent that some opening comments be made available in the record The CHAIRMAN. Absolutely. earlier, the way our aid has been funneled SO exclusively to the nongovernmental sector. Senator LUGAR. So, the recommendation is more aid to these ernment officials to give them a chance to respond, in addition gov- to continued assistance to NGOs and the rest of those on the ground there. Dr. FARMER. Thank you. The CHAIRMAN, Senator Dodd. Senator DODD. Well, thank you very much, Mr. Chairman. And I'm going to ask consent that some opening comments be made available in the record The CHAIRMAN. Absolutely. --- Page 35 --- Senator DODD [continuing). If we can, and try to move this along. [The prepared statement of Senator Dodd follows:] PREPARED STATEMENT OF HON. CHRISTOPHER J. DODD, U.S. SENATOR FROM CONNECTICUT I want to thank Chairman Kerry for holding this hearing, and our distinguished witnesses for sharing their expertise with us today. Dr. Paul Farmer. Paul has I want to extend a special greeting to my good friend Haiti and the world. been active for years in helping the most vulnerable in around Haiti that His organization, Partners in Health, is one of many already operating in has heroically gone above and beyond the call to respond to this earthquake. chalWe should begin by acknowledging that, aside from the monumental policy lenges posed by the disaster in Haiti, the Haitian people have experienced a tragedy on an unimaginable scale. Estimates of the death toll are in the hundreds of thousands, with countless others injured, homeless, orphaned, or in desperate need of food, The water, numbers shelter, merely and hint medicine. at the scope of this catastrophe. The Haitian people have spent generations watching their country teeter on the brink of collapse, as government after government has done little to fight corruption, ignored the rule of law, and failed to provide basic security and social services. Battered by natural disasters and shocking poverty alike, Haiti has one of the lowest life expectancies in the world. to a brighter future when this Haiti was just beginning turn Haitian a corner toward must once start over. earthquake struck. Now, sadly, the people again This tragedy, as could have been expected, has brought out the best in the American people. From the rescue workers, men and women in uniform and State Department, Embassy, and USAID officials risking their own lives to bring comfort to the victims to the ordinary Americans texting donations to assist in relief efforts, our people have sent a clear signal to the Haitians: you are not alone. shoulder The United States Government must also act to help the Haitian people the burden of rebuilding their country and moving forward in the wake of this disaster. In the short term, I believe it is incumbent upon the Obama administration to bring our allies together to establish security and a sense of order in Haiti. Considering how much of the country's infrastructure and government personnel have been lost, I would like to see the United Nations take on a more active role in day-today governance, in close partnership with the Haitian authorities. Haitian back The U.N. would lead an international effort to help the people on their feet, assisting in the rebuilding of infrastructure, institutions, Plrft liveswhile working to ensure that those who have been driven out of their homes by the destruction of Port-au-Prince that are resettled. administration help to coordinate HaitianI've also suggested the Obama Hometown Associations, small American volunteers in the United States by forming skill sets groups of community members who could use their unique experiences and of refuto do things like serve as interpreters, support the temporary Haitians resettlement who are evacugees, and provide assistance to the most severely wounded available the island. ated to the United States for medical treatment not the on economic crisis that For our part, I think Congress should focus on alleviating lurks behind the immediate humanitarian crisis in Haiti. the Senator Lugar and I will be introducing legislation this morning Haiti instructing of outSecretary of the Treasury to work with other nations to relieve their standing international debt, including debt incurred through 2011. Additionally, ele- our legislation will help to spur economic activity, which is an absolutely essential and ment in the recovery process, by promoting trade between the United States Haiti. Last, our bill will instruct the U.S. Government to work with the Inter-American Development Bank to implement an infrastructure development fund that should be used in invest in Haiti's critical infrastructure, including roads, power lines, clean water and sanitation. rebuild and in These are steps we can take right now to help Haiti and Over recover, the my mind, they represent the beginning, not the end of our efforts. coming weeks and months, I look forward to working with other members of this committee, including the chairman, on legislative ideas that can be begin to tackle the more long-term and systemic roadblocks that Haiti will face. This burden reBut we shouldn't imagine that our work will be short or simple. the full of the quires many shoulders. President Obama has already pledged support American people. Let us do the same. rebuild and in These are steps we can take right now to help Haiti and Over recover, the my mind, they represent the beginning, not the end of our efforts. coming weeks and months, I look forward to working with other members of this committee, including the chairman, on legislative ideas that can be begin to tackle the more long-term and systemic roadblocks that Haiti will face. This burden reBut we shouldn't imagine that our work will be short or simple. the full of the quires many shoulders. President Obama has already pledged support American people. Let us do the same. --- Page 36 --- Senator DODD. But, again, to you, Dr. Farmer, we thank you immensely. And I've enjoyed a good relationship with this gentleman for a long time, and commend him immensely for his work in Haiti and elsewhere. Jim Dobbins and I have worked together on numerous issues over the years. And, Dr. Francois, welcome, as well. I want to pick up on this whole point. Even prior to the events of2 weeks ago, in many ways, and having grappled and worked in Haiti for various years, going back to my Peace Corps days, 40 years ago, on the border with Haiti and Dominican Republic-even absent what has occurred over the last 2 weeks, in many ways Haiti has been a failed state. On countless occasions, those of us, either on this committee or elsewhere, have worked, at various times, to try and provide assistance. And we have had the obstacles of refusing to provide assistance to even governments that were questionable in their effectiveness or the levels of corruption that existed, and the like, in Haiti. And sO, in a way, I think the point of, one, dealing with the immediate problems of seeing to it that we're getting resources to get people through this period of time. And while doing that I suggest the idea that, given the magnitude of this tragedy, this offers an opportunity, frankly, to do some things that people have talked about for decades in Haiti, and yet, for various reasons, have been unable or unwilling to grapple with. And that is to start talking about the long-term ability of this country to become self-sufficient, both in terms of its ability to feed and house itself, as well as to govern itself. And that's the opportunity that I think we've been offered, not just our country, obviously, but the community at large. So the question is, How do we do this? And I think there are some wonderful suggestions here. We ought not to get into the debate as to whether or not we need to continue to provide for the immediate needs. But, I think we really need to get into this discussion very quickly, as to how we're going to emerge from this tragedy with the opportunity to do some things that we've never, for various reasons, been able to achieve before. But, if you asked me the question, which I wouldn't know the answer to, today "Who should I call in Haiti if I wanted to talk to someone about this?" my impression is, there really isn't anyone to talk to, at this point, while we're down there basically wandering around trying to provide assistance, where we can, to people through existing organizations. Senator Lugar and I are introducing legislation today. Jim Dobbins, you talked about it, in terms of the barriers to trade, the debt issues. These may not seem like much, but they go to the heart of what Paul Farmer is talking about, and that is getting beyond this immediate need, and getting to the question of how we can start to provide work. I don't know why, for instance, we're not suggesting today thatjust putting people to work to clean up rubble, you could be people $2 or $3 a day, and doubling their income, just to create paying the arteries SO that assistance can get to people at this particular , you talked about it, in terms of the barriers to trade, the debt issues. These may not seem like much, but they go to the heart of what Paul Farmer is talking about, and that is getting beyond this immediate need, and getting to the question of how we can start to provide work. I don't know why, for instance, we're not suggesting today thatjust putting people to work to clean up rubble, you could be people $2 or $3 a day, and doubling their income, just to create paying the arteries SO that assistance can get to people at this particular --- Page 37 --- point. I mean, it's things that can be done immediately to provide some longer term economic hope. And I wonder if you might flesh this out. Is it too wild a tion to be talking about, at least temporarily, some sort of receiver- suggesship? If this were any other entity, we'd be talking about it being completely bankrupt and to the extent then we could talk about some sort of international receivership of this country to begin to then not only provide the immediate relief, but also then to start to provide the assistance to them to build. I'm fearful that what you're going to have happen is that this goes right back to where it was before: the handful of entities in Haiti that have run the show for years and years, economically and others, a small group of families run the country. We all know that, at the end of the day. In the midst of all of this, I'm fearful we're going to roll right back into that situation again, only the conditions will be worse. So, what about the idea of some sort of international for Haiti for the next 2 or 3 years SO that we can, one, do receivership the immediate needs- -provide the immediate needs, but, second, start to provide that kind of support and assistance that would build or construct a set of institutions that would allow them to provide for their own self-sufficiency? Ambassador DOBBINS. Well, there are certainly precedents for that. We've set up provisional international administrations in East TimorSenator DODD. Right. Ambassador DOBBINS [continuingl. In Kosovo, in-and in one or two other situations like that. We've done that in cases where there was no local government or where we overthrew the local government. I don't know of any in which we displaced an ernment that was universally recognized. And sO, I existing think that gov- it would be controversial and difficult to simply impose an international administration in Haiti, unless there was, you know, a pretty clear demand within Haiti for that kind ofSenator DODD. It sounded like, in his poll that was conducted this morningAmbassador DOBBINS. Well, there's a clear demand in the Haitian-American community. But, that's, I think, a little different than a clear demand in Haiti. So, I guess I'd be-there are precedents. It has been done. Now, frankly, you know, we don't do this all that well-the Coalition Provisional Authority in