22 Apr New Introduction to the introduction

On January 12, 2010, Haiti experienced a 7.0 magnitude earthquake just 25 km east of Port-au-Prince in Léogâne. Over the next 12 days at least 52 aftershocks measuring at least 4.5 magnitude shook the island nation. An already fragile infrastructure was shattered. More than 315,000 people were killed and another 300,000 injured or maimed. Between 1.5 and 1.8 people were made homeless.

The earthquake, devastating enough in its enormousness, unveiled the striking legacy of colonial and imperial histories and their destructive effects on Haitians. More particularly, it laid bare geopolitical processes that have impacted Haitian citizenship. Haiti was the first free black republic, a distinction that led to international questions about legitimacy and sovereignty from the outset as it forced new questions of black personhood, and more particularly citizenship, onto the global stage. This meant a refusal for formal recognition by the U.S. and French governments in the first decades, and then great debt burdens and benevolent intercessions ranging from military occupations to humanitarian and development interventions (which are not necessarily exclusive of the occupations) in the following decades.

This continued tentativeness of Haiti’s sovereignty has meant that the social citizenship rights of Haitians have failed to materialize in an even and consistent way. The arrival of military troops, the multiple-donor countries, and the many international organizations that have come to the aid of Haiti over the past 100 years have inadvertently interceded in many social and political relations between the government of Haiti and its people. The construction of a parallel social services system that bypasses the state and multiple military interventions has led to a kind of transnationalization of what are traditionally considered the processes of the sovereign nation state, which in turn has meant a transnationalization of citizenship. Today, Haitians’ political relationship with their own state continues to be replaced by an intricate web of NGOs, peacekeeping troops, and other aid agencies, through which they must navigate their citizenship.

While the earthquake made manifest the direness of the patchwork state of Haiti’s infrastructure, and indeed, this disjuncture between Haitians and their national government, I am most interested in Haitians’ health citizenship. The proliferation of international health and development agencies providing health care draws new questions of the relationship of health to notions of citizenship.  In many ways, health has come to define a new citizenship, one that most closely represents the actual bodily relationship of citizens to their state’s government. These relationships are impacted through social, cultural, and political geographies, and the landscape of these geographies have material effects on the ground. I argue that institutions and philanthropy play an important role in these processes.

I further argue that many of these institutions are often imperial in nature and have, at times, been connected to military moments. It is these moments and their historical legacy that is important to uncover. Haiti, in particular, offers a particularly salient insight into these processes through its 100 years of American foreign policy and interventions in health. Haiti was occupied from 1915 to 1934 by U.S. military forces, during which time the health and sanitation programs were overseen by the U.S. Army Medical Corps. It was during this time, too, that the U.S. government first turned to the private sector for expertise in social and health reforms. This very important turn from American military civilizing missions to philanthropic health and development projects is nowhere more clearly illustrated than in Haiti.

What makes this history of health intervention in Haiti even more important is that many of these same processes unfolded after the earthquake of 2010, though couched in different terms. Again, American military forces landed and took control of all aspects of government and aid, and yet again, there was a turn over to philanthropic (among other) organizations whose relationships with the U.S. government were already firmly cemented. And while the circumstances and the processes were unique to their times, the overarching similarities and impacts cannot be overlooked.

At the root of these processes has been a disregard for Haiti’s sovereignty, more generally, and of the Haitian people’s citizenship more particularly in a pattern that is repeating through time. This dissertation, then, works at both ends of this history – the beginning of the 20^th century and the beginning of the 21^st century – to examine this pattern.