by Sonia Shah
We found people to talk to at the garbage-strewn shore. A group of about a dozen young men milled around aimlessly, hoping for work on one of the small wooden boats moored nearby. They surrounded us as soon as we parked the car. The knot of fishermen untangling ropes in a bombed-out cement structure wouldn’t talk to us, or allow us to take their photographs, but the young men were open to talking. Still, after a few minutes, they told us we had to leave. Somewhere deep inside the neighborhood a conflict was brewing. As we made our way out of the slum, two shiny white trucks emblazoned with the letters UN pulled over in front of us, emitting a stream of soldiers in full combat gear. They trotted off purposely into the interior, single file, rifles in hand.
The details of this specific mobilization were unclear, but I knew that the ongoing cholera epidemic had inflamed a history of violent clashes between local people and outsiders—specifically, United Nations peacekeeping troops. The troops had first arrived in the country in 2004. In principle, their mission was aimed at maintaining peace and order in Haiti, but most Haitians understood the UN presence as an occupation that took over where U.S. troops, which had been sent to Haiti three times over the last century, left off. (The U.S. ambassador admitted as much in a leaked 2008 cable, recognizing the UN troops as an “indispensable tool in realizing USG [U.S. government] policy interests in Haiti.”) Those interests, since the 1990s, were primarily to suppress militants, or what U.S. leaders called “criminal gang members,” who supported the liberation theologian and deposed Haitian leader Jean-Bertrand Aristide. Cité Soleil was a stronghold of both militancy and crime.
As a result, there hadn’t been much peaceable about the UN’s activities in Haiti. Between 2004 and 2006, for instance, UN troops helped the Haitian police and paramilitary forces kill an estimated three thousand people and imprison thousands of Aristide supporters.1 A Haitian parliamentarian called the UN troops “a fish bone stuck in our throats.”2
The cholera epidemic had sparked another outburst of violence between locals and UN soldiers. In Saint-Marc, a crowd threw stones at a local cholera treatment center as UN troops fired upon them. Elsewhere, at a Red Cross clinic, stone-throwing students were confronted by rifle-wielding soldiers. In Port-au-Prince, mobs tore down tents set up to treat cholera patients.3 The situation in Cap Haitien was so dire, with mobs burning down police stations, that the entire city was put under lockdown. Schools, shops, and offices closed while aid workers hid in office buildings, the walls covered in graffiti reading UN = KOLERA. Cholera had ignited such discord and violence that the UN’s humanitarian chief called the disease “a threat to national security.”4
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Cholera riots date back to the nineteenth century. Across Europe and the United States, paroxysms of violence fanned out in cholera’s wake, a “pandemic of hate,” as the historian Samuel Cohn has described it, that nipped on the heels of disease like an angry dog.5
It doesn’t really make sense, on the face of it. It would seem that in times of social stress—say, the arrival of a deadly contagion—the appropriately healthful response would be to move even closer together, to clasp hands and stand shoulder to shoulder in the face of the intruder. Instead, epidemics of new disease often set in motion “an inexorable collapse of morals and manners,” as the critic Susan Sontag wrote.6 They “spawn sinister connotations,” the medical historian Roy Porter added.7 And the discord sparked by epidemics isn’t generalized or diffuse. As in Haiti, it’s often focused with laser-like intensity on specific groups of people—scapegoats—who, among all the potentially culpable groups and social factors, are fingered as being especially responsible for the epidemic.