Haiti, the U.N. missions in Kosovo and in East Timor-they've been successful, but they've had difficulties. I mean, this is not easy to do. So, I do tend to think that a supportive role-clearly, the international community is going to be providing most public services in Haiti. In fact, they already were, before the conflict. But, whether you'd want to formalize that, I'd be a little skeptical, Senator. Senator DODD. Paul, any thoughts on this? Dr. FARMER. I think that, given the extremity of the circumstances, you know, I wouldn't be surprised if you'd hear support in Haiti, on the streets, as they say, in the same way that you did among Haitian-Americans. do. So, I do tend to think that a supportive role-clearly, the international community is going to be providing most public services in Haiti. In fact, they already were, before the conflict. But, whether you'd want to formalize that, I'd be a little skeptical, Senator. Senator DODD. Paul, any thoughts on this? Dr. FARMER. I think that, given the extremity of the circumstances, you know, I wouldn't be surprised if you'd hear support in Haiti, on the streets, as they say, in the same way that you did among Haitian-Americans. --- Page 38 --- That said, I think there must be another way to do this accompaniment of an extremely fragile civil service and government. And the problem, as you and I have discussed on a number of occasions, all this see-sawing policy, you know, this flipping back, especially over the last 2 decades. And it has taken a toll, because, you know, if you-if the policy is, "OK, we're going to bypass, completely, the public infrastructures, and only support, with our aid, the NGOs" -and you made this point in 2003, in this very roomthen-that we're harvesting some of that now. There is-that's why things were-the government was weak before January 12. So, I think-and I'm not really qualified to comment on receivership; I just don't know enough about it, and I know there are other people here who do-I think there will be resistance to that, and think that we can find a means of accompaniment. And, you know, just back to the example of gainful employ for the hundreds of thousands of people, or millions, really, who need employment now-I mentioned-again, I'm troubled by the title "cash for work," because it's SO absurd. Senator DODD. Yes. Dr. FARMER. But, if we were to put significant amounts of our support in the cash-for-work programs that are around watershed protection, agricultural endeavors, and made sure there is gender equity or focus on women, especially in these efforts, we could have substantial transfer of resources to the poor and the needy. And if we do that with an eye, as in Rwanda, toward strengthening the local government structure, I think that would be a better received. But, of course, people are at the end of their rope, as you are guessing. The CHAIRMAN. Senator Corker. Senator DOpD. Dr. Francois, do you have any quick comments on that all? Quickly. Dr. FRANCOIS. Sorry. My only comment would be to refer to that Haiti Advisory Group that was put together. And, again, as I mentioned in my testimony, those recommendations are very much alive and could be very useful as we move forward. The CHAIRMAN. Senator Corker. Senator CORKER. Mr. Chairman, thank you. And I want to thank our witnesses. My sense is that Haiti is a place where we have an opportunity. There's universal support of the people of Haiti. I think all of us, in some form or fashion, have been touched by, Haiti. I can absolutely say I would not be in the U.S. Senate today without been to Haiti in 1982. And I know that there are Americans having all across this country that have been involved there and certainly are touched and saddened by what has occurred. It does seem like we have an opportunity to get this right. And I appreciate the analysis that has been given, and also appreciate the comments by friend from Connecticut. my I have to tell you that there's no question in my mind, we need to do whatever is necessary right now, as far as pouring resources in. And we just need to be in charge, and that's what's happening; the international community is in charge. I think there's no question that all of our efforts in the past to do good things, which many of you are involved in, in some ways has occurred. It does seem like we have an opportunity to get this right. And I appreciate the analysis that has been given, and also appreciate the comments by friend from Connecticut. my I have to tell you that there's no question in my mind, we need to do whatever is necessary right now, as far as pouring resources in. And we just need to be in charge, and that's what's happening; the international community is in charge. I think there's no question that all of our efforts in the past to do good things, which many of you are involved in, in some ways --- Page 39 --- do undermine the government. Because we all-let's face it-we all-every volunteer group, every NGO does what it does in Haiti in spite of the government. We work around the government. That's what everyone does. And I think that the notion of building the government up in some form or fashion, that's an important concept. AndI think your reference to Rwanda, which I would say-with dramatically different leadership, let's face it-it: is a great example of what can happen. I guess, as Ilisten to the very good analysis, Mr. Dobbins, about some of the things that need to occur, I still have difficulty understanding how we're going to transition from what we all need to do, whatever it takes now, to causing Haiti to actually take the lead. And I-while maybe "receivership" is not the right word to use, I have to tell you, for a period of time I think something far more draconian than just us working behind the scenes to prod reforms and those kind of things are going to be necessary. And so, I think we're saying the right things, concepts-wise, but I find it very difficult to believe, with the type of leadership that Haiti has had-we see people here in Haiti flourish under good government. We know that government has been an absolute disaster for generations in Haiti, and it, unfortunately, has held wonderful people back from reaching their potential. And I sense that we're going to have to do far more draconian things to cause the country to function. And I wish you would expand just a little bit more. I don't-I mean, the concepts you've laid out are great. I just don't know how we get from A to B without us taking a much, much stronger role than what you've signified, as it relates to rebuilding. All kinds of urban development opportunities. I mean, there's tremendous opportunities just in how we lay out infrastructure and change cities like Cite Soleil and other kind of places, which can never flourish in their existing form. There are things we can do now that I don't think the Government of Haiti ever will have the ability to do in the short term. Ambassador DOBBINS. I think it's important to understand that in Haiti we're now superimposing a relief and recovery operation on top of an existing post-conflict stabilization and reconstruction operation. In other words, there has been international operation in Haiti, with 10,000 troops and about a billion dollars a year of assistance, since 2004, which was actually beginning to make a difference when it was set back, first by a series of hurricanes and then by this latest and largest disaster. So, there are, in fact, reform programs that are agreed internationally, that are-in many cases, are agreed with the Haitian Government, that are in place and were beginning to have effect. We now need to redouble our effort to complete those reforms. We need to evaluate whether there are new and more ambitious reforms that could be put in place as the result of the greater flexibility of the Haitian system, created by this disaster and the additional resources. We need to evaluate the new ideas that are coming forward. set back, first by a series of hurricanes and then by this latest and largest disaster. So, there are, in fact, reform programs that are agreed internationally, that are-in many cases, are agreed with the Haitian Government, that are in place and were beginning to have effect. We now need to redouble our effort to complete those reforms. We need to evaluate whether there are new and more ambitious reforms that could be put in place as the result of the greater flexibility of the Haitian system, created by this disaster and the additional resources. We need to evaluate the new ideas that are coming forward. --- Page 40 --- But we-what we need to make sure are that the new operation operates synergistically with the old operation and the old structures that were set up. I do believe that we-that, as I suggested, somebody in the U.S. Government, in the administration, needs to be made responsible for the overall American policy toward Haiti, toward that policy with other governments, representing it with integrating the Haitians, and working with the Congress. I think the Congress needs to provide that individual with the resources necessary, and the flexibility, SO that they can choose carefully those targets for assistance of that sort. I do think that, for instance, in the question of infrastructure, you know, actually bricks-and-mortar stuff, our experience in Iraq suggests that simply building things for people is of little enduring value if they haven't invested-and if they-and if you don't have a contractual plan in which there is funding-a funding stream for maintaining that infrastructure once you've built it. We built a whole bunch of electric plants in Iraq. Iraqis weren't charging for electricity. And since they weren't charging for electricity, there was no resource stream that was going to maintain those electric plants once they were built. When the World Bank builds an electric plant, they require a plan which has that kind ofb built-in resource stream that will sustain the project. So, we do need people who know how to do these things, who have done them before, I think, to take the lead, set the criteria, establish the conditionality, and then use our political influence and our money to make sure those conditions are met. Senator CORKER. Well, thank you for your testimony. Mr. Chairman, I thank you for having the hearing, and I hope that-we very seldom, candidly, have a-much of a way to make a lot of difference-I hate to say it-on this committee. I hope that, somehow or another, we will keep a focus on this panelThe CHAIRMAN. I hope you're speaking for yourself on that. Senator CORKER. Well, you did a great job with Karzai, and I'll say that again. But, it really- (Laughter.] Senator CORKER [continuing). The fact is that this is an tunity for us, I think, to continue to put pressure-to make oppor- sure that more draconian steps are taken, instead of willy-nilly kinds of things that have yielded the same kind of results. And I thank you for the hearing, and for your testimony. The CHAIRMAN. Well, I couldn't agree with you more, Senator, I think-and we'll come to that point, after Senator Shaheen. But, I don't disagree with you at all. I think this is a moment, and I think it's going to take a tough hand of leadership. I noticed the vote has not gone off, SO in true Senate fashion, we're kind of drifting along here. (Laughter.] We can extend the time a little bit and have a second round, which is good. Senator Shaheen. Senator SHAHEEN. Yes, I prefer to think of it as an opportunity to finish my questions. So. I want to thank each of you for being here, and for into this horrific human tragedy. I share my colleagues' your insights gratifi- . I think this is a moment, and I think it's going to take a tough hand of leadership. I noticed the vote has not gone off, SO in true Senate fashion, we're kind of drifting along here. (Laughter.] We can extend the time a little bit and have a second round, which is good. Senator