Years of political turmoil and gang warfare have taken their toll on the physical and mental health of the people of Haiti and on the provision of basic services, such as healthcare. Since the assassination of President Jovenel Moïse in 2021, however, the situation has taken a marked turn for the worse and pushed the western hemisphere’s poorest country to the brink of collapse.

In 2023, the capital, Port-au-Prince, and other areas of the country continued to be rocked by politically and economically rooted gang violence, which sometimes exploded into full-scale street battles, such as the ones in April and May, which resulted in hundreds of deaths and injuries. On 24 April 2023 alone, our teams admitted around 50 people with gunshot and knife wounds to our medical facilities.

The foreign intervention requested by Prime Minister Ariel Henry did not materialise during the year but remains a looming presence as Haitian citizens, in particular in the capital, are confronted by the daily threat of being kidnapped, mugged, sexually assaulted or even killed.

The results of an MSF survey indicate that between August 2022 and July 2023, more than 40 per cent of all deaths in Cité Soleil, Haiti’s largest slum, were linked to violence. Forty per cent of the women surveyed said they had foregone antenatal care due to the risk of being exposed to violence while travelling to a hospital or clinic.

Our teams continued to deliver a range of medical services in Port-au-Prince and several other areas in the country, including general healthcare and treatment for burns, trauma, and sexual and gender-based violence. Our facilities include hospitals in Tabarre and Cité Soleil, a sexual violence and reproductive healthcare clinic in Delmas, and an emergency and stabilisation centre in Turgeau. In addition, we support health centres and operate mobile clinics in the most affected neighbourhoods of Port-au-Prince, such as Brooklyn, Bel Air and Delmas 4, as well as sites where people have gathered after fleeing violence. We are able to work in these hard-to-reach areas because MSF’s work is perceived positively and respected by the communities.

However, our teams were not immune to the risks posed by the volatile security situation in the country. Serious security incidents, which endangered our staff and resulted in the deaths of two of our patients, forced us to suspend some of our activities. We ended our support to Raoul Pierre Louis Hospital in Carrefour in January when a wounded patient was removed by gunmen and shot dead. We temporarily closed our Cité Soleil hospital in February and April due to fighting in neighbouring streets and suspended activities at our Tabarre facility for almost two months after armed men stormed in and forcibly removed a patient in July.

In December, the Turgeau emergency centre closed its doors indefinitely when a patient was taken from an ambulance and killed in the street.

Sexual and gender-based violence

Sexual and gender-based violence (SGBV) is a widespread issue in Haiti. The deepening socio-economic crisis and high levels of armed violence have had a considerable impact on the psyche of entire communities, who have become isolated and more exposed to the risk of sexual aggression.

We ran two clinics, one in Port-au-Prince and one further north in Gonaïves, to provide victims and survivors of SGBV with specialist medical, psychological and social care. A free telephone helpline has also increased access to care, offering victims remote psychological support and referrals to health centres. Our mobile clinics working in hard-to-reach neighbourhoods include SGBV care in their services.

Maternal and neonatal health

The provision and accessibility of maternal healthcare are extremely limited in Haiti, contributing to the highest maternal and neonatal death rates in the Western Hemisphere (5.3 per cent and 2.4 per cent, respectively). Our activities in the south of the country aim to respond to these pressing needs.

In February, we reopened a hospital for maternal and neonatal healthcare in the town of Port-à-Piment, a former government-run facility that was damaged beyond repair in the 2021 earthquake.

Our teams rebuilt and upgraded the hospital, which now offers surgery for patients with obstetric complications, as well as ante- and neonatal care. However, as many other medical facilities in Sud department were never properly repaired, access to healthcare remains limited for pregnant women and newborns.