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HAITI: FROM RESCUE TO RECOVERY 

AND RECONSTRUCTION 

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.gov/congress/index.html 

COMMITTEE ON FOREIGN RELATIONS

JOHN F. KERRY, Massachusetts, Chairman

CHRISTOPHER J. DODD, Connecticut 

RUSSELL D. FEINGOLD, Wisconsin 

BARBARA BOXER, California 

ROBERT MENENDEZ, New Jersey 

BENJAMIN L. CARDIN, Maryland 

ROBERT P. CASEY, JR., Pennsylvania 

JIM WEBB, Virginia 

JEANNE SHAHEEN, New Hampshire 

EDWARD E. KAUFMAN, Delaware 

KIRSTEN E. GILLIBRAND, New York 

RICHARD G. LUGAR, Indiana 

BOB CORKER, Tennessee 

JOHNNY ISAKSON, Georgia 

JAMES E. RISCH, Idaho 

JIM DEMINT, South Carolina 

JOHN BARRASSO, Wyoming 

ROGER F. WICKER, Mississippi 

JAMES M. INHOFE, Oklahoma 

DAVID MCKean, Staff Director

KENNETH A. MYERS, JR., Republican Staff Director

(II)

C O N T E N T S 

Page 

Dobbins, Hon. James, director, International Security and Defense Policy 

Center, National Security Research Division, RAND Corp., Washington, 

DC .......................................................................................................................... 14

Prepared statement .......................................................................................... 18 

Response to question submitted for the record by Senator Robert P. 

Casey, Jr. ....................................................................................................... 44 

Farmer, Dr. Paul, U.N. Deputy Special Envoy for Haiti, Boston, MA ................ 6 

Prepared statement .......................................................................................... 9 

Francois, M. Rony, M.D., incoming director of public health, State of Georgia, 

Atlanta, GA ........................................................................................................... 21 

Prepared statement .......................................................................................... 24 

Kerry, Hon. John F., U.S. Senator from Massachusetts, opening statement ..... 1 

Lugar, Hon. Richard G., U.S. Senator from Indiana, opening statement ........... 4 

ADDITIONAL PREPARED STATEMENTS SUBMITTED FOR THE RECORD

Christopher J. Dodd, U.S. Senator from Connecticut ........................................... 31 

Kirsten E. Gillibrand, U.S. Senator from New York ............................................ 43 

U.N. Human Settlements Programme, UN-HABITAT, submitted by Christopher W. Williams, Washington, DC ................................................................ 44 

National Haitian America Elected Officials (NHAEON), submitted by State 

Representative Marie St. Fleur, Boston, MA ..................................................... 46 

International Housing Coalition (IHC), Washington, DC .................................... 47 

Habitat for Humanity International submitted by Chris Vincent, director, 

congressional relations/international affairs, Washington, DC ........................ 48 

InterAction, A United Voice for Global Change .................................................... 50 

(III)

(1) 

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 of the 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 into— 

we 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 reality 

is, we are. 

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 being pulled 

out alive, just a little more than 2 weeks after the earthquake. 

2 

It’s impossible not to be moved by the suffering, but also by the 

resilience and the dignity of the Haitian people. 

It’s our duty, as neighbors, and, frankly, as fellow human beings, 

to respond to this tragedy. And that responsibility does not 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 closely— 

my staff, myself—with dozens of families in Massachusetts to expedite the adoptions of Haitian orphans that were already underway 

before the earthquake. 

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 DeLong, who 

lost her life, then to recognize the enormous loss suffered 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 perVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
3 

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 foundation— 

physical, 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 Rene ́ Pre ́val 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, security, 

and rule of law. 

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 days— 

I 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 De ́brosse 

Pre ́val, 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 impressive 

witnesses with deep knowledge of Haiti and the challenge 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 enorVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
4 

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 emergency 

assistance to Haiti was clearly warranted. The heroic 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 parents. The Secretary’s quick action on both provisions will ensure 

that 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 

5 

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 temporary 

resettlement of refugees, and provide assistance to Haitians 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 

6 

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 of bravery 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 people 

in the world would be so patient and calm in the face of so much 

suffering. This observation, though accurate, must not be misunderstood. People in Haiti are afraid, not only for their options 

and futures, but, quite simply, for their safety. 

7 

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. 

It is humbling to see the relief effort be so slow, in large part because 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. 

How will we fund such settlements, ongoing relief, the sewing of 

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; 

8 

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 U.N.—that 

a mere $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 is 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 physician 

and teacher at Harvard, I’ve been lucky to work with Partners in 

Health, the Clinton Foundation, and the Government of Rwanda in 

9 

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 of jobs 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 over— 

to 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 of what 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. PAUL FARMER, U.N. DEPUTY SPECIAL ENVOY FOR

HAITI, BOSTON, MA 

Thank you for inviting me to testify today before the Senate Committee on Foreign Relations. I speak as the U.N. Deputy Special Envoy for Haiti—President Clinton, as you know, is the Special Envoy—and 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 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, 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 flying from Port-au-Prince to Montreal on Monday, headed to a conference on coordinating responses to the 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 and 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. 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 about 5,000 employees, most of them community 

health workers. 

Of course, 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 colVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6621 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
10 

leagues, and I have been in the cities of Port-au-Prince, Jacmel, and Le ́ogaˆne, as 

well as the less-affected Central Plateau and Artibonite Valley. Everywhere we have 

seen acts of great bravery 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 people 

in the world would be so patient and calm in the face of so much suffering. This 

observation, though accurate, must not be misunderstood. People in Haiti are afraid 

not only for their options and futures, but still quite simply for their safety. A few 

nights ago, we sat in empty 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. 

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 from 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 will be difficult to manage, but we must hasten our efforts to get 

tents, tarpaulins, and latrines or composting toilets to Haiti. It is humbling to see 

the relief efforts be so slow—in large part because delivery of services was so weak 

before the quake. Now we must do 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 a 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. 

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, Spain, Brazil, the European Union, the Inter-American 

Development Bank, the World Bank, and others.1 Indeed, most countries have 

responded. Even in far away and once-afflicted Rwanda, a group of community 

health workers making less than $200/month have been able to pull together $7,000 

in donations 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. 

