Haiti's capital is in a state of high tension as armed groups vie for power across the city and challenge the government. An economic and political crisis has worsened since at least mid-2018, and violence and insecurity are widespread. The assassination of the president in July 2021 only underlined the instability of the situation.
Armed clashes and attacks on neighborhoods have continued in recent months, with many different groups involved in the clashes, and people suffer the consequences of indiscriminate violence, including open gunfire, burning down homes and pillaging. Meanwhile a fuel shortage brought about by tensions over the port has threatened vital services, including medical ones, and reduced access to health care.
Urgent needs for thousands in displacement sites
Violence and armed clashes in Port-au-Prince have resulted in the displacement of approximately 19,000 people in recent months. Families with young children, people living with disabilities and other vulnerable people are among those who have been violently removed from their homes or forced to flee for safety.
“I was coming back from the city center when I heard gunfire. I couldn’t even reach the house. All my belongings have gone up in smoke. As everyone in the neighborhood, I fled and came here,” says Marie-Jose, a widowed mother of eight who lives now in Parc Celtique, a sports stadium which is being used as an informal displaced persons site in Solino. “We live in misery here; we don’t have anything. What we need the most is food, latrines and somewhere to sleep.”
Those who couldn’t seek refuge with friends and family fled to informal displacement sites such as Parc Celtique. There are currently about eight informal displacement sites in Port-au-Prince in schools, stadiums and churches. The unsanitary conditions and overcrowding in these sites pose significant risks to people’s physical and mental health and increase existing vulnerabilities. Some women and girls have reported sexual violence, harassment and physical violence in the sites, where they lack privacy and safe spaces.
MSF is providing health care through mobile clinics and providing drinking water and sanitation services to displaced people in Parc Celtique and another site, St. Yves parish in Delmas 5. MSF also provided services to people taking shelter in a school building in the neighborhood of Delmas 103, before they were relocated in October. Despite these efforts, there is an urgent need for more humanitarian support to displaced people, including food, water, sanitation services and permanent shelter.
“Many people sleep outdoors on hot or wet concrete without mattresses, and there is a lack of safe drinking water and food,” explains Mariana Cortesi, MSF medical coordinator. “In some sites, there are no showers at all so people bathe using buckets out in the open or behind tarps. In others, people do not have access to any latrines and so they are forced to resort to open defecation. These conditions, paired with overcrowding, are a concern for potential outbreaks of infectious diseases such as diarrheal diseases and COVID-19.”
Ordinary victims of indiscriminate violence
Amidst the growing insecurity, violence threatens everyone in Port-au-Prince. An MSF staff member from the Tabarre hospital was fatally shot on his way home from work in May 2021. MSF medical teams receive patients suffering from gunshot wounds, knife wounds or assaults every day in Port-au-Prince. “When armed clashes erupt in some neighborhoods in Port-au-Prince, we can receive dozens of injured patients in one day. We are doing our best to provide quality medical care to everyone, even though sometimes it’s very difficult,” says Tania Joachim, an operating theatre nurse at MSF's burns and trauma hospital in Tabarre.
Patients describe violent events that can occur without warning. Manuelle Lina, pregnant with twins, was returning from a market when she was struck by vehicles fleeing a shootout between armed groups. Severely injured, Manuelle was admitted to the emergency room at MSF’s Tabarre hospital: “I had a broken foot and some broken ribs. The medical staff also performed a sonogram, and my little boy and girl were moving normally, but by the day after, I had lost both of them.”
In 2021, MSF’s emergency center—previously located in Martissant and forced to move to Turgeau after being targeted by heavy gunfire in June—has treated an average of 150 patients suffering from violence-related trauma each month. MSF’s Tabarre hospital regularly receives trauma patients referred from Turgeau, and about half of the hospital’s trauma patients suffer injuries from violence.
The number of people in Haiti, and specifically girls and women, who report experiencing sexual and gender-based violence (SGBV), continues to be alarmingly high, especially in Port-au-Prince. One in eight women in Haiti aged between 15-49 years have experienced SGBV in their lifetime. MSF runs a free 24/7 hotline service and two SGBV clinics—the Pran Men’m clinic (Haitian Creole for “take my hand”) in Port-au-Prince and a newer adolescent sexual health project in Gonaïves.
Since 2015, MSF has treated over 7,000 survivors of SGBV, of which over half were minors under the age of 18 years. In recent weeks, our teams have documented a change in the nature of SGBV cases, with several survivors reporting they were victims of kidnappings and sexual violence, with many of the incidents involving one or more armed aggressors.
Hampered access to health care
Survivors of SGBV face many risks in seeking medical care and legal protection. Shame, stigma, fear of disclosure and social consequences, as well as difficulties to reach health facilities all inhibit patients from seeking care. In some neighborhoods where violence is more prevalent, people are not able to move in and out of the area freely or are afraid to do so.
Rising insecurity has also forced health facilities to close or reduce their services, significantly limiting access to health care in some areas of the capital. In addition to the emergency center in Martissant, armed clashes in February 2021 pushed MSF to relocate its burn care program from Cité Soleil to Tabarre.
The recent fuel shortage compounded challenges for medical facilities to stay open and for patients, including survivors of sexual and gender-based violence, to reach them. “Transportation fees in the capital quintupled, meaning many people have not been able to reach those health care facilities that remain open, unless they walk for hours, because transportation is either very expensive or simply unavailable,” explains Mariana Cortesi.
The fuel shortages affected every sector, including public institutions, banks, municipal water supplies, shops and the prices of essential goods, making daily life extremely difficult.
With continual uncertainty and insecurity, maintaining health care services in Haiti has become as much as a challenge as it is needed. “I don’t know what our patients would do if MSF couldn’t provide them with free health care anymore,” Joachim says. "The situation in Haiti is catastrophic. I only hope it could change."