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A health worker at St. Boniface Hospital checks on an infant. Staff at health facilities across Haiti continue providing care amid unrest. (Photo courtesy of Health Equity International)
Since 2010, Haiti has faced a catastrophic earthquake that killed more than 200,000 people, Hurricane Matthew, cholera outbreaks, the assassination of former President Jovenel Moïse in July 2021, and a 7.2-magnitude earthquake the following month.
Several doctors, hospital officials, and nonprofit leaders who spoke with Direct Relief say the current situation in Haiti is the most difficult within the past 15 years, due to widespread gang violence in Port-au-Prince and a range of cascading problems that have occurred as a result, including border, airport, and port closures, food insecurity, inflation, and large numbers of internally displaced people.
On March 18, a U.S. State Department spokesperson said in reference to recent events in Haiti that “it is not hyperbole to say that this is one of the most dire humanitarian situations in the world.” Earlier this week, “the majority” of pharmacies and health clinics near the currently closed State University of Haiti Hospital, also known as General Hospital, were burned down by gangs.
“We’ve never seen a situation like this,” said Dr. Marc Edson Augustin, medical director of the St. Luke’s Foundation, which runs a hospital in Port-au-Prince and clinics nationwide that care for about 60,000 patients annually.
“Nobody is allowed to function, to move around. They fear for their lives. It’s a country in collapse,” said Augustin, whose sister, a pediatrician, was kidnapped by gangs in 2022.
“We are living in chaos,” said Hadson Albert, a communications official at St. Damien Pediatric Hospital in Port-au-Prince. Albert said gangs are active in the hospital’s neighborhood and his neighborhood. St. Damien is the only hospital providing care for children with cancer and one of the few that treats high-risk pregnancies. Part of the St. Luke’s Foundation, it is funded through donations and mostly offers free services to vulnerable populations in Haiti.
“The situation is the worst we’ve ever seen during our three-decade tenure in Haiti. There’s never been a time when the entire country has been paralyzed by the situation in Port-au-Prince like it is now,” said Project Medishare’s Jenna Green. Project Medishare provides care to about 55,000 patients annually at Hospital Bernard Mevs in Port-au-Prince and about 100,000 patients annually at its clinics in the Central Plateau region, near the border with the Dominican Republic.
Augustin said that during past natural disasters, people were able to seek to move around to find hospitals and clinics that were still open. Now, most are afraid to leave home due to gang violence and the threat of being kidnapped. He said patient levels at this hospital have been dramatically reduced since the start of the year.
“What’s been going on has been building up since the assassination of our elected president in 2021. Gangs have slowly taken control and have attacked hospitals, schools, and the government,” Augustin said. In 2023, Haiti saw its murder rate double compared to the previous year, totaling more than 4,700 deaths, according to a United Nations report.
A community health worker with Health Equity International administers a vaccine to a child in southern Haiti during medical outreach. The organization operates a health facility in Haiti that has been responding to cholera outbreaks locally, of particular concern in young children. (Photo courtesy of HEI)
While both St. Luke’s and St. Damien remain open, both reported drastically reduced patient flows, as many residents are afraid to leave their homes. Staff members at both hospitals have had to do extended shifts of up to 24 hours, compared to standard shifts lasting between 8 to 12 hours. Some staff members choose to stay on-site for days at a time. These measures reduce the amount of travel. Healthcare workers have been targeted for robberies and kidnappings in recent weeks.
“We are doing our best to maintain the same level of care,” Albert said.
“We’re living day by day. I’m anxious to find out if we’ll be able to be resupplied. Nothing is certain,” Augustin said.
These current obstacles, combined with crises of the past and the economic opportunities present in the United States and Canada, have led to a large exodus of medical and other professionals from Haiti in the past decade, further compounding the challenges of providing healthcare.
Countryside Concerns Increase
Outside of Port-au-Prince, in the nation’s rural areas, hospitals and clinics face severe challenges related to large numbers of internally displaced people, food shortages, and reduced access to medicine and medical supplies – even for hospitals that were prepared. Patient levels are also reported to have dropped due to fears of leaving home and the increased cost of fuel.
“We built an infrastructure to be independent,” said Jessica Laguerre, who spoke to Direct Relief from Port-au-Prince. Laguerre is the chief operating officer at Hôpital Albert Schweitzer, or HAS, which is located about 100 kilometers northwest of Port-au-Prince in the Lower Artibonite Valley. The hospital has its own power grid, solar panels, oxygen plant, access to water, staff quarters, and stockpiles of medicines and supplies to last between one and three months.
“Having that removes most challenges most institutions are facing in Haiti,” she said, interrupting her response to note gunshots she heard in the distance. The staff at HAS are all Haitian, and Laguerre believes they have higher motivation since “they are serving their family and friends.”
