In Port-au-Prince, Haiti, armed groups are continually battling the government and its supporters for territorial control. This cycle of violence regularly prevents residents from moving around in the city. The few hospitals still operating are sometimes forced to suspend activities for security reasons, further limiting people’s ability to access care — especially for those most vulnerable. 

The situation is particularly critical in the commune of Cité Soleil, which is fragmented into 34 neighbourhoods that are all controlled by armed groups. Within the commune, roads are regularly blocked by barricades or checkpoints, where the risk of being stopped, arrested, assaulted, or even killed is constant. When residents of these neighbourhoods need medical care, they regularly face an impossible dilemma: go seek treatment and take on all risk, or forgo it and let their condition worsen, potentially beyond being able to be treated.

Two years ago, Ronaldo* was diagnosed with asthma, a potentially fatal illness. He was first prescribed medication, then an inhaler, a routine treatment in many countries. Yet the 19-year-old suffers greatly from the illness, both because of the cost of treatment and the grip armed groups hold over many neighbourhoods of Port-au-Prince. He was treated in the Médecins Sans Frontières (MSF) emergency room in Cité Soleil after having asthma attacks. 

Like many patients, Ronaldo cannot reach MSF’s hospital in Cité Soleil when armed groups are fighting in the vicinity. 

“When the security situation gets worse and there’s gunfire, I can’t go out, especially when asthma attacks hit,” Ronaldo explains. “In those moments, my family pours cold water over my body to try to relieve me.”

The impossibility of providing care amid gunfire 

In early May 2026, intense fighting broke out between several rival armed groups in Cité Soleil and Croix-des-Bouquets. 

“The clashes came within less than 200 metres of the medical facility’s perimeter,” says Thomas Curbillon, MSF head of mission. “In less than 12 hours, the teams treated more than 40 patients with gunshot wounds. A guard was hit by a stray bullet inside the hospital compound.” 

Several hundred people — staff, their families, civilians from the neighbourhood — took refuge there. Faced with this extreme spike in violence, MSF was forced to evacuate patients and staff on 11 May and temporarily suspend our activities.

The hospital remained closed for three weeks, until 1 June. This was the third time in three years that our teams have had to make the difficult decision to suspend our medical activities in Cité Soleil. 

“Under normal circumstances, the outpatient department sees around 150 patients a day, and bed occupancy often exceeds 80 per cent,” notes Curbillon. “That gives an idea of the consequences for the population when our activities are interrupted for several weeks.” 

Even when the hospital is open, violent clashes in Cité Soleil can still prevent patients from reaching it. 

“The fighting can trigger heavy automatic weapon fire across entire streets or neighbourhoods around our hospital,” says Sarah Chateau, MSF’s head of operations for Haiti. “When that happens, patients don’t come; they try as hard as they can to avoid getting caught in crossfire. The hospital is then almost deserted, and our patients with chronic illnesses, except those already admitted, lose access to care.”

Armed clashes can also deprive women and their babies of maternal and newborn healthcare. In June 2026, a fresh surge of violence in Cité Soleil and around the MSF-supported Isaïe Jeanty maternity hospital forced our teams to suspend their medical activities for several weeks. 
 

A healthcare system pushed to breaking point 

When a patient chooses to take the risks and go seek care, there is no guarantee that they will find a facility to treat them at the end of the journey. Across the country, the capacity of care has collapsed. According to the World Health Organization (WHO), only 26 per cent of medical facilities are still fully functional. The rest have closed, been looted, or are operating at reduced capacity for lack of staff, equipment, or safe conditions. 

Rosemie*, who lives in Cité Soleil and has diabetes, laments the situation. 

“The small hospitals in my neighbourhood were destroyed, and everything in them was looted,” says Rosemie. 

At 76, she was hospitalised for several days at the MSF hospital in Cité Soleil. She had recently discovered she was diabetic and her condition had deteriorated. Before this, she knew nothing of the disease, and had only heard that it “kills people, gives them wounds, and can even lead to amputation”. 

When she came in for a consultation at MSF, she could no longer walk. The illness had weakened her and she had lost weight.

“The Ministry of Health’s budget is very limited,” explains Chateau. “Haiti’s humanitarian crisis has been underfunded internationally for years. In this context, someone with a chronic illness has little chance of being able to continue their treatment, and in the event of a severe episode, their life can be at risk.” 

For other facilities, options for transferring patients in critical condition to the MSF hospital in Cité Soleil are very limited, and sometimes non-existent. Instead, patients with gunshot wounds are sent to Tabarre, MSF’s specialised trauma hospital. 

