'This is not a time to get sick,' says a doctor in Haiti on the health-care crisis

It isn't easy to get a blood transfusion in Haiti these days.

"I had a call from a friend seeking care for a family member," says Dr. Wesler Lambert, executive director of the nonprofit Zanmi Lasante, affiliated with Partners in Health and Haiti's largest health-care provider outside the government. "They wanted [a] blood transfusion for him." Members of his family were willing to donate blood, but it wasn't safe enough for them to travel to the hospital.

In another case, Lambert found blood for a patient but wasn't able to get it transported just 30 miles away.

Transfusions are but one casualty in the turmoil gripping Haiti. Street gangs have been a part of the country for decades, but in the last few years they've become increasingly powerful and violent. In early March, while Prime Minister Ariel Henry was in Nairobi negotiating an arrangement to bring a Kenyan-led security force to Haiti, the gangs seized the opportunity to band together. They shuttered the airport, attacked police stations and freed several thousand prisoners.

In response to these actions, Henry agreed to step down earlier this week. The gangs are now demanding a political role in whatever comes next. Gang leaders are holding press conferences even as their members hold much of the capital of Port-au-Prince hostage, terrorize the country at large and kidnap people — including children, women and health workers.

This rampage is preventing many Haitians from getting basic services like health care. Gangs have been looting hospitals, forcing some to close. Lambert said he's needed a police escort inside an armored vehicle just to make it to work.

Increasingly, doctors, nurses, lab technicians, psychologists and social workers are opting out of this deadly urban obstacle course. Some stay home. Others have left the country, marking "the most important exodus of the best and brightest in [Haiti's] history," says a Port-au-Prince-based physician who asked NPR not to mention his name out of fears it would make his family a target for gangs.

Zanmi Lasante, which serves more than 780,000 patients across its 17 health facilities, tells NPR that it is seeing 40% fewer people. This is partly because the group has reduced operating hours in light of security concerns and logistical challenges.

With the explosion of more intense violence over the last couple weeks, hospitals and clinics are seeing more frequent electricity outages. Medications and oxygen are in short supply. As a result, even if people manage to get to a health center, they may not receive the care they need.

An OB-GYN who works in Port-au-Prince and Cap-Haitien says if you have money, you have options for health care. Those who are poor suffer the most — and more than half the country's population falls below the poverty line.

The OB-GYN, who asked that their name not be used because of the fear of being targeted by kidnappers, says, "Pregnant women are afraid to go to the hospital to seek care. Why? Because they are afraid to get shot. There are gangs everywhere. The gangs are powerful."

Traps set for health workers

This doctor says two colleagues were kidnapped in the street on their way to the hospital by gangs last December. It's not uncommon for people to inform gangs of the whereabouts of health workers. Sometimes, "a patient might set up an appointment with the doctor," the doctor says, but it's a trap. "This is why sometimes doctors do not answer [calls] at night [from] unknown people."

The OB-GYN isn't sure why the gangs are targeting health workers — one observer notes that everybody is being targeted, "from the merchant at the street corner to bank CEOs." The doctor believes that health workers in particular may be at risk of kidnapping because of a belief that their family would have money to pay a ransom and perhaps because the kidnappers might need medical care.

Ultimately, the OB-GYN's two colleagues were released, but the doctor says they weren't the same — one spent a week crying and the other refused to talk about what happened and cut off ties with his social circle.

"When [a] person is released," the doctor says, "you feel you are unsafe because this person has given information. That means they know about you." The kidnapping was the final straw for this physician, who no longer goes to the hospital.

And then, a week ago, the OB-GYN says their pregnant cousin needed a C-section to deliver her baby. It was nighttime and she worried about venturing too far. She and her mother made their way to the closest hospital. But there wasn't enough electricity or oxygen to perform the procedure, and, says the doctor, their cousin died.

The baby died too.

Cities hit hard but rural areas suffer too

The state of health care is particularly bad in the cities because that's where most of the gangs are entrenched. But it's a nationwide issue. Because Port-au-Prince is the governmental and economic hub of Haiti, "the political and social upheavals resonate throughout the entire country, imperiling the health and well-being of the Haitian population," says Dr. Samuel Pierre, a physician at Haiti State University.

And while rural areas may be a bit safer from gang activity, there are other issues. Because gangs are guarding both primary roadways that leave the capital to the north and the south and drivers risk being robbed and killed or kidnapped, drugs that are needed in rural areas are often stuck inside Port-au-Prince.

There are also reports that this blockade is also contributing to malnutrition, with agricultural products going rotten as they await delivery.

All of this is happening at a time when 362,000 people are internally displaced and gangs are using rape and sexual violence as a weapon to instill fear. This toxic combination translates to skyrocketing medical needs.

"People are living in extreme vulnerability," says Carlotta Pianigiani, an emergency coordinator with the Alliance for International Medical Action, a nongovernmental group that offers emergency medical care in conflict zones, with a focus on sexual and reproductive health. She's currently based in Port-au-Prince. Those who are displaced "are living in camps. They are living in schools, in classrooms, in governmental buildings. They are sleeping under the sky. Sometimes they have two latrines for 5,000 people."

These conditions are ripe for the spread of disease, and yet the danger of working in Haiti right now is restricting her group's ability to respond.

"For example, every morning," Pianigiani says, "we ask everyone to check that everything is OK before leaving [for work] and if attacks start or there are some uncertainty or some issues, we ask them to go back to their families and seek shelter."

Despite their reduced capacity, for the moment, the health-care group Zanmi Lasante says it's running its emergency care 24/7. But Dr. Wesler Lambert, the group's director, worries that emergency services could give out at any moment.

"If we don't get fuel, the hospital will stop," he says. "So we have to buy fuel at double the usual price." Even with fuel, however, straightforward medical procedures often stall out.

The Haitian physician based in Port-au-Prince quoted earlier in this story (and who asked for anonymity to protect his family) says he's never seen the situation this bad. "This is not a time to get sick," he says.n