Even if adequate resources are available, the task before us will be extremely difficult. Medical jargon, though at times arcane, can be helpful here. Today, Haiti is 

facing what we would term ‘‘acute on chronic’’ problems. Before January 12, the 

country was already facing huge long-term challenges in public health and education, the unemployment rate over 70 percent, and a majority of its population was 

living on less than $2 a day.2,3 Food and water insecurity were already huge problems.4 Does this catastrophe create a chance for all of us to have a sounder, more 

solidarity-based relationship with Haiti? Or is it to be yet another chapter in a 

jeremiad of 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 and worrisome: despite $402 million pledged to support the Haitian 

Government’s Economic Recovery Program, when the country was trying to recover 

from a series of natural disasters resulting in a 15-percent reduction of GDP, it is 

estimated that a mere $61 million have been disbursed.5 In the Office of the Special 

Envoy, we have been tracking the disbursement of pledges, and as of yesterday we 

estimate that 85 percent of the pledges made last year remain 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.6

The aid machinery currently at work in Haiti keeps too much 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 the hemisphere 

11 

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 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. 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 reconstruction.’’ 9 A Such an account should be managed in collaboration with partners, the 

U.N., and, of course, Haitian leadership, which would work directly and openly 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 U.S. 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 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 Foundation in Rwanda (and in Malawi and Lesotho), I joined President Clinton 

6 months ago as his deputy in the U.N. role he originated. As Special Envoy for 

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 Citadel. 

This has been 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 most 

inside it perished on January 12. But the need for such investments, and the need 

for public works that would create hundreds of thousands of 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 

to shill for ‘‘cash for work’’ programs—for the quaint notion that people should be 

paid for their labor. Let us at least be honest: It is absurd to argue that voluntarism 

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 

achieve long-term benefits for Haiti. The UNDP is helping to organize programs of 

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. 

12 

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 of the social tensions that inevitably arise as 

half a million homeless people are integrated into new communities. 

Haiti needs and deserves a Marshall Plan—not the ‘‘containment’’ aspects of that 

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 which 

aid is delivered now as compared to in 1946—well before the term ‘‘beltway bandits’’ 

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 

plan that uses a pro-poor, rights-based approach based on something far different 

from the charity and failed development approaches that have marred interactions 

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 

people: social and economic rights, reflected, for example, in job creation, local business development, watershed protection (and alternatives to charcoal for cooking), 

access to quality health care, and gender equity. Considering all these goals together orients our strategic choices. For example, cash transfers to women, who hold 

the purse strings in Haiti and are arbiters of household spending, will have significant impact. This is a chance to learn and move forward and build on lessons 

learned in adversity—to build hurricane-resistant houses with good ventilation to 

improve air quality from stove smoke; to build communities around clean water 

sources; to reforest the terrain to protect from erosion and to nurture the fertility 

of the land for this agriculturally dominant country. It is the chance to create shelter, 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. 

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 of what we are now experiencing. Many people look at Haiti and despair. They say that aid is wasted, that there is no hope for this country. I would 

answer them with the positive experience of building Haitian-led programs in the 

Central Plateau and Artibonite Valley regions that have created 5,000 jobs for people who would otherwise have no steady work. I advance this model not because 

it is associated with our efforts, but because job creation is the surest way to speed 

up the cash flow that is essential now. It is also the fastest way to make amends 

for 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 potential of our support to help rescue and transform our poorest neighbor. The 

response from citizens of the United States to the recent events in Haiti has been 

overwhelming and encouraging. There is the promise of solidarity by our leadership 

to make long-term commitments to the kinds of investments needed in Haiti—and 

to fulfilling them. 

For two centuries, 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. 

As I wrote with colleagues in a recent op-ed—which is available in my written 

testimony—as physicians working in Haiti, we know firsthand that Haiti itself will 

soon be the casualty if we do not help build back better in the way envisioned by 

Haitians themselves. 

———————— 1Walker, P. ‘‘Haiti Earthquake Aid Pledged by Country.’’ Guardian.co.uk 26 January 2010. 

Available at: http://www.guardian.co.uk/news/datablog/2010/jan/14/haiti-quake-aid-pledges-country-donations (accessed January 27, 2010). 2Flintoff, Corey. ‘‘In Haiti, A Low-Wage Job Is Better Than None,’’ All Things Considered, 

June 14, 2009. Available at: http://www.npr.org/templates/story/story.php?storyId=104403034 

(accessed January 27, 2010). 3 In 2006, the World 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). Available at: http://siteresources.worldbank.org/INTHAITI/Resources/Haiti.AAG.pdf (accessed January 26, 2010). 

13 

4For an overview of Haiti’s water insecurity and past delays in international commitments 

to address this crisis, see Varma MK, Satterthwaite ML, Klasing AM et al. Wo`ch nan soley: 

The denial of the right to water in Haiti. Robert F. Kennedy Memorial Center for Human 

Rights, Center for Human Rights and Global Justice at NYU School of Law, Partners In Health, 

and Zanmi Lasante, 2008. Available at: http://www.chrgj.org/projects/docs/wochnansoley.pdf 

(accessed January 27, 2010). 5This estimate of disbursements was prepared in January 2010 in an internal memorandum 

of the U.N. Office of the Special Envoy For Haiti. President Clinton, in his capacity as U.N. 

Special Envoy, frequently appealed to donors to fulfill their commitments. See Helprin J, ‘‘Bill 

Clinton Chides Nations Over Help to Haiti.’’ Associated Press, September 9, 2009. Available 

at: http://www.newsvine.com/lnews/2009/09/09/3243861-bill-clinton-chides-nations-over-help-forhaiti (accessed January 27, 2010). 6Farmer, P. ‘‘Challenging Orthodoxies: The Road Ahead for Health and Human Rights.’’ 

Health and Human Rights: An International Journal 2008; 10(1): 5-19. 7Daniel, Trenton, ‘‘Bill Clinton Tells Diaspora: ‘Haiti Needs You Now,’ ’’ Miami Herald, August 

9, 2009. Available at: http://www.miamiherald.com/news/americas/haiti/story/1179067.html 

(accessed January 27, 2010). 8Farmer P, Smith Fawzi MC, and Nevil P. ‘‘Unjust Embargo of Aid for Haiti.’’ The Lancet 

2003; 361: 420 423. 9Sachs, J. ‘‘After the Earthquake, How To Rebuild Haiti From Scratch.’’ Washington Post, 17 

January 2010. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/ 

AR2010011502457.html (accessed January 27, 2010). 10 Republic of Rwanda, Ministry of Health, and Partners In Health. ‘‘African Rural 

Healthcare: An Evaluation of the South Kayonza, Rwanda Project’’ (2005–2011). Programme Report, Ministry of Health, 2006. 11 United Nations Development Programme. ‘‘Human Development Report: 1997.’’ New York: 

Oxford University Press, 1997. 146–148. Available at: http://hdr.undp.org/en/media/hdrl 1997lenlindicators1.pdf (accessed January 27, 2010). 12 Republic of Rwanda. ‘‘Rwanda Vision 2020.’’ Kigali: Ministry of Finance and Economic Planning, Republic of Rwanda, 2002. Available at: http://www.cdf.gov.rw/documents%20library/ 

important%20docs/Visionl2020.pdf (accessed January 27, 2010). 

