Caught in Haiti's
Civilians Caught in Haiti's Waves of Conflict
Published at: Doctors
Without Borders - Médecins Sans Frontières
One bullet came to rest under
Charles'* left jaw after ripping
through the right side of his neck. Another bullet shot through
Robert's chest and lodged in his ribcage next to his aorta. Yet
another tore into 9-year-old Pierre's leg, exploded in fragments and
broke his femur in two.
These were just a few of the victims of Haiti's continuing unrest
recovering from recent gunshot wounds at MSF's trauma center in Port
au Prince, where politically motivated violence has wracked the city
in waves since September 2004. By the end of March 2005, MSF surgical
and medical teams had treated more than 1,000 patients – nearly
for gunshot wounds – since the project opened at the 42-bed St.
Joseph's Hospital in late December 2004.
The Changing Nature of the Violence
For months, intense fighting was confined to several of the capital's
vast, densely populated seaside slums, or "quartiers populaires."
From visits to the city morgue, MSF estimated that 100 people were
killed each month from September to December 2004 as armed bands
supporting and opposing exiled President Jean-Bertrand Aristide
actively fought in the streets. Hundreds of homes were burnt to the
ground in Cite Soleil and Bel Air, and many people fled the areas to
stay with family or friends elsewhere in the city.
Today, the conflict is more sporadic and diffuse, spreading
unpredictably into other parts of the city. Intense political
jockeying among many groups in Haiti – members of the transitional
government, the small but powerful business community, pro- and anti-
Aristide forces, the Haitian National Police (HNP), and the former
military – points to a likely continuation of conflict for the
When asked, people living and working in the most affected areas of
Port au Prince say they have never experienced such insecurity and
they see little reason to hope for a better situation in the near
future. While no one can predict when the levels of violence will
rise or fall, it is fairly certain that another brutal chapter of
unrest in Haiti will be written.
Treating Gunshot Victims
Dr. James Smith is a 27-year-old general surgeon from Ireland who
arrived in Haiti in mid-January. It is his second mission with MSF.
With gunshots, there are some victims that never get to a doctor
because the person dies instantaneously – maybe a major vessel
heart was hit, something that kills them straight away. Then there
are wounds that would kill someone eventually, but more slowly, maybe
their bowel or liver is perforated and there is slow bleeding –
something where if you operate, you can actually do something to stop
them from dying. Then there are patients who could have serious
debilitating problems from the gunshot wound such as a broken bone.
And finally you get cuts and grazes and nicks from stray bullets
which you clean up to prevent infection.
We see about 3 gunshot victims a day, maybe 1 or 2 a day with
fractures where we have to bring the patients into the operating
theater to clean it up. About twice a week we need to do a
laparotomy. When a patient has been shot in the chest, the chest
fills with blood or the lung has collapsed, you need to put a chest
drain in. Between 50-60 patients come in every week to get their
I most remember one patient who died. His brother came in a few days
earlier, with quite a big hole blown into the back of his chest. We
closed that up and put in a chest drain because his lung had
collapsed. Then about four days later his brother came in shot with
exploding bullets in the chest and abdomen. So much liver was
destroyed he just bled out.
I was in Guinea before, working as the surgeon in a District
Hospital. I saw elective cases as well as consultations. I think I
saw only 3 gunshot wounds the whole time I was there, which is a lot
for a district hospital.
A Haitian physician working for MSF
We have a lot of injuries caused by fragmentation bullets. Like the
patient you saw upstairs, he had a huge injury just from where the
bullet hit him. Usually there is a small entry wound and a small exit
wound. These bullets, though, they explode inside the abdomen of the
patient and cause a lot of internal injuries. Fragmentary bullets are
used by everyone – it seems they are using
ammunition for a war, not
for a city.
We had violence before, a lot of violence. But the kinds of gunshot
wounds we have now are different. We used to see 38 caliber bullets.
They don't cause many internal injuries. Now, it is something that
explodes inside. We had a lot of crime before. Everyday we would
receive one or two gunshot wounds. Now we have 3 or 4 or more. It was
mainly crime then, but now we have more political violence. It's not
directed like a persecution, but affects everybody in the country.
Treating Victims of Sexual Violence
Olivia Gayraud, a French emergency nurse, has been the field
coordinator for the trauma center in Port au Prince since October
2004. She started with MSF in 1998 and has worked in Abkhazia,
Democratic Republic of Congo, Ivory Coast, Uganda, Afghanistan, East
Timor, Burundi, Madagascar, and Sudan.
