In the winter of 2003, when war loomed in Iraq and every rock was suspected of concealing a terrorist, one might have imagined that the last thing on the minds of American diplomats would be a little impoverished country like Haiti, a mere third of an island, which lacks even an army. But the United States has a foreign policy everywhere, and, as a rule, the weaker and poorer the nation, the more powerful the policy is.

Most Americans if they visited Haiti would, I imagine, come away with new definitions of poverty. What you notice most of all are absences of the most basic things. Water, for instance. In a recent survey of the potable water supplies in 147 nations, Haiti ranked 147th. It’s estimated that only 40 percent of Haiti’s roughly 8 million people have access to clean water.

In the capital, Port-au-Prince, the morning after rain, you see working men take up manhole covers and lean in beneath the pavement, dipping buckets into the city’s brimming drainage channels. They use the water to wash cars for pay, and occasionally, when the day gets hot, you’ll see one of them invert a bucket over his head. This is very dangerous, because any contact with sewer water invites skin diseases and a mere thimbleful swallowed can cause bacillary dysentery.

All over Haiti, you see boys and girls carrying water, balancing plastic buckets on their heads as they trek long distances up and down the hillsides of Port-au-Prince or climb steep footpaths in the countryside. Many of the water-carriers are orphans, known as restavek–children who work as indentured servants for poor families. Contaminated water is one of the causes of Haiti’s extemely high rate of maternal mortality, the main reason there are so many orphans available for carrying water. “Sanitation service systems are almost nonexistent,” reads one development report. Many Haitians drink from rivers or polluted wells or stagnant reservoirs, adding citron, key lime juice, in the belief that this will make the water safe. The results are epidemic levels of diseases such as typhoid, and a great deal of acute and chronic diarrhea, which tends to flourish among children under 5, especially ones who are malnourished. Hunger is rampant. “Haitians today are estimated to be the fourth most undernourished people on earth, after Eritrea, Ethiopa, and Somalia,” the World Bank reported in 2002. The cures for many waterborne ailments are simple. But in Haiti, it’s estimated (almost certainly overestimated) that only 60 percent have access even to rudimentary healthcare. In the countryside, the vast majority have to travel at least an hour, over paths and main roads that resemble dry riverbeds, to reach health centers, which not only charge fees that most can’t afford to pay but also lack the most basic provisions.

Last winter, I visited the centerpiece of Haiti’s public health system, the University Hospital in Port-au-Prince. It was founded in 1918, during the time when American Marines occupied and essentially ran the country. It’s a large complex of concrete buildings in the center of the city, and it seemed to be open when I arrived. My Haitian guide and I strolled over toward the pediatric wing. It seemed unnaturally quiet. No babies crying. Inside, the reason was obvious. There were no doctors or nurses or patients in sight, only a young male custodian, who explained that the doctors had recently ended a strike but that the nurses had now launched one of their own. Strikes at the hospital are frequent; this one had to do with current political strife.

“Where did the sick children go?” I asked my Haitian guide.

“They went home.” She made a face. “To die.”

We walked past rows of empty metal cribs, and then, turning a corner, down at the end of a long row of old metal beds with bare, stained mattresses, we saw a lone patient. A girl lying on her side, very thin in the arms and legs, with a swollen belly. Her mother, standing beside the bed, explained that the girl had been sick for a long time. The doctors said she had typhoid. When the strike began, the mother and daughter had simply stayed, because the mother didn’t know what else to do. But a doctor did stop in now and then, and had left behind some pills.

At the hospital, the morgue, at least, was functioning. I looked into the one reserved for victims of diseases, mostly diseases that could have been prevented or cured. The door was made of corroded metal, like the door to a meat locker. The room inside was filled with trays on racks, stacked horizontally, several bodies per tray, the majority children, the little girls still in their dresses, bows in their hair.

Diarrhea alone kills sixty-eight Haitian children out of every 1,000 before the age of 5. Did many of the people in the morgue die because of dirty water? I asked the medical director.

“Oh, of course!” he said. He also told me, “Sometimes we have to put more bodies together than we’re supposed to, because there isn’t room.”

Haiti is in dreadful shape. No one disputes the fact. So it seems odd that over the past few years foreign aid to the country has actually declined. Haiti still receives assistance, from the United States, the European Union, Canada, Japan and various United Nations organizations, but the total amount has been reduced by about two-thirds since 1995. The United States has cut its donations by more than half since 1999. The World Bank, meanwhile, has shut down its lending to the country, for the time being at least, and has closed its Haiti office, leaving behind only an administrator and driver.