[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 

are useful in diagnosing what is happening in Haiti and in setting a path. In the 

coming weeks, there will be scores of prescriptions for Haiti, but there must also 

be diagnoses, too. What is going on right now would be described in clinical terms 

as an ‘‘acute-on-chronic’’ picture: Haiti’s majority has long been dealing with serious 

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—miraculous 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 hospital— 

and 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 general 

hospital reveal: In the space of less than a week, the hospital, run by local 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. 

This disaster has brought together goodwill and interest in Haiti such that for the 

first time in the country’s history, there may soon be enough surgeons and trauma 

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 of violence, 

what strikes many of us is the overall sense of calm: Former President Clinton, 

14 

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. 

A young Haitian colleague, already on the faculty of Harvard Medical School, 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 housing in Haiti is now worsened by the acute problem of half a million newly homeless. 

In 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 

of Haitians is busy raising funds) has a lot to offer beyond material assistance. One 

post-surgical ICU doctor, Dr. Ernest Benjamin, wrote to his home institution in New 

York to say that ‘‘at last this is starting to look like a functioning hospital.’’ 

He and other Haitian professionals living in the United States—Haitian physicians and nurses are a powerful force there—have much to offer a large-scale rebuilding effort if it 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. 

First, long-term lack of coordination of relief and reconstruction efforts will be 

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. 

One potential model of recovery for Haiti is the nation of Rwanda. After the 1994 

genocide, Rwanda was overwhelmed by the international helping class, which included, in addition to many people of good will, a flock of trauma vultures, consultants 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 

private actors, and contributed to Rwanda’s remarkable post-genocide stability and 

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 Haiti 

and can draw on local knowledge and local hands to respond to the immediate needs 

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. 

Fifth, we must make sure that deportation of Haitians from the United States 

and elsewhere stops. 

Prescriptions for Haiti will be bountiful from outside, but we must ensure that 

the prescriptions are correct. Haiti needs a different kind of assistance, one built 

on solidarity and respect and rooted in what the Haitian people want for themselves. Assistance offered now must develop food sovereignty for Haiti and investment in the rural area, now seeing an influx of those displaced from the capital. 

The next few weeks will reveal some sense of the long-term prognosis for the reconstruction 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. 

15 

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 peace— 

of 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. 

In 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 operations with which I became associated, including Somalia, early in 

the decade, then Bosnia and Kosovo, and, finally, Afghanistan, on 

behalf of the Bush administration. And since leaving office, I’ve 

had an opportunity to reflect not only on that American experience, 

but also on a dozen or more U.N. and other operations 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 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 

succor over the last 2 weeks to recognize its essentially peaceful 

character. Haiti is no Somalia, Iraq, or Afghanistan. 

16 

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 contingent 

there. We have a unique attribute to draw on, which is a number 

of Haitian-American 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 promised 

to restore a freely elected President and then to keep American 

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 potential to promote growth and social justice, but on their capacity 

to ease tensions in the society and promote reconciliation 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 going 

to flow into Haiti in the coming weeks, and the temptation will 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 proVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00020 Fmt 6633 Sfmt 6602 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
17 

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 not 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 spent. 

Seventh, 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 inVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00021 Fmt 6633 Sfmt 6602 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
18 

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 SECU- RITY 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, 

it is important torecognize that one now has an international disaster relief operation superimposed on top of a preexisting post-conflict reconstruction mission. The 

earlier of these two operations began in 2004, when American and then-United 

Nations troops assumed responsibility for security in Haiti. 

Of the two operations, humanitarian relief is clearly the more urgent, but post 

conflict stabilization and reconstruction is ultimately the more important. One intends to restore Haiti, the other to transform it. 

The ultimate aim of any post conflict mission is to leave behind a society better 

able to look after itself. Usually this means the ability to manage political domestic 

competition in ways that do not spill over into violent conflict. In Haiti’s case, the 

objective must also be to improve that society’s capacity to deal with the sort of natural 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 of its 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 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. 

First, the final departure of ex-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 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 barriers to progress. 

My personal experience 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 reconstruction missions across each of these American-led interventions, plus a larger number 

19 

of U.N.-led operations. Based on this body of work, I offer the following suggested 

guidelines for future aid to Haiti. 

First, security is an essential prerequisite to reform, as it is to private investment. 

In the absence of security, any positive changes will eventually be washed away. 

Fortunately, Haiti is not a difficult society to secure. Contrary to the 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 succor over the past 2 weeks to recognize its essentially peaceful nature. Haiti is 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 of American police to the U.N. international police contingent. In doing so, the United 

States should draw, in particular, on Creole-speaking Haitian-American policemen 

from places like Miami and New York. 

Second, stabilization and reconstruction operations take time. The 1994 Americanled international 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 promised to restore a freely elected 

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 promised to do this all within the space of 2 years. This his administration preceded to 

do, hitting every benchmark, achieving every target, and suffering almost no casualties in the process. But 2 years was too short a time to fix a society as troubled 

as Haiti’s. In the end the 1994 intervention accomplished little of lasting value. 

Recent post-conflict stabilization and reconstruction operations have been lasting 

8 to 10 years. The current effort in Haiti began in 2004, but the country has since 

suffered devastating flood damage and now the earthquake. The clock on this 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 

programs need to be evaluated not just on their potential to promote growth and 

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 programs may be less. This means that programs to relieve poverty and create jobs will 

be a necessary part of any larger aid effort, even if their immediate impact is 

ephemeral, for without such visible signs of progress, significant elements of the 

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—security, 

power, water, health and education—to the vast majority of its people. Haiti is, for 

instance, the only state in the entire Western Hemisphere that does not provide free 

primary education to most of its children. 

The urgency of the immediate crisis requires that donor countries themselves 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 infrastructure—hospitals, schools, roads, electricity, telephones 

and government buildings. But these institutions should not be rebuilt on the old, 

inefficient, corrupt foundations. Rather the scale of this disaster offers the opportunity to accelerate long planned, oft delayed reforms in each of these sectors. 

The port of Port-au-Prince has, for instance, long had the highest cost per ton in 

the hemisphere despite having the lowest wage rate. We should help rebuild this 

port, but not with the same grossly inefficient management and distorted cost structure. 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. 

20 

Large amounts of American and other donor money will flow into Haiti in coming 

weeks. The temptation will be to spend most of it on American and foreign NGOs 

that can deliver essential services with fair reliability and good accountability, 

which Western legislators insist upon. But this sort of aid leaves behind no lasting 

local capacity to sustain those services. The second priority will be on bricks and 

mortar construction. This too will leave the underlying Haitian institutions 

unaltered. Such aid should, thus, be oriented to the extent possible on enhancing 

Haiti’s capacity to govern. This means providing the Haitian Government the 

wherewithal to hire well qualified staff at competitive wages, and programs to further train such staff and provide them the information systems and other support 

service needed to maximize their efficiency. 