Calling the troops scapegoats is not to say that there was no basis for the animosity between UN soldiers and local Haitians, or that UN soldiers were not complicit in cholera’s spread. Indeed, the UN had hired soldiers from cholera-struck Nepal, whom they could pay a fraction of what the United States paid its own soldiers, and it was these soldiers who had introduced cholera into Haiti. But while the troops introduced the pathogen, they could not logically be held responsible for the way it ignited across the country. That had to do with larger, more deeply rooted problems beyond their immediate control, like poverty, the lack of clean water, and the dislocations caused by the preceding earthquake. Nor were the troops, at the time when they were attacked, actively contributing to the epidemic. On the contrary, they and others associated with them were ostensibly trying to help.8
A handful of psychological studies offer some clues about the social and political contexts in which scapegoating is most likely to occur. These studies attempt to measure subjects’ willingness to blame scapegoats under various experimental conditions. In one study, subjects who were reminded of their powerlessness over a social crisis or the inability of their government to protect them from it expressed a greater desire to punish a scapegoat, compared to subjects who were simply told of the presence of the crisis. Other subjects, who were reminded of their own role in contributing to a crisis, expressed a similar eagerness to punish scapegoats.9 In another study, subjects who perceived less control over their lives believed that scapegoated groups were more powerful than did subjects who perceived more control over their lives.10 Just who the scapegoat is makes a difference, too. Groups that seem incompetent, weak, or circumscribed in their social power are less likely to attract blame. It’s groups that seem feasibly complicit in social crises (a corporation as opposed to the Amish, in the case of environmental damage, for example), powerful, and yet also mysterious who are the most likely targets, studies have found.11
The psychiatrist Neel Burton, who has written about the psychology of scapegoating, sees it as a form of projection. Powerlessness and complicity, he says, are uncomfortable feelings that people naturally seek to expunge or escape, and one way to do that is to project them onto others. When those others are punished, the old feelings of powerlessness and guilt are transformed into feelings of mastery or even “piety and self-righteous indignation.”12
That may be why epidemics caused by novel pathogens so often lead to violent scapegoating. Because they’re poorly understood and specialize in striking societies with weak and corrupt social institutions, such epidemics are especially adept at disrupting people’s sense of control over their environment. At the same time, their ravages are not inescapable, either, like the effects of wars or floods. Certain people are struck, while others are not, suggesting some form of complicity, however opaque.
Ancient peoples captured the impulse to scapegoat during social crises in telling rituals. In ancient Greece, during epidemics or other social crises, beggars or criminals called the “pharmakos” were ritually stoned, beaten, and driven out of society. In ancient Syria, female goats designated as the vehicle of evil were decorated with silver and driven out into the wastelands to die alone during royal weddings. The word “scapegoat” itself derives from a ritual described in Leviticus in the Old Testament, in which God commands Aaron to sacrifice two goats for the Day of Atonement. One was to be slaughtered. The other goat, for “Azazel,” was to be symbolically laden with all of the transgressions of the Israelites and then sent out into the desert to perish alone. The ritual sacrifice of the Azazel goat, which the King James version of the Bible translates as “scapegoat,” dramatized people’s desire to expunge the powerlessness and guilt of life in a world of capricious hazards, from famines to epidemics.13
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Scapegoating is particularly disruptive during epidemics because it often targets the very groups of people most likely to be able to contain epidemics and alleviate their burden.