Shaheen. Senator SHAHEEN. Yes, I prefer to think of it as an opportunity to finish my questions. So. I want to thank each of you for being here, and for into this horrific human tragedy. I share my colleagues' your insights gratifi- --- Page 41 --- cation at the outpouring from not only the United States, but from the rest of the world, to try and respond to this tragedy. And I guess my first question, before I ask more about the long term, is if each of you are satisfied that everything is currently being done that can be done with the short-term relief efforts. Dr. Farmer, you talked about how slow the relief efforts are, and, to a great extent, that's because of the lack of infrastructure. But, is there more that should be done right now to address those relief efforts? Dr. FARMER. Thank you very much, Senator. I think there is a mismatch between the degree of interest and resources that we, including we as a nation, are putting in, and the ability to absorb it, which is the-you know, the fruit of failed policies in the past. Now, that-in the middle of an emergency like this, you're not going to spend a lot of time on diagnosingSenator SHAHEEN. Right. Dr. FARMER [continuing). That problem. And sO, I would say, yes, there is more that we can do, but it's very specific things. For example, you bring in surgeons, but you have to also bring in supplies and long-term nursing, et cetera. And if I could bring this back to our previous discussion-and I used the word "accompaniment". if we have the patience, even for the relief work-because the relief work is not going to be over in the next weeks-if we have the patience to accompany properly the various actors on the ground, which include, of course, lots of NGOs and church groups, et cetera, but also the remnants of the Haitian public health and public education sector, I think we'll have reward in-you know, back to Senator Corker's question. You know, if you, say, for example, had a division between the NGOs in Haiti-a division of labor-and the international financial institutions, like the World Bank, and you said to the NGOs, "Look, part of your job now is to find a way to help accompany this shattered public infrastructure back, whether that be schools"-and 85 percent of schooling in Haiti is private. So that-and, to me, if you look back and say, "That's one of the reasons Haitians are not very literate, because they have these" they call them "T'ecole borlette," you know, like lottery schools, because you take your chances when you go there. So, we need to have a Ministry of Education that could insist on proper, not.just building codes, but curriculum. And that's going to take a patient kind of relief accompaniment. Same for health care. And I'd just like to, again, sound a note of great optimism. When we-I've been in Haiti, as I said, 25 years. For the first 15 years of my engagement-and our engagement-we did not do this the right way. We had a lot of good will, we built a hospital in a squatter settlement. We're very proud of it. I was there Sunday It was spotless. There were people lying on the floor who morning. had been tended to and had casts and were post-op. You know, all the beds were full. So, I was very proud, and all of us are. But, what we really needed to do, which we did over the last decade, was to say, "How can we do this same thing in the public health sector, with the Ministry of Health?" And so, we did. And we created thousands of jobs, and strengthened and rebuilt these public hospitals. That's an M.O. that I endorse, not because we did less. There were people lying on the floor who morning. had been tended to and had casts and were post-op. You know, all the beds were full. So, I was very proud, and all of us are. But, what we really needed to do, which we did over the last decade, was to say, "How can we do this same thing in the public health sector, with the Ministry of Health?" And so, we did. And we created thousands of jobs, and strengthened and rebuilt these public hospitals. That's an M.O. that I endorse, not because we did --- Page 42 --- it, but because it's an effective way of addressing this lack of absorptive capacity in the public sector. And I think the same can be said for-and it's more difficult with agriculture, of course, because those are privately held fields, many of them. But, at least for health and education, NGOs have to do this. "Do this," meaning what? Support the weak public sector. One of my colleagues just passed me a note saying that the Haitian Government is looking for $3.4 million just to pay rent for office space. Who can deny that they have no office space? Theirall their federal buildings collapsed. So, then that's a transition- -and I'll stop-just to the private investment part. Haiti does not want to be dependent of foreign aid any more than Rwanda does. And Rwanda's vision for development is called Vision 2020, and it says by 2020 there will be no foreign aid going into Rwanda. In order to do that, of course, we need job creation and private investment. I had been working a lot with the Inter-American Development Bank, and I can tell you, again, to sound a note of optimism, last fall all the hotels in Port-au-Prince were full of people who'd come in to invest in Haiti from Latin America, Haitian investors. Couldn't get a hotel room. We were going to have a meeting this week in the Montana Hotel, which, unfortunately, just collapsed. But, it was for investors. So-from Ireland-so, I think there is good news out there, if we can just marshal our resources. Senator SHAHEEN. Well, to follow up a little bit on what Senator Corker raised, and to go back to what I think each of you are saying, as you look at longer term, is the first priority governanceassistance with governance in Haiti? And, if that's the case, then who should we look to to take responsibility to do that? Is it the international community? Is the United Nations the entity that's going to get that done? Is it oversight from this committee and our State Department in the United States that's going to get that done? Is it pressure from the Haitian-American community? Who takes responsibility to get that-if it is governance-to get that done? Ambassador DOBBINS. I-as I suggested, I mean, I think that the-that in the security sector-police, courts, prisons-and in the general political support of the Porlament-siectione-1 think the U.N. is the best place to do those. I think, in terms of resuscitating ministries, like the Education Ministry, Transportation Ministry, Agricultural Ministry, and the Health Ministry, it's probably somebody else. It may vary. A single country may decide, "OK, we're to fund public education in Haiti.' And Japan or the United States going or someone else will say, "That's going to be our sector. We'll do public education." It has to fit in a broader framework. Or, as I've suggested, the World Bank or the Inter-American Development Bank may take a major ministry or a major-you know, recreating downtown Port-au-Prince as their focus, and become the main funder and coordinator of other funders in that. I do think that a division of labor between the World Bank and the U.N. should be the two primary international institutions. I think the United States can be very influential. But, I think that, someone else will say, "That's going to be our sector. We'll do public education." It has to fit in a broader framework. Or, as I've suggested, the World Bank or the Inter-American Development Bank may take a major ministry or a major-you know, recreating downtown Port-au-Prince as their focus, and become the main funder and coordinator of other funders in that. I do think that a division of labor between the World Bank and the U.N. should be the two primary international institutions. I think the United States can be very influential. But, I think that, --- Page 43 --- you know, an American czar who sits in Haiti and makes these kinds of decisions would probably be counterproductive. The CHAIRMAN. SenatorSenator SHAHEEN. Yes. The CHAIRMAN [continuingl. I'm going to have to cut you off. Senator SHAHEEN. Thank you. The CHAIRMAN. Senator Cardin. Senator CARDIN. Thank you very much, Mr. Chairman. And let me thank our witnesses. I think this has been a very helpful hearing. We're looking-the Congress is looking at our foreign aid programs and how we restructure our foreign aid programs and-in order to use foreign aid more effectively in carrying out U.S. tives internationally. And at a previous hearing, I raised the objec- issue on gender-matters issues and how many of the countries that we do business with, their record on gender equality is very, very and how can we focus our foreign aid program to be more effective poor, in carrying out that objective. When we look at Haiti and look at our previous foreign aid commitments in that country, we certainly were not terribly successful, as it related to the governance issues, as we've seen in this crisis. So, the question is basic, What can we learn from Haiti as we look at trying to restructure our foreign aid programs internationally? What can we learn from Rwanda? I was-Mr. Farmer, I was very impressed by your observations of the progress that's been made in Rwanda. I mean, how do we sort of learn from our experiences SO that we not only focus on what needs to be done in Haiti, from the point of view of longer term sustainability, including governance issues and international assistance and investment and jobs, but what can we change in-I guess, in the overall strategy of this country, in trying to avoid another Haiti in the future? Dr. FRANCOIS. Thank you, Senator. I believe that, you know, that change that you're referring to has to begin inside Haiti. And when we talk about, you know, governance and leadership, again, we have to remember that this country rose to become independent back in 1804. So, again, I'm personally, you know, skeptical about trusting entities that, in my opinion, have not delivered. Again, all you have to do is look at the response, or lack of thereof, of the leadership in Haiti. So, as we move forward, I believe that we need to partner with leadership that has utmost integrity, leadership that puts Haiti and the Haitian people first. Senator CARDIN. But, here's the dilemma. We ments are what they are. Yes, we can try to impact can't-govern- them and impact the way that they develop the institutions of democracy that can protect their people from not only natural disasters, but from abusive practices of a government. That needs to be part of our strategy. I guess my point is, How do we structure our foreign assistance budget that does not become a tool for anti-American intervention in the country, but is-uses the right incentive, SO that when we put money into a country, we know that it will get to the purposes for what we intend? We ments are what they are. Yes, we can try to impact can't-govern- them and impact the way that they develop the institutions of democracy that can protect their people from not only natural disasters, but from abusive practices of a government. That needs to be part of our strategy. I guess my point is, How do we structure our foreign assistance budget that does not become a tool for anti-American intervention in the country, but is-uses the right incentive, SO that when we put money into a country, we know that it will get to the purposes for what we intend? --- Page 44 --- Ambassador DOBBINS. Let me offer a rather self-serving to that. We don't have a very introspective, reflective foreign-aid response bureaucracy. The Defense Department spends a lot of time and a lot of money trying to find out what it did wrong. After-action reports, tactical, operational, and strategic lessons are a major element of military learning. And if you look at the military from-in Iraq, from 2003 to 2007, you see very substantial improvement, because they reflected on what they did wrong; they wrote studies, they changed the