Unbearable insecurity in Haiti amidst violence and economic crisis – Médecins Sans Frontières (MSF) International

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The capital of Haiti 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 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 between various groups and attacks on neighbourhoods have continued in recent months, as 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 healthcare. 
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 centre when I heard gunfire. I couldn’t even reach the house,” says Marie-Jose, a widowed mother of eight who now lives in Parc Celtique, a sports stadium that is being used as an informal displaced persons site in Solino. 

“All my belongings have gone up in smoke. As everyone in the neighbourhood, I fled and came here,” she says. “We live in misery here; we don’t have anything. What we need 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 areas 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. 
Our teams are providing healthcare through mobile clinics as well as drinking water and sanitation services to displaced people in Parc Celtique and another site – St. Yves parish in Delmas 5. Despite these efforts, there is an urgent need for more humanitarian support for 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,” says Mariana Cortesi, MSF medical coordinator. 
“In some sites people do not have access to any latrines and so they are forced to resort to open defecation,” says Cortesi. “These conditions, paired with overcrowding, are a concern for potential outbreaks of infectious diseases such as diarrhoeal diseases and COVID-19.”  
Amidst the growing insecurity, violence threatens everyone in Port-au-Prince. An MSF staff member from Tabarre hospital was fatally shot on his way home from work in May 2021. Our medical teams receive patients suffering from gunshot wounds, knife wounds or assaults every day in Port-au-Prince.
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,” says Manuelle.

In 2021, our emergency centre – previously located in Martissant and forced to move to Turgeau after being targeted by heavy gunfire – has treated an average of 100 patients suffering from gunshot wounds 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, 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. We run a free 24/7 hotline service and two SGBV clinics and a newer adolescent sexual health project in Gonaïves. 
Since 2015, we have 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.
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 neighbourhoods 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 healthcare in some areas of the capital. In addition to the emergency centre in Martissant, armed clashes in February 2021 pushed MSF to relocate its burn care programme from Cité Soleil to Tabarre.
The recent fuel shortage compounded challenges for medical facilities to stay open and for patients, including survivors of SGBV, to reach them. The fuel shortages have 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 healthcare services in Haiti has become an enormous challenge. “I don’t know what our patients would do if MSF couldn’t provide them with free healthcare anymore,” Joachim says. “The situation in Haiti is catastrophic. I only hope it could change.” 
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