ACAPS Briefing Note: Haiti - Humanitarian Impact of Gang Violence (2 June 2023)

KEY FIGURES Briefing note 02 June 2023 1 Any comments or questions? Please contact us at info@acaps.org CRISIS OVERVIEW Gangs have existed in Haiti for decades, but related violence has been rapidly increasing in several areas of the country since 2021. In December 2022, the UN estimated that 60% of Port-au-Prince, the country’s capital, was under gang territorial control (AP 09/12/2022). By April 2023, this figure had increased to about 80% (UN 14/04/2023; NYT 22/03/2023). Gangs have also established their presence in other regions of the country, including Cap Haïtien (Nord), Gonaïves (Artibonite), Jacmel (Sud-Est), Jérémie (Grand’Anse), and Les Cayes (Sud) (ICG 27/07/2022). In 2022, around 2,180 homicides were recorded in Haiti, an increase of more than 35% compared to 2021 (UNSC 17/01/2023). Other violent crimes, such as rape and kidnapping, also increased in 2022 (TNH 14/11/2022; The Telegrapgh 15/07/2022) . During the first quarter of 2023, 815 homicides and over 630 kidnappings were reported across the country, representing respective increases of 21% and 63% compared to the last quarter of 2022 (SCR 25/04/2023). On 24 April 2023, new gang clashes in Port-au-Prince resulted in the burning of houses and several stabbings and shootings (MSF 27/04/2023). There are 200–300 gangs across Haiti, around half of which are in Port-au- Prince (OCHA 13/04/2023 and 17/03/2023). These gangs are sometimes organised in federations of more than a dozen gangs. The two main gang federations are the Fòs Revolisyonè G9 an Fanmi e Alye, usually abbreviated as G9 or FRG9, and the GPèp, which translates to G-People in English (Haïti Liberté 13/07/2022) . Jimmy ‘Barbecue’ Chérizier, a former policeman, leads G9, and Gabriel Jean Pierre, known as Ti Gabriel, leads the GPèp (Brookings 03/02/2023). Chérizier created G9 in May 2020, and the GPèp appeared several months later to compete for the control of Cité Soleil, one of the neighbourhoods most affected by violence in Port-au-Prince (InSight Crime 29/12/2021). Both gang federations have alliances with politicians and police officials. There are accusations that the G9 is close to the Haitian Government and is receiving money from high-level officials (InSight Crime 24/11/2022). On the other hand, the GPèp has alliances with opposition members that aim to weaken the Government (Haïti Liberté 13/07/2022; InSight Crime 21/07/2022). These alliances are important, as gangs use the impunity they generate to carry out violent acts without consequence and increase their power (UNSC 26/04/2023; News24 09/03/2023) . These alliances also give them access to arms, financing, and ammunition from government sources (IHRC/OHCCH 22/04/2021; DW 08/10/2022). The gangs have also assumed some governance functions, such as providing financial assistance in areas under their control. In return, politicians receive electoral assistance, with gangs using violence to mobilise voters (GI-TOC 17/10/2022; Niño 08/02/2023) . As at 15 March 2023, gangs had forcibly displaced at least 160,000 people since 2021. IDPs live in host communities or informal collective sites with limited shelter, health services, education, and food access. The violence has increased food prices, and half of Haiti’s population has reported struggling to eat (OHCHR 21/03/2023). There are records of snipers committing random violence against people in the streets and kidnapping people, resulting in self- imposed lockdowns for civilians (OHCHR 10/02/2023). Schools and hospitals have had to close as a result of their staff falling victim to the violence (OCHA 23/04/2023; UNICEF 09/02/2023) . Although violence has been mainly concentrated in Ouest department, especially in Port-au-Prince, gangs exist in many parts of Haiti. People report the most movement restrictions in Artibonite, Centre, and Ouest departments (OCHA 17/03/2023). HAITI Humanitarian impact of gang violence 80% OF PORT-AU-PRINCE IS CONTROLLED BY GANGS 40% DECREASE IN THE NUMBER OF POLICE OFFICERS BETWEEN 2020-2023 +160,000 PEOPLE DISPLACED BY CRIMINAL VIOLENCE IN HAITI 30% OF HAITIAN WOMEN BETWEEN 15-30 YEARS OLD HAVE BEEN VICTIMS OF SEXUAL VIOLENCE Briefing note | 02 June 2023 2 KEY MESSAGES • Gang presence increased in Port-au-Prince between November 2022 and May 2023. As at April, gangs controlled an estimated 80% of Port-au-Prince. They have also spread beyond Port-au-Prince, mainly to the other areas of Ouest department and to Artibonite department. • Gangs have also become more violent. Homicides and kidnappings have steadily increased since 2018. Although figures are unreliable, cases of sexual violence have increased, mainly used to punish rival gang members or pressure them for ransom. • Violence is unlikely to decrease in the short term. Firstly, the Haitian National Police (PNH) is outnumbered and outgunned in many areas, with a 40% reduction in their personnel over