Preface to the Paperback Edition


excerped from the book

Pathologies of Power

Health, Human Rights, and the New War on the Poor

by Paul Farmer

University of California Press, 2005, paperback

Amartya Sen

"... the deprived groups in the "First World" live, in many ways, in the "Third." For example, African Americans in some of the most prosperous U.S. cities (such as New York, Washington, or San Francisco) have a lower life expectancy at birth than do most people in immensely poorer China or even India."


Preface to the paperback edition

Chidi Anselm Odinkalu, "Why More Africans Don't Use Human Rights Language"

"Instead of being the currency of a social justice or conscience-driven movement, "human rights" has increasingly become the specialized language of a select professional cadre with its own rites of passage and methods of certification. Far from being a badge of honor, human rights activism is, in some of the places I have observed it, increasingly a certificate of privilege."

Nobel Laureate Oscar Arias, former president of Costa Rica, describes how this occurred in an opinion piece published in the Washington Post. It's worth citing at length:

" The 1991 coup against Haiti's first democratically elected president was definitive proof of the army's predatory role. Even though the 1994 agreement returning Jean-Bertrand Aristide to office called for a reduction of the army from 7,500 to 1,500 troops, a force that size was still a clear threat to democratic governance. In 1995 I visited Haiti to discuss with President Aristide the benefits of doing away with the army entirely [as had been done in Costa Rica]. He readily agreed that the army was a problem, but he doubted he would have the political mandate to tackle it.

... Since Aristide said that he could not abolish the army without the support of the Haitian people, the Arias Foundation for Peace and Human Progress commissioned an independent polling firm to gauge popular support for the idea. The results were stunning: 62 percent of Haitians were strongly in favor of abolition and only 12 percent were against. These figures were key in convincing Aristide that demilitarization was an idea whose time had come. He cut the army's funding and set in motion a legislative process to have the abolition of the army enshrined in Haiti's constitution."

Since the modern Haitian army had never known, in the long years of its existence, a non-domestic enemy, it's easy to see why there was so much popular support for its abolition. Early results of the abolition were evident in 1996, when Jean-Bertrand Aristide became the first president in Haiti's almost two-hundred-year history to peacefully hand over power to another elected civilian, René Préval. President Arias attended Préval's inauguration ceremony and recalled that "Aristide happily noted that the only members of the army still on the government payroll were twenty marching band musicians." Cut to the same city in early March 2004. The military checkpoint is back, but now the soldiers' uniforms are different. Although an international peacekeeping force now resides in Haiti, these aren't foreign troops. They're Haitians, several of them former army officers. They are sporting what one assumes is army surplus, because "US ARMY" is emblazoned on much of their gear. The lapels bear distinctly un-Haitian names-" Fletcher," for example, is not a moniker I've encountered in two decades of seeing patients in rural Haiti.

How did this unpopular army suddenly return to its former haunts and checkpoints? It wouldn't have happened without the mechanics of a coup. Amy Wilentz, writing in The Nation, put it succinctly:

"One thing about coups: They don't just happen. In a country like Haiti, where the military has been disbanded for nearly a decade, soldiers don't simply emerge from the underbrush; they have to be reorganized, retrained and resupplied. And of course, for something to be organized, someone has to organize it."

As Wilentz suggests, many questions remain unanswered. We know that U.S. funds overtly financed Aristide's opposition. But did they also fund, even indirectly, the rebellion that so prominently featured high-powered U.S. weapons only a year after 20,000 such weapons were promised to the Dominican Republic, next door?

[U.S.] aid through official channels had never been very substantial. Counted per capita, before the embargo the United States was giving Haiti one-tenth what it was distributing in Kosovo. But claims heard since the overthrow from the mouths of former ambassadors and the Bush administration-that hundreds of millions of dollars flowed to Haiti-are correct, though misleading. Aid did flow, just not to the elected government. Most [U.S. aid to Haiti] went to non-governmental organizations, and some of it went to the anti-Aristide opposition. U.S. organizations like the International Republican Institute and the National Endowment for Democracy funneled hundreds-of-thousands, perhaps millions, of dollars to the opposition.

... the Boston Globe finally stumbled upon the facts:

"For three years, the US government, the European Union, and international banks have blocked $500 million in aid to Haiti's government, ravaging the economy of a nation already twice as poor as any in the Western Hemisphere.