Then there is the case of the Inter-American Development Bank. The IDB isn’t as well-known as some of the other IFIs (the international financial institutions, or “Iffies” in aidspeak) but ranks as a major player in Latin America and the Caribbean. It has long been one of the most important lenders to Haiti. In the late 1990s it made comprehensive plans for a passel of new low-interest loans to address some of the country’s most pressing needs–$148 million in all for improving roads, education and the public health system, and for increasing the supplies of potable water. But in the spring of 2001, when the loans were about to be disbursed, the US representative on the IDB board of executive directors wrote the bank’s president asking that the process be halted. This was unusual. No member nation is supposed to be able to stop the disbursement of loans that are already approved. Nevertheless, the IDB complied. The Haitian government also lost access to loans it could have received from the IDB over the next several years, worth another $470 million.

The State Department seemed reluctant to discuss this matter. I was granted an interview with a senior department official only on condition that I not use his name. He told me it wasn’t just the United States that had wanted to block the IDB loans; it was “a concerted effort” of the Organization of American States. The legal justification for blocking the loans, he said, originated at an OAS meeting called the Quebec City Summit, which produced something called the Declaration of Quebec City. But that document is dated April 22, 2001, and the letter from the IDB’s US executive director asking that the loans not be disbursed is dated April 6, 2001. So it would seem that the effort became concerted after it was made. The reason for blocking the loans, according to the official, was “to bring pressure to bear on the Aristide government, to address what the OAS itself and other members of the international community saw as serious flaws in the 2000 electoral process.”

The official was referring to elections held in May 2000, in which Jean-Bertrand Aristide’s Lavalas political party won large majorities in both houses of the Haitian Parliament. Each candidate had to win a clear majority to avoid a runoff, but the election procedures made it impossible to determine whether some had won majorities or merely pluralities. This was the case with eight Senate seats, in seven of which Lavalas candidates had received the most votes. But the Provisional Electoral Council eschewed runoffs, and declared those eight the winners. Opposition parties claimed the elections had been stolen, and many foreign diplomats made a fuss. Soon, many were calling the entire election “fraudulent.” This seemed rather harsh, given the fact that to a great extent, foreigners had financed, managed and monitored the proceedings, and in the immediate aftermath many observers had declared a victory for Haiti’s fledgling democracy. Sixty-five percent of Haiti’s eligible voters had turned out, many walking miles along mountain paths and waiting for hours in the hot sun to vote. Moreover, those eight contested Senate seats didn’t affect the balance of legislative power. Even if they’d lost them all, Lavalas would still have had control of Parliament.

The election didn’t seem like a sufficient reason for cutting aid to Haiti. To me the State Department’s explanation seemed like obvious diplomatic obfuscation, what diplomats called “irregularities in vote-counting” serving as the pretext for reducing the amount of money that went to Haiti’s government.

Back in 1990, after centuries of slavery and dictatorship, Haitians finally got the chance to vote in free and fair elections. They chose Aristide, a Catholic priest from a poor parish of Port-au-Prince, as their president by an overwhelming margin–he received 67 percent of the vote in a field of thirteen candidates. Aristide’s liberation theology–a doctrine whose central tenet is “to provide a preferential option for the poor”–won him a devout following among Haiti’s poor but few friends in the first Bush Administration. After just seven months Aristide was deposed by a military junta, which ruled the country with great violence and cruelty for three years. Finally, in 1994, the Clinton Administration sent troops, which restored Aristide and his government. In the remaining year and a half of his term, Aristide made some small progress in rooting out the endemic corruption that various juntas and dictatorships had left behind. With the help of the United States, he also disbanded the Haitian Army, which the US Marines had reconstituted during the American occupation of Haiti in the early part of the century–an army, it was often said, that never knew an enemy besides the Haitian people.

An array of foreign governments and Iffies pledged their help in rebuilding Haiti, but many of the donors insisted that in return for their aid Aristide institute “structural economic adjustment”–the privatization of state-owned enterprises, for example. According to one diplomat who spent a great deal of time conferring with him, Aristide was “privately ambivalent and publicly ambiguous” about the Iffies’ recipes for Haiti. Too ambiguous to suit some of his former admirers on the left, for whom neoliberal economic reform is anathema, but also too ambiguous to win over any of his numerous detractors on the right.

In 1996, Aristide, barred from seeking a consecutive term by the Haitian Constitution, endorsed as his replacement an old friend, René Préval, and for the first time in Haitian history, a democratically elected head of state turned over power to another. Aristide ran for president again in November 2000. Citing the unresolved flaws in the May legislative elections, the United States declined to assist or monitor the presidential elections, which the political opposition in Haiti also boycotted. Aristide won easily, though–and legitimately, in the eyes of most of the world. But by then he had acquired many detractors, a large and varied cast, mostly situated outside Haiti.