doctrine. We don't do that. The British aid agency spends a lot of its money on research and analysis, and gets people to tell them what they're doing wrong and how they could do it better. And there's no money in the AID budget for that kind of retrospective, "What did we do wrong? How can we do better?" Now, this is a self-serving analysis. That's what the RAND Corporation does. And we do it for the Pentagon all the time. And so, that's a-sorry. Dr. FARMER. I don't work for the RAND Corporation. And SObut I want to echo what you say, as a volunteer. I mean, I'm lucky enough to be able to be a volunteer for all these-this quarter of a century in Haiti and Rwanda because I have a job at Harvard. But, Iand I want to say what you're- what you suggest is not at all self-serving. There is no real critical feedback loop in foreign aid. And we can easily develop that. We can use RAND or universities or other people who are not just trying to be part of the Beltway Bandit scene, but are really saying, "How can we improve the quality of aid and not have us looking back and saying, gee, you know, Haiti or Rwanda or whatever was". I mean, Rwanda, for example, prior to the genocide, was called "The Switzerland of Central Africa." And there's a book, by a man named Peter Uvin, called "Aiding Genocide,' which is about how the aid that was going in-massive amounts of aid-mostly from France and Europe, I believe, not from our country-actually set the stage for the genocide. And you'll see that-some would argue that the massive amounts of aid going into Haiti have actually served-inadvertently, I believe-to weaken, for example, food security. The good news is, with very-you don't need to be a nuclear scientist to figure out that some of the rules of the roads would be the ones you mentioned. For example, gender equity. What are the ground rules on job creation for women in a grant even to do with education and health, agricultural improvement, small business investment? And that's one-you know, job creation, gender equity. The-if half of-a lot of these big grants, half of it goes to overhead. And I've done some study of this at Harvard, looking at major grants in the health care sphere, where more than 50 percent doesn't leave the United States, or stays in consultancies, in overhead. I just think that's way too high. And we can create a lot of jobs just by tweaking the rules a little bit. And then, finally, I would say, integrating this into the district plans of these places-into the local plans-is difficult, but critical. Senator CARDIN. That's very helpful. I appreciate that. Mr. Chairman. , half of it goes to overhead. And I've done some study of this at Harvard, looking at major grants in the health care sphere, where more than 50 percent doesn't leave the United States, or stays in consultancies, in overhead. I just think that's way too high. And we can create a lot of jobs just by tweaking the rules a little bit. And then, finally, I would say, integrating this into the district plans of these places-into the local plans-is difficult, but critical. Senator CARDIN. That's very helpful. I appreciate that. Mr. Chairman. --- Page 45 --- The CHAIRMAN. Thanks very much, Senator Cardin. We're on the back end of the vote here. We have a couple of minutes. I wouldjust like to ask a couple of things. Some Haitians have complained that they haven't heard or seen very much from President Préval since the earthquake. Is that a fair criticism? Do you want to speak to that, Dr. Francois? Dr. FRANCOIS. Senator- - Chairman Kerry, I've watched quite a bit of news on this tragedy. I have not seen President Préval but once, and what he said was that he lost his home. So, again, understanding, really, the magnitude of this earthquake and what it has done-again, it's-I can certainly understand that there would be an initial paralysis in any leader, but, from my perspective, crises, again, are where good leaders define themselves. SoThe CHAIRMAN. Well, let me pin all of you down for a second here, because I want-we've got to try to pull this in. And I apologize. There are a number of questions, particularly about the aid programs, that we wanted to air publicly, that would be, I think, very valuable. But, let me get at, sort of-What percentage, would you say, of Port-au-Prince, has to be rebuilt now? Dr. FARMER. Just as an eyewitness, the majority of it. because, all-againThe CHAIRMAN. Are we talking about 75, 80 percent? Dr. FARMER. Seventy-75 percent, yes. The CHAIRMAN. Seventy-five-percent rebuild. Dr. FARMER. The standing structures are-there's this fecklessness of it, SO you'll have a building standing or a home standing, surrounded by collapsed buildings. SoThe CHAIRMAN. That is a-I mean, that's just a-it boggles the mind, to think about clearing the debris and where it's going to be put. And then to begin to contemplate the rebuild after that isyou're looking at several years of major investment and construction, correct? I don't see how this-I want to come back to Senator Dodd's concept. Maybe "receivership" is the wrong term. But, I don't know how you get this done with any semblance of normality, in terms of the approach. This has to be a kind of-a, you know-and, I think this probably the wrong term, but it's almost-it's again, like a D-Day invasion. I mean, you've got to have SO many moving coordinated, and you've got to come in there with a new city parts planning concept. You got to have a vision for what you want this to look like. And what kind of government buildings? And where place are they going to be put? And will that contribute to the functionality, in the long term of the country? I don't see any entity, at this point, or movement--and I've talked to Dr. Shah about this-that suggests to me the global community is coming together around that kind of organizational effort in the way that it ought to. Dr. FARMER. I'd just like to get this out of the way, Senator. As someone who has been very much opposed to any encroachment on the sovereignty of Haiti, as someone who has underlined the dignity of the Haitian people and their struggle over 200 years for basic social and economic rights, and perhaps also underline some the country? I don't see any entity, at this point, or movement--and I've talked to Dr. Shah about this-that suggests to me the global community is coming together around that kind of organizational effort in the way that it ought to. Dr. FARMER. I'd just like to get this out of the way, Senator. As someone who has been very much opposed to any encroachment on the sovereignty of Haiti, as someone who has underlined the dignity of the Haitian people and their struggle over 200 years for basic social and economic rights, and perhaps also underline some --- Page 46 --- of my own country's previous and less than fruitful engagement, I would like to say that I still agree-you are right-there is notwe need-this task 1S SO massive that we-you know, we need the international A-team on this case, working with the Haitian people. We still, you know-and I can tell you-in Haiti, I went to a meeting where I saw 40 or 50 Haitian architects and urban planners working under a tree, trying to work. So, I think there are people there. The CHAIRMAN. I'm convinced that this can be coordinated. I don't-it doesn't have to be the-I believe that this can be pulled together. I need to run and vote. So, I apologize for kind of-I believe it can be pulled together, and I think it can be done in a way that empowers Haitians. You can pull-you can work hand in hand. But, I don't think they would, for a second, balk at the notion that there's an expertise that is necessary, there are resources necessary, there's a level of planning necessary, and SO forth, that they would acknowledge, beyond the current capacity. Ithink you can develop this. And if you put the rules-the rules are SO critical, that you talked about. If there's an active effort not to just leave it all to the NGO or to the outside contractor, or to whatever entity, but to bring the Haitians into the process and rebuild sufficiently, you create wealth, you create confidence, you begin to build that future that we're looking at. Otherwise, I think-what Senator Dodd said-we're just going to buy into a kind of diminishing sense of urgency, a diminishing focus of attention, and ultimately wind up in the same unsustainable situation that we have faced for the last 25 years, as you know. You've been struggling with it. So, we're not going to let go of this. We're going to stay very focused. We're going to try to press this concept of how we're to pull this together, because there is a willingness to put a going lot of aid and effort into it. I think, you know, the best chance for Haiti-the best chance for Haiti, in all of the definitions that we have given it, in terms of the problem over the last 25 years-is to take this moment and create the kind of joint, internationally cooperative rebuilding effort that provides a sustainable Haiti. And I think that the key is to really get at that. We're going to talk with the administration about it. And we'll obviously have them up here at some point in the near term to talk about this. And then we look forward to following up with you. We will leave the record open for-if you don't mind-for about a week. And maybe some colleagues-we'll try not to burden you with any written questions, but I would like to build the record, with respect to some of the things that we weren't able to ask you publicly today. So, I thank you. Ambassador DOBBINS. Senator. The CHAIRMAN. Yes. Ambassador DOBBINS. Could Ijust say, it's refreshing to come up here and make a series of proposals and be told that we're not asking for enough. And it's refreshing to have that pressure coming from both sides of the aisle. I think this 1S a very hopeful sign. colleagues-we'll try not to burden you with any written questions, but I would like to build the record, with respect to some of the things that we weren't able to ask you publicly today. So, I thank you. Ambassador DOBBINS. Senator. The CHAIRMAN. Yes. Ambassador DOBBINS. Could Ijust say, it's refreshing to come up here and make a series of proposals and be told that we're not asking for enough. And it's refreshing to have that pressure coming from both sides of the aisle. I think this 1S a very hopeful sign. --- Page 47 --- The CHAIRMAN. Well, appreciate that comment. We'll look forward to working with you very, very much. And I am absolutely convinced that unless we get this thing into a bigger coordinated concept, we're just buying into the same old, same old. And then, of course, everybody'11 walk away. And that'll have an impact on failed states elsewhere, and other prospects elsewhere. So, I think that there's a uniqueness to this challenge. And hopefully we can take it in hand. Dr. Francois, I-ifI don't get over there, they'll cut me off on the vote. So, I got to get over there. I apologize, profusely. So, we stand adjourned. And I thank you. [Whereupon, at 11 a.m., the hearing was adjourned.] ADDITIONAL MATERIAL SUBMITTED FOR THE RECORD PREPARED STATEMENT OF HON. KIRSTEN E. GILLIBRAND, U.S. SENATOR FROM NEW YORK dreds When of a thousands massive earthquake shook Haiti and its people on January 12, it left hunburied in rubble and an entire country in complete despair. Whenever people are suffering around the world, Americans have always been compelled to do what we can to help. It is who we are. We have poured in hundreds of millions of dollars in donations; sent teams of medical to help the units Haitian and supplies Government to help bring relief; and dispatched thousands of troops I am proud of the response of securely our government, provide these our supplies. organizations, and our communities. nonprofits, our faith-based able I share this commitment to help the people of Haiti in the wake of this tragedy. In an effort to make it easier for American citizens to donate unspeak- to