three years. Secondly, the number of gangs are increasing in the country, and alliances are weak even within gang federations, which could lead to more violence over territory control. • Gang violence has led to the closure of multiple markets and the abandonment of land in Artibonite, one of Haiti’s main agricultural regions. Livelihood disruption is worsening the food insecurity crisis, which already affects almost half of Haiti’s population. • Gang violence has also increased internal and international forced displacement, displacing at least 160,000 people who find themselves in makeshift shelters or host communities with limited access to basic services and food. • Some humanitarian aid targets crises other than criminal violence, such as cholera outbreaks and food insecurity. While those crises may overlap, humanitarians are limited in their ability to act, as the Haitian State has very limited control over some cities. Gangs have also attacked aid workers and looted their supplies, limiting responders’ ability to address the issues fueled by gang violence (TNH 14/12/2022). • The funding required for humanitarian response has almost doubled since 2022 in a context where it is almost impossible to operate in the areas where funding is most needed, such as Port-au-Prince, and humanitarian constraints prevent the smooth running of operations across the country (FTS accessed 11/05/2023). Most of the Humanitarian Response Plan’s funding is meant to curb the food insecurity crisis, and the geographical focus is on Ouest department (OCHA 13/04/2023). About this report Aim: this report highlights the humanitarian impact of the recent increase in gang violence in Haiti. In November 2022, ACAPS published another report on the deteriorating humanitarian situation in the country, with a focus on Port-au-Prince, where gang violence was already described as a driver of multiple crises (ACAPS 01/11/2022). Since then, while several other drivers have deteriorated, such as the cholera outbreak or the high cost of living, gang violence has further increased, worsening the severity of the insecurity and displacement crises. Gang violence is aggravating the humanitarian situation, and humanitarian space is increasingly decreasing. This report is a follow-up on the November report, including on the risks identified and their materialisation. The focus is on gang violence, and the geographical scope has been extended to cover the entire country. Method: this report was built on a review of secondary sources from humanitarian organisations, think tanks, and local and international media. Limitations: the very nature of the crisis limits what information is available on gang violence in Haiti. In the most affected areas, leaving their homes puts people at risk of attacks, and people may choose not to report instances of crime to avoid retaliation from gangs. Consequently, figures on sexual violence, kidnappings, and displacement are likely higher than what ACAPS can access (ICG 14/12/2022). The intertwining of the gang violence crisis with other crises, such as health, displacement for different reasons, and food insecurity, makes it difficult to understand the real magnitude of the impact of violence. Although we have attempted to isolate the effect of gang violence where possible, there will be times when the crises are difficult to separate. TABLE OF CONTENTS Anticipated scope and scale....................................................................................................................3 Humanitarian access constraints...........................................................................................................3 Impact of gang violence............................................................................................................................4 Compounding factors................................................................................................................................9 Briefing note | 02 June 2023 3 ANTICIPATED SCOPE AND SCALE Given the constraints, the Haitian security forces cannot curtail gang violence in the short term. Gangs outnumber the PNH in some areas of the capital, and they have burnt and looted some police stations in search of weapons (TNH 14/11/2022). PNH officers are also underpaid, and their troops are not sufficiently armed. In 2020, the country had about 15,000 police officers (CRS 03/03/2020). As at 2023, this figure had decreased to around 9,000, as many officers had resigned or left the country (NYT 22/03/2023). Although the number of gang members is unknown and constantly changing, 2022 estimates suggested that 20,000– 30,000 people belonged to gangs (TRT World 21/10/2021). In January 2022, gangs carried out a series of targeted killings of police officers, leading to protests and several resignations among members of the police force (CBS News 27/01/2023). The police union have said that the salary of police officers is