Gang violence brings Haiti’s health system to the brink of collapse

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Taïna Cenatus, a 29-year-old culinary student in Haiti, lost her balance at school one day this month and fell, but it wasn’t until she hit the ground that she realized a stray bullet had hit her face. . .

It left a small hole in his cheek, only his jaw and teeth were missing.

Unlike many Haitians wounded by gunfire amid a vicious gang takeover of the capital, Port-au-Prince, Cenatus was lucky that day: He made it to a clinic. But he still feels pain, his wound swells and he can’t get any relief, with more and more hospitals and clinics abandoned by staff or looted by gangs.

“My teeth hurt,” he said. “I can feel something is wrong.”

A gang assault on Haiti’s capital has left an already weak health care system in ruins.

More than half of the medical facilities in Port-au-Prince and a large rural region called Artibonite are closed or not operating at full capacity, experts said, either because they are too dangerous to reach or because their medicines and other supplies have been stolen.

The State University Hospital, the largest public hospital in the country, is closed. Blood supplies are running low, fuel to run generators is hard to come by, and because of street violence, clinics that remain open are unable to transport patients who need more sophisticated treatment. Doctors are also predicting a sharp rise in maternal and infant deaths as thousands of women will be forced to give birth at home in the coming weeks.

Haiti’s public health system has responded to repeated emergencies in recent years, from a devastating earthquake in 2010to hurricanes to COVID-19 to anger and Zika. The tension has been wearing down the foundations of the system for a long time.

Poor patients cannot afford to pay for services, further harming chronically underfunded hospitals and making it difficult to purchase necessary items. Before gangs took control of Port-au-Prince, hospitals still closed their doors from time to time because doctors went on strike to protest rampant kidnappings of medical professionals.

Earlier this year, up to 20 percent of Haitian hospital medical professionals had left for the United States and Canada, according to the United Nations.

Several Haitian Health Ministry officials did not respond to requests for comment.

Jean Marc Jean, a 37-year-old freelance journalist, was covering anti-government protests last month when a police tear gas canister hit him in the left eye.

He had three surgeries to remove his eye and repair his orbit before the hospital where he was treated was closed because it was behind the National Palace, which had been attacked by gangs. Patients recounted the bullets whistling past in the hospital courtyard. His wound became infected, so his doctor braved the streets to make a house call.

“Thankfully, our neighborhood is safer than others,” Jean said. “Still, I was surprised when the doctor said he could come to our house.”

Mr. Jean said he needed another operation to implant a prosthetic eye. His brother spent all day Friday looking for painkillers and antibiotics because most pharmacies were closed. Jean said he could try to get the infection treated at another hospital, but gangs could make travel impossible.

Haiti has been mired in gang-fueled violence for years, but it increased after the assassination of President Jovenel Moïse in 2021. Gangs that had concentrated in particular neighborhoods grew in size, firepower, and influence, causing the rate of murders and kidnappings to skyrocket.

A Kenyan-led international deployment aimed at helping quell the violence (an effort backed by the United Nations and largely funded by the United States) has been repeatedly delayed. When Haiti’s leader, Prime Minister Ariel Henry, a neurosurgeon who once worked in the Ministry of Health, visited Kenya in late February, gangs took advantage of his absence.

Instead of fighting each other, they banded together to attack police stations, prisons, hospitals and other government buildings, demanding his resignation. Mr. Henry, now stranded in Puerto Rico, has agreed to resign once a committee-type interim government is established and a new leader is appointed.

Meanwhile, gang members have emptied many medical facilities and taken almost everything of value, including beds and vehicles.

“The bandits looted, destroyed and turned everything upside down,” said Bishop Theodule Domond, general director of St. Francis de Sales Hospital, one of the largest and oldest hospitals in Port-au-Prince with the only oncology unit in southern Port-au-Prince. Haiti.

With violence escalating in the surrounding neighborhood, staff evacuated all patients to private hospitals in recent days, just before armed gang members invaded nearby streets, looting and burning several government buildings.

San Francisco was not saved.

“They took everything,” said Dr. Joseph R. Clériné, the hospital’s medical director. “When we can return to the building, we will have to take an inventory. But we will have to wait for calm to return. “It’s too dangerous right now.”

Two staff members, a nun and a driver, were briefly able to enter the facility and reported seeing broken windows and empty rooms where furniture and medical equipment had been stolen. The privately run Roman Catholic hospital estimates the damage at between $3 million and $4 million.

Dr. Wesler Lambert, who runs Zanmi Lasante, a network of clinics affiliated with Partners in Health, a nonprofit public health organization that has operated in Haiti for decades, said several of his 16 clinics had closed for days to save on critical expenses. supplies. But given the fear of venturing out and the lack of transportation, there haven’t been many patients to treat.

“For now, our main shortage is fuel to keep the generators running,” he said. “We will run out of other essential medicines. Not because we don’t have them: we have them in our main warehouse. “We can’t transport them.”

Another major aid group providing extensive medical care in Haiti, Doctors Without Borders, said it had increased the capacity of one of its hospitals and opened a new one with 25 beds and an operating room. But the group can’t bring in more doctors: the country’s main airport remains closed because gangs control the area around it.

Blood products are running low and patients who need a higher level of care are stuck.

“It’s not sustainable at all,” said Dr. James Gana, who treats patients and helps run aid group clinics. “It is not sustainable for the Haitian population, nor for us.”

Still, Dr. Oscar M. Barreneche, Haiti representative of the Pan American Health Organization, said some health care providers had remained “very resilient” in the face of adversity.

The situation is particularly serious for many pregnant women.

About 3,000 women in Haiti will give birth next month and 500 of them will have complications, according to Philippe Serge Degernier, country representative of the United Nations Population Fund, the organization’s sexual and reproductive health agency. However, only 50 hospitals in Haiti can treat complications related to childbirth, and that was when they were able to function normally.

About 1,500 Haitian women die annually during childbirth, Degernier said, a number that is sure to increase this year.

“The health system is collapsed,” he said. “Any decent health professional, who has a family and a good education, is no longer in Haiti.”

Dr. Batsch Jean Jumeau, president of the Haitian Society of Obstetrics and Gynecology, said the lack of functioning hospitals would force more women to give birth at home. Most Haitian women already give birth at home, but midwives lack training to deal with complications.

“We cannot say that giving birth at home is very safe in Haiti,” said Dr. Jean Jumeau.

“We often say in Haiti that in Port-au-Prince it is as if we were on a boat,” he added. “There is no captain or direction, and we, the people, are inside and we don’t know where we are going or what can be done to save us.”

André Paultre contributed reporting from Port-au-Prince, Haiti.

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