aster relief, I cosponsored legislation, which has become law, to waive tax deduction dislimits on all charitable contributions to Haitian relief efforts. In addition, I urged President Obama to grant Temporary Protected Status (TPS) for Haitian nationals residing in our borders. I appreciate that the administration acted since the earthquake to quickly allow Haitians in the United States-to continue to be able to live in this country without fear of returning to a country ravaged by such devastation. While there are many urgent needs in Haiti, I believe that the United States must particularly focus its relief efforts on the children of Haiti. I worked with my colleagues in the Senate to call on the administration to ensure that the safety and well-being of Haiti's orphans are given top priority in U.S. relief efforts. I pleased to see that the Department of Homeland Security responded to our call, was announcing humanitarian parole for children who have been confirmed as orphans In and were in process for an intercountry adoption to the States. orderto unite FIRILA ing that children with Haitian orphans Haitian with prospective American families while ensurHaiti, I urged the administration existing to work families with the are families not mistakenly and the licensed taken from tion agencies in Haiti and the United States to complete all ofthe appropriate adop- vetting as quickly and as carefully as possible. I also. joined my colleagues in Secretary Napolitano to work quickly to expand humanitarian requesting Haiti that have close family members in the United States. parole to I orphans in for a moratorium on external debt that Haiti owes to the InterAmerican Finally, have called ment Bank. In the aftermath of the worst earthquake in Haiti in more than Develop- two centuries and with the world community focused on bringing the Carribean nation immediate relief and reconstruction efforts, Haiti must not be saddled with its outstanding multilateral debt in the foreseeable future. As President repaying U.N. Special Envoy for Haiti, has said, Haiti made a good beginning and Clinton, was the than ever to securing a bright future before the earthquake. this closer President Clinton still believes that Haiti can succeed. We all Despite stand in tragedy, the Haitian people and remain hopeful that their country will recover, succeed, unity with and overcome. The extreme loss of life and unimaginable hardship that many are from this disaster is heartbreaking and tragic. Many of these families experiencing have experienced both far too much anguish already. My thoughts and prayers are with the in the United States and in Haiti, affected by this disaster. families, for Haiti, has said, Haiti made a good beginning and Clinton, was the than ever to securing a bright future before the earthquake. this closer President Clinton still believes that Haiti can succeed. We all Despite stand in tragedy, the Haitian people and remain hopeful that their country will recover, succeed, unity with and overcome. The extreme loss of life and unimaginable hardship that many are from this disaster is heartbreaking and tragic. Many of these families experiencing have experienced both far too much anguish already. My thoughts and prayers are with the in the United States and in Haiti, affected by this disaster. families, --- Page 48 --- RESPONSE OF JAMES DOBBINS TO QUESTION FOR THE RECORD BY SENATOR ROBERT P. CASEY, JR. DEBT RELIEF Question. Since 2007, the Inter-American Development Bank (IDB) has only provided grants to Haiti. Last year, the International Monetary Fund (IMF) and the World Bank forgave $1.2 billion in debt relief to Haiti. Haiti completed the Heavily Indebted Poor Countries (HIPC) program which triggered another wave of debt relief amounting to $62.7 million by the Paris Club group of official creditors. However, Haiti still owes more than $1 billion in debt. In the case of the IDB, Haiti still It owes is my $441 understanding million. that the multilateral lending institutions are discussing ways limit Haiti's debt as a result of this catastrophe. În the 110th Congress, I introduced the Jubilee Act, which not only provided debt relief to some of the most indebted nations, but it also sought to stop predatory lending to these nations. Mr. Dobbins, what can the United States do, in concert with the international community, to ensure that Haiti does not emerge from this crisis heavily indebted once again? Do you believe this is the right time to call on Haiti's creditors to forgive the remainder of its debt? Answer. Under current cireumstances, most if not all aid to Haiti should be in the form of grants. Loans should be considered only in the case of commercially viable projects which will result in a clear revenue stream capable of both amortizing the debt and maintaining whatever has been built. Donors providing grant assistance to Haiti should exercise their influence to insure that the Haitian Government does not undertake unnecessary or ill-considered financial commitments. Further debt forgiveness should certainly be considered as part of the international communities response to the Haitian earthquake. PREPARED STATEMENT OF U.N. HUMAN SETTLEMENTS PROGRAMME, UN-HABITAT, SUBMITTED BY CHRISTOPHER W. WILLIAMS, WASHINGTON, DC PHASE ONE: EMERGENCY RESPONSE TO HAITI EARTHQUAKE On 14 January, UN-HABITAT (see institutional information below) together with other members of the Inter-Agency Standing Committee consolidated inputs from 12 International Organizations (IOs) and 24 international nongovernmental organiza- shelter tions (NGOs) into the United Nations Flash Appeal. Specific proposals on relief and recovery prepared by UN-HABITAT are incorporated in the Flash Appeal (see annex 1). On 15 January 2010, the Secretary General established the United Nations Disaster Assessment Team (UNDAT) to undertake a rapid assessment of the needs in Haiti following the earthquake in Port-au-Prince. Among the lead sectors, the United Nations formed the "Emergency Shelter and Non-Food Item Cluster." Representatives of UN-HABITAT and 12 UNOS and NGOs under the leadership of the International Organization for Migration are in Haiti as part of the UNDAT. UN-HABITAT and other members of UNDAT are gathering information to adjust the Flash Appeal to realities on the ground. The ageney is exploring coordination officials, mechanisms and identifying opportunities for partnerships with Haitian address international organizations, as well as citizen groups that have emerged to basic needs. The process is challenging given the intense demand for the affected population estimated to be over 500,000, the collapse of ports, IT, and road infrastructure. As part of UNDAT, the organization will next month consolidate the outcomes of the rapid assessment into a revised Flash Appeal. PHASE TWO (A): SHELTER RECOVERY The shelter recovery strategy advocated by UN-HABITAT is based on experience working in post-disaster situations in which 70 percent of affected population is living on less than $2/day. The organization seeks to ensure that the provision of settle- housing is equitable, responds to the needs of those most vulnerable (informal effort. ments, displaced), and involves the affected communities in the rebuilding Focus on Non-Displaced Populations: The shelter recovery strategy focus is on nondisplaced populations to assist those who want to rebuild housing in their former neighborhoods. Experience worldwide shows that people affected by disasters are keen to return to their homes as soon as possible to regain a sense of place, adjust to the psychological trauma of the disaster, and reclaim their lives. population is living on less than $2/day. The organization seeks to ensure that the provision of settle- housing is equitable, responds to the needs of those most vulnerable (informal effort. ments, displaced), and involves the affected communities in the rebuilding Focus on Non-Displaced Populations: The shelter recovery strategy focus is on nondisplaced populations to assist those who want to rebuild housing in their former neighborhoods. Experience worldwide shows that people affected by disasters are keen to return to their homes as soon as possible to regain a sense of place, adjust to the psychological trauma of the disaster, and reclaim their lives. --- Page 49 --- Self-Build and Re-use of Rubble: Despite the extent of devastation in an earththere is of a surprising amount of reuseable materials that can be salvaged for purposes Haitians ceru resistant rebuilding their homes. Using rubble with technologies, the approach has proved highly effective when earthquakewhere including by Pakistanis in the aftermath of the earthquake. deployed The elsewill provide a more durable solution that will resist rains and hurricane approach will avoid the logistical bottlenecks that Haitians may encounter if they winds. It on tents which may only arrive in great quantities at the beginning of rely the solely season and won't hold up. rainy Shelter Resource Centers: The establishment of shelter resources centers, also plied effectively in other post-disaster situations, including Pakistan, provide dem- aponstration, centers information, and technical assistance. They also double as community and can be used by shelter partners for the distribution of nonfood items. Cash-for-Work: have Haitians are in desperate need for cash as most forms of ment been destroyed, yet most Haitians are able and to work. employ- Cashfor-Work systems can be put into place for the collection of willing rubble, both for relocating rubbish and for salvaging materials for housing reconstruction. need Building Material and other Support: Haitians can use salvaged materials but they will also roofing select building materials to reconstruct housing. It will be important during the recovery period for the international community and Haitian organizations to the to purchase materials. Haitians can use the shelter resource centers disburse materials at a subsidized rate or on a "material-for-work" related challenge will be congestion at the ports. The United States could make basis. this A a distribute priority food. and expedite the delivery of needed building materials, as it is doing to PHASE TWO (B): URBAN SYSTEMS RECOVERY The earthquake, having devastated the city of Port-au-Prince, is the world's largest urban humanitarian crisis. By its very nature it requires perhaps a comprehensive, urban systems management approach. This involves supporting simultaneously urban multiple delivery mechanisms including shelter, land, water, sanitation, safety, health and food. The challenge for recovery is coordination and identiTAT fying ways of managing, expertise across various sectors in urban areas. UN-HABIviews the first weeks following a disaster as crucial for and urban stakeholders to respond to the enormous urban rehabilitation supporting government effort. In practice this implies supporting government to convene stakeholders to ensure that the planning process is consultative and participatory, to invest heavily in coordinating the process, and to provide technical assistance for implementation. PHASE THREE: RECONSTRUCTION UN-HABITAT welcomes efforts in the coming weeks to organize consultations that bring together Haitians and the international community to consider ways to design urban development to transform not just Port-au-Prince but, more tantly, the wider economy of Haiti. An important proposal is investment Les imporand Cap Haitien as well as Port-au-Prince in seaports and free enterprise-zones Cayes that generate new manufacturing jobs. This would require substantial investment in infrastructure and housing, as well as job training and rapid skill development to supHaiti working will enable people and their families. The development of multiple urban centers ETL Haitians with support from the international reconstruct Port-au-Prince as a more