To the American right, liberation theology had long seemed like an especially dangerous doctrine, combining Marxist analysis with a call to connect the struggles of Christ to those of the poor. And Aristide’s preaching and criticisms of the United States, combined with his great popularity among the Haitian poor, made him a natural target for right-wing politicians, such as Jesse Helms, who had denounced Aristide, even retailing slanders against him. Some of Aristide’s early detractors are still in the American government. One of Helms’s chief aides on the Senate Foreign Relations Committee, Roger Noriega, was until recently the permanent US representative to the OAS. In that capacity, he issued a number of statements criticizing Aristide and his government. Recently he was nominated as the Bush Administration’s chief of policy on Latin America.

Today, Aristide’s critics argue variously that he is guilty of fomenting corruption and violence, or of condoning them, or, at the very least, of being too irresolute to put a stop to them. And it may be that, as one former diplomat told me, Aristide returned to power in 1994 with a “never again” attitude, resolving that if his enemies had guns and thugs, he would not be without them either. When I interviewed Aristide, he allowed that the issue of controlling his supporters was “a preoccupation,” and added that he couldn’t control agents provocateurs who committed crimes in the name of Lavalas. (A common sort of charge in Haiti. Opposition leaders have claimed, for instance, that Lavalas staged the notorious armed attack on the presidential palace on December 17, 2001, in order to have a pretext to attack them.) Aristide also told me, “I will do more to try to provide security and push the judicial system to render justice and not to delay and delay.”

I wasn’t sure he’d get very far in those efforts. Haiti now has about 3,500 poorly trained and ill-equipped police, including many amenable to payoffs and bribes, and some involved in drug trafficking. The United States has withdrawn all its support for the police and judicial system and, with the OAS, has been demanding that Aristide improve security and the administration of justice. A State Department official told me that the United States was trying to give “recognized political parties as much training as possible so they can compete nationally.” In fact, Washington has long tried to create a counterforce to Aristide’s vast popular support–most preposterously back in the mid-1990s, when the American soldiers temporarily occupying the country were told by their commanders that a right-wing terrorist organization called FRAPH was the “loyal opposition” to Aristide. More recently, public documents show, the United States helped to create the main political opposition, the Democratic Convergence, and has aided it in developing platforms and strategies. In theory, this could be a laudable program; democracy benefits from real competition. But it is sinister if, as Aristide’s supporters say, part of Washington’s strategy is to make room for an opposition by crippling Aristide’s government–by blocking IDB loans, for example.

Over the past few years, the United States and the OAS have placed increasingly onerous conditions on the Aristide government, which have included satisfying the demands of the political opposition. Foreign diplomats insisted that the senators in the contested seats resign; all did so several months after Aristide’s re-election as president. Aristide has continually called for new elections, but the opposition has demanded that Aristide resign before they will cooperate. A State Department official in Haiti told me that the United States won’t countenance such intransigence but also said that no support for new elections in Haiti will be forthcoming until Aristide improves “security,” among other things. But it may be, as Aristide’s supporters believe, that no support will be forthcoming until Washington thinks elections will yield the result it wants.

There is no telling, of course, how new elections would turn out, but it is possible to guess. The United States has commissioned opinion polls in Haiti. These have not been released publicly, but I managed to obtain one, dated March 2002. The most striking thing about the data is that on many significant issues between 40 and 46 percent of those surveyed either refused to answer or said they had no opinion. Among those who responded, the poll reveals a rise in national cynicism. And the poll does show significant declines in Aristide’s ratings from a poll conducted a year before, but those are declines from a very high level. About 60 percent of those who responded in 2002 named him as the leader they trusted most, and no more than 4 percent named anyone else. About 40 percent of respondents also named Lavalas as the political party they sympathized with, while only about 8 percent named the Convergence.

One foreign journalist recently wrote, “Among the disaffected former supporters [of Aristide] are virtually all of Haiti’s leading intellectuals and artists, the persons who had best articulated the humane values that should be at the basis of any new Haitian society.” But should Haiti’s leading artists and intellectuals, however well articulated and humane their values, be the ones to define a new Haitian society? Perhaps 80 percent of Haitians live in poverty, about 70 percent in poverty so desperate that they’ve never had a chance to go to school, let alone become intellectuals. These are the people most often invoked in discussions about Haiti’s suffering, but they are also the people least often consulted on the question of what should be done. The main exception has been elections. The Haitian poor demanded the right to vote. They ran grave risks to get it–in the aborted elections of 1987, for instance, when thugs employed by the junta in power gunned down would-be voters at polling places. And when they’ve finally had their chance, the impoverished majority has, time and again, turned out in large numbers and expressed their hopes by electing Aristide.

