Images of Gulf Coast residents killed or left homeless by Hurricane Katrina in early September came as a shock to many Americans, who are unaccustomed to seeing such stark misery within their country, the most affluent and powerful in the world. If any country would be able to respond promptly and effectively to a “natural disaster,” Americans thought, it would be their own. TV viewers heard people exclaim over and over, “This can’t happen in America.”

But disasters are never wholly and purely “natural,” as the residents of New Orleans and dismayed onlookers have discovered. How can we pretend that racism, a social disaster, played no role in the aftermath of Katrina? Even here in Rwanda, where Partners In Health has launched its newest project, we saw the faces of those left behind, and they were black faces.

Unsurprisingly, perhaps, a number of journalists have compared the desperate situation in New Orleans to that in Haiti, a country dear to all of us at Partners In Health and a country familiar to journalists as this hemisphere’s most vulnerable, as far as bad weather is concerned. In May 2004, flooding in southern Haiti, near the Dominican border, killed 1,700. Then, in mid-September, Tropical Storm Jeanne made landfall in Puerto Rico and the Dominican Republic before moving towards Haiti. One of the most perceptive commentators on Haiti, and on the history of the Americas in general, is the Jamaican writer John Maxwell. Writing presciently from Jamaica several days before Jeanne pummeled Haiti, Maxwell drew a direct connection to the social disasters that have long plagued his neighbors. In Haiti, he observed,

the slightest storm is likely to kill hundreds of people, because their landscape has been stripped and there is little vegetation to restrain the waters. Additionally, since February, the Haitians are leaderless, their society decapitated by the ouster of their President, their social networks disrupted by gangs of criminals who have been allowed by the moribund conscience of the world to assume hegemony over the poorest and proudest people of the hemisphere.

I won’t go into the causes of their poverty nor the justification for their pride; we’ve been there before. But when so-called statesmen, Caribbean statesmen, can imagine turning over any group of human beings to the mercies of the thugs now ruling Haiti, one wonders not how their minds work, but whether their minds work at all. If there is… disaster in Haiti the effects will be compounded by the fact that the leadership of the country is in the hands of people whose only skill is in mayhem and whose consciences are as dead and buried as the victims of their massacres going back three decades.

…. All of us [who suffer from hurricanes] will be licking our wounds, all of us would wish to welcome assistance from abroad, but the Haitians alone will have no say in how their land and nation is resuscitated and repaired. In Grenada and in Jamaica, in the Dominican Republic, in Barbados and Jamaica and in Cuba, neighborhood committees will see to the distribution of relief, will try to ensure fairness, will attempt to protect the weakest and to enlist the strong in their assistance.

That will not happen in Haiti.1

Maxwell was right, of course. Tropical Storm Jeanne moved northwest, never making landfall in Haiti, but thrashing the island’s denuded hills with torrents of rain. Avalanches of water and mud rolled from the hills to the coast. The death toll in Haiti, as of October 4, 2004, stood at 1,970, with another 884 reported missing and most presumed dead. Over 300,000 people, most in the hardest-hit city of Gonaïves, were left homeless. What of Maxwell’s prediction that the de facto government would not be up to the task of disaster relief? Sure enough, the New York Times was soon reporting that international relief efforts in Jeanne’s wake were hampered by a lack of help from the Haitian government and the local authorities in Gonaïves: “‘We are having trouble organizing and distributing food because there is no authority existing in the town,’ said Eric Mouillefarine, who heads the Haiti branch of the United Nations Office for the Coordination of Humanitarian Affairs. ‘The government is absolutely not responding.’” 2 This will sound eerily familiar to the people of New Orleans.

