‘It’s a feeling of claustrophobia as safe zones shrink’: the fight to save lives as gang war consumes Haiti | Society

Dr James Gana stepped out on to the balcony of his hospital overlooking a city under siege. “There’s a sensation of ‘What’s next?’. Desperation is defi­nitely present,” the Médecins Sans Frontières (MSF) medic said, as he stared down at one of scores of camps for displaced Haitians in their country’s violence-plagued capital. The chatter of voices and children playing rose up from the tent city below.

Gana, a Nigerian physician, arrived in Port-au-Prince in Januaryat the start of what most call one of the Caribbean country’s worst-ever years. Within weeks, a coalition of criminal groups called Viv Ansanm launched a brutal insurrection, flooding Gana’s emergency centre with shooting victims and forcing thousands to leave home.

“It’s definitely a feeling of claustrophobia … as the safe zones continue to shrink,” Gana said of the mood among patients, many uprooted as Viv Ansanm fighters turned vibrant communities into wastelands of burned housing and barricaded streets.

MSF (Doctors Without Borders) is a humanitarian organisation providing medical care in more than 70 countries. It is one of three charities we are raising money for through the 2024 Guardian and Observer appeal in support of civilians affected by war and conflict, alongside War Child and Parallel Histories.

At Gana’s MSF emergency centre in late October, up to 85% of Port-au-Prince already lay outside government control. In the days that followed, an already desperate situation deteriorated further as gang fighters launched fresh attacks, including on a wealthy hilltop enclave where many diplomats, aid workers and members of Haiti’s elite live.

International flights into the city were halted for the second time this year after gunfire struck three aircraft. Activists said more than 100 suspected gang members had been killed by police or vigilante mobs known as Bwa Kale in a matter of days. By November, the violence was overwhelming – even for MSF’s hardy team of doctors and nurses. The group halted all healthcare services in Port-au-Prince for the first time in 30 years after one of its ambulances was attacked by vigilantes and police.

“It’s really a disaster,” said Jean-Marc Biquet, MSF’s head of mission in Haiti, as he described the incident that triggered that suspension.

On 11 November, an MSF ­vehicle was stopped as it carried three wounded patients to one of the only public hospitals still functioning. A six-hour standoff with dozens of police and vigilantes followed, during which the MSF staff received death and rape threats. The patients were abducted and taken to a nearby street. At least two were murdered.

The decision to suspend MSF’s activities piled further misery on a nation already mired in insecurity and poverty, leaving thousands of patients without care, including a growing number of victims of sexual and gender-based violence.

Biquet said MSF clinics were the only place where “poor people – which is the vast majority of the population – can access and receive treatment. So [it] was a very hard decision to take.

“But as you can imagine, our staff are traumatised. They are really afraid to continue to work. So we had to ­suspend [activities] even if it’s a ­disaster on top of the present ­disastrous situation.”

Haiti’s present disaster has roots that stretch back hundreds of years to when the former French colony was mercilessly exploited by European plantation owners and then, even after gaining independence in 1804, forced to pay crippling reparations in what has been called “the greatest heist in history”.

The 20th and early 21st century saw a series of ill-fated foreign interventions, almost three decades of dictatorship and, in 2010, a devastating earthquake that brought Port-au-Prince to its knees.

But the city’s recent slide into criminal anarchy – which a nascent US-backed international policing mission has so far failed to reverse – has accelerated since the 2021 assassination of President Jovenel Moïse. Since then, an estimated 700,000 people have taken shelter in camps for internally displaced people like that outside Gana’s ER, with tens of thousands more fleeing their neighbourhoods recently.

One camp occupies Haiti’s communications ministry: its offices, car park, corridors and roof now packed with penniless families who lack sanitation facilities, food and jobs.

A banner hanging from the ministry’s front gate reads: “Life is more beautiful without violence.” But the camp’s spokesperson, Denesca Marc Clenshon, an economics teacher forced from both his school and his home, saw little sign of the bloodshed abating. In fact, he feared the camp’s inhabitants might soon have to flee elsewhere. A stray bullet had recently invaded its supposedly safe premises.

As he toured the occupied ministry, Clenshon described how he had taken refuge there after the gang offensive began in February. “We saw people with guns hitting the streets and didn’t know if they were coming for us or not. So it was really scary,” the 31-year-old said, recalling how crowds scattered “like crazy ants” to avoid being shot.

Clenshon shook his head when asked what he thought the endgame of the gangs might be. “Perhaps they want to take over the whole country,” he said. “I feel stressed and panicked.”

Biquet hoped MSF – which is seeking assurances from the interim government that its workers will not be harmed – might soon restart operations. But he said the relentless violence was taking a heavy toll on his staff, several of whom have lost their homes recently.

“The situation has deteriorated a lot,” Biquet said, describing Port-au-Prince’s eerily deserted streets. “The schools are closed. There’s not much traffic on the roads. There are more and more barricades everywhere. People are scared.”

What did the coming weeks hold? “Who knows? I am not Madame Soleil,” Biquet replied, referring to the famous French astrologer. “But I’m afraid we may face more difficult days in the near future.”