insufficient considering the risk of lethality (NYT 22/03/2023). These aspects make it unlikely for the gangs to stop the escalation of violence or for Haiti’s security forces to be able to stop them. Gang violence in Haiti is also likely to continue because of several risks of dispute. The first is at the intragang level. Alliances between the gangs that make up the G9 and the GPèp are weak (Le Nouvelliste 03/07/2020). Some gangs were enemies before becoming allies, and there have been violent disputes between them in some neighbourhoods (InSight Crime 29/12/2021; GI-TOC 17/10/2022) . The second is between gang federations and other criminal groups seeking to contest their control over some neighbourhoods. An example is the 400 Mawozo, which exercises control over Croix-des-Bouquets, a Port-au-Prince neighbourhood. This gang is considered one of the largest in the country and has used kidnappings as one of its main tactics (InSight Crime accessed 20/05/2022). The third risk of dispute, possibly producing the most violence, is the war between the G9 and GPèp federations. These federations have been fighting for more than three years. Given their alliances with politicians, the political crisis will likely encourage the latter to use the former for protection or to attack their opponents (InSight Crime 21/07/2022; PBS 21/10/2022). Illegal gun markets have also armed gangs with machine guns (UNODC 28/02/2023; CFR 25/04/2023). The high number of armed gangs, their alliances with sectors of the police and politicians, and the weak alliances within and between them are likely to sustain the violence resulting from the turf wars over time. Haiti’s Prime Minister, Ariel Henry, has at various times called for international military intervention in the country (TWP 07/10/2022). Civil society groups favour a Haitian-led solution, rejecting calls for foreign intervention (TNH 14/11/2022). The opposition has also criticised the request, believing it would expand Henry’s power during the political crisis. Previous foreign military interventions have failed and undermined public confidence in the authorities and the international community (Foreign Affairs 10/03/2023; NYT 19/12/2021). The Haitian Government has not established formal IDP camps, leading to the expansion of multiple makeshift shelters with limited access to humanitarian assistance in Port-au-Prince. As at April 2023, over 38% of the IDPs lived in 50 makeshift shelters, the vast majority without access to basic services. The remaining IDPs live with host communities in an environment where they share very limited resources (UNSC 14/04/2023). Despite the absence of formal camps, the Government has taken a stand against makeshift shelters. In November 2022, the PNH evicted more than 3,000 IDPs from Hugo Chavez Square near the Port-au-Prince airport (Le National 18/11/2022; TNH 14/12/2022). As gang violence continues, the conditions in which migrants live will likely worsen in the absence of available camps and the increasingly limited resources of host families. HUMANITARIAN ACCESS CONSTRAINTS Access of humanitarians to people Between 2019–2022, there were 11 instances of gangs attacking health aid providers. Over 60% of these incidents occurred in 2022 (Insecurity Insight 08/03/2023). Between 2020–2022, there were at least 37 deaths, injuries, kidnappings, or arrests of aid workers in the country (Insecurity Insight 23/05/2023). Gangs have kidnapped some aid workers to ask for ransom (Le Journal de Montréal 31/01/2023) . They appear to have carried out some of these attacks without precise intent to target humanitarians, but the high level of randomness of the violence in Haiti puts anyone living in the affected areas at risk (TNH 14/12/2022). Security constraints Widespread insecurity puts the functioning of humanitarian programmes at risk. Even when armed groups do not directly attack humanitarian workers, fighting usually occurs near facilities, so some organisations cannot guarantee the safety of either their staff or the population they support. Médecins Sans Frontières (MSF) cited this reason for temporarily closing its Cité Soleil hospital (MSF 08/03/2023). The violence also prevents aid workers from moving around neighbourhoods. Several humanitarian organisations have reported negotiating with gangs to move around safely, as the Haitian Government has lost control over much of the capital (Newsweek 16/08/2021; TNH 07/02/2022). For humanitarian responders, moving through national roads is costly and dangerous in many areas (ACAPS 14/07/2021; OCHA 05/07/2021) . The arrival of most goods in the country through the capital also challenges how humanitarian responders transport goods to other affected areas of the country, which can prevent the delivery of critical aid to people in need. Gangs have closed roads, leading at various times to fuel and other goods crises in Haiti (Reuters 27/09/2022). Briefing note | 02 June 2023 4 Access of people