“We also have solutions for certain lifesaving surgeries, for example, for people suffering from peritonitis,¹ ” says Dr Jérôme Fritsch, medical adviser at the MSF hospital in Cité Soleil. “We can transfer them to Sainte-Camille hospital, where they’ll be treated by surgeons. MSF covers all hospitalisation costs.” 
 

Chronic diseases: The leading cause of death in Haiti 

“While the MSF hospital was closed, I had nowhere to go,” explains Maryse*, a woman living with diabetes and hypertension. “I can't afford to go to a private hospital, or even buy my medication.” 

Chronic diseases are life-long conditions for patients which require regular monitoring and medication. 

“Accessing care can prove very difficult in the Haitian context,” says Dr Fritsch. “Conditions like diabetes, hypertension, asthma, or epilepsy require medication that is often expensive, and sometimes unavailable at pharmacies because of supply problems.” 

In the emergency department of the MSF hospital in Cité Soleil, medical teams see around 30 patients each day, some of whom are in acute crisis linked to a chronic illness. They accounted for around 10 per cent of patients in June 2026. The clinical picture varies depending on each patient’s illness, but all of them are in a severe state, requiring rapid treatment. 

“In the case of hypertension, these are patients who can no longer breathe properly, whom we may need to put on oxygen and treat for oedema,²” adds Dr Fritsch. “Diabetic patients, whose blood sugar is too high, can fall into diabetic ketoacidosis,³ which is the leading cause of death from diabetes.”

Once stabilised after a period of hospitalisation, patients are given medication, or insulin for those with diabetes, before returning home. 

“When a diabetic patient is discharged, they have to keep taking their insulin at home, monitor their blood sugar and diabetes-related complications, and make sure they eat a balanced diet,” says Dr Fritsch. “That's extremely difficult for this type of patient.” 

Although it is the leading cause of death in Haiti according to WHO, MSF teams see relatively few deaths linked to chronic diseases at the Cité Soleil hospital. 

“Most deaths happen outside of health facilities, because patients are unable to travel due to violence or the cost of transport, or because they are too frail and facing an acute crisis,” says Dr Fritsch. 

Since March 2026, a partnership with the Haitian Foundation for Diabetes and Cardiovascular Diseases, (FHADIMAC), has made it possible to offer a year of follow-up care to certain hypertensive or diabetic patients. 

“To benefit from this programme, patients must first have been admitted to MSF’s emergency department for a crisis linked to one of these illnesses,” explains Dr Fritsch. “We hope this care can help break the vicious cycle these patients are trapped in, between emergency care, stabilisation, hospitalisation, returning home, difficulty accessing treatment, and going back to the emergency room.”

However, complications linked to chronic diseases require specialised care that is sometimes unavailable in the Haitian capital. Without follow-up, a person with hypertension can suffer a stroke, “a situation for which there is almost no solution in Port-au-Prince,” says Dr Fritsch. 

Cost of living and stigma: Further obstacles to accessing care 

The recent surge in fuel prices has driven up the cost of food and transport, further entrenching the cycle of poverty for people who are vulnerable. 

“Our care is free, but there are people for whom simply having to take a mototaxi to get here, which costs around 100 gourdes, or about 70 US cents, means they can’t afford the transport and so can't reach our hospital,” explains François Batistin, MSF deputy project coordinator in Cité Soleil.

Residents of Cité Soleil also face strong stigma simply because of where they live. 

“People from Cité Soleil are afraid to go into other neighbourhoods, like Delmas or Pétion-Ville, for example,” Batistin continues. “They could be mistaken for members of armed groups, or suspected by the Haitian police of being linked to them.” 

“Cité Soleil is the most populous commune in the greater Port-au-Prince area, and yet it is a zone completely abandoned by the state, with a bad reputation because of the control exerted by armed groups,” says Batistin. 

For several years, Haiti has been facing a deep, multidimensional crisis. In Cité Soleil, home to around 300,000 people, medical needs are immense due to limited access to essential services and healthcare. 

“People struggle to leave Cité Soleil to get treatment elsewhere, while people from outside take the risk of coming into Cité Soleil to see MSF because the medication is good quality and the care is free,” says Batistin. 

MSF teams have continuously adapted our response to an ever-evolving crisis after 15 years of presence in Cité Soleil. But on our own, we cannot make up for the ongoing collapse of access to care. As long as residents risk their lives to see a doctor or continue treatment, ensuring accessible, continuous, quality care will remain a major humanitarian emergency in Port-au-Prince.

*Patients' first names have been changed to protect their anonymity.