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Living with Haiti's violent past
THE LANCET
HEALTH AND HUMAN RIGHTS almost completely collapsed after years of conflict and have become breeding grounds for infectious diseases. Health professionals also face the problem of treating patients who have been tortured by guards. Patients often present with broken bones, bruises, or fractured skulls from violent beatings; some have serious burns because the torturer has poured fuel on them and set them alight. Few doctors are prepared to talk openly about such atrocities because they fear violent reprisals and are also aware that some of their colleagues choose to collaborate with the Taliban or actively promote their restrictions on the provision of health care. The Taliban say that they have brought security to the areas they control, but the experience of a terrorised Afghan health worker is different. He told me: “Security, what security? Taliban guards looted my house . . . My wife does not dare go out of the house; my sister-in-law has been beaten in the street; my teenage daughters cry all the time; I am afraid that I shall be punished for an absurd reason such as not having a long beard. Is this security?”. AP
at her. A doctor managed to treat this Taliban laws. In one hospital, guards woman and her child without being ordered all 80 female patients home found out, but most women are not because their modesty could not be so fortunate. Recently, a pregnant preserved in an overcrowded ward. woman delivered her baby in a But it is not just women health Kabul street while her husband was workers and patients who are targeted being beaten by guards for taking by the Taliban. In Taliban-held areas, her to hospital. male doctors are not allowed to treat women or girls, with the exception of their own female relatives. Moreover, doctors are viewed with suspicion and hostility. The Taliban frequently ridicule and humiliate doctors in public and guards routinely question doctors about their moral conduct in hospitals. Such treatment not only affects doctors on a personal level, but also makes it difficult for them to practise with any authority. In this intimidating environment, many doctors who witness Afghan women in Kabul Taliban violence against women do not feel able to help. Women who In a country where so many are venture out onto the streets to seek denied access to medical care and medical care, or for any other reason, health workers are forced to flee in are frequently attacked by Taliban search of safety for themselves and guards and warned not to appear on their families, the need for adequate the streets again. Afghan refugees in health-care sevices has never been Pakistan told me how a mother living so great. Doctors routinely treat in Furah tried to take her toddler who people who have been maimed by had severe diarrhoea to the doctor. A landmines, injured in the fighting Taliban guard noticed her and she between warring factions, or shot at began to run away. The guard fired for refusing to obey Taliban guards. In several rounds from his Kalashnikov addition, public-utility systems have
Abbas Faiz Amnesty International, London, UK
Living with Haiti’s violent past n September, 1991, the then President of Haiti, Jean-Bertrand Aristide, was overthrown by a military coup only 9 months into his term of office. Haiti, once again, faced authoritarian rule and brutal repression, reminiscent of the violent 30-year Duvalier dictatorship. The army, police, and paramilitary groups relentlessly terrorised the most vulnerable sectors of Haitian society who had supported President Aristide. Constitutional order was restored in October, 1994, but despite the presence of a UN peacekeeping force due to leave in July, 1997, criminal violence, police brutality, and attacks on state officials are still common. Between 1993 and 1996, as part of the UN Human Rights Mission in Haiti, we investigated the physical and psychological sequelae of human rights abuses in Haiti.1 Based on a sample of 49 victims of violence and torture, we found that over a quarter of survivors had permanent, serious physical disability, about half suffered from post-traumatic stress disorder,
I
2
over a third had depressive syndrome, and a quater had psychosomatic problems. Various coping strategies have been adopted by survivors. Many people have sought care from indigenous forms of healing, such as medsin fey, a system of herbal medicine, and vodou, the traditional religion of Haiti. But these methods have had only limited success because the nature of brutal political violence cannot be easily addressed within traditional systems of knowledge. A combination of traditional, biomedical, and ethnopsychiatric approaches have proved to be more effective. However, inadequate communication between health workers and human rights activists and between international observers and local groups has emphasised the need for debate on the cultural perspectives of health and human rights issues in Haiti. One of the recommendations of our research is the need to establish a rehabilitation centre for victims of the military coup run by Haitian health professionals. With international
support, this centre would be able to address the long-term therapeutic, psychological, social, and legal dimensions of the rehabilitation process. Above all, the centre would begin to address the greatest obstacle to recovery: the amnesia that pervades the collective memory of Haitian society as it comes to terms with the violence of its recent past. As the philosopher Agnes Heller asserts, “The politics of repression are the politics of psychological repression; even the guilty begin to forget their guilt . . . But the suffering of the mourner is not mitigated by the lapse of time”.2 C Marotte, H R Razafimbahiny cⲐo Human Rights Fund, 17 Cite Wilson II, Port-au-Prince, Haiti 1
2
Marotte C, Razafimbahiny H R. Forgotten memory: Haiti 1991–1995. Montreal and Port-au-Prince: Regain-Cidhica Books (in press). Heller A. The limits to natural law and the paradox of evil in human rights. In: Shute S, Hurley S, eds. The Oxford Amnesty Lectures 1993. New York: Basic Books, 1993.