Still, the hospital staff are subject to violence and kidnappings, with the hospital’s surrounding area ranking second behind Port-au-Prince for gang violence. Laguerre said that a staff member had been kidnapped and that gunshot wound victims had risen from a maximum of 10 cases per year to about 10 to 12 per week.
Stressing the importance of keeping hospitals as neutral zones, she recounted a situation where a well-known gang member came in to be treated after having been shot. People in the community found out and were planning to “storm into the hospital and lynch him.”
Laguerre and her team immediately called the police to remove him to another location for treatment, which they did in an armored vehicle.
Health staff at Hospital Albert Schweitzer. (Courtesy photo)
While all of the issues are troubling, Laguerre pointed out that the Lower Artibonite Valley is known as the country’s food basket, making the pervasive food insecurity-related issues even more shocking.
“You’d think a farming community would always have at least the minimum amount of food… you can only imagine what the rest of the country is facing,” she said. A new food program Laguerre and her colleagues created quickly went from one location serving 200 plates per day to five locations, with two more planned for this week, serving 600 plates each.
Hunger was also cited as a leading concern by Locally Haiti, which operates a hospital in Petit-Trou-de-Nippes, which was severely damaged during the 2021 earthquake.
“This community is not self-sufficient. A lot of food and goods come from Port-au-Prince and the Dominican Republic,” said Wynn Walent, head of Locally Haiti.
“Food is much more expensive, and people are hungry. It’s true throughout the country and also true in our area,” he said.
Walent said that there has been a large increase in population, who have mostly been displaced from Port-au-Prince and have gone to live in the countryside with family members.
“Anecdotally, we’ve seen a 25% increase in the number of students enrolled in the school we support,” Walent said.
Walent said that a substantial increase in violence has not reached Petit-Trou-de-Nippes and that the work of their hospital has not been impeded, though restocking supplies is a concern with the closed border.
A new hospital is being constructed by Locally Haiti with support from Direct Relief. (Photo courtesy of Locally Haiti)
“We’re not trying to trivialize concerns, but help does reach people, even in the current circumstances, and can make a difference,” he said.
Project Medishare’s clinics in the Central Plateau face a similar situation in terms of gang violence to that in Petit-Trou-de-Nippes, Jenna Green said.
“We’re in the rural areas, and there’s not as much money in the rural areas for gangs, “ she said. Project Medishare has extended deployments to three weeks for their staff due to the danger of traveling between Port-au-Prince.
Project Medishare’s two clinics are open in the Central Plateau as are two maternity centers in the same area. During one day recently, only three patients showed up across all of their clinics. Overall, Green said monthly patient totals are about half of what they were last year, due to a mix of fuel costs and security concerns.
In addition to fuel costs, pharmaceutical and supplement costs have also increased dramatically. Prenatal vitamins, for example, have increased 400% in cost compared to January 2023.
Green said the closure of the Dominican Republic border is also impacting their ability to source medications and other supplies. “We are severely lacking supplies,” she said. Hospital Bernard Mevs ran out of oxygen and blood for during a period earlier this month but remains open.
Adding to the import problem, Green said that while the port at Cap-Haitien is open for sea freight, stringent Haitian regulations prevent the import of goods for many charities since many government bureaus are closed.
Like other nonprofits throughout Haiti, Green said Project Medishare prioritizes nutrition and recently adjusted their school meal program, which serves 8,000 meals per week. To keep it active, they hired mothers of the pupils to work as chefs and bought produce and other ingredients locally, at greater cost, since it was the only viable option, given the disruptions to the supply chain.
Peace and Perceptions
Augustin, referring to over a dozen hospitals that have been attacked in recent weeks, struggled to see how the situation would stabilize without outside help.
“I have to admit, it’s starting to seem hopeless. We’ve been waiting for international support to end this nonsense… I don’t see why the gang would put down their guns if not forced to do so. They outnumber the police and have more firepower,” he said.
“We need peace,” Augustin said.
Despite the problems, Laguerre, Green, and others see reason for hope looking forward. Green noted that her optimism comes from staying open and delivering care. Laguerre focuses on the potential of the majority of Haitians rather than the minority who are creating the instability.
“It’s a small percentage of people, and they are terrorizing us, but once we do the groundwork, we can move the country in a different direction,” Laguerre said.
“There are a lot of beautiful things happening here… there’s so much energy being directed by Haitians at any opportunity given to help,” she said.
Laguerre believes that Haiti might not be as far from stability as it may seem, even given all the current violence and associated problems.
“We’re a tiny country, and it wouldn’t take much for us to get back on track. We need a little security and help, and we’ll do the rest on our own,” she said.