to aid The spread of violence across different areas of the capital has trapped many of the population in need in gang-controlled neighbourhoods, restricting them from seeking assistance (Newsweek 16/08/2021; TNH 07/02/2022). Gangs have closed roads several times to demand money from road users travelling by car or motorbike, and they have hijacked some buses at illegal roadblocks. In some areas, there are lists of cars allowed to pass. Gangs have also killed people for refusing to pay the amount they impose (St Kitts & Nevis Observer 27/02/2023) . IMPACT OF GANG VIOLENCE In April 2023, projections suggested that around 5.2 million out of a population of 11 million needed humanitarian assistance in Haiti. This figure is a 6% increase compared to 2022, with around 300,000 more people needing assistance. 4.2 million were projected to need shelter, while two million needed protection. The areas with the most people projected to need humanitarian assistance and protection were the departments of Ouest (1.8 million) and Artibonite (824,000) (OCHA 13/04/2023). Among the people in need, OCHA estimates that 1.5 million suffer as a direct result of gang violence in terms of insecurity, movement restriction, forced displacement, hunger, the closure of basic health and education services, and protection concerns, including widespread sexual violence and kidnapping (OHCHR 21/03/2023). Haitians living outside Port- au-Prince are also in need and suffer from the sociopolitical crisis and indirect impacts of gang violence, including street blockades, fuel shortages, and rising food prices (OCHA 17/03/2023) . Killings, kidnappings, and forced recruitments • Homicide rates tripled in Haiti between 2018 (6.87 per 100,000 inhabitants) and 2022 (18.84 per 100,000 inhabitants). • Kidnappings increased by 2,673% between 2018–2022. During the first quarter of 2023, the number of kidnappings was already equivalent to 63% of those in 2022. • Different disorganised and grassroots vigilante groups are killing suspected gang members, increasing some types of violence. Incidents have included burning people alive in the streets and lynching. • Children and adolescents are at risk of gang recruitment, with gangs offering them money to join armed groups and threatening them with violence should they refuse. Given the extent of gang violence in Ouest and Artibonite departments, particularly in Port- au-Prince, homicides have risen steadily since 2018. The homicide rate in Ouest department in 2022 was more than 44 per 100,000 inhabitants, above the countrywide rate of 18.84 per 100,000 (UNSC 17/01/2023). In Artibonite, gangs have killed 138 people since July 2022, more than the total number of homicides since 2019 (WFP 27/04/2023). Numbers and rates of homicides in Haiti (2018–2022) Source: ACAPS using data from SCR (accessed 08/05/2023) Gang warfare means that civilians perceived as allies (family members, friends, or people living in rival-controlled neighbourhoods) risk being killed by other gangs to send a message to their enemies (BBC 05/12/2022). Snipers shooting randomly in certain neighbourhoods have killed some people (AP News 10/02/2023). Gangs also target the relatives of police officers (AP 22/01/2023) . This situation implies that people living in neighbourhoods under gang territorial control are particularly exposed to the risk of death or injury. Other forms of violence, such as vigilantism, have recently emerged. Some neighbours have organised themselves to punish suspected gang members. This retaliation poses the risk of homicides at the discretion of those involved in vigilante groups. Vigilante mobs have killed at least 75 people accused of gang membership between January–April 2023 (BINUH/ OHCHR 09/05/2023; AP 02/05/2023) . The killings are often public, with groups beating up people with stones or burning them alive near politicians’ homes or police stations (The Guardian 30/04/2023) . Briefing note | 02 June 2023 5 The number of people killed in this manner is likely higher than the reported number (CBC 08/05/2023) . Besides committing homicides, gangs have increasingly used kidnapping to extort money from individuals in exchange for release. Between 2021–2022, there was a 107% increase in kidnappings. Between 2018–2022, the figure grew by 2,673% (SCR accessed 08/05/2023). During the first quarter of 2023 alone, there were 637 kidnappings in Haiti, a 63% increase compared to the same period in 2022 and almost 47% of the total number of kidnappings for the entirety of 2022 (UNSC 14/04/2023; The Nation 17/04/2023). There is a risk of the kidnappers killing abductees if the ransom is unpaid. Kidnapping targets have ranged from diplomats, NGO staff, and businessmen to ordinary people, for whom lower ransoms have been demanded (Bloomberg 31/03/2022; The Nation 17/04/2023). Table 1. Number of reported kidnappings in Haiti (2018–2022) YEAR NUMBER OF REPORTED KIDNAPPINGS 2018 49 2019 78 2020 234 2021 655 2022 1,359 