A precarious calm in Port-au-Prince, Haiti

Since opening in December 2004, MSF has treated nearly 8,000 people at the trauma center at St. Joseph's hospital, including more than 1,700 gunshot victims. Even with fewer violence-related injuries, people continued to arrive at the emergency room everyday, with staff there treating 20-25 patients a day.

The intense, escalating violence endured by people throughout Port-au-Prince from November 2005 to January 2006 was suddenly replaced by a fragile quiet in the days leading up to Haiti's presidential elections on February 7. No more sporadic eruptions of gunfire in Martissant, Centre-Ville, Carrefour, and other slums or quartiers chauds. No more barrage of bullets exchanged between armed groups and UN soldiers in Cite Soleil and elsewhere in the city.

If Haiti were officially at war, there would be a word for this abrupt turn of events: ceasefire. However one defines it, though, most Haitians simply welcomed the respite from the low-grade urban conflict that has ravaged the capital in waves since President Jean Bertrand Aristide was pressured from office nearly two years ago.

It also allowed elections to proceed after more than two months of delay and controversy. Haitians lined up before sunrise to cast their vote for President and, ten days later, agronomist and former president René Préval was declared the winner with more than 50 percent of the vote.

The citywide calm was reflected at the 56-bed trauma center opened by Médecins Sans Frontières (MSF) at St. Joseph's hospital.

"We treated eight gunshot victims in the first week of February 2006," said Ali Besnaci, the head of mission for MSF's trauma center in the capital's Turgeau neighborhood. "This is a noticeable drop from the 30 gunshot victims treated on average each week from November to January."

For some, the most recent peak of violence inflicted a toll that will last a lifetime.

Twelve-year old Renaud* was playing near his home on the outskirts of the Martissant slum on January 22 when a group of armed men began firing. He was shot in the head, and is now paralyzed on his left side. His mother, Wildona, has not left his bedside since he was shot, and she spends her days and night trying to make him as comfortable as possible, wetting his lips, feeding him, helping him sit up.

Twenty-two year old Michel was shot in the neck as Minustah soldiers and an armed group exchanged fire in December near the Ascierie D'Haiti iron factory in Cite Soleil. A bullet went right through the wall, he said, hitting him while he worked and leaving him paralyzed for life from the waist down.

Christophe, a 29-year old mason, will never walk again since being shot in the side while a similar exchange erupted near the airport as he made his way to work on November 8, 2005.

These three gunshot victims are among the 44 patients recovering at the 48-bed physical MSF-run rehabilitation center in the capital's Pacot neighborhood. The ornate and spacious three-story yellow house - built in the 1920s and known locally as the "Maison Gingerbread" - coupled with bucolic campus-like grounds provide a quiet refuge for those recuperating from a variety of traumas.

"This is a post-surgical rehabilitation center for patients with fractures from car accidents, paralysis from gunshot wounds, amputated limbs, or those with serious burns," said Dr. Claudia Lodesani, MSF's medical coordinator. "They usually stay one to three months to receive care as well as physical therapy to learn how to cope with their new situations."

The center's staff also provides up to 50 follow-up medical or surgical consultations and 20 physical therapy sessions everyday for people who require treatment on an outpatient basis.

Since opening in December 2004, MSF has treated nearly 8,000 people at the trauma center at St. Joseph's hospital, including more than 1,700 gunshot victims. Even with fewer violence-related injuries, people continued to arrive at the emergency room everyday, with staff there treating 20-25 patients a day.

"We mainly treat people with injuries caused by car accidents or domestic accidents," said Rachael Craven, a 35-year old anesthetist from Bristol, England. "And we see a full range of traumas: fractures, head injuries, chest injuries, burns. More than one-third of the patients, though, come in because of some kind of violence, and for the most part it's gunshot victims."

The violence that many feared around the election did not materialize, but MSF will remain in Port-au-Prince treating trauma victims as the political situation evolves.

"We have seen two major peaks in the violence over the past year," said Besnaci. "We hope this precarious calm lasts, because the civilian toll so far has been enormous."

* Patients' names have been changed.