Haiti: How violence is affecting health and health care workers

Dr Priscille Cupidon, medical activity manager of the Médecins Sans Frontières (MSF) urban violence project in Port-au-Prince, the capital of Haiti, explains how the chronic extreme violence gripping the city has impacted medical care and healthcare workers like her.

I am a doctor in Haiti’s capital, Port-au-Prince, hearing gunfire as armed groups and police battle for control of our city.

This kind of fighting began several years ago, but in recent weeks it has become increasingly violent, like a war. On February 28, it was announced that elections could be postponed until August 2025. Armed civilian groups reacted by uniting against the government, attacking police stations, administrative offices, banks, port and airport facilities and other state institutions. This prevented the prime minister from returning to Haiti, given that our airports were closed.

On 28 February, tension exploded in Haiti after the announcement that the elections have been postponed again to be held “no later than August 2025”. The announcement led to an extremely violent confrontation between the powerful gangs that control most of the Haitian capital and the authorities, with civilian vigilante groups often involved. Violence is ranging virtually unchecked in Port-au-Prince and producing a great number of injuries. In response to the surge in medical needs, MSF teams stepped up their response for trauma and life-saving care for people injured during the riots.

Others remain in homes that have become unlivable, exposed to crossfire and looting. Recent violence even made it more difficult to access drinking water in some neighborhoods, because water trucks could not resupply them.

The situation in Port-au-Prince today is a humanitarian crisis and it demands an urgent response, especially for vital needs including health care, water and sanitation

I manage a mobile clinic from Doctors Without Borders that provides health care in some of the city’s chronically violence-affected neighborhoods. We see the direct and indirect effects of violence on the health of our patients. These include adults struggling to manage chronic illnesses such as diabetes, and children with fevers and diarrhea. Extreme stress often causes mental trauma or hypertension. Many people have skin infections due to a lack of water for hygiene.

The violence is now like gangrene, spreading and threatening us all! Throughout the city, many people have fled because their homes were burnt down or looted by groups that attacked their neighborhoods. More and more areas of the city are emptying out as the conflict progresses. Tens of thousands of people have moved into schools, churches or sports fields in undignified conditions where they lose their privacy and become more vulnerable.
Dr Priscille Cupidon
MSF Medical Activity Manager

Our team visited a neighborhood near the center of the city on March 19, where we hadn’t had access since February 29. The medical needs in the area are very high and are only likely to grow now that health care is so limited. For example, we saw patients suffering from tuberculosis who do not feel safe to leave the neighborhood for treatment due to conflicts and tension between different zones. Barricades and fighting across the city have since prevented our mobile clinic staff from going to work, leaving these patients in a very vulnerable situation.

The women we have seen in our mobile clinics in recent months are often survivors of violence, including rape. As a doctor and as a woman, I can tell that many are afraid to talk about it, because the threat is still in the community. Social stigma can also make survivors reluctant to come forward, because they do not want their families and neighbors to know what happened to them. We do everything we can to make survivors feel safe when they confide in us, but many are already pregnant or have a sexually transmitted infection at that point. We accompany them to our main clinic for sexual violence.

For years, health professionals in Haiti have been working in a difficult environment. The country’s deepening political and economic crises have left medical facilities with few resources. Our health care system is falling apart.

Like other professionals, health care workers have been individually targeted by violence as the situation has worsened. Doctors and nurses have left the country for the United States and elsewhere, including friends and colleagues. Now there aren’t many of us left.

The violence is also preventing patients and staff from reaching medical facilities on a daily basis. Some hospitals, such as Haiti’s State University Hospital, cannot currently function. Another university hospital, Saint-François de Sales, has been completely vandalized and young doctors can no longer complete their training there. The only public university hospital still in operation is La Paix, but it is often overloaded and lacking in resources. Tragically, more women with high-risk pregnancies may die as a result.

Haiti’s main port and airport are now closed, and the Dominican Republic has tightened restrictions on the countries’ border. Given the turmoil of recent weeks, the departure of professionals from Haiti, including doctors and other health care workers, could accelerate once travel becomes possible again.

Those of us still in Haiti are doing our best to serve the community when we can, but we also need care, especially mental health support, because we are witnessing so much violence and cruelty.

We’d like to be able to regain at least the serenity we had a few years ago. Today, we work, go home and lock ourselves in a cage. I’m convinced that all my Haitian brothers and sisters will unite with me in saying that right now we want to live our lives. It’s a right we’ve lost.

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