I write about this with some ambivalence. Having been recently to Haiti for a reporting project on the aftermath of the earthquake, this book was a valuable first guide. It starts out very strong, evoking the carnage, the initial pulling together, and the incredible efforts of relief workers to save lives and locate bodies. There are some extremely moving essays by witnesses, many of them medical workers whose life work has been ruined or badly damaged. The death toll was almost unprecedented, some 300,000 died within the first weeks - it was one of the only recorded major earthquakes ever to occur in a capital city at 7 on the richter scale.
The first days occupy 120 pages. At first, I was with it, but after 70 pages it was almost too much. The book then degenerates into a helter skelter commentary that mixes policy, individual medical cases, and the personal efforts of the author, Dr. Paul Farmer of Harvard University. It is part lament, part prescription, part cry of anguish, part triumph, but leaves the terrible question of what can really be done. Not only is it difficult to get a clear idea of what is happening, but there are gaps in coverage, outdated observations, and factual errors. For example, in my reporting project, I was investigating the establishment an internal displaced persons camp, Corail, which was established as a temporary site but is becoming a permanent ghetto - they took homeless people there to avoid rain-induced mudslides, but it too is in a flood plane. Farmer said the project was considered and then unfortunately abandoned. Moreover, the role of the US military is barely covered, and they provided crucial rescue and medical services in the first 3 months, truly a triumph for American aid. Indeed, there is no clear idea about the policy questions raised, such as who was in charge, what the Haitian government did or could have done, and even what the options were. I know that it is easy to criticize in retrospect, that Farmer was pressed in the maelstrom of catastrophies about him, but I must mention these failures.
As I see it, there were several phases: 1) relief and rescue, body disposal, and peace keeping.; 2) preparing for the rainy season, largely by moving refugees into planned camps from makeshift ones; 3) redevelopment planning; 4) cholera outbreak; 5) stagnation of the effort. The most interesting part of the book for me was the example of Rwanda, where Farmer is also working to much greater success. Rwanda shows that positive outcomes are possible, though it is a cry of despair regarding Haiti. Now, a year after the book appeared, I can say from direct witness that not much more has happened.
I have no doubt that Farmer is a dedicated, indeed, great provider of services to those in need in lesser developed countries. That is why I feel reluctant to criticize this book, which has significant value as a first cut about what was done. But it is only a first step and badly incomplete. It is also written in his capacity as a deputy commissioner for the UN under Bill Clinton. As such, he had to be diplomatic and, I suspect, hold his punches. This is a pity.
Haiti represents a singular tragedy, in a nation plagued by mismanagement, greed, and rapine, the very definition of a predatory state. Only the victims are the citizens. As one observer said, the state isn't strong enough to do anything except exploit its own citizens. The earthquake caused so much damage in large part because the building codes were either ignored or circumvented by bribes. I left the country with great pessimism, at the paralysis of its leaders, the fragmentation of aid efforts, and the escalating violence in the streets. Farmer, who remains committed to the country, will no doubt continue his efforts. He is a remarkable public servant and I envy his intelligence and idealism, his sense of cause.