Haiti’s Health Crisis Grows as Gangs Destroy Hospitals, Pharmacies

‘Countdown to death’: Haiti’s health crisis grows as gangs destroy hospitals, pharmacies

Miami Herald

By Jacqueline Charles

03/31/2024

Nadjla Juste no longer sleeps. If she’s not listening for the repeated gunfire that has now become all too familiar, she’s keeping an ear open for her mother’s heaving breaths. A heart-disease and diabetic patient, Carole Dieujuste also has kidney disease, requiring several dialysis treatments a week. Her last treatment was more than a month ago. “What can we do, other than remain at home until the crisis passes?” Juste, 29, said on a recent afternoon in violence-engulfed Port-au-Prince about her mother, whose frail body is threatening to shut down over the delay in treatment. “She is taking medication, but it can’t really make a difference.” Dieujuste, 59, is so weak that she’s unable to stand on her own and requires help bathing and eating. Still, when armed men rampaged through the family home near the capital’s downtown on Feb. 29, she managed to find the strength to flee. It had been been two weeks since her last treatment because the machine at the Hospital of the State University of Haiti, where those with little means go for care, wasn’t working. Now, she just stays in bed all day. “When you’re in the middle class and you don’t have money to go see a doctor, it’s really difficult,” said Juste, who doesn’t live far from a privately run dialysis center that she can neither afford nor get to because the center is closed due to a lack of medical supplies. “There are times I don’t sleep. I stay at her bedside. The doctor sometimes comes to see her or we communicate on the phone, if he can’t make it .... But it’s really difficult to take care of someone in such a fragile state.”

As an alliance of criminal gangs continue to sow chaos and turn Port-au-Prince into a war zone, Haitians are being forced to suspend treatment for illnesses like kidney disease, cancer and common infectious killers like HIV/AIDS and tuberculosis. Paralyzed by fear and a sense of helplessness, they have few options. Hospitals are shuttered, pharmacies have been looted and torched and roads are blocked, creating shortages of food, water and life-saving medical supplies. Meanwhile disease is spreading, anxiety is mounting and no one knows what to do, or where to turn.: Haiti’s health sector is on life support as doctors and nurses flee gang violence.  Already on life support before the orchestrated armed attacks, Haiti’s health system is now on the brink of total collapse, with at least half of Port-au-Prince’s health facilities closed or functioning below normal capacity, according to the United Nations.

Haitians are facing starvation. Diseases like waterborne cholera are spreading. Mental stress is a growing problem as Haitians find themselves forced to flee. “It feels like there is no hope,” Juste said. A resident at Lycée Marie Jeanne camp in Port-au-Prince said on March 29, 2024 that both she and her son have been battling bouts of heavy vomiting and diarrhea for days now.  The intense violence comes at a moment of great political uncertainty. The last elections were held nearly eight years ago, the constitution is in dispute, and the assassination of the last president, Jovenel Moïse, remains unsolved. Some of the accused were among the inmates who escaped on March 2 when the gangs broke into the country’s two main prisons.

On Friday, after more than two weeks of internal bickering and disagreements, the names of seven-voting members and two non-voting observers who will make up a proposed transitional presidential council were finally sent to outgoing Haitian Prime Minister Ariel Henry by the chairman of the Caribbean Community, Guyana President Irfaan Ali. The council still needs to be installed, elect a president and agree on a prime minister to replace Henry, who was pressured to resign by U.S. and Caribbean leaders amid calls by the gang alliance for his resignation. The new prime minister will then form a government. The U.S., which is struggling to fund a Multinational Security Support mission led by Kenya, has big expectations for the new council despite doubts in Haiti about whether the new presidential panel will be enough to stem the violence. The council’s members are also tasked with readying Haiti for the arrival of the multinational mission to help the Haiti National Police, and set a path toward long overdue elections.

More than 30 private and public health facilities, including hospitals and clinics, have been vandalized, burned and forced to close in metropolitan Port-au-Prince since the attacks began a month ago, Haiti’s health ministry told international humanitarian aid workers last week. Those that are still operating face shortages of life-saving supplies and personnel. Vaccine stocks will run out at the end of April if nothing is done, the U.N. has warned. “You’re confronted by a situation where you’re praying to God that you don’t get sick because if you do, you don’t see a way in which you are ongoing to be able to resolve it,” said Dr. Audie Metayer, who trains new doctors and runs the dialysis center at the State University Hospital, commonly referred to as the General Hospital.

