Overview:
The malfunction of the Haitian health system continues to deteriorate, particularly due to increasing gang violence. The consequences are multiplying and raising concerns for the future with doctors who could leave the system, a lack of adequate training for future doctors and more patients who will not have hospitals to attend in certain areas. A situation that requires rapid intervention from state authorities.
PORT-AU-PRINCE — Dr. Samuel Faldor and his colleagues had never felt the threat of violence from gangs come so close as they went about treating patients in Haiti’s capital. But on Feb. 29, days before gangs engineered a mass prison break with far-reaching effects, the doctors in Haiti’s largest hospital — State University Hospital of Haiti (HUEH) — experienced the violence firsthand.
“The violence came to find us at our workplace that day,” said Dr. Faldor, who left the hospital under heavy gunfire from the armed bandits, thanks to armored police vehicles.
Today, the largest hospital in the country is devoid of its healthcare professionals. Dr. Faldor, like many other doctors, worries about their future in the country. It is unclear when medical activities will resume.
“We can no longer work, do what we know how to do, nor learn or enjoy the profession,” Dr. Faldor said. “This situation of violence will cause numerous traumas and leave serious sequels [long-term effects] among us doctors.”
For years, bandits have targeted doctors or their health centers, leaving many dead, injured, robbed or kidnapped. However, the resurgence of armed violence in Port-au-Prince has prompted numerous healthcare professionals to stay home, unable to provide care to their patients. Several hospitals have also been forced to close their doors. Other facilities, such as Saint-François de Salle and Asile Français, have been vandalized.
On April 2, armed gang members continued with their assault on the Champ-de-Mars area in an apparent plan to take over Haiti’s National Palace, the seat of the government. The plan went into action with the assailants launching an assault from the premises of the HUEH nearby. They converted it into a fortress to face off with Haitian National Police (PNH) officers.
The bandits later vacated the premises after meeting with resistance from the police, resulting in injuries to some police officers and the destruction of a police armored vehicle. This action disrupted the planned reopening of the hospital, as announced by the facility’s director.
According to the United Nations, gangs now control more than 80% of Port-au-Prince, with an estimated 3.5 million people living there. Their criminal actions affect all segments of society, making it difficult to access healthcare centers. UNICEF reports that in the entire country, six out of 10 hospitals are not functional. Currently, only two surgical facilities are functioning in Port-au-Prince, adds the organization.
Dr. Faldor, a general practitioner, said such criminal activity had long-ranging impacts on patients and health workers’ lives and futures.
“I have known patients suffering from lung infections and cancer who have died because they are no longer able to continue their treatment,” Faldor said. “There are doctors who are now neglected and who are trying by all means to escape this stressful situation because their lives come first.”
Faldor said every time insecurity knocks on the door of the medical sector and prevents doctors from providing care, the country will suffer in the long term. Patients will continue to develop chronic illnesses in the future. Doctors will become less effective, professionals will leave the country, creating a staffing shortage and new doctors will experience many gaps. All these factors will have repercussions on the Haitian population and the healthcare system, he said.
Dr. Emmanuel César said Feb. 29 is the first time he has experienced such violence. He remembers that in the morning, they received many more patients wounded by bullets than usual.
“Everyone was in shock, especially when some people reported that the bandits had stormed the hospital,” Dr. César tells The Haitian Times. “Even in times of war, some institutions like hospitals never cease to function.”
Dr. César, an internist, said doctors can no longer provide care to patients because they cannot travel around and are often targets of kidnappings when out and about.
“When you are there to provide care and you are blocked, people continue to die due to lack of care,” he said. “There is no greater disappointment than that.”
Insufficient healthcare system struck by insecurity
In its “Annual Statistical Report 2022” on Haiti’s healthcare system, the Unit of Studies and Programming (UEP) reports data going back nearly seven years, the anyway available:
- 1,007 healthcare institutions were identified in the country between 2017 and 2018.
- Of that number. 35.9% are walk-in health centers, 35.0% dispensaries and community centers, 16.2% centers with beds 16%, and 12.9% hospitals.
- The Western department alone accounts for 36.4% of healthcare infrastructure, while the other departments have lower percentages ranging from 3.4% to 12.0%.
- About 47.1% of healthcare services are privately owned, while the public sector manages 34.2% of healthcare distribution in the country.
- The country had a total of 7,597 hospital beds, with 46.9% in the Western department. The national average hospital bed density is 6.4 beds per 10,000 inhabitants.
- The country had 8,615 medical personnel for about 11 million people, and the national ratio was 7.3 medical personnel per 10,000 inhabitants.
These statistics, which give an idea of the situation of Haiti’s healthcare system, report that the total health expenditure of the State is 4,366 gourdes or USD 51.5 per inhabitant in 2019.
Victims of insecurity rise, doctors forced to be absent
Alongside the problems of lack of hospitals, medical personnel, hospital beds, and financial resources, Haiti’s healthcare system is now facing gang violence. A situation that affects not only doctors targeted by gangs but also patients whose access to healthcare becomes more difficult. Several hospitals are forced to close, and the country’s largest hospital has not been spared.
Among the patients is the case of Guito Saintil, who is forced to stay at the general hospital because he has nowhere else to go since Feb. 29.
“The reason why I’m still here [at the hospital], is I can’t run,” says Saintil, who spoke to The Haitian Times while visiting the hospital.”I don’t want to flee the rain just to drown in the river,” he adds.
Saintil has been suffering from skin disease since 2018 and moves around in a wheelchair at the general hospital. His life now revolves around applying a treatment cream to his wounds to relieve his skin pain.
“I am left all alone, with my arms hanging.”
Guito Saintil
He is one of those who have nowhere to go after the majority of patients, parents, and all the doctors fled the area threatened by gang gunfire. “I am left all alone, with my arms hanging,” said Saintil, who fled his home in Carrefour Feuilles.
Dr. Reynald Bélance, who works in pediatrics at HUEH, recognizes the impact of this situation on patients. He explains that at this type of moment, the population has a greater need for health workers who are unable to travel.
“As a doctor, this situation affects me when it prevents me from continuing my training, from providing care which is an obligation for us,” said Dr. Bélance. “It is with a feeling of sadness that we live through this period where doctors are blocked because of the escalation of violence for almost a month,” he added.