Source: ACAPS using data from SCR (accessed 08/05/2023) Another risk of gang expansion is the forced recruitment of children and adolescents. Schools function as protective environments that help children avoid contact with gang members, and the closure of several schools has left children more vulnerable to gang recruitment. According to the testimony of recruited children and youth, gangs offer to pay between HTG 1,500–2,500 (approximately USD 15–25) and threaten to kill those who refuse the offer (NYT 22/03/2023; UN 03/07/2022) . Gangs use children in multiple ways, including as spies to warn of the presence of police or rival gangs or as hired assassins for the armed group. This use of children in criminal violence puts them at risk of rival gangs retaliating or the community stigmatising them (InSight Crime 03/06/2022; OHCHR 17/05/2022). Gangs also use social media to attract recruits. Gang leaders display high-value items to motivate children and young people and invite them to join their armed groups. These high-value items are taken as proof that those who join the gangs will achieve good living standards (TWP 11/06/2022). Sexual violence • An estimated 30% of Haitian women between 15–30 years old have been victims of sexual violence. • Medical and mental health services available to victims are insufficient and inadequate. • Armed gangs have tried to force officials and humanitarian workers to share personal data about victims receiving medical and psychological care. • Gangs use sexual violence to punish members of rival gangs or to pressure families to pay ransoms. Gangs have used sexual violence against women and girls (NYT 22/03/2023). An estimated 30% of Haitian women between 15–30 years old have been victims of sexual violence (UN 27/11/2022) . Actual figures are likely higher, as stigma, shame, and fear of reprisal from gangs lead to the underreporting of sexual violence. Many traditional reporting sites, such as hospitals, women’s centres, and police stations, have also closed because of the violence (TNH 14/11/2022). In 2017, at least half of the victims of sexual violence treated by MSF were under 18 years old, and almost 97% were women. The actual number of male victims is likely higher, as social stigma makes them less likely to report. The medical and mental health services available to victims are insufficient and inadequate (MSF 12/07/2017). In 2022, MSF reported treating more than 100 victims of sexual violence (MSF 20/12/2022). Even though gang violence has increased incidents of sexual violence, related reports have decreased because victims fear retaliation from the perpetrators. Armed gangs have tried to force officials and humanitarian workers to share personal data about victims receiving medical and psychological care (TNH 14/11/2022; The Guardian 14/11/2022) . Gangs have used sexual violence to terrorise and punish members or relatives of other gangs. They have also used rape to establish territorial control in rival communities. Gangs target women living in communities accused of collaborating with the police or another gang, punishing them with rape or killing them (UN 27/11/2022; HRW accessed 17/05/2023). They have also used rape to terrorise and pressure families to pay the ransom for abductees (OHCHR 14/10/2022; TNH 14/11/2022) . At other times, gang members appear to use sexual violence only to exercise their power, as they have raped (in some cases, with multiple perpetrators) women in informal camps and those displaced from their homes (The Guardian 14/11/2022). Briefing note | 02 June 2023 6 Education • By February 2023, at least one million children in Port-au-Prince had no access to education because of gang violence. • Gang violence has closed 1,700 schools in the Haitian capital. Gangs have attacked 31% of schools in Port-au-Prince. • School enrolment in Haiti decreased by 22% between 2021–2022. • Gangs have looted some schools, and many teachers have reported being victims of extortion, leading some to resign. By mid-2022, gang violence had closed at least 1,700 schools in Port-au-Prince; this represents more than 10% of the total number of schools in the country (UN 03/07/2022; Scholaro accessed 23/05/2023) . These closures resulted in at least 500,000 children losing access to education in the country’s capital (UN 03/07/2022). Estimates suggest that this number had increased to more than one million by February 2023 (AA 10/02/2023). Around four million children or almost all the children in Haiti had their right to education disrupted in 2022 (OCHA 17/03/2023). As at October 2022, 2.4 million children could not return to school because of gang violence or the resurgence of cholera (UNICEF 10/10/2022). As at April 2023, gang violence had destroyed more than 1,250 schools and caused logistical constraints to efforts to rebuild the schools (STC 11/04/2023). Gangs have attacked 31% of Port-au-Prince’s schools and occupied several others. Some schools