During the nineteenth century, it was physicians and religious leaders who were often the targets for violence. When cholera hit Europe in 1832, rumors that hospitals were in the business of killing patients to rid society of those deemed “surplus” made the rounds. People stoned and assaulted local physicians, accusing them of killing cholera victims for the express purpose of dissecting their bod
ies. More than thirty riots erupted in Britain and France between February and November 1832, from stone-throwing episodes that contemporaries called “petty tumults” to melees involving hundreds.14
During cholera outbreaks in New York, mobs attacked quarantine centers and cholera hospitals, and blocked health officials from removing cholera-struck corpses from their tenements. (During one confrontation, health officials were forced to lower a coffin to the ground via a window.)15 In cholera-struck Madrid in 1834, citizens became convinced that the monks and friars—who contentiously supported the king’s brother’s designs upon the throne—had brought the cholera by poisoning the wells. Angry mobs converged in Madrid’s public squares, ransacking religious houses and Jesuit church buildings and murdering fourteen priests. The Franciscans of San Francisco suffered heavily: forty were stabbed, drowned in wells, hanged, or hurled from rooftops. “The bloody scenes did not end until well into the night,” the historian William J. Callahan notes.16
Immigrants were similarly targeted for violent scapegoating. Like health-care workers and religious leaders, they were considered somehow complicit in outbreaks: the correlation between immigrant neighborhoods and the prevalence of disease was clear enough to see. Of course, the building owners who crowded immigrants into urban tenements and the commercial interests that dominated trade and travel routes contributed as much if not more to the spread of disease, in relatively easy-to-see ways, too, but were spared from the violence. Immigrants, with their mysterious culture and outsider status, suffered the brunt instead.17
Cholera’s arrival led once welcoming communities to refuse to rent rooms to passing immigrants and travelers. “Distressed strangers were obliged to sleep in the streets, in the fields,” and in beds “made principally with bed clothes, and a few boards and sticks,” a local newspaper in Lexington, Kentucky, noted in 1832.18 Residents of the towns lining the Erie Canal refused to let boats enter their waters, or to let anyone on passing boats disembark, even passengers attempting to return home.19
The particular immigrant groups blamed for cholera’s spread varied over the decades. In the 1830s and 1840s, it was the Irish. “Being exceedingly dirty in their habits, much addicted to intemperance and crowded together in the worst portions of the city,” the New York City board of health noted in 1832, the “low” Irish “suffered the most” from cholera. The Irish “brought the cholera this year,” Philip Hone complained in his diary, “and they will always bring wretchedness and want.”20 In 1832, fifty-seven Irish immigrants living in an isolated clearing in the woods of Pennsylvania—they had been hired to clear a path for a new rail line between Philadelphia and Pittsburgh—were quarantined and then secretly massacred, their shacks and personal belongings burned to the ground. “All were intemperate, and ALL ARE DEAD!” local papers gleefully reported.21 Investigators unearthed the workers’ smashed and bullet-riddled skulls from a mass grave in 2009.22
In the 1850s, the wave of violence that followed cholera crashed upon Muslims, in particular, pilgrims on Hajj. Muslim religious stricture requires that all practitioners perform the Hajj pilgrimage to Arafat, about twelve miles east of the Saudi Arabian city of Mecca, at least once in their lives.23 As the pace of international trade and shipping picked up, so did the number of Hajjis. In 1831, 112,000 pilgrims participated in Hajj; by 1910, an estimated 300,000 did.24 Cholera outbreaks followed as well. In one of the worst outbreaks, in 1865, cholera killed fifteen thousand Hajj pilgrims.25
Anxieties among Western elites that the Hajj would infect the West with cholera—which they continued to describe as a disease of Asian filth despite its proven affinity for Western cities—grew accordingly. The series of international meetings convened between 1851 and 1938, which resulted in the 1903 International Sanitary Convention and served as a precursor to the World Health Organization, focused specifically on how to selectively confine Meccan filth from contaminating Western society. “Mecca, I hold, is the place of danger for Europe,” the British doctor W. J. Simpson put it, “a perpetual menace to the Western world.” Indeed, added another influential Brit, “the squalid army of Jagganath with its rags and hair and skin freighted with infection may any year slay thousands of the most talented and beautiful of our age in Vienna, London, or Washington.”26 The trouble with Hajj pilgrims from India, another added, is that they “care little for life or death,” but “their carelessness imperils lives far more valuable than their own.”27 The French recommended sealing off the Middle East entirely, by selectively banning Hajj pilgrims from traveling by sea at all, forcing them to journey to Mecca in caravans over the desert.28
In the 1890s, cholera-fueled scorn in New York City fell upon Eastern European immigrants. They had been pouring into the city over previous years, and social panic about them and the cholera they might bring with them rose in lockstep. Prominent New Yorkers—progeny of earlier waves of immigrants themselves—demanded that the gates be slammed shut.
