April 8, 2005
Members of the Security Council,
Médecins Sans Frontières (MSF) is grateful for this opportunity to address our concerns to you about the current crisis faced by people in Haiti, in particular in Port au Prince.
Civilians in the capital have been caught in the crossfire of extreme violence that has wracked the city in waves since September 2004. From visits to the city morgue, MSF estimated that 100 people were killed each month from September to December 2004 as armed factions supporting and opposing exiled President Jean-Bertrand Aristide fought in the streets of the seaside slums, or "quartiers populaires", of Cite Soleil and Bel Air.
MSF has been present in Haiti since 1991, mainly providing assistance in the country's provinces or in response to natural disasters. In December 2004, MSF opened a 42-bed trauma center at St. Joseph's Hospital in order to provide free emergency medical and surgical services to the growing number of people injured by violent acts who had little or no access to care. MSF also offers post-surgical physiotherapy at a nearby rehabilitation center. Today, both facilities are filled to capacity.
From December 19, 2004 until April 3, 2005, our teams treated 1,293 patients – 391, or more than 30%, suffered injuries from violent attacks, including 303 people treated for gunshot wounds, 34 for machete or knife wounds, and 22 for rape. Of those we have treated for violent injuries, 190, or nearly half, were women, children, and elderly, a point that highlights the fact that civilians are bearing the brunt of the sporadic, ongoing violence in Port au Prince. Every month, the number of such patients has increased, and we have begun to see injuries caused by exploding bullets – injuries that, as one doctor told me when I was in Haiti, are unusual for a city setting but common in war zones.
Before our program began, intense fighting seemed to be confined to Cite Soleil and Bel Air. Today, though, the violence is apparently spreading to many other neighborhoods throughout the city. While most of our patients continue to arrive from Cite Soleil and Bel Air, we receive patients every day from neighborhoods like Centre Ville, St. Martin, La Saline, Poste Marchand, Delmas 33, Carrefour, and Carrefour Feuille.
From what our patients tell our doctors and nurses, people have been shot and killed, both deliberately and unintentionally, by all of the armed groups active in Haiti today. Our patients say they have been targeted directly by factions in the "quartiers populaires" for their perceived allegiance to one group or another, sometimes killed in areas controlled by rival factions for being considered "traitors." Women and children have come to our trauma center after being shot during unpredictable flare-ups of indiscriminate shooting near their homes, or while buying or selling goods at public markets, or simply while walking down the wrong street at the wrong time. We have also received a number of patients who said they were wounded by the Haitian National Police (HNP) during police actions in many parts of the city, including several people from Bel Air who told us they were wounded when the HNP opened fire on demonstrators there in March. A few patients have also said they were wounded during Minustah operations.
Conditions of life in several of the capital's poorest neighborhoods are terrible and rapidly getting worse. Already impoverished before this latest crisis, these neighborhoods are falling into near-total ruin. Economic activity in some areas has ground to a halt in an atmosphere where extortion, robbery, murder, and rape are common. Shops have been burnt to the ground, and shopkeepers who refuse to pay extortion fees have been executed. At a moment when most people are struggling to find even the most meager resources to survive from one day to the next, they fear venturing out into a lawless environment, virtually held hostage in their homes.
Outside the capital, general impoverishment leads to the lack of access to even the most basic health care services, as well. MSF has provided primary and maternal health care in Petite Riviere, Artibonite Department, since 2000. A recent survey conducted by MSF found that the cost-recovery, or user fee, system causes half of the already indigent population to sell off tools and other equipment just to pay for minimal health care. With the majority of people in the area struggling to survive on less than 50 cents a day, it is not surprising that one in ten people said they cannot access health services because of the cost.
Violence in Haiti's capital, though, remains MSF's main concern, as it continues to wreak havoc on civilians and destroy hundreds of lives. Women and young girls, in particular, are being victimized by heinous sexual violence. Our medical teams have treated 22 of victims of extremely violent sexual attacks, some committed against girls as young as 10 years of age. Many victims have been severely injured or forced to witness the murder of a parent before being kidnapped and brutally gang raped. These women and young girls often suffer further humiliation after their ordeal because they are afraid that if people find out they went for help, they will be killed. Based on our patients' testimony and other sources, rape seems to be used by some groups as a strategy to instill fear in civilians, and the true scale of sexual violence is certainly much greater than the number of victims MSF has treated.
Families in areas of the capital most affected by violence are fleeing to other parts of the city. Civilians without any resources, though, are forced to remain, often at the risk of deprivation and severe harm. Patients come to MSF from all over Port au Prince, with a majority brought to the trauma center by the Red Cross and Minustah. But we know for sure that many victims in places like Cite Soleil have no access to MSF's trauma center or any other health facility. They are forced to hide for days without any treatment for their wounds. Those with serious injuries have little chance of surviving. Sometimes the wounded can't afford to pay for transportation, or no transportation exists in a neighborhood following an eruption of gunfire. If the wounded manage to get to a public hospital, they may find a structure that lacks medical staff and supplies. Nearly none of the wounded can afford the high price charged for private care, while some civilians say they fear arbitrary arrest if they seek treatment for violent injuries.
Steps must be taken to ensure that the violently wounded can access lifesaving medical care. This access must not be conditioned on any considerations, political or otherwise, except need. MSF's trauma center is located near but not within the areas of most intense fighting, which allows people from all over the city to access its services. To date, our presence and humanitarian work has been respected by all armed groups. MSF, though, has not set up any facilities in areas of Cite Soleil secured by Minustah in order to avoid acts of retaliation against our patients or team by those factions who may feel under attack by Minustah forces.
Fighting erupts in many of the city's neighborhoods nearly every night, with people there confined to their homes in a state of constant fear. Many of those who have lived and worked in Port au Prince for decades told me when I was in Haiti that they have never experienced such levels of violence and insecurity. They said that the anxiety they feel today is far and above worse than at any time during the country's many recent political crises. The needs and safety of civilians most affected by this brutal reality must be at the center of any response to the present emergency. At the very least, the ability for those wounded in the violence to access life saving medical and surgical care must be assured.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)