are also serving as temporary shelter for families displaced by the violence. During the first two months of 2023, there were attacks on 72 schools compared to eight during the same period in 2022 (AA 10/02/2023). These numbers are low-confidence estimates given the high levels of displacement and access restrictions resulting from violence. Gangs have started attacking schools to obtain additional income. They have looted some schools and kidnapped teachers for ransom. Some students have died during these attacks (AA 10/02/2023). Increased violence against schools, students, and their educational and administrative staff has increased fears around attending school during the violence and forced several institutions to close or students to leave school (The Haitian Times 08/03/2023). The forced displacement of many families also affects the ability of children to continue attending school (UNICEF 22/11/2022). The gang violence crisis continues a trend of education disruption in Haiti. Towards the end of 2019, the political crisis and multiple protests across the country also led to school closures (France 24 23/10/2019). In 2020, the COVID-19 pandemic completely closed all schools between March–June. Schools reopened in August, but teachers had to give the content of the entire school year in the remaining time between August–October (Outreach International accessed 08/05/2023) . Several students were also unable to return to school, as their parents had lost their sources of income (CERF 27/10/2020). The national school closures between 2019–2023 have led to Haitian students losing 190 school days, equivalent to an entire school year. Some students have lost more than these days (GPE 03/04/2023). Internal displacement • Gang violence has forcibly displaced at least 160,000 people in Haiti. • As at May 2023, violence has displaced more people than natural disasters in Haiti. • At least one-third of IDPs live in makeshift shelters with limited access to basic services. Those living in host communities must share increasingly scarce resources in the face of rising prices and the widespread disruption of livelihoods. Between the beginning of the current gang violence crisis in 2021 and March 2023, at least 160,000 people were forcibly displaced in Port-au-Prince (OHCHR 21/03/2023). From these, more than 127,000 are still living in a situation of displacement (BINUH/OHCHR 09/05/2023). Some displaced people have moved to the south of the country, mainly to the departments of Grand’Anse and Sud. As at August 2022, between 75–80% of IDPs lived in host communities or in the homes of relatives or friends (OCHA 17/03/2023; IOM 10/10/2022). The rest lived in makeshift shelters, which ranged from tents in informal sites in parks or on the streets to schools and churches used as collective shelters (The Grio 23/07/2022; Al Jazeera 28/04/2022). Violence has displaced more people than natural disasters in Haiti (OCHA 17/03/2023). The Haitian Government has confirmed that there would be no formal camps for those displaced by gang violence. In November 2022, the Government shut down the main informal camp in Hugo Chavez Square, which was sheltering more than 3,000 people displaced from Tabarre and Cité Soleil (TNH 14/12/2022). The makeshift shelters used by displaced people are in bad condition and made with plastic sheets that cannot withstand extreme weather conditions. The informal sites do not have WASH facilities or access to safe drinking water (OHCHR 21/03/2023; Medium 03/11/2021). People lack water storage containers and NFIs, such as kitchen kits, beds, and blankets (OCHA 17/03/2023). The lack of adequate shelter exposes these people to protection risks, and several women have experienced rape or sexual assault in the sites (RTL 25/08/2021; St Kitts & Nevis Observer 25/10/2022) . Briefing note | 02 June 2023 7 The pressure on host communities is increasing with the continual displacement and rise of food prices and the cost of living. The increase in violence will likely generate further displacements, including multiple displacement for some, worsening their situation (OCHA 17/03/2023) . International migration flows • The number of Haitians who crossed the Darien Gap during the first quarter of 2023 is already higher than the total number who crossed it during 2022. • Mexican authorities project more than 50,000 asylum applications from Haitian people by the end of 2023. In 2022, around 17,100 Haitians applied for asylum in Mexico. • In 2022, Dominican Republic deported more than 154,300 Haitians, 500% more than in 2021. Besides resulting in forced internal displacement, gang violence in Haiti has led to an influx of migrants and refugees to Latin America and the US. There is no comprehensive record of the number of Haitian people migrating, fleeing, or living in those countries. Some available figures indicate that the number has significantly increased since 2021. In 2022, more than 22,000 Haitians