“Prevent further immigration to this country,” Mayor Hugh Grant wrote to President Harrison in 1892, “until all fear of the introduction of cholera shall have disappeared.” The country’s newspaper of record agreed. “With the danger of cholera in question,” The New York Times reported in a front-page article, “it is plain to see that the United States would be better off if ignorant Russian Jews and Hungarians were denied refuge here … These people are offensive enough at best; under the present circumstances they are a positive menace to the health of this country … Cholera, it must be remembered, originates in the homes of human riffraff.”29
In 1893, amid rising hysteria about cholera-infected immigrants, New York City officials quarantined the Normannia, a vessel carrying immigrants from Hamburg, Germany, which had suffered cholera deaths en route. City officials wanted to hold the passengers at a hotel on Fire Island, but before they could disembark, armed mobs gathered on the docks and threatened to burn down the hotel. For two days, the mob jeered at the trapped passengers and barred them from leaving the vessel. Two regiments from the National Guard and the Naval Reserve had to be called in to allow them safe passage to land.30
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Violent, cholera-fueled scapegoating in the nineteenth century intensified the pathogen’s disruptive impact but probably didn’t play much of a role in increasing cholera’s death toll. Violence against physicians and immigrants surely reduced people’s access to medical care, but given the state of medical treatments for cholera at the time—vast quantities of calomel, a mercury compound; tobacco smoke enemas; electric shock; and interventions such as plugging the rectum with beeswax, among others—that probably increased rather than decreased people’s chances of surviving. The reverse is true now, because containment measures are actually effective. Today, when health-care workers and their containment measures are attacked, pathogens kill more people.31
During the 2014 Ebola epidemic in West Africa, health-care workers attempting to safely remove still-contagious corpses were chased, lied to, and assaulted. In Guinea’s second-largest city, Nzérékoré, riots broke out when a team arrived to disinfect the local market. Near Guéckédou, villagers burned a bridge connecting their village to the main road to repel health-care workers. In another nearby village, a mob attacked a team of eight health-care workers, politicians, and journalists as they attempted to distribute information about Ebola. Two days later, their corpses—including three with slit throats—were found in the septic tank of the village’s primary school. “We don’t want them in there at all,” a village chief in Guinea explained to The New York Times, referring to health-care workers. “They are the transporters of the virus in these communities.”32
Commentators often explained West Africans’ mistrust of Western medicine by pointing to their superstitious beliefs around disease transmission, but recent historical events in the affected countries probably played more of a role. People in Guinea, Liberia, and Sierra Leone had suffered more than two decades of human-rights violations and atrocities at the hands of the mi
litary before Ebola arrived, eroding public trust in authority figures. The fact that health-care workers, imbued with official authority, were mostly foreigners probably didn’t help inspire confidence among the locals either.
In South Africa, the government itself attacked lifesaving containment measures: the antiretroviral medications that treated AIDS. At an international scientific conference on AIDS held in 1985, National Institutes of Health researchers had reported—on the basis of what turned out to be a faulty assay—that HIV had infected two-thirds of schoolchildren in Uganda, and up to one-half of the population of Kenya. The claim was grossly exaggerated, but the idea that the new virus originated in the “heart of darkness” struck a chord among Western journalists. Sensationalistic stories about HIV’s impact in Africa became, as Kenyan president Daniel arap Moi put it, “a new form of hate campaign.”33 Outraged at Western scientists’ and their news media’s implication that Africans were to blame for HIV’s spread, antiapartheid leaders such as South African president Thabo Mbeki dismissed the entire notion that HIV existed at all. AIDS, Mbeki said, was just a newfangled term for malnutrition and diseases of poverty.34 For years Mbeki’s government refused to provide AIDS medications to South African patients, and restricted the use of donated medications as well. (His administration touted the healing powers of lemon juice, beetroot, and garlic instead.) Between 2000 and 2005, more than three hundred thousand South African AIDS victims died prematurely for lack of effective treatment.35