The saga of the blocked IDB loans has continued. In September 2002, the OAS seemed to relent a little, and resolved that the Iffies should resume normal relations with the Haitian government. But this had no immediate practical effect. The World Bank had no plans to make new loans. And the IDB couldn’t disburse the loans for clean water and health and roads and education, because arrears had accumulated since 2000. Haiti now owed the bank millions more in debts on previous loans, ones taken out, ironically enough, by Aristide’s predecessors–by “Baby Doc” Duvalier and by various military juntas that had tried to kill Aristide several times back in the late 1980s. Haiti didn’t qualify for the international program of debt relief because Haiti didn’t owe enough. It did, however, owe more than it could pay. So if the loans were going to be released, some foreign government or institution would have to make a bridge loan to Haiti. One senior State Department official told me that the United States was in favor of a bridge loan, but only if Aristide’s government met various conditions. Clearly, the IDB loans were still being used to exert pressure on Aristide.

This past summer the Haitian government decided to pay the arrears itself, a total of $32 million, a sum that represented more than 90 percent of the country’s foreign reserves. In effect, the government has all but bankrupted itself for the sake of those loans and in the hope of more to come.

Last winter I made a call to the World Bank, to the person then serving as its Caribbean country director, Orsalia Kalantzopoulos. I knew that the World Bank had run into the same problems as the IDB, and that loans were being held up by about $25 million in arrears. But I wondered why it had pulled out of the country. It seemed like a strange thing to do, given that its mission statement reads, “Our dream is a world free of poverty.”

Kalantzopoulos told me, “The problem was that most of the projects, with very few exceptions, did not meet their objectives. In addition, the projects had a lot of execution problems. There was not proper procurement and sometimes money was not going to the projects described.” She added, ” The bottom line is, if there is not the political will to use the money properly, does it really make sense to mortgage the next generation?”

Of course, the status quo doesn’t promise future generations much of a future in Haiti. And the Iffies are already making the current generation of Haitians pay for the sins of the past.

Today, the United States is passing almost all of its direct aid to Haiti through USAID, which then funnels the money to various NGOs. But according to Gerard Johnson, until recently the IDB’s representative there, this tactic is only a palliative, not a cure. “In the sense of development, NGOs cannot replace the government. They can satisfy short-term humanitarian problems, they’re very important as a partner to government, but I don’t think you can avoid the government and do lasting development.” The only real solution in the long run, Johnson felt, was to strengthen the institutions within Haiti, and one way to do that was through IDB loans. Haiti, he explained, has an informal economy, untaxed and untaxable, that probably accounts for about 85 percent of the country’s employment. Incompetence and corruption are problems, but the bigger problem is that the government can’t raise enough in taxes to do much more than pay its employees’ salaries. Low-interest IDB loans could provide the capital for making real improvements.

There are a few examples of successes even in Haiti. One of Johnson’s favorites was a recent Canadian project that had brought reliable electricity to the city of Jacmel. One of the most harmful legacies of the American occupation early in the twentieth century and of the Duvaliers’ long rule has been the centralization of everything. The Jacmel project was so far fairly successful, Johnson thought, because the Aristide government had ceded control, including over revenues, to the local government. “This is exactly the model that we would like to replicate with the water loan,” Johnson told me. “Support good governance, support local government, and that’s definitely linked to democracy. The people are to stand in relation to the state to the point where they’re willing to trust enough to pay their water rates, which sounds like something automatic in Washington, DC, but in Haiti when you pay your water rate, you may or may not get water.”

Of course, some opponents of neoliberal economic reform believe that poor countries should have no truck with the Iffies, because the conditions that are invariably attached to their aid usually end up doing further harm to the poor. I raised this objection with Dr. Paul Farmer. He is a professor of medicine and medical anthropology at Harvard and the medical director of a remarkably effective and expanding public health system in a desperately impoverished region of rural Haiti. He has also published a number of articles critical of the Iffies and neoliberal economic reforms. He told me, “Anti-neoliberal people say Haiti would be better off without the IMF and the World Bank and the IDB, but there’s no topsoil left in a lot of the country, there are no jobs, people are dying of AIDS and coughing their lungs out with TB, and the poor don’t have enough to eat. These are problems in the here and now. Something has to be done. Haiti is flat broke, and I don’t see what else the government can do but turn to the Iffies. It’s the job of the true friends of Haiti to protect it from the hypocrisies of the Iffies.”

I have spent portions of the past three years in Haiti, mostly in the country’s famished, deforested central plateau. During that time I’ve met a number of people who describe themselves as peasants, among them a man in his 30s, named Ti Jean Gabriel. When I spoke with him last winter in Haiti, he said he wished he could talk with President Bush and tell him about the problems in the country. He could tell his own story, how when he was 8 he had so few clothes that he used to work naked in his father’s field. “I feel like if I could get to the right person, so I could explain the situation…”

I told him that some people thought giving more aid to Haiti now would be a mistake. What was his response to that?

He leaned toward me. “I will answer your question with a question,” he said. “You have seen Haiti. Do you think Haiti needs more aid?”