Unable to get to the facility, which remains closed, Metayer, 62, said he spends his days trying to help dialysis patients find alternative centers for treatment. But the reality, he said, is patients “who are most vulnerable die.” Those with some means “will go from one center to another,” braving gunfire and barricades. Four years after this aerial view of the new Hospital of the State University of Haiti in Port-au-Prince, the area now resembles a war zone after an alliance of armed gangs launched a series of coordinated deadly assaults on February 29, 2024. Financed by France, the United States and the Haitian government, the new hospital was promised after Haiti’s Jan. 12, 2010, earthquake, but has not yet opened. The former structure remains closed due to violence. Jean Marc Hervé Abélard For the Miami Herald In some cases, the cost of dialysis— anywhere from $113 to $200 a session — is unaffordable for patients who need two or three sessions a week, and in any case, many of the centers are closed because there is no electricity, fuel or even treated water.

Port-au-Prince’s Toussaint Louverture Airport hasn’t seen a commercial airliner since March 4, and the seaport, a boat since March 5. Hundreds of containers, some with medical supplies and medication, remain under the control of armed groups. On Monday, at least a dozen pharmacies and clinics downtown near the General Hospital were burned. The hospital itself has so far been spared. Fearful for their safety, doctors and nurses assigned to health centers that are open are staying home. Those who make it in to work find medical supplies running low or gone. And in some cases the power is off. Haiti’s state-owned power company, Electricité d’Haïti, said last week that some of its substations in the metropolitan area were destroyed, leaving several areas without power.

Medical facilities that remain open lack the means to treat chronic illnesses or emergencies like gunshot wounds, and in some cases even basic ailments. “When you suggest to a patient to go here and they tell you, ‘I can’t go there,’ what more can you say?” Metayer said. As a physician who took an oath to save lives, Metayer said he feels “disarmed.” Even if he braves the dangerous streets to go see an ailing patient, “you ask yourself, what can I really do for this person? Where am I going to send them?” There is no medicine, no blood, no oxygen, he said. “We cannot say how many people we have lost. We don’t know and we can’t do the statistics because when someone dies, they die. You don’t hear anyone cry; you don’t hear anyone complain,” Metayer said. “You can’t even count the dead, because everyone just stays silent.” Metayer was at work the day the violence erupted, sending doctors, nurses and even patients on a desperate flight to safety under a hail of bullets. “The bullets were hitting all of the hospitals’ walls,” he recalled.

Gangs have left a trail of destruction in downtown Port-au-Prince, transforming it into a post-apocalyptic scene where buildings have been burned, solar panels ripped off and hospitals vandalized. Among the victims: the midwifery Sage-femme School and several other big, privately run hospitals nearby, including the rebuilt St. Francis de Sales Hospital. The 125,000-square-foot facility was rebuilt after the 2010 earthquake by U.S. Catholics. “I don’t understand what the gangs are thinking,” said Dr. Ronald LaRoche, whose multi-story private Jude-Anne DASH Hospital was looted and everything inside destroyed. The hospital is part of LaRoche’s DASH network of private hospitals and clinics. Gangs also attacked another of his medical centers next to the U.S. Embassy in Tabarre. “They took everything and they destroyed it.” He has since shut down two other DASH medical centers in the area. “I moved out everything and even my big hospital in Delmas 48, I had to move everything from inside. We put them on a truck. Can you imagine moving a hospital to hide it from gangsters?” he said. “You can’t imagine what we are living now. It’s a tragedy.” The poor are paying with their lives, he said. “They have no money. The government doesn’t exist. The private sector doesn’t exist for these poor people,” LaRoche said. “It’s not a political thing. It’s not an ideological fight. We have gangsters, we have bandits destroying and making everybody flee. Whatever is your socioeconomic or education status, we are all in the same boat. We all are fleeing, we are running away and nobody knows why.”

The demise of Haiti’s health sector comes after years and millions of dollars in investment, especially after the 2010 earthquake that destroyed most of Port-au-Prince and its surrounding areas. New hospitals were built and non-governmental organizations and foreign donors like the U.S. Agency for International Development invested in preventing maternal and child deaths, improving low vaccination rates and increasing access to hygiene and sanitation. The U.N., which recently launched a humanitarian appeal for $674 million to respond to the crisis, has raised just $45 million. The worsening crisis, Haitians says, has become “a countdown to death.” “Bit by bit it’s advancing like a cancer spreading through the body,” said Louise Carmel Bijoux, an anthropologist who comes from a family of well-known Haiti physicians.

