Co-Chairmen Representatives McGovern and Wolf and distinguished members of the commission, thank you for the opportunity to submit a written statement for today’s hearing on Aid Delivery in Haiti: Development Needs, Capacity Building, and Challenges.
Human Rights Watch has significant expertise in investigating and analyzing aid delivery in Haiti, in particular, through a human rights framework. Within weeks of the January 12, 2010 earthquake, Human Rights Watch began monitoring the aid response in Haiti and human rights concerns that were emerging. In the months after the quake, Human Rights Watch raised particular concerns with the United Nations and other key actors about gaps in protection measures for women and girls in the camps and documented a few cases of sexual violence.
In 2011, Human Rights Watch released a report entitled Nobody Remembers Us: Failure to Protect Women’s and Girls’ Right to Health and Security in Post-Earthquake Haiti that documented the lack of access to reproductive and maternal health care after the earthquake and described how hunger led some women and girls to trade sex for food and how poor camp conditions exacerbated the impact of sexual violence because of difficulties accessing post-rape care. The report highlighted how aid and recovery efforts failed to adequately address the needs and rights of women and girls.
In particular, the report found that, 18 months after the earthquake, the voices of women directly affected by the earthquake had been excluded from the reconstruction process. At the time of the research, more than a million people lived in displacement camps. Women and girls interviewed by Human Rights Watch expressed frustration that they lacked basic information that would allow them to access available health care services, many funded by international actors. The women and girls interviewed by Human Rights Watch described serious obstacles they faced in accessing prenatal and obstetric care, leading some to deliver their babies in their muddy tents or en route to the hospital. Most women and girls interviewed by Human Rights Watch did not know which organizations worked in and around their camps, when and where services were available, and to whom they should complain if there was a problem.
The extreme vulnerability and poverty in the camps—general food distribution stopped within two months of the earthquake and unemployment in the camps was very high—led some women and girls interviewed by Human Rights Watch to form relationships with men for the sake of economic security, or to engage in transactional or survival sex. According to the women and girls we interviewed and surveys conducted by other human rights organizations, the exchange of sex for food is common. Without adequate access to contraception, women and girls faced increased vulnerability when they survived by trading sex for food. Moreover, many engaged in these practices in secret, making them vulnerable to violence because they lacked what little protection might be available from social networks or the community.
In the nearly five years since the earthquake, the displacement camps have decreased in size by about 90 percent. While the conditions of these camps are still a pressing concern, Human Rights Watch has shifted its focus to look at human rights concerns facing women and girls in Haiti that transcend the boundaries of displacement camps. In particular, we have focused on (1) protections for victims of gender-based violence and (2) the rights to water and sanitation in schools.
Protections for Survivors of Sexual and Gender-Based Violence
In 2010 and 2011, Human Rights Watch found in its research that some survivors of sexual violence in the displacement camps had difficulty accessing post-rape care necessary to prevent pregnancy or transmission of sexually transmitted disease. Social stigma and shame created further obstacles to seeking care. Six of the pregnant women and girls who spoke with Human Rights Watch—3 of whom were 14 to 15 years old—said their pregnancies resulted from rape. Victims of violence continue to face challenges in accessing medical care, and support should be provided to ensure women and girls have access to comprehensive post-rape care.
Human Rights Watch has engaged with direct legal service providers who confirm that social stigma and shame also prevent many women and girls who are survivors of sexual and gender-based violence from seeking legal recourse. When they do, the path to justice can be difficult. Giving victims access to legal support and representation can be helpful in eliminating some barriers to justice. Organizations such as Bureau des Avocats Internationaux (BAI) have made strides in holding perpetrators of rape accountable through Haiti’s fragile justice system.
Nevertheless, gender-based violence remains a significant concern in Haiti and the legal protections afforded to victims remain weak. A criminal code reform process first funded by the United States Institute for Peace in 2008, with continued support by USAID, is an important opportunity to introduce criminal provisions on gender-based violence that are consistent with international standards. The criminal code reform process is currently under review by a presidential commission, which should submit a recommendation to President Michel Martelly by the end of 2014.
