Oppression Disguised as Aid

The Colonial Legacy Behind Haiti’s Struggling Healthcare System

The Haitian revolution was the first successful slave revolt in history, which led to Haiti becoming the first Black republic to gain independence in 1804. Photo courtesy of thediasporaproject.co.uk

In rural communities in the United States, it takes an average of 34 minutes to reach the nearest hospital. In rural Haiti, the average is two hours. Infectious diseases including tuberculosis, cholera and HIV/AIDS go untreated due to the lack of basic healthcare infrastructure and the violence disrupting the provision of health services. The healthcare system of Haiti is, in effect, nonfunctional, and the problems that plague the system are linked to political instability and rampant violence.

A study conducted by researchers from Oxford University and the University of Miami reveals that healthcare workers and medical students are targets of violence. Healthcare workers are afraid to go to work and medical students are fearful for their safety, the future of healthcare is looking bleak. As a daughter of two patriotic Haitian parents, I have been raised to be a proud Haitian. It is painful to watch a country that fought for its independence with such bravery fall apart. To understand the predicament of violence and instability that so powerfully shapes the Haitian healthcare system, it is important to consider Haiti’s colonial history and legacy. The current crisis is a result of the social structures and institutions that have been strategically set in place by foreign nations to prevent the advancement of Haiti and maintain outside control.

Every day, Haitians, including children, are forced to flee through burning streets as gang violence continues to disrupt their lives. Photo by Ralph Teddy Erol, Reuters

Reparations, Occupation and Exploitation

Since the country’s independence, Western nation-states have repeatedly sabotaged Haiti’s development. In 1804, Haiti became the first Black republic to gain independence from European colonial control, following a successful revolution against the French led by enslaved people. Black people gaining victory over their oppressors was seen as a great threat by the West. The United States and Europe could not let the rest of the world see that Black people were capable of overthrowing European rule and governing themselves, so they found a way to keep the country on its knees. In 1825, the French forced Haiti to pay 90 million francs equivalent to 13 million euros/15 million in US dollars, not considering inflation, in reparations related to the loss of revenue from the productive labor of enslaved Haitians. In 1915, Haiti’s national sovereignty would be further undermined when the U.S. military invaded. Journalist Jennifer Bauduy, author of The 1915 U.S. Invasion of Haiti: Examining a Treaty of Occupation explains that during the 19-year occupation that followed, the United States infiltrated Haiti’s financial system, government, and military during the occupation, systematically violating Haiti’s national sovereignty.

Corrupted Regimes and the Deliberate Sabotage of Haiti’s Democracy

After the occupation, the United States continued to use Haiti as a pawn with a series of paramilitary regimes, manipulating presidents and the military as tools in service of a U.S. agenda. In 1957, the corrupt U.S.-backed Haitian army elected François Duvalier, who was succeeded in office by his son, Jean Claude Duvalier. As explained by legal scholar Jordan Dollar, the Duvalier regime relied on U.S. aid and military assistance to implement U.S. policies, for instance, by using forces like the Tontons Macoutes to crush protests against U.S influenced paramilitary rule, and supporting the U.S. fight against communism during the Cold War. After Haitian citizens expressed their rightful dissatisfaction, the pressure of resistance movements caused this regime to fold. Jean Claude Duvalier fled the country in 1986.

After having their voices disregarded for nearly two centuries, the Haitian people regained their independence when they elected Jean-Bertrand Aristide in 1990 in the country’s first democratic presidential election. Whereas previous rulers had been put in place to serve U.S. interests, Dollar explains that President Aristide sought to restore national sovereignty and advance the interests of the Haitian people. He had plans to empower the working class, reform the Haitian army and ensure that wealthy elites paid their fair share in taxes. The United States pledged its support for this election, but declassified records have revealed that the CIA and Defense Intelligence Agency (DIA) designed and funded smear campaigns and assembled a paramilitary group to stage a coup. Aristide’s plans would have foiled U.S. political and economic interests, so less than a year into his presidency, Aristide was overthrown. To maintain the semblance of support for a democratically elected government, the United States concealed its involvement by relying on Haitian military leaders trained to act as a proxy.

As the United States welcomed a new president, Bill Clinton, into office, the country seemingly had a change of heart. In 1994, the United States invaded Haiti to restore President Aristide to power. Publicly, Clinton voiced support for Haitian democracy, but historian Philippe Girard reveals that Clinton’s advisors had recommended the invasion to make him appear presidential and tenacious at a moment when he was being called out as weak and incompetent. Once again, the United States did not see Haiti as an independent country but rather as a prop to be used for its own benefit.