Of the more than 362,000 Haitians forced to abandon their homes as of Friday, March 29, 2024 because of gang violence and kidnappings in recent years, about 195,000 of them are in the west region, which encompasses metropolitan Port-au-Prince. Johnny Fils-Aimé Special for the Miami Herald Bijoux recently issued a heartbreaking plea for help. The destruction is similar to what you’d see in war zones, where the living are forced to lie with the dead, waiting for families and morticians to come claim the corpses. “If no one responds to this SOS, the majority of people living in Port-au-Prince will die,” Bijoux said. “They will die from several causes, from the armed individuals who day after day are showing up at people’s front doors, from the humanitarian and health problems, and from lack of food.” Juste is hoping to save her mother before that day comes. She hopes that a promise to reopen the General Hospital on April 1 is kept. But the situation remains tense and volatile, the U.N. said after acknowledging that after briefly reopening, one hospital, Bernard Mevs, was forced to abruptly close because of gunfire.

Steve Colimon, 39, gets dialysis twice a week. So far, he’s been able to get his treatment, even if it has meant a few days’ delay. Sometimes no treated water is available to run the machines. Other times the nurses can’t come. He gets to his treatment by moto-taxi when available, or by foot if not. He will soon run out of two of his medications, and a pharmacist already warned him he won’t be able to find them in Haiti after this week. “The area near the General Hospital where you had a lot of pharmacies, you used to be able to go there and find medications you couldn’t find anywhere else. They’ve burned and pillaged all, and there is no access downtown,” said Colimon, who pays $113 per dialysis session at a private hospital. “It’s very stressful for us.” Colimon lives in constant fear from one day to the next that he will wake up and be unable to get his treatment because either the center has been burned to the ground or forced to close. The father of a 9-year-old boy, Colimon says he suffers in silence and tries to stay motivated by focusing on his music. He’s a classical cellist. He tries not to burden his son with his medical problems, but still, the child struggles to understand what is going on when he can’t go to school or can’t get the medications to treat his anemia. “It’s as if we’re in a war,” Colimon said. “You go to a supermarket and shelves are bare because nothing is coming into the country. Everywhere you look there are problems.”

Recently, while sitting in the chair at the dialysis center, he and some of his fellow patients began talking. One made a startling admission: He preferred to die than live this way. “It’s very difficult to see that you are in dialysis with someone, sitting next to you and getting the same treatment as you and they tell you something like that,” Colimon said. “It is not easy.”  The impact of the ongoing violence threatens to have long-term effects. Malnutrition rates among children are skyrocketing, according to the U.N., and famine looms. Nearly 5 million Haitians are starving, and 1.6. million people face emergency levels of acute hunger, which increases the risk of child wasting and malnutrition.

The growing crisis is also being felt outside Port-au-Prince. Zanmi Lasanté, the Haitian organization that runs the largest non-profit hospital, the University Hospital of Mirebalais, is struggling to transport medicines from Port-au-Prince to the Center and Artibonite departments for the hospitals it supports. In the Artibonite Valley and the Northeast regional departments, cholera is spreading. The response is inadequate due to a lack of partners in the field and the inability to replenish supplies. Medical supplies to deal with cholera can’t be distributed, leading to fears of a wide outbreak, the U.N. recently said. Additionally, as the number of people who have fled from their homes has grown to more than 362,000, some shelters are filled to capacity or worse.

Healthcare in the camps for the displaced continues to face challenges, like suspected cases of cholera. A gentleman inside Lycée Marie Jeanne camp in Port-au-Prince, who didn’t want to be identify, said that given the lack of water and the poor sanitary conditions in the displacement camps, it would be difficult for there to not be cholera, the waterborne disease that spreads when people lack access to potable water. As of Friday, March 29, 2024 at least 10 suspected cases have been identified inside the displacement camp. Johnny Fils-Aimé Special for the Miami Herald Genèse Délice, 66, a mother of four who said she was forced to flee from her home in the Carrefour-Feuilles neighborhood of the capital in August “with only the clothes on my back,” spends her days praying for salvation. She and others sheltering at the Vincent Stadium stopped getting meals from the U.N.’s. World Food Program and mayor’s office in October. “I am hungry. My eyes are not well. I cannot see out of one eye at all,” Délice said. “I want to get out of here. They’re shooting all over the place, all day. People are dying. “I don’t have any relief,” she added. “I just put myself in the hands of God because God is all I have.”

Miami Herald contributor Johnny Fils-Aimé contributed to this report from Port-au-Prince. This story was originally published March 31, 2024, 11:53 AM. 

Photo Credit: Miami Herald