Haitian Red Cross arriving at the MSF trauma center with a gunshot victim. In response to the lack of appropriate medical care for the wounded, in late December 2004, MSF opened a 56-bed trauma center at St. Joseph's, a Port-au-Prince hospital. It is the only facility providing free, high quality emergency medical and surgical care to the victims. The direct violence seen in this medical program (gunshot victims and knife wounds, beatings, burns, head trauma) reflects the deteriorating security situation and its direct impact on the population.

Pierre Salignon, General Director of the international medical humanitarian organization Médecins Sans Frontières (MSF) in France, recently returned from a visit to Haiti. He describes the extreme violence reigning in Port-au-Prince’s poorest neighborhoods and how the United Nations (UN) Stabilization Mission in Haiti (Minustah) — far from restoring calm — has been drawn into a war against supporters of former President Aristide. As the security situation continues to deteriorate in Haiti's capital, MSF has called on all armed groups in the city to respect the safety of civilians and allow immediate access to emergency medical care for those wounded in clashes.

Wednesday, June 22, 2005 It is about ten a.m. in Port-au-Prince. A Haitian Red Cross ambulance pulls up to the emergency entrance of St. Joseph’s Hospital, sirens wailing. Two Red Cross volunteers wearing white helmets jump out of the car. They lift a man with a gunshot wound out on a bloody stretcher.

He was gunned down, it seems, just a few moments ago on the streets of the Haitian capital, during an exchange of gunfire between UN troops and supporters of exiled President Jean-Bertrand Aristide, the notorious Chimères. The hospital is a flurry of activity. Doctors and nurses rush about.

Five emergency gunshot wounds have already been admitted this morning. One man, stretched out on a bed, is giving blood for a relative; another is undergoing surgery for a severe abdominal wound. In all, a fairly ordinary morning in Port-au-Prince.

People in Haiti are living in constant fear, caught as they are between widespread criminal violence and an armed insurrection against Prime Minister Gérard Latortue who was put in power in late 2004 after the autocratic President Aristide was pressured into exile, mainly by the US and France.

More than a third of the city is considered “extremely dangerous” - at the mercy of armed groups, most of them Aristide supporters. A Haitian member of the MSF team gave this grim summary of the situation: “When you walk down the street, you don’t know whether you’re still alive or already dead.”

While the UN Security Council renewed the mandate of the UN “Stabilization” Mission in Haiti — 7,400 blue helmets and international policemen, plus an additional 1,000 men for the upcoming pre-electoral period — violence against civilians in Port au Prince is a daily occurrence (the rest of the country is still calm), and the number of wounded treated by MSF continues to grow.

In response to the lack of appropriate medical care for the wounded, in late December 2004 MSF opened a 56-bed trauma center at St. Joseph’s, a Port-au-Prince hospital. It is the only place that provides free, high quality emergency medical and surgical care for the many victims of violence. Since March 2005, MSF has also provided post-surgical physiotherapy at a 27-bed physical rehabilitation center.

The direct violence seen in this medical program (gunshot victims and knife wounds, beatings, burns, head trauma) simply reflects the deteriorating security situation and its direct effect on the population.

By early July, the MSF team had treated teams have treated more than 3,100 patients – 1,112, for violence-related injuries. Almost half of victims are women, children, or elderly, most often injured during violent confrontations between either the Haitian National Police (HNP) or UN forces and criminal pro-Aristide groups entrenched in several of the capital’s slums.

Nearly 900, or one third, of the victims have been treated for gunshot wounds — in some cases caused by exploding bullets. The vast majority of the 30 or so deaths recorded at St. Joseph’s Hospital between December 2004 and May 2005 were from gunshot wounds. About 40 women have also been treated for rape, with the victims receiving both medical and psychological care.

Some of the wounded are brought in by the UN or by private taxis. But most of the injured are referred to MSF by the Haitian Red Cross, who put themselves at considerable risk every day in order to do their work. In mid-June, two of their volunteers were seriously injured (and treated by MSF) in the seaside slum of Cité Soleil, during an exchange of gunfire between Minustah soldiers and the Chimères.

One of the gang leaders had warned, “If UN soldiers show up on our streets, we’ll shoot.”

According to medical personnel, it is very hard for wounded men and teenaged boys to get to St. Joseph’s. Suspected by the police of belonging to armed opposition groups, they fear being arrested or executed by the police before they can even receive care. One injured man, transported to St. Joseph’s by a local taxi, was arrested right in front of two stretcher-bearers before they could take him out of the vehicle, and driven by the police to Port-au-Prince’s general hospital, where he died an hour later, under police guard and without care.

Faced with the ever-worsening security situation in Port-au-Prince, in early July MSF made a public appeal to all armed actors to spare civilians and facilitate the transfer of the wounded to hospitals, particularly to St. Joseph’s emergency unit, which is trying to take in all of the wounded, no matter who they are.

It is not easy. Civilians, young “combatants” from the slums, and policemen lay side-by-side in hospital rooms, all wounded in the violence wracking the Haitian capital. News of MSF’s treatment program has progressively spread through all the neighborhoods, particularly the poorest, but also to those involved in national and international politics. There is a hope that this means greater security for MSF’s patients and medical and surgical teams in this difficult context.

But we should not delude ourselves. The situation could well deteriorate further, leading to even more violence.

The international community bears a lot of the responsibility. Minustah cannot “reestablish peace” in Port-au-Prince. Because of its mandate from the UN Security Council allowing it to use force in order to accomplish its “mission”, it has become an armed player in the conflict, a source of violence against civilians during police operations in the slums.

No longer taken aback by “collateral damage” caused by UN soldiers, one of its representatives even sees it as the price that has to be paid in order to “stabilize” Port-au-Prince. There seems little concern if Minustah is now seen by a significant segment of the population as an occupation force, buttressing a transitional government with limited powers.

Meanwhile, Haitians continue to live in extreme poverty, faceless victims of an almost forgotten conflict whose quick and peaceful resolution appears highly unlikely.