Vol 349 • April 26, 1997
HEALTH AND HUMAN RIGHTS almost completely collapsed after years of conflict and have become breeding grounds for infectious diseases. Health professionals also face the problem of treating patients who have been tortured by guards. Patients often present with broken bones, bruises, or fractured skulls from violent beatings; some have serious burns because the torturer has poured fuel on them and set them alight. Few doctors are prepared to talk openly about such atrocities because they fear violent reprisals and are also aware that some of their colleagues choose to collaborate with the Taliban or actively promote their restrictions on the provision of health care. The Taliban say that they have brought security to the areas they control, but the experience of a terrorised Afghan health worker is different. He told me: “Security, what security? Taliban guards looted my house . . . My wife does not dare go out of the house; my sister-in-law has been beaten in the street; my teenage daughters cry all the time; I am afraid that I shall be punished for an absurd reason such as not having a long beard. Is this security?”. AP
at her. A doctor managed to treat this Taliban laws. In one hospital, guards woman and her child without being ordered all 80 female patients home found out, but most women are not because their modesty could not be so fortunate. Recently, a pregnant preserved in an overcrowded ward. woman delivered her baby in a But it is not just women health Kabul street while her husband was workers and patients who are targeted being beaten by guards for taking by the Taliban. In Taliban-held areas, her to hospital. male doctors are not allowed to treat women or girls, with the exception of their own female relatives. Moreover, doctors are viewed with suspicion and hostility. The Taliban frequently ridicule and humiliate doctors in public and guards routinely question doctors about their moral conduct in hospitals. Such treatment not only affects doctors on a personal level, but also makes it difficult for them to practise with any authority. In this intimidating environment, many doctors who witness Afghan women in Kabul Taliban violence against women do not feel able to help. Women who In a country where so many are venture out onto the streets to seek denied access to medical care and medical care, or for any other reason, health workers are forced to flee in are frequently attacked by Taliban search of safety for themselves and guards and warned not to appear on their families, the need for adequate the streets again. Afghan refugees in health-care sevices has never been Pakistan told me how a mother living so great. Doctors routinely treat in Furah tried to take her toddler who people who have been maimed by had severe diarrhoea to the doctor. A landmines, injured in the fighting Taliban guard noticed her and she between warring factions, or shot at began to run away. The guard fired for refusing to obey Taliban guards. In several rounds from his Kalashnikov addition, public-utility systems have
Abbas Faiz Amnesty International, London, UK
Living with Haiti’s violent past n September, 1991, the then President of Haiti, Jean-Bertrand Aristide, was overthrown by a military coup only 9 months into his term of office. Haiti, once again, faced authoritarian rule and brutal repression, reminiscent of the violent 30-year Duvalier dictatorship. The army, police, and paramilitary groups relentlessly terrorised the most vulnerable sectors of Haitian society who had supported President Aristide. Constitutional order was restored in October, 1994, but despite the presence of a UN peacekeeping force due to leave in July, 1997, criminal violence, police brutality, and attacks on state officials are still common. Between 1993 and 1996, as part of the UN Human Rights Mission in Haiti, we investigated the physical and psychological sequelae of human rights abuses in Haiti.1 Based on a sample of 49 victims of violence and torture, we found that over a quarter of survivors had permanent, serious physical disability, about half suffered from post-traumatic stress disorder,
I
2
over a third had depressive syndrome, and a quater had psychosomatic problems. Various coping strategies have been adopted by survivors. Many people have sought care from indigenous forms of healing, such as medsin fey, a system of herbal medicine, and vodou, the traditional religion of Haiti. But these methods have had only limited success because the nature of brutal political violence cannot be easily addressed within traditional systems of knowledge. A combination of traditional, biomedical, and ethnopsychiatric approaches have proved to be more effective. However, inadequate communication between health workers and human rights activists and between international observers and local groups has emphasised the need for debate on the cultural perspectives of health and human rights issues in Haiti. One of the recommendations of our research is the need to establish a rehabilitation centre for victims of the military coup run by Haitian health professionals. With international
support, this centre would be able to address the long-term therapeutic, psychological, social, and legal dimensions of the rehabilitation process. Above all, the centre would begin to address the greatest obstacle to recovery: the amnesia that pervades the collective memory of Haitian society as it comes to terms with the violence of its recent past. As the philosopher Agnes Heller asserts, “The politics of repression are the politics of psychological repression; even the guilty begin to forget their guilt . . . But the suffering of the mourner is not mitigated by the lapse of time”.2 C Marotte, H R Razafimbahiny cⲐo Human Rights Fund, 17 Cite Wilson II, Port-au-Prince, Haiti 1
2
Marotte C, Razafimbahiny H R. Forgotten memory: Haiti 1991–1995. Montreal and Port-au-Prince: Regain-Cidhica Books (in press). Heller A. The limits to natural law and the paradox of evil in human rights. In: Shute S, Hurley S, eds. The Oxford Amnesty Lectures 1993. New York: Basic Books, 1993.
Vol 349 • April 26, 1997