Fifth, the Haitian state should be built from the bottom up as well as the top 

down. This means assistance to mayors and local councils, and funding which will 

allow key government agencies to establish a presence beyond Port-au-Prince. For 

decades the population has moved off the land and into the big cities, particularly 

the capital. This exodus has now, as a result of the earthquake, been reversed. 

Assistance efforts should be designed to help those who have left the city to find 

a livelihood in the countryside, rather than return to the shanty towns from whence 

the have fled. 

Sixth, the U.S. Government needs to organize itself for a sustained high-intensity 

effort to promote these reforms. The President and Secretary of State should invest 

a single individual with authority and responsibility for Haiti comparable to 

that Ambassador Richard Holbrook 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, etc., 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 ensure that this money is 

carefully targeted and well spent. 

Seventh, it is important that the international program to reform Haitian institutions not bear a made-in-Washington imprint. Large-scale international assistance 

will carry with it significant leverage to promote change, but this pressure needs 

to be exerted in a carefully calibrated manner. Candidate programs for reform need 

to be carefully chosen, local champions identified and empowered, local opponents 

co-opted, politicians lobbied and the public informed. The United Nations and the 

World Bank, the two major international institutions most heavily engaged in Haiti 

should be out in front, choosing and designing the necessary reforms and conditioning assistance on their achievement. The United Nations should continue to lead 

in reforming the security sector, to include police, courts and prisons, and in supporting elections and promoting political reform. The World Bank should assume 

leadership throughout the economic and social sphere, identifying the key changes 

needed and setting the conditions for assistance. The United States should work in 

concert with the other key donors, particularly Canada, France and the European 

Union, forming a small core group to quietly help the U.N. and the World Bank define their reform objectives and then working largely behind the scenes to ensure 

these objectives are achieved. The United States should contribute directly to U.N. 

and World Bank funds for Haiti, and should make sure that its own bilateral programs, and those of other donors contribute to, rather than undercut the reform programs set out by these institutions. 

Finally, there are a couple of things that the United States is uniquely positioned 

to do by reason of its proximity to Haiti. These involve trade and immigration. 

In 2006 Congress passed legislation providing Haiti uniquely generous but timelimited access to the U.S. market. As with the U.N. peacekeeping mission, the time 

clock on this access should be set back to zero, recognizing that the earthquake has 

more than swept away whatever had been accomplished since these preferences 

originally went into effect. 

The United States should also consider temporarily raising its annual quota for 

Haitian immigration. Haitian society may be economically dysfunctional, but 

Haitian immigrants have, quite to the contrary, proved to be hard-working, familyoriented, 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 that they remit 

to relatives in Haiti is another dollar that does not need to come from the U.S. taxpayer. Expanding legal Haitian immigration thus seems a classic win-win 

proposition. 

The current crisis, though tragic, offers the chance to boost Haiti out of decades 

of 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. 

21 

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 Monday, 

I will be the director of public health for the State of Georgia. 

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. 

22 

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 l’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 promoters of agents—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 Haitian-Americans 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 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 

23 

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 year. 

But, that number would steeply decline, since many of the medical 

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 expertise 

and experience in law enforcement, corrections, and public 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 organizations. 

My 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:] 

24 

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 Georgia. 

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: (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 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 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 worked as an engineer in Port-au-Prince and 

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 

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 l’Hopital’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 were already inadequate. Construction from scratch might 

be considered. 

The source of the water supply might be adjusted after evaluation of the Cul-deSac Plain aquifer capacity and inventory of other reserves through groundwater 

25 

hydrology. Another very viable option is to tap in 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 primary 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 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 today, included a wide range of problematic issues that fall into the following categories: 

• Security Recommendations 

• Economic Development Recommendations 

• Disaster Preparedness/Environmental Rehabilitation 

Although Florida was the main partner for these projects, I would propose that 

these recommendations be adopted by 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 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 year, but that 

number will steeply decline since many of the medical schools were destroyed. 

What will happen to medical-students already enrolled? How will they complete 

their studies? Will opportunities to study abroad 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 expertise and experience 

in law enforcement, corrections, and public safety to assist the growth 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 of export opportunities for Haitian products would be primary goals. 

• The United Nations should begin now to assist Haiti’s Ministry of Commerce, 

Industry & 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 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 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 organizations. My personal hope is that a new generation of leaders will emerge from these ashes to selflessly lead Haiti onto a new 

26 

path of prosperity through integrity, hard work, transparency, perseverance, and 

true democracy. 

The CHAIRMAN. Thank you very much, Dr. Francois. 

In fact, thank you—thank you, all of you, for helping to really lay 

out the magnitude of the challenge here and put a lot of ideas 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 tight— 

obviously 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 I just 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 get 

the right kind of peanuts, multivitamins, other things that 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 

27 

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 

parts of the country, certainly, but also other parts of the world. 

So, 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 to— 

Who’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 here’’—you 

know, you begin to organize all of that. There are a lot of free actors floating around. Can you speak to this question of who’s going 

to both direct and enforce these rules of the road? And how do 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 I—it’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,’’ they’re 

called. There need—needs to be a really locally driven process 

there. And this may not be the most popular thing to say, but in 

1995, when Rwanda laid down the law, saying, ‘‘If you, 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 

28 

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 summary—— 

The 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 of it’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 generous, and it is the best-resourced thing the international community 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 is 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 your 

comments by citing a very interesting poll that appeared in this 

morning’s Miami Herald, with the headline ‘‘Haitian-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 Pre ́val’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 

29 

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 

Haitian-Americans do not see it as immaterial as to which party 

takes charge, they do believe that one or the other had better do 

so. 

The respondents to the poll also assert that President Pre ́val 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 I’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 plans 

that are in place in probably every State, is that you have an infrastructure 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 preparedness. 

And you can tell, from the lack of the response, that 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, 

30 

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 got there, 

late at night, we found—at 10 o’clock at night, we found the 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 government officials to give them a chance to respond, in addition 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. 

31 

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. 

I want to extend a special greeting to my good friend Dr. Paul Farmer. Paul has 

been active for years in helping the most vulnerable in Haiti and around the world. 

His organization, Partners in Health, is one of many already operating in Haiti that 

has heroically gone above and beyond the call to respond to this earthquake. 

We should begin by acknowledging that, aside from the monumental policy challenges 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, water, shelter, and medicine. 

The numbers merely hint 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. 

Haiti was just beginning to turn a corner toward a brighter future when this 

earthquake struck. Now, sadly, the Haitian people must once again start over. 

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. 

The United States Government must also act to help the Haitian people shoulder 

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. 