crossed through the Darien Gap, a jungle area between Colombia and Panama through which migrants and refugees travel to Central American countries to reach the US (IOM 17/01/2023). Between January and early April 2023, more than 23,000 people from Haiti crossed the Darien Gap (IOM/UNHCR 14/04/2023). In Mexico, asylum seekers have increased significantly in recent years. Mexican authorities expect more than 50,000 asylum applications in 2023. Between January–March 2023 alone, more than 13,600 Haitians applied for asylum, nearly matching the 17,100 who applied in the whole of 2022. The year with the highest number of Haitian asylum applications in Mexico was 2021, with around 52,000 applications (Reuters 17/04/2023). Between 2021–2022, the US deported more than 25,000 Haitian asylum seekers (Al Jazeera 23/11/2022). Migrants and refugees travelling to the US suffer various abuses and hardships, including violence from armed groups, a lack of food or water, and extreme environmental conditions (ACAPS 19/04/2023 and 21/10/2022) . People say they are fleeing either because they or their relatives suffered attacks in Haiti or because they fear some form of violence (La Prensa Latina 31/01/2023; St Kitts & Nevis Observer 01/02/2023) . The Dominican Republic is another common destination for Haitians, as the two countries share a border. In 2022, the country deported more than 154,300 Haitians, including pregnant women and unaccompanied children (The Miami Herald 20/03/2023). This number is an increase of more than 500% compared to the 24,800 Haitian people repatriated from the Dominican Republic in 2021 (OCHA 17/03/2023). The Dominican Republic Government claims that the number of deportees was more than 170,000 in 2022 (TWP 16/03/2023). The Dominican Republic is building a fence on the border to limit the crossing of people, drugs, and contraband (The Guardian 25/02/2022). Haitian people have reported being imprisoned and beaten up by Dominican authorities (The Miami Herald 21/11/2022). Health and WASH • Approximately 48% of hospitals in the Port-au-Prince metropolitan area are in areas under the control or influence of gangs. • A hospital in charge of attending to around 700,000 people in Artibonite closed because of gang violence. • One in four Haitians travel for more than one hour to reach a health centre. Around 48% of hospitals in the Port-au-Prince metropolitan area are in areas under the influence or control of gangs. Several have had to close because of attacks on their facilities, patients, or medical staff. Between January 2022 and April 2023, there were more than 30 kidnappings of doctors; over 50% happened during the first three months of 2023 (OCHA 23/04/2023) . MSF closed one of its hospitals in Carrefour after gang members entered the hospital, pulled out a patient, and shot him. MSF says the number of people with gunshot wounds has increased recently (MSF 27/01/2023). Another MSF hospital in Cité Soleil has closed twice because of the violence surrounding it (NYT 22/03/2023). The Hôpital  Albert Schweitzer, located in Deschapelles (Artibonite), also closed because of the violence. The hospital served nearly 700,000 people (UNSC 14/04/2023; Project HOPE 16/02/2023). In Haiti, 44% of households consider healthcare assistance a priority. The presence of health facilities in the country is limited, as about 21% of communes have no health centre. One in four Haitians travels more than one hour to reach a health centre (Le Nouvelliste 14/04/2023; OCHA 23/04/2023) . Gang violence prevents patient access to health centres. Child deliveries in health facilities decreased by about 14% in Haiti between 2020–2022 (OCHA 23/04/2023). People displaced by gangs have limited access to healthcare. IOM’s Displacement Tracking Matrix collected data between February–March 2023 showing that at least 63% of IDPs in the Port-au-Prince metropolitan area did not have a medical centre nearby, and around 89% had to walk for at least one hour to reach the nearest health facility. In informal settlements, Briefing note | 02 June 2023 8 people report needing healthcare for fever (73%), cough (57%), and skin diseases (51%). Displaced people lack WASH facilities and live in unsanitary conditions, making them more prone to infections and disease outbreaks (OCHA 23/04/2023). The loss of medical personnel in Haiti also limits healthcare. Even before the crisis, Haiti was short of medical personnel. In 2017, the country had 0.65 doctors, nurses, and midwives per 1,000 people, far below the WHO recommendation of 4.45 per 1,000 (USAID/HFG 04/2017). Some hospitals report that staff have resigned as a result of gang attacks or because they are afraid of being victims of violence (OCHA 23/04/2023). These departures worsen the existing shortage of staff in hospitals. Gang violence, along with the fuel and electricity crisis, increases operating costs, which also affects health services. Between November 2021 and September 