Taïna Cenatus, a 29-year-old cookery student in Haiti, lost her balance at school one day this month and fell, but only to hit the ground when she realized she had been hit in the face by a stray bullet. .
It left a small hole in her cheek, only her jaw and teeth were missing.
Unlike many Haitians wounded by gunfire in the midst of a vicious takeover of the capital, Port-au-Prince, Ms. Senatus was actually lucky that day — she made it to a clinic. But she still hurts, her wound swells and she can’t get relief as more and more hospitals and clinics are abandoned by staff or ransacked by gangs.
“My teeth hurt,” he said. “I can feel something is wrong.”
A gang attack in the Haitian capital has left an already weak health care system in tatters.
More than half the medical facilities in Port-au-Prince and a large rural area called Artibonite are closed or not operating at full capacity, experts said, because they are too dangerous to access or drugs 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, the clinics that remain open are unable to transport patients who need more advanced treatment. Doctors are also predicting a sharp rise in maternal and infant deaths as thousands of women are forced to give birth at home in the coming weeks.
Haiti’s public health system has responded in recent years to repeated emergencies, from a devastating earthquake in 2010 to hurricanes to Covid-19 to cholera and Zika. The strain has long eroded the foundations of the system.
Poor patients cannot afford to pay for services, further crippling chronically underfunded hospitals, making it difficult to buy essential supplies. Before the gangs took control of Port-au-Prince, hospitals still closed their doors from time to time because doctors would go on strike to protest rampant kidnappings targeting health professionals.
By the beginning of this year, up to 20 percent of medical professionals in Haitian hospitals 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, 37, a freelance journalist, was covering anti-government protests last month when a police tear gas hit his left eye.
He underwent three operations to remove the eye and repair the socket 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 through the hospital courtyard. His wound became infected, so his doctor braved the streets for a house call.
“Fortunately, our neighborhood is safer than some others,” Mr. Jean said. “Even so, I was surprised when the doctor said he could come to our house.”
Mr Jean said he had to have another operation to implant a prosthetic eye. His brother spent all of Friday looking for painkillers and antibiotics because most pharmacies were closed. Mr Jean said he could try to treat his infection at another hospital, but gangs could make travel impossible.
Haiti has been in the throes of gang-fueled violence for years, but it escalated after the assassination of President Jovenel Moïse in 2021. Gangs that had been concentrated in specific neighborhoods grew in size, firepower and influence, driving up the rate of murders and kidnappings skyrocketed.
A Kenyan-led international deployment meant to help 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 health ministry, visited Kenya in late February, gangs took advantage of his absence.
Instead of fighting each other, they united to attack police stations, prisons, hospitals and other government buildings, demanding his resignation. Mr. Henry, now stranded in Puerto Rico, has agreed to step down once an interim committee-style government is in place and a new leader is appointed.
Meanwhile, gang members have stripped several medical facilities, taking most of the valuables, including beds and vehicles.
“The robbers looted, vandalized and overturned everything,” said Mr. Theodule Domond, the general manager of St. John’s Hospital. Francis de Sales, one of the largest and oldest hospitals in Port-au-Prince with the only oncology unit in southern Haiti.
With violence rising in the surrounding neighborhood, staff evacuated all patients at private hospitals in recent days, shortly before armed gang members took over nearby streets, looting and setting fire to several government buildings.
Saint Francis was not spared.
“They took everything,” said Dr. Joseph R. Clériné, the hospital’s medical director. “When we can get back into the building, we’ll have to take an inventory. But we will have to wait for calm to return. Right now, it’s too dangerous.”
Two staff members, a nun and a driver, were able to briefly enter the facility and reported seeing broken windows and empty rooms where furniture and medical equipment had been stolen. The private Roman Catholic hospital estimates the damage at $3 million to $4 million.
Dr. Wesler Lambert, who runs Zanmi Lasante, a network of clinics affiliated with Partners in Health, a public health nonprofit that has been active in Haiti for decades, said several of his 16 clinics were closed for days at a time to save critical supplies. But given the fear of going out and the lack of transportation, there were not many patients for treatment.
“Currently, our main shortfall is fuel to keep the generators running,” he said. “We’re going to run out of some other essential drugs. Not because we don’t have them — we have them in our main warehouse. We can’t transfer them.”
Another major aid group providing extensive health care in Haiti, Doctors Without Borders, said it had increased capacity at one of its hospitals and opened a new one with 25 beds and an operating room. But the team can’t fly in more doctors – the country’s main airport remains closed because gangs control the area around it.
Blood products are running out 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 groups’ clinics. “It’s not sustainable for the Haitian people and it’s not sustainable for us.”
But Dr. Oscar M. Barreneche, representative in Haiti for the Pan American Health Organization, said some health care providers remained “very resilient” in the face of adversity.
The situation is particularly dire 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 for the United Nations Population Fund, the agency’s sexual and reproductive health agency. However, only 50 hospitals in Haiti can treat birth-related complications — and then they were able to function normally.
About 1,500 Haitian women die annually during childbirth, Mr. Degernier said, a number that is sure to rise this year.
“The health system is collapsing,” he said. “Every decent health professional who has a family and has a good degree is no longer in Haiti.”
Dr. Batsch Jean Jumeau, president of the Haitian Society of Obstetrics and Gynecology, said the lack of functioning hospitals will force more women to give birth at home. Most Haitian women already deliver babies at home, but midwives lack training to deal with complications.
“We cannot say that home delivery is very safe in Haiti,” said Dr. Jean Jumeau.
“We often say in Haiti that in Port-au-Prince it’s like being on a boat,” he added. “There is no captain, no direction, and we humans are in it, and we don’t know where we are going and what can be done to save us.”
Andre Poltre contributed reporting from Port-au-Prince, Haiti.