There are many reasons Jeanne, a slow-moving tropical storm with relatively low wind speeds, caused such devastation in a country it never even crossed, and those reasons are social. And just as those left behind in New Orleans had to suffer humiliation and uncertainty, in spite of the valiant efforts of many (including some of our own supporters), so too did Jeanne’s survivors. As the huge toll taken in Haiti by Jeanne came to light, journalists arrived to cover the story and, again, the story will sound familiar to those following Katrina. CNN reported that U.N. peacekeepers, in place since the violent overthrow of Haiti’s elected government, “fired into the air to keep a hungry crowd at bay” and “fired smoke grenades as crowds of Haitian flood victims tried to break into a food distribution site.” The relief workers themselves, it seems, were in need of relief: “As they waited for days, one woman yelled at a Red Cross worker on the balcony of City Hall ‘Help me. I’m hungry.’ The Red Cross volunteer yelled back ‘I’m hungry, too.’” 3

It’s no wonder that New Orleans’ and Haiti’s disasters sound similar. Many Americans have forgotten that the Louisiana Purchase was the direct result of Napoleon’s defeat at the hands of the Haitians in 1804. Haitian President Jean-Bertrand Aristide, in exile in South Africa, made reference to this history in a condolence note made public recently: “The connection [between Haiti and Louisiana] … finds new root in a shared human suffering caused by this week’s catastrophic storm and ensuing floods.”

John Maxwell’s reflections on this connection are a good deal sharper. Haiti and the poor of New Orleans are, he wrote, now linked by yet another bond: catastrophe following the “decapitation of democracy.” 4 After Katrina, the images of the dead and dying, the squalor and ruin of cities, the hopelessness and despair of some of the survivors, have shaken us profoundly. But have they shaken us enough? Some had not realized that such desperate poverty existed in the United States, or that a substantial segment of our population lives without ready access to basic services, such as education and health care, that most in “developed” countries take for granted. And things are not getting better: since 2003, 800,000 more Americans are without health insurance, and an estimated 1.1 million more Americans have slipped below the poverty line in the past two years.

The best monument to the catastrophe in New Orleans and the Gulf Coast, it has been noted, would be a serious national effort to address the poverty and inequality that afflicts the entire country. 5 But can we respond effectively by addressing poverty in our own country alone? The shared history of Louisiana and Haiti reminds us that cultures, populations, hurricanes, and need refuse to be confined by national borders.

All of us at Partners In Health are confident that the American people will respond generously to the great need of those hit by Katrina. We know a lot about American generosity, because that’s what permits us to do our work in Rwanda, Haiti, Peru, Boston, and elsewhere. We know that homes will be opened, and that students from the Gulf Coast will be offered spots in schools elsewhere; we are sure that the beautiful city of New Orleans will be rebuilt. Many of us hope to be a part of the rebuilding.

But Katrina is also the latest reminder that the project of reconstruction must be underpinned by a vision of a world without indecent poverty, without racism, and without the accelerating divestment in public infrastructures now registered in the United States and elsewhere. The collapse of New Orleans’s levees is as clear a message as possible about the risk of gutting public works. The siphoning of resources away from public health will mean that Katrina’s wake will include precisely the sort of misery seen in Haiti and in the poorer regions afflicted by last year’s tsunami. The great vulnerability to which we expose all those who lack fundamental social and economic rights, including the right to be protected from foreseeable and, indeed, predicted disasters, is a cause worth fighting for. In a reflection on the impact of Tropical Storm Jeanne, Julia Taft, writing for the New York Times, concluded that “the biggest killer in natural disasters is poverty. The same hurricane tides that flood houses in Florida sweep away entire neighborhoods in places like Gonaïves, Haiti. And while survivors need places to live, simply rebuilding their tin-roofed shacks in flood plains guarantees they will suffer again.” 6

Allaying human suffering and promoting human dignity, at home and abroad, are part of the prescription and the reason for rebuilding. Addressing persistent poverty, at home and abroad, remains our most pressing task.

Paul Farmer

Rwanda, September 2005


  1. 2004. “Under the Gun.” Jamaica Observer , 12 September.
  2. McKinley, Jr., John C. 2004. “Floodwaters Recede from Haitian City, but Hunger Does Not.” New York Times, 25 September, 7.
  3. “Jeanne Leaves More than 1,070 Dead in Haiti.” 2004. CNN.com, 22 September. “Haiti Mob Attacks Relief Truck.” 2004. CNN.com, 24 September.
  4. John Maxwell. 2005. "Losing New Orleans,” The Jamaica Observer, September 4.
  5. Nicholas D. Kristof. 2005. "The Larger Shame" (Op-Ed), New York Times, September 6.
  6. Taft, Julia. 2004. “Storm-Tossed Lessons.” New York Times, 3 October, 11.
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