efficient, sustainable, and better community serviced to municipality, thereby reducing precarious settlements on hillsides. INSTITUTIONAL OVERVIEW UN-HABITAT is the of the United Nations responsible for urban development, and EA Member States to achieve Millennium housing Devel- and opment Goal Target 11 (on slum improvement), and Target 10 (on water and sanitation in cities). There are an estimated 1 billion people living in informal and slums. The United Nations estimates that at current rates of settlements there be 2 billion slum dwellers by the year 2030. Simply stated, one in three growth, of will will be living in urban slums. humanity in With headquarters in Nairobi, Kenya, UN-HABITAT maintains field 87 countries managed by regional offices in Japan (Asia and operations (Latin America and the Caribbean), Poland (Eastern Europe), Kenya Pacific), (Africa/Arab Brazil States), and Habitat Program Managers in 40 country offices through a cooperation agreement Chief with its sister agency, UNDP. The organization is a member of the U.N. Executive Board, Inter-Agency Standing Committee of Humanitarian cies, United Nations Development Group, Commission for Africa, WHO Commission Agen- will will be living in urban slums. humanity in With headquarters in Nairobi, Kenya, UN-HABITAT maintains field 87 countries managed by regional offices in Japan (Asia and operations (Latin America and the Caribbean), Poland (Eastern Europe), Kenya Pacific), (Africa/Arab Brazil States), and Habitat Program Managers in 40 country offices through a cooperation agreement Chief with its sister agency, UNDP. The organization is a member of the U.N. Executive Board, Inter-Agency Standing Committee of Humanitarian cies, United Nations Development Group, Commission for Africa, WHO Commission Agen- --- Page 50 --- for Social Determinants of Health, and the Commission for the Legal Empowerment ofthe Poor, among others. UN-HABITAT advances shelter and urban development strategies by policy advice, technical assistance, and credit enhancements to governments, providing municipal tries. authorities, These include private companies, and NGO/CBO partners in a wide range of counChina, and South Africa, emerging as well market as low-income economies and such as Brazil, Russia, India, Africa, Asia, and Latin America. The organization also very-low-income works with countries countries in con- in flict, post-conflict and post-disaster situation in Iraq, Afghanistan, Pakistan, Sudan, tsunami-affected Asian countries, West Bank and Gaza with a combined Liberia, project portfolio of $800 million. The Governments of Japan, Sweden, Norway, Spain, Bahrain, Italy, Canada, and the United States provide annually both and special purpose support. general HUMANITARIAN ASSISTANCE UN-HABITAT is principal member of the Inter-Agency Standing Committee for humanitarian operations (ASC) chaired by the Office ofthe Coordinator of Humanitarian Agencies (OCHA). It serves as the lead agency for the Housing, Land and Property (HLP) cluster and is currently supporting an initiative of the TASC to develop a strategy for enhancing humanitarian assistance in urban settings. In emergency situations it supports the efforts of the international community to identify appropriate strategies for shelter recovery and urban land and service delivery systems. The organization maintains an active network of experts from diverse backgrounds who it calls upon to support relief and recovery efforts in disaster situations. Of particular relevance to ongoing crisis in Haiti is the emergency strategy deployed by the UN-HABITAT in Pakistan in the aftermath response of the earthquake. PREPARED STATEMENT OF THE NATIONAL HAITIAN AMERICA ELECTED OFFICIALS (NHAEON) SUBMITTED BY STATE REPRESENTATIVE MARIE ST. FLEUR, BOSTON, MA INTRODUCTION The National Haitian American Elected Officials Network (NHAEON) is a nonpartisan coalition determined to improve relations between the United States and Haiti. NHAEON is committed to bringing a renewed national and local focus to key legislative, Haiti. There diplomatic, security, economic, and human rights issues that impact are 21 Haitian-American elected officials in NHAEON representing, six states-Florida, York. NHAEON, Illinois, in collaboration Massachusetts, with New Hampshire, New Jersey, and New ment of Haitians (NOAH), submits the the National Organization for the Advancestantive Haitian-American involvement in following the Haiti request Relief Effort. for coordinated and subBACKGROUND An earthquake of 7.0 magnitude hit Haiti on January 12, 2010. Its was primarily in the capital, Port-au-Prince. Nevertheless, the devastation caused epicenter the earthquake and its ensuing aftershocks stretch well beyond Port-au-Prince. by Carrefour, Delmas, Petionville, Leogane, Croixc-des-Bouquet, Jacmel and other nearby cities/towns have all sustained tremendous damages. The Haitian-American community thanks President Obama and Congress for the leadership shown in to this tragedy. Our government's swift, focused and unequivocal response for the Haitian people and its commitment to provide relief have set the tone this international CRPSN emergency relief operation. As well, the Haitian-American community preciates the authorization ofTemporary Protective Status (TPS) for undocumented apHaitians currently in the United States. Those who are benefiting from TPS will not only be able to work but they will also be able to send some remittances back to Haiti to help their families. As Haitian-Americans, Elected Officials who represent significant constituencies, many of whom are of Haitian descent, we offer this testimony in support of the three following principles: 1, The Sovereignty of the state of Haiti must be recognized and protected. We recognize of that the governance of Haiti is not very strong. However, the Government Haiti is a recognized and democratically elected body. We the concept of a receivership for the state of Haiti. We believe that categorically our American oppose Government must play a significant role in accompanying the Haitian Government in its journey to build a stronger and much more predictably state ratus and to rebuild the country. American ingenuity and determination, functioning properly appa- offer this testimony in support of the three following principles: 1, The Sovereignty of the state of Haiti must be recognized and protected. We recognize of that the governance of Haiti is not very strong. However, the Government Haiti is a recognized and democratically elected body. We the concept of a receivership for the state of Haiti. We believe that categorically our American oppose Government must play a significant role in accompanying the Haitian Government in its journey to build a stronger and much more predictably state ratus and to rebuild the country. American ingenuity and determination, functioning properly appa- --- Page 51 --- directed, will allow us to chart a course that will support the strengthening of demoby cratic institutions. We know strengthening democratic institutions can be realized tives directing technical and financial support with clear measurable goals and (i.e., the role of Partners In health and the Inter-American objecBank). The United States is particularly well-suited to help Haiti because Development it is to the greatest number of Haitian professionals across all disciplines. These Haitian- home Americans are passionate about Haiti and ready to actively in forth the vision of a rebuilt-Haiti and the implémentation of participate that vision. As setting we, as Haitian-Americans have the direct connections with Haiti, we are connected well, culturally, linguistically and in many case, we have a financial stake in getting the rebuilding of Haiti right. also 2. The allocation with and distribution of foreign aid must be reformed SO that it is stitutions. aligned Given the supporting building capacity in the state of Haiti and its civil inspectfully that emergency situation that exists on the ground in Haiti, we reGovernment request with clear Foreign aid be distributed directly to or through the Haitian ity of its ministries and objectives and accountability measures to support the capactional capacity of ministries departments. such as the Such Ministry an approach of Health, will Education, strengthen the functation, Energy, Environment and others. In addition to the ministries, there Transpor- a governmental system in place that includes the heads of the 10 of is the country, the mayors of the various municipalities and, among local departments elected officials, there are azecs and kazecs that serve the population as elected officials. The full utilization of this existing system makes distribution recognized of relief much efficient and will strengthened these institutions as we move forward toward recon- more struction. 3. The People of Haiti and Hattian-Americans must have an integral role in the recovery and rebuilding of Haiti. There are approximately 2.5 million Haitians Haitian-Americans who were born in Haiti, living here in the United States and of America. This group has sired approximately 5 million Haitian-Americans born the United States. Haitian-Americans are appreciative of the enormous in of support from our American Government and our fellow Americans for outpouring the of Haiti. We are proud of the role that our Armed Forces and medical people are playing on the ground to assist the devastated people of Haiti. However, professionals Haitian-Americans grow increasingly frustrated watching the continual deterioration an already devastated country without access to direct avenues for their time and of talent to mitigate the suffering of the Haitian people and to help with the of Haiti. Therefore, we respectfully ask for inclusion as a direct partner in the recovery ning now underway for the recovery and rebuilding of Haiti. planThank you for the opportunity to offer written testimony on The Haiti Relief and Rebuilding Effort. Our actions in this moment is critical to the future of the state of Haiti, many of our families there and the quality of life for many of our constituents here in the United States. PREPARED STATEMENT OF INTERNATIONAL HOUSING COALITION (IHC), WASHINGTON, DC The International Housing Coalition (IHC) has been monitoring the situation Haiti with a particular focus on the impacts of the disaster on housing and critical in residential infrastructure. The situation is desperate, as we all know, and efforts now rightly focused on immediate relief, life-saving medical care, critical food and are water, and security. At the same time, the enormous destruction to Haiti's housing stock threatens not just the immediate health and well-being of the the country's long-term social and economic viability. Experience around population, the world but shows that the post-disaster rescue phase quickly morphs into recovery and then reconstruction. This process will happen in Haiti with or without the of the international community and a comprehensive reconstruction support The U.S. Government (USG), along with other parties, has plan. a critical role to in making reconstruction resources available quickly. These resources must be play in a strategic way to steer the reconstruction process in a positive direction. used must be used equitably and efficiently to shelter families and reestablish commu- They nities in ways that enhance their resistance to future natural disasters. More than a million Haitians are homeless and many more are living in unsafe compromised structures. Shelter is a precondition for economic and security, and investments in other sectors are compromised development, when recipients health, lack safe and secure shelter. The importance of shelter cannot be overstated the physical and psychological toll that the earthquake has taken on the given in and around Port-au-Prince. population strategic way to steer the reconstruction process in a