Now, we have treated about 20 patients from extremely violent sexual
attacks. You can't imagine. The youngest ones have been 10 years old.
Many of them had one of their parents killed before being kidnapped,
and it's always many men, between 4 and 10. The rapes are very, very
brutal, and the women and young girls are afraid that if people find
out they went for help that they will be killed.
If they seek treatment within 72 hours of the rape, we can prescribe
antiretrovirals (ARVs) for HIV prophylaxis and antibiotics for
prophylaxis against sexually transmitted diseases (STDs). If they
don't come within the first 72 hours, we can only give them the
prophylaxis for STDs.
It's important for us to network with other groups, stressing the
importance of the first 72 hours,
because after, it's too late. We
have to continue to let people know, especially in the hardest hit
areas like Bel Air and Cite Soleil. But it will be difficult –
of community groups don't exist anymore because of the insecurity.
Community workers can't work anymore because of the violence. It's
just too dangerous.
It's hard to imagine the situation getting any worse, because since
September 2004 it has already been the worst many people here have
ever seen. They say it was never this bad before – with Aristide
the coup d'etat in the 90s. We'll see what happens, though.
Especially before the November elections – there are groups that
don't want the elections to happen.
Some people in Port au Prince know there is violence but they only
hear about it on the radio and feel like it is very far away. They
may change part of their routine – maybe they don't go to the
as often as they used to. It's more the people living in the center
simple people, very poor people
– who are affected.
Voices of Those Caught in Port-au-Prince's
Charles, 33 years old
On the first day of Carnival, Sunday, I was near my house sitting at
a restaurant listening to music. A friend came in and yelled to run
because there would be problems. I didn't have time to get away, and
got shot in the leg by the rat pa kaka [note: Creole term for “rats
that are still-living”]. They just robbed a store and ran off
didn't want anyone to bother them so they were just shooting
everywhere. My two friends were shot, but they died. I came to the
It's getting worse because nobody can talk about the rat pa kaka
doing such things. If you tell the police, they can exterminate your
whole family, so everyone is afraid to talk. The police aren't sure
who is in a gang and who is not, so they think everyone who lives in
an area is a gang member or collaborator. So even if I tell the
police, the police may think I am a gang member.
I'm not working now and I have a family to support. My wife gave
birth 6 months ago to a baby girl, our first child. So if this would
stop, maybe I could find a job.
Robert, 9 year-old boy
I was shot by the police. Everyone was running, I was running too.
The police car came up starting shooting all over the place, and I
got shot in the leg. This was in January. I think the police were
shooting because the rat pa kaka were in the neighborhood.
Madeline, Robert's 22 year old mother
I've been in the hospital with Robert for a month. When I left Bel
Air, it was really bad. Every time there was shooting, many people
would die. I don't think it will get better and a lot of people have
left the area. I will never go back.
Florence, mother of another young boy who was
recovering from a gunshot wound
I was in front of my house and I saw a lot of men coming down the
street. I didn't see any guns but I was suspect. I told the children
to get inside, and was helping my son jump over the wall, but he was
shot in the leg. We left Cite Soleil in November because we had so
many problems – they stole things and burned my house near the
market. My daughter has her own house and still lives in Cite Soleil.
She says they are shooting every night.
Pierre, 20 years old
I am originally from Jacmel, in the southeast. I was walking on the
street, looking for a friend in Post Marchand so we could go to Santo
Domingo, when I was shot by the police. There was a girl with me at
the same time but she died. I didn't know what happened. They were
just shooting, shooting all around. The situation is terrible. If I
could leave the country, I would.
Cheryl, 24 years old
I was in the street with my boyfriend and another couple on
Valentines day. Two men with firearms stopped us, my boyfriend and
the other guy ran, but my girlfriend and I couldn't get away. They
demanded money and jewelry but we didn't have anything, so the men
wanted to rape us. The police came, and when the two men saw them,
they shot me in the stomach. The situation in Haiti is very
dangerous. At 6 pm you have to stay home, you can't go out. Even if
you don't have any problems, you can be a victim of violence at any
time. I wish it would stop but it just gets worse and worse. It
wasn't like this before.
*All patients' names have been changed
Doctors Without Borders/Médecins Sans Frontières (MSF).
© 2004 MSF. All rights reserved.
article with photos:
Forwarded by the Haitian Lawyers' Leadership Network
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