The U.N. would lead an international effort to help the Haitian people get back 

on their feet, assisting in the rebuilding of infrastructure, institutions, and lives— 

while working to ensure that those who have been driven out of their homes by the 

destruction of Port-au-Prince are resettled. 

I’ve also suggested that the Obama administration help to coordinate HaitianAmerican volunteers in the United States by forming Hometown Associations, small 

groups of community members who could use their unique experiences and skill sets 

to do things like serve as interpreters, support the temporary resettlement of refugees, and provide assistance to the most severely wounded Haitians who are evacuated to the United States for medical treatment not available on the island. 

For our part, I think Congress should focus on alleviating the economic crisis that 

lurks behind the immediate humanitarian crisis in Haiti. 

Senator Lugar and I will be introducing legislation this morning instructing the 

Secretary of the Treasury to work with other nations to relieve Haiti of their outstanding international debt, including debt incurred through 2011. Additionally, our 

legislation will help to spur economic activity, which is an absolutely essential element in the recovery process, by promoting trade between the United States and 

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. 

These are steps we can take right now to help Haiti rebuild and recover, and in 

my mind, they represent the beginning, not the end of our efforts. Over the 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. 

But we shouldn’t imagine that our work will be short or simple. This burden requires many shoulders. President Obama has already pledged the full support of the 

American people. Let us do the same. 

32 

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 

of 2 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 that— 

just putting people to work to clean up rubble, you could be paying 

people $2 or $3 a day, and doubling their income, just to create the 

arteries so that assistance can get to people at this particular 

33 

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 suggestion to be talking about, at least temporarily, some sort of receivership? 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 receivership 

for Haiti for the next 2 or 3 years so that we can, one, do 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 Timor—— 

Senator DODD. Right. 

Ambassador DOBBINS [continuing]. 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 existing government that was universally recognized. And so, I think that 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 of—— 

Senator DODD. It sounded like, in his poll that was conducted 

this morning—— 

Ambassador 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. 

34 

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 room— 

then—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 

I 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 DODD. 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 having 

been to Haiti in 1982. And I know that there are Americans 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 my 

friend from Connecticut. 

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 

35 

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. 

And I 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 I listen 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. 

36 

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 integrating 

that policy with other governments, representing it with 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 

of 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 panel—— 

The 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 opportunity for us, I think, to continue to put pressure—to make 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 your insights 

into this horrific human tragedy. I share my colleagues’ gratifiVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00040 Fmt 6633 Sfmt 6602 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
37 

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 diagnosing—— 

Senator 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 ‘‘l’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 morning. 

It was spotless. There were people lying on the floor who 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 

38 

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? Their— 

all 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 governance— 

assistance 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 Parliament—elections—I 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 going to 

fund public education in Haiti.’’ And Japan or the United States 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, 

39 

you know, an American czar who sits in Haiti and makes these 

kinds of decisions would probably be counterproductive. 

The CHAIRMAN. Senator—— 

Senator SHAHEEN. Yes. 

The CHAIRMAN [continuing]. 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. objectives internationally. And at a previous hearing, I raised the issue 

on gender-matters issues and how many of the countries that we 

do business with, their record on gender equality is very, very poor, 

and how can we focus our foreign aid program to be more effective 

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 can’t—governments are what they are. Yes, we can try to impact 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? 

40 

Ambassador DOBBINS. Let me offer a rather self-serving response 

to that. We don’t have a very introspective, reflective foreign-aid 

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 so— 

but 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, I—and 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. 

41 

The CHAIRMAN. Thanks very much, Senator Cardin. 

We’re on the back end of the vote here. We have a couple of minutes. I would just like to ask a couple of things. 

Some Haitians have complained that they haven’t heard or seen 

very much from President Pre ́val 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 Pre ́val 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. So—— 

The 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—again—— 

The 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. So—— 

The 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 is— 

you’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, again, 

I think this probably the wrong term, but it’s almost—it’s like a 

D-Day invasion. I mean, you’ve got to have so many moving parts 

coordinated, and you’ve got to come in there with a new city planning concept. You got to have a vision for what you want this place 

to look like. And what kind of government buildings? And where 

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 

42 

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 not— 

we need—this task is 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. 

I think 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 going 

to pull this together, because there is a willingness to put a 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 I just 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 is a very hopeful sign. 

43 

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’ll 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—if I 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

When a massive earthquake shook Haiti and its people on January 12, it left hundreds of thousands buried 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 units and supplies to help bring relief; and dispatched thousands of troops 

to help the Haitian Government securely provide these supplies. 

I am proud of the response of our government, our nonprofits, our faith-based 

organizations, and our communities. 

I share this commitment to help the people of Haiti in the wake of this unspeakable tragedy. In an effort to make it easier for American citizens to donate to disaster relief, I cosponsored legislation, which has become law, to waive tax deduction 

limits 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 was 

pleased to see that the Department of Homeland Security responded to our call, 

announcing humanitarian parole for children who have been legally confirmed as 

orphans and were in process for an intercountry adoption to the United States. 

In order to unite Haitian orphans with prospective American families while ensuring that children with existing Haitian families are not mistakenly taken from 

Haiti, I urged the administration to work with the families and the licensed adoption agencies in Haiti and the United States to complete all of the appropriate vetting as quickly and as carefully as possible. I also joined my colleagues in requesting 

Secretary Napolitano to work quickly to expand humanitarian parole to orphans in 

Haiti that have close family members in the United States. Finally, I have called 

for a moratorium on external debt that Haiti owes to the InterAmerican Development Bank. In the aftermath of the worst earthquake in Haiti in more than two 

centuries and with the world community focused on bringing the Carribean nation 

immediate relief and reconstruction efforts, Haiti must not be saddled with repaying 

its outstanding multilateral debt in the foreseeable future. As President Clinton, the 

U.N. Special Envoy for Haiti, has said, Haiti made a good beginning and was closer 

than ever to securing a bright future before the earthquake. Despite this tragedy, 

President Clinton still believes that Haiti can succeed. We all stand in unity with 

the Haitian people and remain hopeful that their country will recover, succeed, and 

overcome. 

The extreme loss of life and unimaginable hardship that many are experiencing 

from this disaster is heartbreaking and tragic. Many of these families have experienced far too much anguish already. My thoughts and prayers are with the families, 

both in the United States and in Haiti, affected by this disaster. 

44 

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 owes $441 million. 

It is my understanding that the multilateral lending institutions are discussing 

ways limit Haiti’s debt as a result of this catastrophe. In 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 circumstances, 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 organizations (NGOs) into the United Nations Flash Appeal. Specific proposals on shelter 

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 agency is exploring coordination 

mechanisms and identifying opportunities for partnerships with Haitian officials, 

international organizations, as well as citizen groups that have emerged to address 

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 housing is equitable, responds to the needs of those most vulnerable (informal settlements, displaced), and involves the affected communities in the rebuilding effort. 