positive direction. used must be used equitably and efficiently to shelter families and reestablish commu- They nities in ways that enhance their resistance to future natural disasters. More than a million Haitians are homeless and many more are living in unsafe compromised structures. Shelter is a precondition for economic and security, and investments in other sectors are compromised development, when recipients health, lack safe and secure shelter. The importance of shelter cannot be overstated the physical and psychological toll that the earthquake has taken on the given in and around Port-au-Prince. population --- Page 52 --- IHC RECOMMENDATIONS Establish a Reconstruction and Development Authority to oversee and coordinate reconstruction efforts. The USG should support the immediate creation of a redevelopment authority for greater Port-au-Prince. The authority would develop a reconstruction strategy and implementation, plan. It would manage and disburse redevelopment funds for housing and basic infrastructure (e.g., local roads, storm water drainage, water reticulation, and sewerage). It would be in a to pool funds from the United States and other donor agencies to maximize position impact, coordinate shelter construction with infrastructure provision, and build between reconstruction and local investment. It would promulgate and linkages monitor minimum standards for construction. Successful housing reconstruction effective public administration and management. Areas not suitable for requires reconstruction should be identified and mapped quickly, before informal reconstruction gains traction and residents should be made fully aware of these restrictions as soon as possible. Ensure that assistance is accessible and provides appropriate incentives to residents of all income levels to rebuild and improve their homes. Given the scale of the disaster and the resulting housing deficit, rebuilding must utilize the full range of local resources and institutions in addition to internationally support. As a practical matter most housing will be provided by the provided themselves and much of this will involve the incremental rebuilding homeowners of structures or improvement of the bemporarytransitional shelter received remaining in the early days of the relief effort. Assistance for home reconstruction must creative incentives for families and others to build using materials and provide that increase resistance to future disasters, while still providing techniques small-scale builders, for self-help construction, and for efforts opportunities by community for groups and cooperatives. hance Ensure that housing and infrastructure reconstruction efforts support and enlocal economic development. Employment generation should be an explicit objective of the rebuilding process in order to increase household income and thereby stimulate consumer demand and production. PREPARED STATEMENT OF HABITAT FOR HUMANITY INTERNATIONAL SUBMITTED BY CHRIS VINCENT, DIRECTOR, CONGRESSIONAL ReLaTORSINTeNAnONAr AFFAIRS, WASHINGTON, DC BACKGROUND ecumenical Habitat for Humanity International (HFHI) was founded in 1976 as a nonprofit, about 2,400 Christian housing ministry. Today Habitat operates in 94 countries, has registered affiliates, and has built nearly 300,000 houses worldwide, providing simple, decent, and affordable shelter for more than 1.5 million HFHI is one of the most recognized, well respected, and largest charities people. in the United States, and the premier not for profit organization focused on affordable housing. For more information, visit www. habitat.org. The mission of HFHI Disaster Response program is to develop innovative housing and shelter assistance models that generate sustainable interventions for vulnerable to or affected by disasters. As a result of lessons learned in people to major disasters for more than 10 years, such as the Asia tsunami and responding Hurricane Katrina, Habitat has developed disaster response systems that enhance its to respond to disasters. Habitat employs these systems to monitor emergencies, capacity to perform needs assessments, and to design programs for sheltering and housing recovery. Disaster Response also builds the capacity of the global Habitat in the areas of disaster mitigation, preparedness, and recovery through community education, training, and partnerships. HFH Haiti has been assisting vulnerable people with their shelter needs 1982 through various types of housing support. Support has included basic shelter since loans, increasing access to materials, providing technical assistance and vocational training through its innovative USAID-funded Building and Training Center project, teaching financial literacy, helping families to rebuild post-hurricane devastation, and promoting disaster-resistant shelter options. HABITAT FOR HUMANITY's HAITI RESPONSE A Disaster Response Assessment Team (DRAT) of regional and disaster response experts Haiti from Habitat for Humanity International (HFHT or Habitat) is currently in working with local Habitat staff to assess local capacity, reestablish oper- needs 1982 through various types of housing support. Support has included basic shelter since loans, increasing access to materials, providing technical assistance and vocational training through its innovative USAID-funded Building and Training Center project, teaching financial literacy, helping families to rebuild post-hurricane devastation, and promoting disaster-resistant shelter options. HABITAT FOR HUMANITY's HAITI RESPONSE A Disaster Response Assessment Team (DRAT) of regional and disaster response experts Haiti from Habitat for Humanity International (HFHT or Habitat) is currently in working with local Habitat staff to assess local capacity, reestablish oper- --- Page 53 --- the ations, and carry out an assessment of damage to the shelter sector. The extent of damage is yet to be tallied, but early estimates are of 1.5 million homeless as a result of the earthquake. This is at least five times the people 2008 hurricane. magnitude of the HFHI is closely coordinating its disaster response with both multilateral and vate OCHA agencies. Recent meetings include daily meetings in Port-au-Prinee of the Shelter Cluster URC sponsored led by IOM; daily calls with USAID; in the Shelter and Water/Sanitation strategy session at the Clinton Global participation Initiative meeting on January 19, 2010, in West Palm Beach, FL:a and coordination with other INGOS including the American Red Cross, CARE, CHF, World Vision, and others. A common recurring theme is how to meet immediate shelter needs while transitioning to recovery, reconstruction, and mitigation of future disasters-"bulding back better.' This focus is very aligned with Habitat's multiphased strategy. Habitat's strategy offers immediate, transitional, and long-term solutions for decent, affordable shelter. The size of Habitat's commitment depends efforts currently underway. Following the 2006 tsunami in Asia, Habitat upon fundraising raised million and served 25,000 families with shelter assistance. $78 Habitat for Humanity will have three primary phases of work in Haiti Phase I-Early recovery starter kits. The kits are designed to help families make bucket, immediate repairs or construct emergency shelter. Materials in the kit include a tarpaulin, wire, pry bar, mason's chisel and trowel, gloves, nails, hammer and saw. The kits watri be distributed by Habitat employees and partners with distribution beginning as early as this week. Phase I-Rehabitation and cleanup. Habitat will mobilize people to remove debris, salvage materials that can be reused, and assist in homes that can be repaired. These activities could include a "cash for rehabilitating work" component providing local, able-bodied people with the tools and means to help with the and earn a small amount of money for meeting other basic needs. recovery Phase lIl-Reconstruction and recovery, including Core homes/Transitional shelters. Habitat plans to replace destroyed homes using a transitional shelter model, rebuilding in a way that reduces risk and improves construction houses can be added to over time, providing an immediate solution quality. with These the beginnings of a permanent home. The core transitional shelter unit along will adhere to five. international Sphere standards, with living space for the average Haitian family of Additionally, Habitat plans to implement its recovery project through Resource Centers that provide technical assistance and to restoration Habitat of the construction sector as well as direct housing production. TELT Resource Centers support ply of housing housing materials, development and improvements, identifving gaps in the local supthat support local livelihoods. designs, finance and skills and addresses them in ways local residents and other humanitarian Throughout, Habitat will cultivate partnerships with tiveness of its response. Habitat is looking organizations into ways to that stimulate can multiply the low-income the effechousing and sector longer term, such as technical support and loans to small enterprises, development and local production of construction materials. Habitat is also looking for funding to collect baseline data into a Geographic Data System, combining satellite photos and field data to help identify immediate shelter interventions, monitor their implementation, and gather information for later phases of recovery on land availability/tenure and disaster risk mapping. RECOMMENDATIONS Transitional Shelter: USAID should shift the policy focus from to transitional shelter as the preferred intervention. Temporary shelter temporary costs are subfected stantial and the money often does not translate into an investment for the afindividuals; by contrast, transitional shelter costs are comparable to temporary shelter costs and constitute an investment. Additionally, there is a ity-building potential of transitional shelter, supporting in the local capaculation and potential for local employment. Thus, the USG expertise should work to time and attention on the of Ret when resources issue transitional shelter, working to ensure that will possible for are not wasted building temporary encampments that sitional remain years to come, but that resources are spent working to create trantheir shelter solutions that will allow families to remain as close as to community and invest in shelter solutions for the long term. possible The USG should ensure that when relocation of affected families is necessary, the relocations are located in stable locations as close to the affected areas as and within natural or expected growth corridors. possible the USG expertise should work to time and attention on the of Ret when resources issue transitional shelter, working to ensure that will possible for are not wasted building temporary encampments that sitional remain years to come, but that resources are spent working to create trantheir shelter solutions that will allow families to remain as close as to community and invest in shelter solutions for the long term. possible The USG should ensure that when relocation of affected families is necessary, the relocations are located in stable locations as close to the affected areas as and within natural or expected growth corridors. possible --- Page 54 --- Housing Expertise: Housing will be a major focus of the rebuilding effort over the long term and the U.S. Government should build the overall and tise on shelter and housing within USAID, the State Department capacity and other expercies responding in Haiti. With U.S. Foreign Assistance lacking a shelter and agen- housing focus to any significant degree on an ongoing basis, current staff and expertise will be essential. More specifically, USAID enhancing needs added capacity to support transitional shelter initiatives-both in Haiti and in general disaster planning and mitigation. Funding for Permanent Housing: Given