Port-au-Prince, Haiti –
When machine gun fire breaks out outside the barbed wire fence surrounding the Fontaine Hospital Center, the noise floods the cafeteria filled with exhausted, scrub-clad medical staff.
and nobody closes their eyes.
Here at Cité Soleil, gunfights are part of everyday life. It is the most densely populated area in the Haitian capital and the center of Port-au-Prince’s gang wars.
As gangs ramp up their crackdown on Haiti, many medical facilities in the Caribbean nation’s most violent neighborhoods close, making Fontaine the last remaining hospital and community in one of the world’s most lawless places. has become one of the institutions.
“We were left alone,” said Loubents Jean Baptiste, the hospital’s medical director.
Fontaine could mean the difference between life and death for hundreds of thousands of people trying to survive, providing a small oasis of calm in a city plunged into chaos.
The dangers on the road complicate everything. When gangsters with gunshot wounds show up at the gate, the doctor asks them to check the doors for automatic weapons, like coats. A doctor cannot safely return to his home in a rival gang-controlled area and has to live in a hospital dormitory. Patients, too frightened to seek basic care because of the violence, arrive in increasingly dire condition.
In Haiti, the poorest country in the Western Hemisphere, access to healthcare has never been easier. However, at the end of last year, he was hit by a one-two punch.
One of Haiti’s most powerful gang coalitions, the G9, has blocked Port-au-Prince’s most important fuel terminal, effectively paralyzing the country for two months.
At the same time, a cholera outbreak exacerbated by gang-imposed movement restrictions has collapsed Haiti’s healthcare system.
The UN High Commissioner for Human Rights, Volker Turk, said this month that violence between the G9 and rival gangs had turned Cite Soleil into a “living nightmare”.
A reminder of despair is never far away. Armored trucks driven by hospital leaders pass by hundreds of mud pies baking in the harsh sun, filling the stomachs of those who can’t afford food. Black spray-painted ‘G9’ tags dot nearby buildings, warning who is in charge.
A UN report in February documented 263 murders in small areas around hospitals between July and December, noting that violence “severely hindered” access to medical services. bottom.
Mirren Siltant, 34, was a street vendor waiting for a checkup in a hospital hallway, nervously clutching medical papers over her pregnant belly.
Nearby, hospital staff play with nearly 20 babies and toddlers. Orphans whose parents were killed in a gang war.
Typically, Siltant spends an hour traveling around the city in a colorful bus, called a tap tap, to undergo an antenatal check-up in Fontaine. There she joined other pregnant women waiting for her test and her mothers cradling their malnourished children in line to be weighed.
All clinics in her area have been closed, she said. For her two months last year, she was unable to leave the house. Gangs have taken the city hostage, making it nearly impossible to navigate the dusty, winding streets.
“Some days we don’t have transportation because we don’t have fuel,” she said. “Sometimes there are shootings in the streets and we are stuck for hours. I am worried now because the doctor said I need to do a caesarean section.”
Health care providers told the Associated Press that the crisis has resulted in more bullets and burns. It has also spurred an increase in unpredictable conditions such as hypertension, diabetes and sexually transmitted diseases, largely because access to primary care has been greatly reduced.
Pregnant women are disproportionately affected. Obstetrician-gynecologist Farande Joseph sees the effects every day, every time she leaves her hospital dormitory and dons light blue scrubs.
A young Haitian doctor, wearing white surgical gloves, makes an incision in a pregnant patient’s belly with a firm hand.
She works swiftly and converses with medical staff in her native Creole when a nurse screams from a baby girl wrapped in a pink blanket.
Such operations are becoming more common, Joseph explains between caesarean sections. This is because the very condition intensified in turmoil can transform a pregnancy from high-risk to fatal.
According to United Nations data, 10,000 pregnant women in Haiti could face fatal obstetric complications from the crisis this year.
These risks are only exacerbated by the fact that many of Joseph’s patients are survivors of sexual violence or widows whose husbands were killed by gangs.
“When I go into labor at 3 a.m., I’m terribly afraid to come here because it’s too early, and I’m afraid something will happen because of the gang,” said Joseph. Babies are often already in pain and it is too late to have a caesarean section.”
It was most evident to Joseph last October when four men rushed to the hospital with a laboring woman stretched over the door. Due to a gang blockade, the woman was unable to find transportation to the hospital after her water broke.
“These four men weren’t even her family. They found her giving birth on the street. When I heard she lost her baby, it made me shiver.” “The situation in my country is very bad and there is not much we can do.”
Fontaine Hospital Center was opened in 1991 by Jose Ulysse, starting as a one-room clinic providing basic medical services to communities with no other resources.
Julis and his family have worked to expand the hospital year after year. They are fighting to keep the door open, Ulysse said.
The hospital reopens hours later, even as a shootout arrives at Fontaine’s door. If the shutdown is prolonged, management fears it will lose momentum and make reopening difficult.
It is currently the only facility in Cite Soleil to perform Caesarean sections and other advanced surgeries.
With most of the people in the region living in extreme poverty, hospitals are struggling to purchase advanced medical equipment with funding from UNICEF and other international aid agencies. We charge very little to our patients. Between 2021 and 2022, the number of patients at his facility increased by 70%.
Hospitals have certain protections as they accept all patients.
“We don’t decide which side to take. If two groups are at odds and they arrive at the hospital like everyone else, we will treat them,” said Jean Baptiste.
Even gangsters understand the importance of healthcare, he added. Yet the wall still feels like it’s getting closer.
With medical vehicle carjackings on the rise, Fontaine can no longer invest in an ambulance. When an ambulance operator is called from an area like Soleil, he gets a simple response: “Sorry, we can’t go there.”
Fontaine’s Mobile Clinic can now be moved a few blocks outside the walls of the facility.
Doctors are worried, but they continue to work as usual.
“You say, well, I have to work. So may God protect me,” said Jean-Baptiste. “As this situation worsens, we decide to go out and face the risks. We must continue to move forward.”