The cutoff, intended to pressure the government to adopt political reforms, left Haiti struggling to meet even basic needs and weakened the authority of President Jean-Bertrand Aristide, who went into exile one week ago.

Today, Haiti's government, which serves 8 million people, has an annual budget of about $300 million-less than that of Cambridge [Massachusetts], a city of just over 100,000. And as Haitians attempt to form a new government, many say its success will largely depend on how much and how soon aid will flow to the country.

Many of Aristide's supporters, in Haiti and abroad, angrily contend that the international community, particularly the United States, abandoned the fledgling democracy when it most needed aid. Many believe that Aristide himself was the target of the de facto economic sanctions, just as Haiti was beginning to put its finances back in order."

Illegally blocking humanitarian assistance to one of the world's poorest countries surely ranks among the most vicious abuses of power in the modern toolkit. Yet the aid embargo didn't even register on the radar of most human rights groups. Many of these groups are now back in Haiti on "fact-finding missions," long after what observers of structural violence would recognize as the decisive facts. One such mission concluded that "international human rights organizations, especially Human Rights Watch and Journalists Without Borders, and to a lesser extent Amnesty International, have taken the NCHR [National Coalition for Haitian Rights] reports uncritically and failed to develop other impartial human rights contacts in Haiti." That is, the international community-the funders, it must be noted-were relying overmuch on local and overseas partisan groups with overt political agendas but little in the way of expertise :in or commitment to documenting rights abuses.

Chidi Anselm Odinkalu
"The current human rights movement in Africa-with the possible exception of the women's rights movement and faith-based social justice initiatives-appears almost by design to exclude the participation of the people whose welfare it purports to advance."

... Local human rights groups exist to please the international agencies that fund or support them. Local problems are only defined as potential pots of project cash, not as human experiences to be resolved in just terms, j thereby delegitimizing human rights language and robbing its ideas of popular appeal.

Rights declarations are, of course, exhortatory and largely unenforceable. And the bad news is that very few enjoy these rights. AIDS and other problems of poverty in Africa remain the obvious cases in point, so why are human rights groups not focusing on these most pressing issues? Odinkalu's penetrating analysis echoes that advanced in Pathologies of Power:

Chidi Anselm Odinkalu

"In Africa, the realization of human rights is a very serious business indeed. In many cases it is a life and death matter. From the child soldier, the rural dweller deprived of basic health care, the mother unaware that the next pregnancy is not an inexorable fate, the city dweller living in fear of the burglar, the worker owed several months arrears of wages, and the activist organizing against bad government, to the group of rural women seeking access to land so that they may send their children to school with its proceeds, people are acutely aware of the injustices inflicted upon them, knowledge of the contents of the Universal Declaration will hardly advance their condition. What they need is a movement that channels these frustrations into articulate demands that evoke responses from the political process. This the human rights movement is unwilling or unable to provide. In consequence, the real life struggles for social justice are waged despite human rights groups-not by or because of them-by people who feel that their realities and aspirations are not adequately captured by human rights organizations or their language."



... a poster caught my eye. It bore the imprimatur of the Catholic Church. Its message, though consonant with Catholic social teachings, would have struck Bostonian parishioners as out of place: "Down with neoliberalism," it said in rainbow colors, "Up with humanity!" Next to it hung a small portrait of the recently martyred Bishop Juan José Gerardi. Two days before he was bludgeoned to death in i998-by officers in the army, according to our hosts-the bishop had released a massive report indicting the army as responsible for 85 percent of the deaths and disappearances during the conflict. Releasing the report was risky, he noted in the last speech he was ever to make, but it was the only way to begin any meaningful process of healing:

"In our country, the truth has been twisted and silenced. God is inflexibly opposed to evil in any form. The root of the downfall and the misfortune of humanity comes from the deliberate opposition to truth, which is the fundamental reality of God and of human beings. This reality has been intentionally distorted in our country throughout thirty-six years of war against the people."

Jeane Kirkpatrick, one of the architects of Ronald Reagan's Central American policies, which helped finance the Guatemalan army's genocidal spree, termed the Universal Declaration of Human Rights "a letter to Santa Claus,"" in large part because the Declaration pressed for social and economic rights.

Eduardo Galeano

"The big bankers of the world, who practice the terrorism of money, are more powerful than kings and field marshals, even more than the Pope of Rome himself. They never dirty their hands. They kill no one: they limit themselves to applauding the show.