USAID lacks a program for housing, any include funding appropriated by Congress for Haiti focusing on the long-term needs must shelter and specific language to ensure funding for programs to support transitional housing solutions. Partnerships: The USG should encourage NGO cooperation and coordination and specifically encourage partnerships to leverage NGOs with key core competencies with donors and NGOS with existing funding to ensure that quality implementation of programming. The USG should develop a sustainable reconstruction strategy for Portau-Prince that recognizes that the most vulnerable families have rebuilding been located in high hazard zones. These areas should be rezoned to preclude residential construction and that rehousing of permanently displaced families considers livelihood opportunities. Material Donations: The USG should work with the Haitian Government and NGOs to ensure coordinated and equitable access to points of entry for material U.S. donations to support reconstruction, ensuring that supply chains are as effective, efficient, and low-cost as possible. PREPARED STATEMENT OF INTERACTION, A UNITED VOICE FOR GLOBAL CHANGE Two weeks after a terrible earthquake rocked the Haitian capital and surrounding areas, aid continues to pour into the country and increasingly is reaching those in need. Despite huge challenges, humanitarian access is daily. In of the Haiti response, InterAction members-U.S. nonprofit improving humanitarian support and development organizations, often referred to as U.S. NGOs-have collectively received an outpouring of donations from the public-totaling over $350 million as of day, January 26, with the number expected to rise in the coming weeks. NGOs Mon- in the InterAction network have several thousand staff on the ground to needs. In typical NGO fashion, the vast majority of these staff are Haitian responding nationals. The situation that these staff are confronting is profoundly with conditions on the ground changing day by day. challenging, INTERACTION NGO RESPONSE of Over humanitarian 82 InterAction members are responding to the needs. Examples of the efforts response professionals include: o Within 8 days of the disaster, one InterAction NGO had opened a new field hospital in Carrefour. The hospital initially had 17 emergency and medical staff providing primary care and emergency surgery. Another member medical treatment of 2,200 people in Leogane 4 days after the supported initial earth- the quake. Another NGO has reached nine geographic areas by partnering with the U.N.'s health cluster. Within 48 hours, one member had activated USAID's Supply Chain ment System (SCMS) project team in Haiti which began Manage- of gency medicines and supplies to Port-au-Prince Hospital. shipments As of January emermore than 40,000 pounds (18,000kg) of medicines and emergency medical sup- 19, plies from warehouse stock had been distributed. Several members are providing psychosocial support for children. One member has distributed emergency shelter materials and tents to hundreds of people. It plans to work with local Haitians to rebuild structures destroyed in the quake. In one InterAction member's Dominican warehouse, Haitian University students NGO are working side by side with local youth groups, former street children, and staff to prepare much-needed food and hygiene kits for survivors. One member has a well-established office in the Dominican Republic which is proving invaluable to facilitating the administration and staffing of food and supply distributions at relief centers. Another InterAction NGO has been able to leverage over a decade of working with local staff in rural areas in Haiti and good connections experience with local and tents to hundreds of people. It plans to work with local Haitians to rebuild structures destroyed in the quake. In one InterAction member's Dominican warehouse, Haitian University students NGO are working side by side with local youth groups, former street children, and staff to prepare much-needed food and hygiene kits for survivors. One member has a well-established office in the Dominican Republic which is proving invaluable to facilitating the administration and staffing of food and supply distributions at relief centers. Another InterAction NGO has been able to leverage over a decade of working with local staff in rural areas in Haiti and good connections experience with local --- Page 55 --- authorities and communities to transition its development program into emergency relief activities. SITUATION ON THE GROUND from Everything the must be brought to Haiti through the airport and port, or by road Dominican Republic. In the first week ofthe disaster, the undated with supply and personnel planes for the U.S. military and airport humanitarian was inagencies-causing rated and the number a logistical of bottleneck. The airport congestion has been ameliomuch greater than the airfield's planes landing has increased but the demand remains to Port-au-Prince by ship was almost capacity completely to receive cut off and and discharge has only aircraft. recently Access been partially restored with differing reports ofits current capacity ranging from 10-40 percent. The extensive destruction of infrastructure, particularly roads, continues to make access to the affected population especially challenging. the After dealing with the immediate tragedy of staff losses and the need to locate lost family members of staff, the NGOS on the faced further problems due to shortages of funds and available Dsrgoa Over the last 2 weeks logistical some needs services have resumed and fuel is available at many gas stations, but other basic services continue; the most ERET care, and shelter. While urgent surgical needs urgent are priorities are water, food, health is an important concern. In addition, experts have decreasing, estimated post that operative care rently approximately 63,000 pregnant women in Port-au-Prince, and there 15 are cur- of them are likely to face life-threatening complications. This week attention percent has creasingly turned to the need to provide shelter for the approximately 1 million Hai- intians left homeless by the disaster. On Monday, the U.N. Office for the Coordination of Humanitarian Affairs (OCHA) reported that the U.N.'s International Office on Migration (IOM) has requested tents for 250,000 families. While these will immediate relief once they arrive and are erected those housed in tents provide vulnerable in the upcoming rainy and hurricane seasons. Conversations will have remain among the NGOs and with USAID and the U.N. about the need for transitional begun shelter. CHILD PROTECTION A priority for the U.S. NGO response includes the plight of children who have become separated from parents or unaccompanied or orphaned as a result of the earthquake. be the first InterAction continues to stress that international adoption should not the response to helping protect and care for vulnerable children. Following immediate provision of life-saving assistance to children, it is critical to and protect extremely vulnerable children from situations of potential exploitation identify or abuse. Tracing family members and reuniting children with existing relatives is the best solution for vulnerable children in post-crisis situations. It is ficult to determine whether children truly are orphans in many cases, extremely and it often diftakes United considerable States and time to fulfill the legal requirements for adoption of both the InterAction Web site: the child's country of origin. (For more information, visit the Mipheweinenntienangartdenternatenat-ndtylienpimar haitl-aherearthgunke) U.N.-U.S. GOVERNMENT COORDINATION A high level of coordination between U.S., international and military actors is ical to meeting the array of challenges on the ground. Throughout the last 2 weeks critboth the U.S. Government and the U.N. have given coordination between their official efforts and the NGOs top priority. In Haiti, the U.N. cluster system was vated within a week of the disaster; 12 clusters focusing on camp coordination acti- and management, education, shelter, food, logistics, nutrition, protection, water sanitation (WASH), agriculture, early recovery, emergency tolecommunications, and and health are serving as the internal coordination mechanism for the U.N./NGO The clusters are holding regular meetings to coordinate their joint efforts. To effort. support response efforts, six clusters have been mobilized in the Dominican Republic. Furthermore, U.N. InterAction has been in close communication with the office of the Special Envoy to Haiti, former President Bill Clinton. On the U.S. Government side, USAID through the leadership of USAID Administrator Office of Foreign Disaster Assistance (OFDA)-has provided NGOS Rajiv with Shah and its cess and support at the highest levels. Within a few days of the disaster, superb USAID acapproved funding to support the establishment of an NGO coordination cell in Portau-Prince. InterAction is partnering with the Geneva-based International Council of Voluntary Agencies (ICVA), to stand and staff this coordination cell. To further improve coordination between the "Sd8 community and the U.N., the cell will be Bill Clinton. On the U.S. Government side, USAID through the leadership of USAID Administrator Office of Foreign Disaster Assistance (OFDA)-has provided NGOS Rajiv with Shah and its cess and support at the highest levels. Within a few days of the disaster, superb USAID acapproved funding to support the establishment of an NGO coordination cell in Portau-Prince. InterAction is partnering with the Geneva-based International Council of Voluntary Agencies (ICVA), to stand and staff this coordination cell. To further improve coordination between the "Sd8 community and the U.N., the cell will be --- Page 56 --- colocated with the U.N. coordination office staffed by OCHA. These humanitarian will free up emergency responders to focus their energies on saving RRnaet and helping people. MILITARY COORDINATION InterAction applauds President Obama's appointment of the USAID administrator as the official emergency response coordinator. While the military, is providing critical logistical support in Port-au-Prince by repairing the port and providing airlift capacity and protection for humanitarian operations, the President has recognized the that the civilian agencies have the necessary expertise and experience to guide the U.S. response. Military from the United States and Canada are supplementing efforts of the U.N. peacekeeping mission in Haiti (MINUSTAH) to provide of muchneeded security for relief distributions. Last week, it was reported that tens thousands of MRES (meale-ready-to-ent) and rations of water were distributed to desperate earthquake victims at a course inside Port-au-Prince, This is but one of the numerous examples where cur lift capacity of the U.S. military combined with U.S. NGO logistical and staff capacity on the ground to move urgently needed relief. LONG-TERM NEEDS As media attention moves on from Haiti in coming months, it is imperative that the United States and the broader international community do not forget the country's reconstruction and long-term development challenges. We applaud the Close commit- colment of the administration to seek necessary funds from the Congress. laboration between OFDA and the USAID mission in Haiti will be needed SO that emergency response efforts dovetail as seamlessly as possible with recovery and long-term development activities. There are positive signs that this collaboration is already beginning. The large Haitian-American community will no doubt provide much-needed human and technical expertise in the longer term NGO effort. The overarching NGO objective is to engage local civil society in an effort to build longterm capacity of local institutions. This will be critically important in securing Haiti's future development.