Haiti’s hospitals have survived cholera and Covid. Gangs close them down.

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

It left a small hole in her cheek, just missing her jawbone and teeth.

Unlike many Haitians who were injured by gunfire during a brutal gang takeover of the capital Port-au-Prince, Ms. Cenatus was actually lucky that day: She made it to a clinic. But she is still in pain, her wound is swelling and she cannot get any relief as more and more hospitals and clinics are abandoned by staff or looted by gangs.

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

A mob attack on Haiti’s capital has left an already weak healthcare system in tatters.

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 say, because they are too dangerous to reach or because their medicine 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 for generators is hard to come by, and because of street violence, clinics that remain open are unable to transfer patients needing more advanced treatment. Doctors are also predicting a sharp rise in maternal and child 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 2010Unpleasant hurricanes Unpleasant COVID-19 Unpleasant cholera And Zika. The tension has been fraying the foundation of the system for a long time.

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

By early 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 canister hit his left eye.

He underwent three operations to remove the eye and repair the eye socket before the hospital where he was treated closed because it was behind the National Palace, which had been attacked by gangs. Patients reported that bullets flew by in the hospital courtyard. His wound became infected, so his doctor braved the street for a house call.

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

Mr Jean said he had to undergo further surgery to have a prosthetic eye implanted. His brother spent all Friday looking for painkillers and antibiotics because most pharmacies were closed. Mr Jean said he could try to get his infection treated at another hospital, but gangs could make travel impossible.

Haiti has been in the grip of gang-fueled violence for years, but violence has spiked following the 2021 elections. assassination of President Jovenel Moïse. Gangs concentrated in certain neighborhoods grew in size, firepower and influence, causing murders and kidnappings to skyrocket.

A Kenyan-led international effort intended to help quell the violence — an effort backed by the United Nations and largely funded by the United States — has been repeatedly postponed. When Haiti’s leader, Prime Minister Ariel Henry, a neurosurgeon who once worked at the Ministry of Health, 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 and demanded his resignation. Mr. Henry, now stranded in Puerto Rico, has done just that agreed to resign once a committee-style provisional government is installed and a new leader appointed.

In the meantime, gang members have emptied many medical facilities and taken virtually everything of value, including beds and vehicles.

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

As violence increased in the surrounding neighborhood, staff evacuated all patients to private hospitals in recent days, just before armed gang members flooded nearby streets and looted and burned several government buildings.

Saint Francis was not spared.

“They took everything,” says Dr. Joseph R. Clériné, medical director of the hospital. “When we can enter the building again, we will have to do an inventory. But we will have to wait until peace returns. It’s too dangerous at the moment.”

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 privately run Roman Catholic hospital estimates damage at $3 to $4 million.

Dr. Wesler Lambert, who heads Zanmi Lasante, a network of clinics affiliated with Partners in Health, a nonprofit public health organization that has been active in Haiti for decades, said several of the 16 clinics were closed for days to protect save on crucial costs. supplies. But given the fear of going out and the lack of transportation, there aren’t many patients to treat.

“Right now our biggest shortage is fuel to keep the generators running,” he said. “We will be running 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 comprehensive health care in Haiti, Doctors Without Borders, said it had increased capacity at one of its hospitals and opened a new hospital with 25 beds and an operating room. But the group cannot fly in more doctors; the country’s main airport remains closed as 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 the aid groups’ clinics. “It is not sustainable for the Haitian people, and it is not sustainable for us.”

Still, Dr. Oscar M. Barreneche, the Haiti representative of the Pan American Health Organization, said some health care providers have remained “very resilient” despite setbacks.

The situation is particularly dire for many pregnant women.

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

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

“The health care system is on the verge of collapse,” he said. “Any decent health worker 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 have no training to deal with complications.

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

“In Haiti we often say that in Port-au-Prince it feels like we are in a boat,” he added. “There is no captain, no leadership, and we, the people, are in it, and we don’t know where we are going and what can be done to save us.”

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