The already volatile situation deteriorated significantly in Haiti in 2022, as rival gangs waged a brutal war on the streets, paralysing and isolating the capital, Port-au-Prince, for extended periods of time. These unprecedented levels of violence led to a steep increase in the number of patients admitted to our hospitals during the year.

July was the worst month, with over 300 people killed and numerous cases of rape reported. Many houses were burnt down, and more than 20,000 people were displaced across the city. In these very challenging conditions, our teams worked to maintain and expand activities in our three trauma and emergency hospitals in Port-au-Prince. We treated victims of gunshot and stab wounds and victims of sexual violence, as well as people with severe burns and injuries related to road accidents.

Our hospital in Cité Soleil had to suspend activities in April after a patient was killed just outside the building. However, in July, we reopened the facility to respond to the large influx of wounded patients.

Following the announcement of an increase in fuel prices in September, violent protests broke out across the country. Barricades were erected, cutting off many of the main roads, and economic activity ground to a halt. The situation was compounded when one of the major gangs blocked access to the country’s main oil terminal for more than a month, exacerbating fuel shortages and forcing healthcare facilities to close or reduce services, as they depend on generators to produce electricity.

Unrest also temporarily disrupted the water distribution network, reducing supply and creating ideal conditions for the resurgence of cholera. As the outbreak spread, the health situation soon became dire, as even basic services had become practically inaccessible due to the ongoing violence and the fuel crisis, which has continued long after access to the oil terminal was restored.  

To alleviate these problems, our teams continue to deliver a range of medical services in the capital and other parts of the country, despite huge challenges in obtaining fuel and medical supplies and in referring patients between different facilities. As well as running and supporting hospitals and health centres, we operate mobile clinics in the most affected neighbourhoods of Port-au-Prince, such as Brooklyn, Bel’Air, Bas Delmas and Delmas 4. We are able to work in these hard-to-reach areas because MSF’s work is perceived positively and is respected by the communities.

Sexual and gender-based violence
Sexual and gender-based violence (SGBV) is a widespread issue in Haiti. The deepening socio-economic crisis and high levels of gang-related warfare have had a considerable impact on the psyche of entire communities, who have become isolated and more exposed to the risk of sexual aggression. MSF runs two clinics, in Port-au-Prince and further north in Gonaïves, and supports three hospitals to provide victims of SGBV with specialist medical, psychological and social care. A free telephone helpline has decreased barriers to care, offering victims remote psychological support and referrals to health centres. Our mobile clinics working in unsafe, hard-to-reach neighbourhoods include SGBV care in their services.

Maternal health
The provision and accessibility of maternal healthcare is extremely limited in Haiti, contributing to one of the highest maternal death rates in the world. Our activities in the south of the country aim to respond to the pressing needs in this area. In 2022, we expanded our sexual and reproductive health activities at our clinic in Port-à-Piment, in Haiti’s southwest, starting to offer surgery for complicated obstetric cases, as well as ante- and neonatal care.

Emergency response to a cholera outbreak
Overcrowded, unsanitary living conditions and poor access to clean water were factors in a major resurgence of cholera, a disease that has killed around 10,000 people since 2010, when the country was hit by an epidemic in the wake of a major earthquake.

Following the arrival of the first suspected cases at MSF facilities in late September, we had admitted approximately 13,000 patients to our six cholera treatment centres (CTCs) in and around Port-au-Prince by the end of the year. In addition, we treated around 2,500 patients in the four CTCs we opened in the department of Artibonite, north of the capital.

Our teams responded to the outbreak across the country, supporting local communities by chlorinating water points and raising awareness on hygiene measures in some of the worst-affected neighbourhoods. In December, we provided logistical support to the cholera vaccination campaign carried out by the Ministry of Health, to ensure that the highest number of people possible were immunised against the disease.