As machine gun fire is heard outside the barbed wire fence surrounding the Fontaine Hospital Center, the noise fills a cafeteria packed with tired medical staff in surgical scrubs.
And no one flinches.
Shooting is part of everyday life here in Cité Soleil, the most populous area of the Haitian capital and the heart of Port-au-Prince’s gang wars.
As gangs tighten their grip on Haiti, many medical facilities in the most violent parts of the Caribbean nation have closed. Fontaine is one of the last hospitals and social care institutions in one of the most lawless places in the world.
“They have left us totally alone,” says Loubents Jean Baptiste, the hospital’s medical director.
The Fontaine can mean the difference between life and death for hundreds of thousands of people trying to survive, offering a small oasis of calm in a city that has fallen into chaos.
The danger in the streets complicates everything: when gangsters with gunshot wounds show up at the door, the doctors ask them to leave their automatic weapons at the entrance, as if they were coats. Doctors cannot safely return home to areas controlled by rival gangs and must live in hospital dormitories. Patients too frightened to seek basic care due to the violence arrive in increasingly deteriorating conditions.
Access to health care has never been easy in Haiti, the poorest nation in the Western Hemisphere. But late last year she suffered two additional severe blows.
One of Haiti’s most powerful gang federations, the G9, blocked the main fuel terminal in Port-au-Prince, essentially paralyzing the country for two months.
At the same time, a cholera outbreak, aggravated by gang restrictions on mobility, brought the Haitian medical system to its knees.
The United Nations high commissioner for human rights, Volker Türk, said this month that violence between the G9 and a rival gang has turned Cité Soleil into “a real nightmare.”
The reminders of despair are never far away. An armored truck driven by hospital officials drives past hundreds of clay cookies baking under a blistering sun to fill the stomachs of people who cannot afford to buy food. On nearby buildings you can see the signature “G9” spray painted black, a warning of who is in charge.
In a February report, the UN documented 263 killings between July and December in the small area surrounding the hospital alone, noting that the violence has “severely hampered” access to medical services.
That was the case for Millen Siltant, 34, a street vendor who waits in a hospital hallway for an exam, nervously clutching medical documentation on her pregnant belly.
Nearby, hospital staff play with nearly 20 babies and young children, orphans whose parents died in gang wars.
Siltant would normally make the hour-long ride across town aboard colorful tap-tap buses for her antenatal checkups in Fontaine. There she would line up with other pregnant women waiting for their studies to be done and with other mothers who carry malnourished children while they wait for them to be weighed.
All the clinics in the area where he lives have closed, he narrates. For two months last year she was unable to leave her home because the gangs that control the city made it nearly impossible to get around the winding, dusty streets.
“Some days there is no transportation because there is no gasoline,” he said. “Sometimes there is a shooting in the street and you spend hours without being able to go out… Now I am worried because the doctor says that I need to have a C-section.”
Health service providers reported that the crisis has caused more gunshot wounds and burns. It has also fueled an uptick in less predictable conditions like high blood pressure, diabetes and sexually transmitted infections, largely because of cuts in access to primary care.
Pregnant women suffer much more. Gynecologist Phalande Joseph sees the repercussions every day when she steps out of her hospital bedroom and into her light blue scrubs.
The young Haitian doctor dons a pair of white surgical gloves and makes an incision in the belly of a pregnant patient, with a steady pulse that only comes with practice. She works fast, conversing with the medical team in her native Creole language, and in that she breaks out crying as a baby that the nurses cover with pink blankets.
Surgeries like these have become more frequent, Joseph explains between C-sections, because the same conditions that have intensified amid the turmoil can turn a high-risk pregnancy into a deadly one.
This year, 10,000 pregnant women in Haiti could face deadly obstetric complications due to the crisis, according to UN data.
Those risks are compounded by the fact that many of Joseph’s patients are survivors of sexual violence or widows whose husbands were killed by gangs. Difficulties are permeated by an atmosphere of fear.
“If they start having contractions at 3 in the morning, they are very scared to come here because it is so early, and they are afraid that something could happen to them because of the gangs,” Joseph said. “Many times, when they arrive, the baby is already suffering and it is too late, so we have to do a C-section.”
That was all too apparent to Joseph last October, when four men rushed into a hospital carrying a woman in labor who was lying on a doorway. Due to gang lockdowns, the woman was unable to find transportation to the hospital after her water broke.
“These four men were not even her relatives. They found her giving birth on the street… When I found out that she lost the baby, she shocked me”, she recounts. “The situation in my country is very bad, and we can’t do much about it.”
The Fontaine Hospital Center was inaugurated in 1991 by José Ulysse. Initially it was just a one-room clinic to provide basic medical services to a community that lacked other medical resources.
Ulysse and his family have worked to expand the hospital year after year. They fight to keep it open, Ulysse said.
Even when the shootings take place outside the Fontaine, the hospital reopens a couple of hours later. If it were to close any longer, administrators fear it would lose momentum and it would be difficult to reopen.
It is currently the only place where caesarean sections and other highly complex surgeries are performed in Cité Soleil.
Because most of the area’s residents live in extreme poverty, the hospital charges patients little or nothing, even as it struggles to purchase advanced medical equipment with funds from UNICEF and other international aid agencies.
Between 2021 and 2022 there was a 70% increase in the number of patients arriving at the facilities. The hospital has some level of protection from crime because it accepts all patients.
“We do not choose sides. If the two groups confront each other and arrive at the hospital like anyone else, we take care of them,” said Jean Baptiste.
Even gangs understand the importance of medical care, he added. However, there is still a feeling that the risks are getting closer.
Increasing medical vehicle thefts have prevented Fontaine from investing in an ambulance. When ambulance operators are summoned from areas like Cité Soleil, they give a simple answer: “Sorry, we can’t go there.”
Now Fontaine’s mobile clinic can go a little more than a couple of blocks off the premises.
“You say, well, I have to work. So God protect me,” Jean Baptiste said. “As this situation worsens, we came out and decided to face the risks… We have to keep going.”