Their officials, international technocrats, rule our countries: they are neither presidents nor ministers, they have not been elected, but they decide the level of salaries and public expenditure, investments and divestments, prices, taxes, interest rates, subsidies, when the sun rises and how frequently it rains.

However, they don't concern themselves with the prisons or torture chambers or concentration camps or extermination centers, although these house the inevitable consequences of their acts.

The technocrats claim the privilege of irresponsibility: "We're neutral," they say."

Take, for example the case of Rwanda. In a study titled Aiding Violence, Peter Uvin argues that development and humanitarian aid to Rwanda in the years prior to the genocide helped to set the stage for what was to occur: "the process of development and the international aid given to promote it interacted with the forces of exclusion, inequality, pauperization, racism, and oppression that laid the groundwork for the 1994 genocide." Of course, the development enterprise, like the human rights community, has defined its mission narrowly. The technocratic approach to development aid has mandated that some issues are brought to the fore while others are ignored. As Uvin, commenting on his own and others' blindness, notes:

Like almost all other players in the development community, I did not have any idea of the destruction that was to come. The pauperization was omnipresent, the racist discourse loud; fear was visible in people's eyes, and a militarization was evident, but that was none of my business, for I was there for another Rwanda, the development model.

In a now classic essay, Orin Starn deplores the failure of his fellow Andeanists to consider the terrible suffering all around them, even though a guerrilla war was soon to wrack Peru for a decade:

"Ethnographers usually did little more than mention the terrible infant mortality, minuscule incomes, low life expectancy, inadequate diets, and abysmal health care that remained so routine. To be sure, peasant life was full of joys, expertise, and pleasures. But the figures that led other observers to label Ayacucho a region of "Fourth World" poverty would come as a surprise to someone who knew the area only through the ethnography of Isbell, Skar, or Zuidema. They gave us detailed pictures of ceremonial exchanges, Saint's Day rituals, weddings, baptisms, and work parties. Another kind of scene, just as common in the Andes, almost never appeared: a girl with an abscess and no doctor, the woman bleeding to death in childbirth a couple in their dark adobe house crying over an infant's sudden death."

... the case of Chiapas, where the rebellion has pitted the rural poor against the Mexican government. Was this "ethnic revitalization"-most of the Zapatista rebels were indigenous people-or a broader movement for social and economic rights? Many statements from the rebels would seem to indicate the latter. On January 18, 1994, Zapatista leaders responded to the Mexican government's offer of conditional pardon with the following retort: "Who must ask for pardon and who can grant it?"

Why do we have to be pardoned? What are we going to be pardoned for? Of not dying of hunger? Of not being silent in our misery? Of not humbly accepting our historic role of being the despised and the outcast? ... Of having demonstrated to the rest of the country and the entire world that human dignity still lives, even among some of the world's poorest peoples?"

Many argue that it is no coincidence that Mexico's first uprising in decades began on the day that NAFTA-the North American Free Trade Agreement-was signed. It was also no surprise that poor health figured strongly among the complaints of the peasants in rebellion. In a declaration at the outset of the revolt, the Zapatistas noted that, "in Chiapas, 14,500 people die a year, the highest death rate in the country. What causes most of these deaths? Curable diseases: respiratory infections, gastroenteritis, parasites, malaria, scabies, breakbone fever, tuberculosis, conjunctivitis, typhus, cholera, and measles."

... in Haiti ... aid flowed freely during almost all years of the Duvalier dictatorships and during much of the violent military rule that followed the collapse of the dictatorship in 1986. Now, however, during the rule of a democratically elected government, the United States has orchestrated an international aid embargo against the Haitian government, freezing an estimated $500 million in promised - and greatly need assistance.

James Gaibraith

"It is not increasing trade as such that we should fear. Nor is technology the culprit. To focus on "globalization" as such misstates the issue. The problem is a process of integration carried out since at least 1980 under circumstances of unsustainable finance, in which wealth has flowed upwards from the poor countries to the rich, and mainly to the upper financial strata of the richest countries.

In the course of these events, progress toward tolerable levels of inequality and sustainable development virtually stopped. Neocolonial patterns of center-periphery dependence, and of debt peonage, were reestablished, but without the slightest assumption of responsibility by the rich countries for the fate of the poor."

Pathologies of Power

Index of Website

Home Page