Rights to Water and Sanitation
Lack of access to clean water and sanitation directly affected the health, the education, and even the risk of violence or death of women and girls in Haiti before the earthquake as well. In the three years before the earthquake, I spoke with numerous women and girls in Haiti about how lack of access to clean water and sanitation shaped their lives. Women told me how poor drainage and large-scale erosion left many homes, communities, and agricultural plots at risk of flooding. Women and girls told me they spent many hours of their days fetching water or traveling to rivers and streams to do their families’ laundry. Those duties kept some girls from getting to school on time, causing them to miss important lessons and fall behind their male classmates.
In Human Rights Watch’s research in the displacement camps, women and girls connected their fear of sexual violence with their poor access to water and sanitation. They told Human Rights Watch that they sometimes feared going to the bathrooms in camps because they were not secure. They described being pinched, poked, or leered at by boys and men in the displacement camps when they washed themselves out in the open, because there was no safe and private place to bathe. However, women and girls also raised many other ways that lack of water and sanitation negatively impacted their lives. Some gave birth in the dirt in tent camps or in the street without access to running water. Many women and girls in the camp had terrible vaginal infections and were not able to manage their personal hygiene, particularly during menstruation.
After the October 2010 outbreak of cholera, women and girls described their anxiety around access to clean drinking water. Countless mothers described caring for children with diarrhea caused by water they knew made them sick. Some women Human Rights Watch spoke with outside of Port-au-Prince had lost children or partners to the cholera epidemic, which has killed at least 8,000 people and sickened more than 700,000 in Haiti since 2010 to date. Often, they had to drink from the same water source that killed their loved ones.
In September 2014, Human Rights Watch began looking at the impact of poor water and sanitation in schools, visiting a number of schools in the Central Plateau of Haiti to assess water and sanitation conditions of educational facilities. These schools, including recently constructed ones, lacked adequate water and sanitation facilities. None of the schools Human Rights Watch visited in September were consistent with the government’s guidelines for the promotion of hygiene in schools. Teachers, students, and government officials all told us that the situation was dire and has a negative impact on students’ education. These schools Human Rights Watch visited are not anomalous in Haiti.
Contrary to what is called for in the government of Haiti’s guidelines for the promotion of hygiene in schools, safe, clean latrines and water for drinking and hand washing are extremely scarce in Haitian schools. Most students and teachers have nowhere to relieve themselves, wash their hands with soap, obtain clean water, or, for women and girls, maintain menstruation hygiene. Where facilities do exist, they may not be sufficient in number, may not function, or may not be clean or safe. Nearly 60 percent of schools lack toilets and more than three-fourths of schools lack water access.
Donors, including the United States through both bilateral aid and multilateral contributions, have invested heavily in tuition waiver, school reading, and nutrition programs in Haiti, often disregarding the inter-dependence with water and sanitation services. These investments have been successful in supporting more Haitian children to register, attend, and stay in school. However, attention must also be given to the conditions in which these children learn. Cooking and eating at school canteens often occurs in the vicinity of students who have no choice but to defecate in the open and where there is nowhere to wash their hands with soap. This makes schools a locus for the spread of disease. A demographic and health survey conducted in 2012 found that school-aged children (age 5-19) represented the highest percentage of cholera victims, and the second highest percentage of cholera deaths (age 5-14), compared to all other age groups.
Lack of potable water and sanitation at home or at school can increase the risk for water-borne illnesses and diarrheal disease, and lessen the amount of time children are in school. Teachers in Haiti told Human Rights Watch that diarrheal disease is disruptive to children’s education. Some of their students stay home for more than a week to recover from preventable diarrheal disease. The Inter-American Development Bank has stated that “[i]nstead of promoting children’s health, many schools in Haiti expose children to health hazards such as diarrhea and intestinal worm infections. These conditions, mainly due to inappropriate sanitation and unsafe water sources, have been shown to hinder both the physical and intellectual development of children.”
Girls suffer additional harms from the lack of access to water, sanitation, and hygiene at home or at school, including absenteeism for collecting water or due to lack of adequate menstrual hygiene management. We spoke with girls in Haiti who leave school to go home to wash and change the materials they use to manage their menstruation, because they cannot do that at school—leaving some to miss as much as 30 minutes of instruction every time they need to change their materials. Some teachers told Human Rights Watch that girls sometimes stay at home during menstruation because they have no option to manage their hygiene at school. Girls in Haiti need access to clean water and sanitation facilities, as well as hygiene education and materials, to ensure their consistent attendance in school.