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. 

45 

Self-Build and Re-use of Rubble: Despite the extent of devastation in an earthquake there is a surprising amount of reuseable materials that can be salvaged for 

the purposes of Haitians rebuilding their homes. Using rubble with earthquakeresistant technologies, the approach has proved highly effective when deployed elsewhere including by Pakistanis in the aftermath of the earthquake. The approach 

will provide a more durable solution that will resist rains and hurricane winds. It 

will avoid the logistical bottlenecks that Haitians may encounter if they rely solely 

on tents which may only arrive in great quantities at the beginning of the rainy 

season and won’t hold up. 

Shelter Resource Centers: The establishment of shelter resources centers, also applied effectively in other post-disaster situations, including Pakistan, provide demonstration, information, and technical assistance. They also double as community 

centers and can be used by shelter partners for the distribution of nonfood items. 

Cash-for-Work: Haitians are in desperate need for cash as most forms of employment have been destroyed, yet most Haitians are able and willing to work. Cashfor-Work systems can be put into place for the collection of rubble, both for relocating rubbish and for salvaging materials for housing reconstruction. 

Building Material Support: Haitians can use salvaged materials but they will also 

need roofing and other select building materials to reconstruct housing. It will be 

important during the recovery period for the international community and Haitian 

organizations to purchase materials. Haitians can use the shelter resource centers 

to disburse the materials at a subsidized rate or on a ‘‘material-for-work’’ basis. A 

related challenge will be congestion at the ports. The United States could make this 

a priority and expedite the delivery of needed building materials, as it is doing to 

distribute food. 

PHASE TWO (B): URBAN SYSTEMS RECOVERY

The earthquake, having devastated the city of Port-au-Prince, is perhaps the 

world’s largest urban humanitarian crisis. By its very nature it requires a comprehensive, urban systems management approach. This involves supporting simultaneously multiple delivery mechanisms including shelter, land, water, sanitation, 

urban safety, health and food. The challenge for recovery is coordination and identifying ways of managing expertise across various sectors in urban areas. UN–HABITAT views the first weeks following a disaster as crucial for supporting government 

and urban stakeholders to respond to the enormous urban rehabilitation 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 importantly, the wider economy of Haiti. An important proposal is investment Les Cayes 

and Cap Haitien as well as Port-au-Prince in seaports and free enterprise-zones that 

generate new manufacturing jobs. This would require substantial investment in infrastructure and housing, as well as job training and rapid skill development to support working people and their families. The development of multiple urban centers 

in Haiti will enable Haitians with support from the international community to reconstruct Port-au-Prince as a more efficient, sustainable, and better serviced municipality, thereby reducing precarious settlements on hillsides. 

INSTITUTIONAL OVERVIEW

UN–HABITAT is the agency of the United Nations responsible for housing and 

urban development, and for assisting Member States to achieve Millennium Development 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 settlements 

and slums. The United Nations estimates that at current rates of growth, there will 

be 2 billion slum dwellers by the year 2030. Simply stated, one in three of humanity 

will be living in urban slums. 

With headquarters in Nairobi, Kenya, UN–HABITAT maintains field operations 

in 87 countries managed by regional offices in Japan (Asia and Pacific), Brazil 

(Latin America and the Caribbean), Poland (Eastern Europe), Kenya (Africa/Arab 

States), and Habitat Program Managers in 40 country offices through a cooperation 

agreement with its sister agency, UNDP. The organization is a member of the U.N. 

Chief Executive Board, Inter-Agency Standing Committee of Humanitarian Agencies, United Nations Development Group, Commission for Africa, WHO Commission 

46 

for Social Determinants of Health, and the Commission for the Legal Empowerment 

of the Poor, among others. 

UN–HABITAT advances shelter and urban development strategies by providing 

policy advice, technical assistance, and credit enhancements to governments, municipal authorities, private companies, and NGO/CBO partners in a wide range of countries. These include emerging market economies such as Brazil, Russia, India, 

China, and South Africa, as well as low-income and very-low-income countries in 

Africa, Asia, and Latin America. The organization also works with countries in conflict, post-conflict and post-disaster situation in Iraq, Afghanistan, Pakistan, Liberia, 

Sudan, tsunami-affected Asian countries, West Bank and Gaza with a combined 

project portfolio of $800 million. The Governments of Japan, Sweden, Norway, 

Spain, Bahrain, Italy, Canada, and the United States provide annually both general 

and special purpose support. 

HUMANITARIAN ASSISTANCE

UN–HABITAT is principal member of the Inter-Agency Standing Committee for 

humanitarian operations (IASC) chaired by the Office of the 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 IASC 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 emergency 

disaster situations. Of particular relevance to ongoing crisis in Haiti is the response 

strategy deployed by the UN–HABITAT in Pakistan in the aftermath 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, diplomatic, security, economic, and human rights issues that impact 

Haiti. There are 21 Haitian-American elected officials in NHAEON representing six 

states—Florida, Illinois, Massachusetts, New Hampshire, New Jersey, and New 

York. NHAEON, in collaboration with the National Organization for the Advancement of Haitians (NOAH), submits the following request for coordinated and substantive Haitian-American involvement in the Haiti Relief Effort. 

BACKGROUND

An earthquake of 7.0 magnitude hit Haiti on January 12, 2010. Its epicenter was 

primarily in the capital, Port-au-Prince. Nevertheless, the devastation caused by the 

earthquake and its ensuing aftershocks stretch well beyond Port-au-Prince. Carrefour, Delmas, Petionville, Leogane, Croix-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 response 

to this tragedy. Our government’s swift, focused and unequivocal support for the 

Haitian people and its commitment to provide relief have set the tone for this international emergency relief operation. As well, the Haitian-American community appreciates the authorization of Temporary Protective Status (TPS) for undocumented 

Haitians 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 that the governance of Haiti is not very strong. However, the Government 

of Haiti is a recognized and democratically elected body. We categorically oppose the 

concept of a receivership for the state of Haiti. We believe that our American Government must play a significant role in accompanying the Haitian Government in 

its journey to build a stronger and much more predictably functioning state apparatus and to rebuild the country. American ingenuity and determination, properly 

47 

directed, will allow us to chart a course that will support the strengthening of democratic institutions. We know strengthening democratic institutions can be realized 

by directing technical and financial support with clear measurable goals and objectives (i.e., the role of Partners In health and the Inter-American Development 

Bank). The United States is particularly well-suited to help Haiti because it is home 

to the greatest number of Haitian professionals across all disciplines. These HaitianAmericans are passionate about Haiti and ready to actively participate in setting 

forth the vision of a rebuilt-Haiti and the implementation of that vision. As well, 

we, as Haitian-Americans have the direct connections with Haiti, we are connected 

culturally, linguistically and in many case, we have a financial stake in getting the 

rebuilding of Haiti right. 

