Taïna Cenatus, a 29-year-old culinary student in Haiti, lost her balance at school one day this month and toppled over, but it was not until she hit the ground that she realized she had been hit in the face by a stray bullet.
It left a small hole in her cheek, just missing her jawbone and teeth.
Unlike many Haitians wounded by gunfire in the middle of a vicious gang takeover of the capital, Port-au-Prince, Ms. Cenatus was actually lucky that day — she made it to a clinic. But she is still in pain, her wound swelling, and she cannot get any relief, with more and more hospitals and clinics abandoned by staff or looted by gangs.
“My teeth hurt,” she said. “I can feel something is wrong.”
A gang assault on Haiti’s capital has left an already weak health care system in tatters.
More than half of the medical facilities in Port-au-Prince and a large rural region called Artibonite are closed or not operating at full capacity, experts said, because they are too dangerous to reach or their medicine and other supplies have been stolen.
The State University Hospital, the country’s largest public hospital, is closed. Blood supplies are running low, fuel to run generators is hard to come by and, because of the street violence, clinics that remain open cannot transfer patients needing more sophisticated treatment. Doctors also predict a sharp rise in maternal and infant deaths, as thousands of women will be compelled to give birth at home in the coming weeks.
Haiti’s public health system has responded in recent years to repeated emergencies, from a devastating earthquake in 2010, to hurricanes to Covid-19 to cholera and Zika. The strain has long been fraying the system’s foundation.
Poor patients cannot afford to pay for services, further crippling chronically underfunded hospitals, making it difficult to purchase needed items. Before gangs took control of Port-au-Prince, hospitals still closed their doors from time to time, because doctors would go on strike to protest rampant kidnappings targeting medical professionals.
By early this year, up to 20 percent of the medical professionals at Haiti’s hospitals had left for the United States and Canada, according to the United Nations.
Several officials with Haiti’s Ministry of Health did not respond to requests for comment.
Jean Marc Jean, 37, a freelance journalist, was covering antigovernment protests last month when a police tear-gas canister hit his left eye.
He had three surgeries to remove the eye and repair the socket before the hospital where he was being treated closed because it was behind the National Palace, which gangs had attacked. Patients recounted bullets whizzing by in the hospital courtyard. His wound became infected, so his doctor braved the streets for a house call.
“Fortunately, our neighborhood is safer than some others,” Mr. Jean said. “Even so, I was surprised when the doctor said he could come to our house.’’
Mr. Jean said he needed to have another operation to have a prosthetic eye implanted. His brother spent all of Friday in search of painkillers and antibiotics, because most pharmacies were closed. Mr. Jean said he could try to get his infection treated at another hospital, but gangs could make it impossible to travel.
Haiti has been in the throes of gang-fueled violence for years, but it surged after the 2021 assassination of President Jovenel Moïse. Gangs that had been concentrated in particular neighborhoods grew in size, firepower and influence, sending the murder and kidnapping rate soaring.
A Kenya-led international deployment that was meant to help quell the violence — an effort backed by the United Nations and financed largely by the United States — has been repeatedly delayed. When Haiti’s leader, Prime Minister Ariel Henry, a neurosurgeon who once worked at the Health Ministry, visited Kenya in late February, gangs took advantage of his absence.
Instead of fighting one another, they banded together to attack police stations, prisons, hospitals and other government buildings, demanding his resignation. Mr. Henry, now stranded in Puerto Rico, has agreed to step down once a provisional committee-style government is put in place and names a new leader.
In the meantime, gang members have stripped many medical facilities bare, taking most anything of value, including beds and vehicles.
“The bandits looted, vandalized and turned everything upside down,” said Msgr. Theodule Domond, the director general of St. Francis de Sales Hospital, one of Port-au-Prince’s largest and oldest hospitals with the only oncology unit in southern Haiti.
With violence rising in the surrounding neighborhood, the staff evacuated all of the patients to private hospitals in recent days, just before armed gang members overran nearby streets, ransacking and setting fire to several government buildings.
St. Francis was not spared.
“They carried off everything,” said Dr. Joseph R. Clériné, the hospital’s medical director. “When we are able to get back into the building, we will have to do an inventory. But we will have to wait for calm to return. Right now, it’s too dangerous.”
Two staff members, a nun and a chauffeur, were able to briefly enter the facility and reported seeing broken windows and empty rooms where furniture and medical equipment had been stolen. The privately run Roman Catholic hospital estimates the damage at $3 million to $4 million.
Dr. Wesler Lambert, who runs Zanmi Lasante, a network of clinics affiliated with Partners in Health, a nonprofit public health organization that has operated in Haiti for decades, said several of its 16 clinics had closed for days at a time to save on critical supplies. But given the fear of venturing out and the lack of transportation, there have not been many patients to treat.
“For now, our main shortage is fuel to keep the generators running,” he said. “We will be running out of some other essential drugs. Not because we don’t have them — we have them in our main warehouse. We can’t transport them.”
Another major aid group that provides extensive health care in Haiti, Doctors Without Borders, said it had increased capacity at one of its hospitals and opened a new one with 25 beds and an operating room. But the group cannot fly in more doctors — the country’s main airport remains closed because gangs control the area around it.
Blood products are running low, and patients needing a higher level of care are stuck.
“It’s not sustainable at all,” said Dr. James Gana, who treats patients and helps run the aid groups’ clinics. “It’s not sustainable for the Haitian population, and not sustainable for us.”
Still, Dr. Oscar M. Barreneche, the representative in Haiti for the Pan American Health Organization, said some health care providers had remained “very resilient’’ in the face of adversity.
The situation is particularly dire for many pregnant women.
About 3,000 women in Haiti will be giving birth in the next month, and 500 of them will have complications, according to Philippe Serge Degernier, the country representative for the United Nations Population Fund, the organization’s sexual reproductive health agency. Yet only 50 hospitals in Haiti can treat birth-related complications — and that was when they were able to function normally.
Roughly 1,500 Haitian women die annually during labor, Mr. Degernier said, a number sure to rise this year.
“The health system is in collapse,” he said. “Any decent health professional who has a family and who has a good degree is not in Haiti anymore.”
Dr. Batsch Jean Jumeau, the president of the Haitian Society of Obstetrics and Gynecology, said the lack of functioning hospitals would compel more women to give birth at home. Most Haitian women already deliver babies at home, but midwives lack training to deal with complications.
“We cannot say that delivering at home is very safe in Haiti,” Dr. Jean Jumeau said.
“We often say in Haiti that in Port-au-Prince, it’s like we are in a boat,” he added. “There is no captain, no direction, and we the people are inside it, and we don’t know where we are going and what can be done to save us.”
Andre Paultre contributed reporting from Port-au-Prince, Haiti.