Haiti: Survey reveals core of violence in Port-au-Prince

The retrospective mortality survey was conducted by Epicentre, the epidemiology and medical research branch of MSF, in the Cité Soleil between 25 July and 24 August 2023 , during a truce negotiated between the gangs that fight each other on a daily basis in the streets of the Haitian capital.

The results highlight an abnormally high mortality rate, with more than 40 per cent of all deaths due to violence. A comparison with a similar but less extensive study conducted by MSF in 2007 in the same area, already plagued at that time by fighting, shows an alarming increase in violence over the intervening years: while the level of exposure to violence is noticeably lower in 2023, the mortality figures are considerably higher.

In addition to experiencing violence, 13 per cent of Cité Soleil residents surveyed reported witnessing extreme violence in the streets, including murders and lynchings. 

When compared with previous retrospective mortality surveys conducted as part of MSF’s operations, the crude mortality rate in Cité Soleil is close to the rates seen in the Islamic State group’s stronghold around the Syrian city of Raqqa in 2017 among people exposed to the group’s terror regime and a bombardment by the international coalition, and in Myanmar in 2017 as the Rohingya fled the Burmese army’s campaigns of targeted violence against them. 

A SPIRAL OF VIOLENCE

Almost three years after the assassination of President Jovenel Moïse, the inhabitants of Port-au-Prince are struggling to survive amid clashes between armed gangs, police and civilian self-defence brigades. According to the Office of the UN High Commissioner for Human Rights (OHCHR), at least 806 people were killed, injured or kidnapped in Haiti in January 2024 in what was considered to be the most violent month in more than two years. The situation has deteriorated even further since and on 28 February Port-au-Prince descended into chaos, with dozens of injured people crowding MSF facilities.

Figures from the few surveys  conducted by telephone with residents of Port-au-Prince corroborate those of Epicentre’s survey conducted with residents of Cité Soleil. Epicentre also carried out a study among Haitian MSF staff in 2023 that confirmed a high level of exposure to extreme violence. Nearly half of the households surveyed in these two surveys were affected by one or more forms of violence. 

Since 2021, this violence has led to more than 150,000 people  being displaced from their homes to live in precarious conditions in camps. Going to the doctor or going to school or to work has become extremely dangerous and people risk their lives when they do so. According to the Epicentre survey, 40 per cent of women interviewed in Cité Soleil did not receive antenatal care because they were afraid to go to hospital due to the insecurity. 

UNDERESTIMATED FIGURES

In 2022, Haiti ranked 21st among countries with the highest intentional homicide rates, just behind Venezuela,  while Port-au-Prince was in 20th place for cities with the highest homicide rates (excluding war zones). In 2023, the number of homicides in Haiti more than doubled, with more than 4,700 victims, confirming the considerable increase in violence. In 2023, kidnappings also increased by 83 per cent compared to 2022.

These figures appear to be substantial underestimates if we compare them with the 2,300 violent deaths recorded in the Epicentre survey for Cité Soleil alone, which is home to just  9 per cent of the population of the Haitian capital. This underestimate has been documented in several reports, including a thesis published in 2016 which suggested that the homicide rate in Haiti is underestimated by at least 70 per cent.

After an extremely violent period in the 2000s following the fall of President Jean-Bertrand Aristide, the level of violence remained relatively stable in Haiti, with occasional peaks, until the earthquake of 2010, which caused the death of more than 300,000 people. The collapse of infrastructure and basic services, the displacement of hundreds of thousands of people, and the shortages of food, water and medicine profoundly destabilised Haiti. Since July 2018, there have been a series of increasingly violent protests across the country, linked in particular to a fuel crisis.