2. The allocation and distribution of foreign aid must be reformed so that it is 

also aligned with supporting building capacity in the state of Haiti and its civil institutions. Given the emergency situation that exists on the ground in Haiti, we respectfully request that Foreign aid be distributed directly to or through the Haitian 

Government with clear objectives and accountability measures to support the capacity of its ministries and departments. Such an approach will strengthen the functional capacity of ministries such as the Ministry of Health, Education, Transportation, Energy, Environment and others. In addition to the ministries, there is a 

governmental system in place that includes the heads of the 10 departments of the 

country, the mayors of the various municipalities and, among local elected officials, 

there are azecs and kazecs that serve the population as recognized elected officials. 

The full utilization of this existing system makes distribution of relief much more 

efficient and will strengthened these institutions as we move forward toward reconstruction. 

3. The People of Haiti and Haitian-Americans must have an integral role in the 

recovery and rebuilding of Haiti. There are approximately 2.5 million Haitians and 

Haitian-Americans who were born in Haiti, living here in the United States of 

America. This group has sired approximately 5 million Haitian-Americans born in 

the United States. Haitian-Americans are appreciative of the enormous outpouring 

of support from our American Government and our fellow Americans for the people 

of Haiti. We are proud of the role that our Armed Forces and medical professionals 

are playing on the ground to assist the devastated people of Haiti. However, Haitian-Americans grow increasingly frustrated watching the continual deterioration of 

an already devastated country without access to direct avenues for their time and 

talent to mitigate the suffering of the Haitian people and to help with the recovery 

of Haiti. Therefore, we respectfully ask for inclusion as a direct partner in the planning now underway for the recovery and rebuilding of Haiti. 

Thank 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 in 

Haiti with a particular focus on the impacts of the disaster on housing and critical 

residential infrastructure. The situation is desperate, as we all know, and efforts are 

now rightly focused on immediate relief, life-saving medical care, critical food and 

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 population, but 

the country’s long-term social and economic viability. Experience around the world 

shows that the post-disaster rescue phase quickly morphs into recovery and then reconstruction. This process will happen in Haiti with or without the support of the 

international community and a comprehensive reconstruction plan. 

The U.S. Government (USG), along with other parties, has a critical role to play 

in making reconstruction resources available quickly. These resources must be used 

in a strategic way to steer the reconstruction process in a positive direction. They 

must be used equitably and efficiently to shelter families and reestablish communities 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 development, health, 

and security, and investments in other sectors are compromised when recipients 

lack safe and secure shelter. The importance of shelter cannot be overstated given 

the physical and psychological toll that the earthquake has taken on the population 

in and around Port-au-Prince. 

48 

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 position to 

pool funds from the United States and other donor agencies to maximize impact, 

coordinate shelter construction with infrastructure provision, and build linkages 

between reconstruction and local investment. It would promulgate and monitor 

minimum standards for construction. Successful housing reconstruction requires 

effective public administration and management. Areas not suitable for 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 provided 

support. As a practical matter most housing will be provided by the homeowners 

themselves and much of this will involve the incremental rebuilding of remaining 

structures or improvement of the temporary/transitional shelter received in the 

early days of the relief effort. Assistance for home reconstruction must provide 

creative incentives for families and others to build using materials and techniques 

that increase resistance to future disasters, while still providing opportunities for 

small-scale builders, for self-help construction, and for efforts by community 

groups and cooperatives. 

• Ensure that housing and infrastructure reconstruction efforts support and enhance local 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 RELATIONS/INTERNATIONAL AFFAIRS, 

WASHINGTON, DC 

BACKGROUND

Habitat for Humanity International (HFHI) was founded in 1976 as a nonprofit, 

ecumenical Christian housing ministry. Today Habitat operates in 94 countries, has 

about 2,400 registered affiliates, and has built nearly 300,000 houses worldwide, 

providing simple, decent, and affordable shelter for more than 1.5 million people. 

HFHI is one of the most recognized, well respected, and largest charities 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 people 

vulnerable to or affected by disasters. As a result of lessons learned in responding 

to major disasters for more than 10 years, such as the Asia tsunami and Hurricane 

Katrina, Habitat has developed disaster response systems that enhance its capacity 

to respond to disasters. Habitat employs these systems to monitor emergencies, to 

perform needs assessments, and to design programs for sheltering and housing recovery. Disaster Response also builds the capacity of the global Habitat community 

in the areas of disaster mitigation, preparedness, and recovery through education, 

training, and partnerships. 

HFH Haiti has been assisting vulnerable people with their shelter needs since 

1982 through various types of housing support. Support has included basic shelter 

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 from Habitat for Humanity International (HFHI or Habitat) is currently in 

Haiti working with local Habitat staff to assess local capacity, reestablish operVerDate Nov 24 2008 14:16 Dec 09, 2010 Jkt 000000 PO 00000 Frm 00052 Fmt 6633 Sfmt 6621 S:\HEARING FILES\2010 ISSUE HEARINGS TO PREPARE FOR PRINTING\ISSUE HEARIN
49 

ations, and carry out an assessment of damage to the shelter sector. The extent of 

the damage is yet to be tallied, but early estimates are of 1.5 million people homeless as a result of the earthquake. This is at least five times the magnitude of the 

2008 hurricane. 

HFHI is closely coordinating its disaster response with both multilateral and private agencies. Recent meetings include daily meetings in Port-au-Prince of the UN– 

OCHA sponsored Shelter Cluster led by IOM; daily calls with USAID; participation 

in the Shelter and Water/Sanitation strategy session at the Clinton Global Initiative 

meeting on January 19, 2010, in West Palm Beach, FL; 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—‘‘building 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 upon fundraising 

efforts currently underway. Following the 2006 tsunami in Asia, Habitat raised $78 

million and served 25,000 families with shelter assistance. 

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 

immediate repairs or construct emergency shelter. Materials in the kit include a 

bucket, tarpaulin, wire, rope, pry bar, mason’s chisel and trowel, gloves, nails, hammer and saw. The kits will be distributed by Habitat employees and partners with 

distribution beginning as early as this week. 

Phase II—Rehabilitation and cleanup. Habitat will mobilize people to remove debris, salvage materials that can be reused, and assist in rehabilitating homes that 

can be repaired. These activities could include a ‘‘cash for work’’ component providing local, able-bodied people with the tools and means to help with the recovery 

and earn a small amount of money for meeting other basic needs. 

Phase III—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 quality. These 

houses can be added to over time, providing an immediate solution along with the 

beginnings of a permanent home. The core transitional shelter unit will adhere to 

international Sphere standards, with living space for the average Haitian family of 

five. 