The relationship between the human rights to water and sanitation and many other human rights, including education, is clear. A focus on improving water and sanitation is crucial to any discussions regarding investments aimed at decreasing the risk of water-borne diseases and preventable child deaths in Haiti, an area where the United States has successfully provided significant support. However, no plan to improve child health and decrease preventable deaths is complete without a comprehensive approach to address Haiti’s poor water and sanitation infrastructure, including in schools.
Rights-Based International Aid
The Haitian government is obligated to respect, protect, and fulfill the human rights of those in Haiti—despite the fact that the measures it can take are limited in resources and capacity. The political and economic realities facing the country mean that it would be unrealistic to demand that it alone addresses all of the obstacles to fulfilling these rights. The government is dependent upon donors, international organizations, and several thousand NGOs to fund and implement its plans and deliver a wide range of social services. This is true for Haiti’s measures to address sexual and gender-based violence, the rights to water and sanitation, and a broad range of other public services and human rights obligations.
Donors, including the United States, should deliver aid in a manner that is rights-respecting. Programs should be developed with meaningful community participation, with concerted efforts to include women and girls. Aid transparency with consistent flows of information and complete data is necessary so that civil society and the government of Haiti can monitor implementation of donor activities and their impact on the realization of rights. Development assistance should help build the capacity of the Haitian government, providing it with tools needed to work towards fulfilling the rights of its citizens and to be accountable to them. The Haitian government and donors (and donor-funded NGOs) should support mutual and strengthened accountability related to aid, which is necessary for rights-holders to make the government accountable for its human rights obligations.
The United States government in particular should ensure:
- All of its programming in Haiti is consistent with the implementation of the United States Strategy to Prevent and Respond to Gender-Based Violence Globally and that it publicly tracks progress towards this goal in its key geographical corridors and program areas in Haiti;
- It provides necessary support to the government of Haiti for the adoption of stronger legal protections for victims of gender-based violence, including through the adoption of a criminal code reform consistent with international standards;
- USAID is consistently implementing its Gender Equality and Women’s Empowerment Policy in its work and that it publicly tracks progress towards this goal in its key geographical corridors and program areas in Haiti;
- United States-funded programing in Haiti is developed and executed with meaningful community participation, including by women and girls; and
- United States funded programming in Haiti, through bilateral aid or multilateral contributions, consistently integrates water and sanitation needs across sectors, including health, education, and industry, in an effort to reduce diarrheal disease, eradicate cholera, and promote women’s equality.
 Human Rights Watch, Nobody Remembers Us: Failure to Protect Women’s and Girls’ Right to Health and Security in Post-Earthquake Haiti (New York: 2011), https://www.hrw.org/reports/2011/08/19/nobody-remembers-us.
 La Santé et les Infrastructures Scolaires, Recensement Scolaire 2003, cited in Ministère de l’Education Nationale et de la Formation Professionelle, Direction de la Santé Scolaire, Ligne directrice pour la Promotion de l’Hygiène en Milieu Scolaire, Document Cadre, Juillet 2012, p. 9, http://www.washinschoolsmapping.com/projects/pdf/Haiti_Lignes%20directrices%20PH-EAHMS.pdf (October 7, 2014).
 Enquête Mortalité, Morbidité et Utilisation des Services, EMMUS-V, p. 349, http://www.mspp.gouv.ht/site/downloads/EMMUS%20V%20web.pdf (October 7, 2014).
 A systematic review of public health studies has shown that access to safe drinking water and clean, private toilets has potential to beneficially impact children’s health, which in turn would increase attendance. See Christian Jasper, Thanh-Tam Le and Jamie Bartram, “Water and Sanitation in Schools: A systematic review of the health and educational outcomes,” International Journal of Environmental Research and Public Health, vol. 9, no. 8, August 3, 2012, pp. 2772–2787, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447586/ (accessed June 23, 2014). Incidents of diarrheal disease can be reduced by 30 percent when children and staff at primary schools wash hands properly, according to one study. See Ejemot, R. Regina I., et al., “Hand Washing for Preventing Diarrhea ,” Cochrane Database of Systematic Reviews, no. 3, article no. CD004265, 2009, pp. 1–44, http://www.childsurvival.net/?content=com_articles&artid=498&alert=yes (accessed June 23, 2014).
 Inter-American Development Bank, Increasing Access to Quality Education in Haiti (HA-L1077), Grant Proposal, p. 5, http://idbdocs.iadb.org/wsdocs/getdocument.aspx?docnum=37302335 (October 8, 2014).