The Vicious Cycle of Gang Violence

Constant foreign interventions in the affairs of Haiti has left the country in a state of unrest. With the documented interference of the U.S. government and the Organization of American States (OAS) in elections at the start of the 21st century and the assassination of President Jovenel Moïse in 2021, gangs have established a strong and growing presence in Haiti. Sandra Pellegrini, Senior Analyst for Latin America and the Caribbean at the non-profit organization, Armed Conflict Location and Event Data (ACLED), explains that Haitian political elites use both gangs and law enforcement to suppress political opposition and terrorize citizens. Those who fall in line receive funding and weapons or are absolved of their crimes.

Gang members are often portrayed as bad actors, but it is important to consider their vulnerability as youth whose country has been exploited by coercive political elites. Former senior social development specialist for the World Bank, Alys Wilman, and anthropologist Louis Herns Marcelin explain that impoverished youth who see no future in Haiti are lured into gangs for survival. Many are faced with two options: dying or joining a gang.

NGO Interventionism in Haitian Healthcare

The destructive nature of U.S foreign intervention is evident across Haiti’s healthcare system, including in the country’s response to disease outbreaks and natural disasters. Rather than military invasions, U.S. intervention today takes the form of US-based NGOs. There are currently around 10,000 foreign NGOs operating in Haiti, the majority of which are based in the United States. These organizations have significant authority over humanitarian efforts and public health. Anthropologist Mark Schuller states that since these institution’s leadership is in the United States and their decision-making conversations are in English, Haitians are largely excluded from control over planning and projects. This behavior exemplifies the white savior complex. Rooted in colonialism, it assumes that people of color are unable to govern themselves and require the help of white people. It is what makes U.S.-led restoration efforts in Haiti following disease outbreaks and natural disasters so insulting, despite the genuine intentions of people who want to help others. NGOs have also taken the lead in providing basic healthcare services to Haitian people, yet the root problems of political instability, non-democratic decision-making, and economic marginalization go unaddressed and are even exacerbated by the presence of so many foreign-led organizations. Are these organizations truly helping, or are they just adding to a situation of instability?

After seven police officers were killed in 2023, Hôpital Albert Schweitzer in Deschapelles in Haiti’s Artibonite Valley was forced to shut down, showing how much the instability and violence are impacting the delivery of healthcare in Haiti. Photo courtesy of the Miami Herald.

Change Must Happen in Order for Healing to Start

It is impossible to address healthcare in Haiti without addressing the physical and structural violence that foreign nations, especially the United States, have imposed. Haiti never got the chance to realize full independence because of the manipulation and greed of its oppressors. To rebuild the country with a functioning healthcare system, U.S. influence in Haitian political affairs needs to be eliminated. Corrupt authorities need to be replaced with progressive, democratically elected leaders to establish national sovereignty. When the political system in Haiti has been strengthened, efforts to improve healthcare infrastructure alongside law enforcement and education systems can begin. As one of the first steps, the Haitian government should have stricter regulatory control over NGOs, which should be Haitian-led. Many of the NGOs in Haiti have taken exclusive control over the healthcare system in Haiti, but one notable example that takes a different approach to restoration efforts in Haiti is Partners in Health. The organization works with Haitian communities to support long-term, locally led healthcare, and I believe the goal is for countries like Haiti to achieve equality and stability in healthcare so that Haitians can build and sustain their own system without relying on foreign aid. Partners in Health does not seek to control the healthcare system, unlike many other NGOs in Haiti, they want Haitians to lead the way—a model that shows other NGOs this is possible.

The people of Haiti are capable of building a healthcare system and public health infrastructure without foreign-led intervention. Restoring the country will take time, and there will be difficulties along the way. As a proud Haitian, I am disheartened when I see the current situation, but I believe Haiti can find redemption again. I remember a moment in high school when a classmate said, “Haiti being poor is their fault.” I did not know what to say at that moment. I lacked the knowledge of how nations, including the United States, have repeatedly exploited and violated a nation that fought for and earned its independence. The reality is that Haiti is full of determined, intelligent and persevering individuals who can sustain their own country. France and the United States realized that early on. That is why they did everything in their power to suppress Haitian sovereignty. Today, Haitians do not need ongoing interventions; they need to be heard, respected and left alone to heal their country.