Additionally, Habitat plans to implement its recovery project through Habitat 

Resource Centers that provide technical assistance and support to restoration of the 

construction sector as well as direct housing production. Habitat Resource Centers 

support housing development and improvements, identifying gaps in the local supply of housing materials, designs, finance and skills and addresses them in ways 

that support local livelihoods. Throughout, Habitat will cultivate partnerships with 

local residents and other humanitarian organizations that can multiply the effectiveness of its response. Habitat is looking into ways to stimulate the low-income 

housing sector longer term, such as technical support and loans to small enterprises, 

and 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 temporary to transitional shelter as the preferred intervention. Temporary shelter costs are substantial and the money often does not translate into an investment for the affected individuals; by contrast, transitional shelter costs are comparable to temporary shelter costs and constitute an investment. Additionally, there is a capacity-building potential of transitional shelter, supporting expertise in the local population and potential for local employment. Thus, the USG should work to focus 

time and attention on the issue of transitional shelter, working to ensure that 

when possible resources are not wasted building temporary encampments that 

will remain for years to come, but that resources are spent working to create transitional shelter solutions that will allow families to remain as close as possible to 

their community and invest in shelter solutions for the long term. 

• 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 possible 

and within natural or expected growth corridors. 

50 

• 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 capacity and expertise on shelter and housing within USAID, the State Department and other agencies responding in Haiti. With U.S. Foreign Assistance lacking a shelter and housing focus to any significant degree on an ongoing basis, enhancing current staff 

and expertise will be essential. More specifically, USAID 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 

funding appropriated by Congress for Haiti focusing on the long-term needs must 

include specific language to ensure funding for programs to support transitional 

shelter and 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 rebuilding Portau-Prince that recognizes that the most vulnerable families have 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 U.S. 

NGOs to ensure coordinated and equitable access to points of entry for material 

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 improving daily. In support 

of the Haiti response, InterAction members—U.S. nonprofit humanitarian 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 Monday, January 26, with the number expected to rise in the coming weeks. NGOs in 

the InterAction network have several thousand staff on the ground responding to 

needs. In typical NGO fashion, the vast majority of these staff are Haitian nationals. The situation that these staff are confronting is profoundly challenging, with 

conditions on the ground changing day by day. 

INTERACTION NGO RESPONSE

Over 82 InterAction members are responding to the needs. Examples of the efforts 

of humanitarian response professionals include: 

• 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 supported the 

medical treatment of 2,200 people in Leogane 4 days after the initial earthquake. 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 Management System (SCMS) project team in Haiti which began shipments of emergency medicines and supplies to Port-au-Prince Hospital. As of January 19, 

more than 40,000 pounds (18,000kg) of medicines and emergency medical supplies 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 are working side by side with local youth groups, former street children, 

and NGO 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 experience 

working with local staff in rural areas in Haiti and good connections with local 

51 

authorities and communities to transition its development program into emergency relief activities. 

SITUATION ON THE GROUND

Everything must be brought to Haiti through the airport and port, or by road 

from the Dominican Republic. In the first week of the disaster, the airport was inundated with supply and personnel planes for the U.S. military and humanitarian 

agencies—causing a logistical bottleneck. The airport congestion has been ameliorated and the number of planes landing has increased but the demand remains 

much greater than the airfield’s capacity to receive and discharge aircraft. Access 

to Port-au-Prince by ship was almost completely cut off and has only recently been 

partially restored with differing reports of its current capacity ranging from 10–40 

percent. The extensive destruction of infrastructure, particularly roads, continues to 

make access to the affected population especially challenging. 

After dealing with the immediate tragedy of staff losses and the need to locate 

the lost family members of staff, the NGOs on the ground faced further logistical 

problems due to shortages of funds and available cash. Over the last 2 weeks some 

banking services have resumed and fuel is available at many gas stations, but other 

needs for basic services continue; the most urgent priorities are water, food, health 

care, and shelter. While urgent surgical needs are decreasing, post operative care 

is an important concern. In addition, experts have estimated that there are currently approximately 63,000 pregnant women in Port-au-Prince, and 15 percent of 

them are likely to face life-threatening complications. This week attention has increasingly turned to the need to provide shelter for the approximately 1 million Haitians 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 provide 

immediate relief once they arrive and are erected those housed in tents will remain 

vulnerable in the upcoming rainy and hurricane seasons. Conversations have begun 

among the NGOs and with USAID and the U.N. about the need for transitional 

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. InterAction continues to stress that international adoption should not 

be the first response to helping protect and care for vulnerable children. Following 

the immediate provision of life-saving assistance to children, it is critical to identify 

and protect extremely vulnerable children from situations of potential exploitation 

or abuse. Tracing family members and reuniting children with existing relatives is 

the best solution for vulnerable children in post-crisis situations. It is extremely difficult to determine whether children truly are orphans in many cases, and it often 

takes considerable time to fulfill the legal requirements for adoption of both the 

United States and the child’s country of origin. (For more information, visit the 

InterAction Web site: http://www.interaction.org/article/international-adoption-andhaiti-after-earthquake.) 

U.N.–U.S. GOVERNMENT COORDINATION

A high level of coordination between U.S., international and military actors is critical to meeting the array of challenges on the ground. Throughout the last 2 weeks 

both 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 activated within a week of the disaster; 12 clusters focusing on camp coordination and 

management, education, shelter, food, logistics, nutrition, protection, water and 

sanitation (WASH), agriculture, early recovery, emergency telecommunications, and 

health are serving as the internal coordination mechanism for the U.N./NGO effort. 

The clusters are holding regular meetings to coordinate their joint efforts. To support response efforts, six clusters have been mobilized in the Dominican Republic. 

Furthermore, InterAction has been in close communication with the office of the 

U.N. Special Envoy to Haiti, former President Bill Clinton. On the U.S. Government 

side, USAID—through the leadership of USAID Administrator Rajiv Shah and its 

Office of Foreign Disaster Assistance (OFDA)—has provided NGOs with superb access and support at the highest levels. Within a few days of the disaster, USAID 

approved 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 up and staff this coordination cell. To further 

improve coordination between the NGO community and the U.N., the cell will be 

52 

colocated with the U.N. coordination office staffed by OCHA. These humanitarian 

professionals will free up emergency responders to focus their energies on saving 

lives 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 

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 the 

efforts of the U.N. peacekeeping mission in Haiti (MINUSTAH) to provide muchneeded security for relief distributions. Last week, it was reported that tens of thousands of MREs (meals-ready-to-eat) and rations of water were distributed to desperate earthquake victims at a golf course inside Port-au-Prince. This is but one of 

the numerous examples where the 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 commitment of the administration to seek necessary funds from the Congress. Close collaboration 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. 

Æ