2022, some hospitals reported that fuel costs increased by up to four times (OCHA 23/04/2023). Gangs have also occupied gasoline stations and blockaded the main oil terminal, forcing hospitals to close temporarily or to reduce their operations because of a lack of fuel (VOA 20/10/2022; Al Jazeera 27/09/2022) . As at September 2022, the fuel crisis affected at least three-quarters of the 22 largest hospitals in the country, and 73% lacked supplies or medical personnel (UNICEF 26/09/2022; OCHA 13/04/2023) . The crisis has also caused a scarcity of other medical supplies in Haiti, including oxygen (OCHA 23/04/2023). Livelihoods • At least 87% of the Haitian population lives in poverty and 30% in extreme poverty. • Criminal violence severely affects people who make a living from agriculture, as some markets are not functioning and transportation is more expensive and dangerous, hampering the commercialisation of the food. • At least 5,800 hectares of land have been abandoned in Artibonite because of gang violence. • Self-imposed confinements limit the population’s ability to access jobs and make a living. Although there is no recent official data available, the World Bank estimates that 87% of people in Haiti were living in poverty and 30% in extreme poverty in 2021 (WB accessed 10/05/2023 a) . Since 2019, the Haitian economy has consecutively contracted yearly (Focus Economics 16/05/2023) . 89% of those engaged in the agrarian sector do subsistence farming, but around 65% of them affirm that they do not have the financial or human resources to keep cultivating (PI 11/01/2023). Criminal violence causes supply routes to operate intermittently, making movement between some regions dangerous and preventing several markets from functioning, meaning that people who depend on agriculture struggle to market their products (InSight Crime 27/02/2023). In Artibonite, people have abandoned large proportions of lands because of the violence, particularly in the communes of Dessalines and Petite Rivière-de-l’Artibonite. Estimates suggest that around 2,400 hectares of arable land were lost between 2022–2023; between 2018–2023, 5,800 hectares were lost (WFP 27/04/2023). Artibonite is Haiti’s main agricultural region, where 90% of domestic rice production occurs (InSight Crime 27/02/2023). Besides affecting agriculture, gang clashes also lead many Port-au-Prince neighbourhoods to live in intermittent self-imposed confinements for protection (NYT 22/03/2023; UN 12/07/2022) . Coupled with limited transportation because of a lack of gasoline or gang- enforced illegal roadblocks, these confinements severely constrain those who commute between neighbourhoods to get to work, putting their livelihoods at risk (TRT World 07/07/2022). Living costs have also risen rapidly in the country. As at October 2022, the prices of staple foods (rice, wheat, flour, corn, bean, sugar, and vegetable oil) had increased by 88% (PI 11/01/2023) . As at March 2023, these prices had continued to increase (WB 27/04/2023). Gang violence is one of the main reasons behind the price increases (VOA 12/07/2022). The closure of small businesses and a reduction in tourism also disrupt the livelihoods of parts of the population (IPC 10/2022). Food insecurity and malnutrition • About half of the Haitian population is experiencing high levels of acute food insecurity. • Households spend between 60–75% of their income on food. • At least one in five children in Haiti suffers from acute malnutrition. Note: ACAPS is preparing a thematic note on food insecurity in Haiti that will be published soon. Briefing note | 02 June 2023 9 Gang violence has worsened the food insecurity crisis that Haiti has been experiencing for more than ten years. 4.9 million people are experiencing high levels of acute food insecurity in the country. This figure represents nearly half of the country’s total population. IPC analysed nearly 1.8 million people, estimating that 18% are experiencing Emergency (IPC Phase 4) food insecurity. Food insecurity affects Cité Soleil and Ville de Jérémie the most; in September 2022, 5% of Cité Soleil’s population faced Catastrophe (IPC Phase 5) food insecurity. Humanitarian food assistance reduced this number in 2023, ensuring that the most vulnerable people moved from IPC 5 to improved phases. The main drivers of food insecurity in Haiti are criminal violence, low agricultural production, the rising cost of transportation, and high inflation. In Haiti, the number of food-insecure people rose from 2.3 million in 2018 to 4.9 million in 2023. Food insecurity affects Artibonite, Cité Soleil, the rural area of Grand’Anse, Haut Nord-Ouest, Haut Plateau, La Gonave, Nippes, Nord-Est, and Sud the most (IPC 14/10/2022 and 23/03/2023). Households report spending 60–75% of their income on food (TRF 18/07/2022; IPC 10/2022). Consequently, the disruption of livelihoods directly affects food insecurity (UN 12/07/2022). Some coping mechanisms for the high cost of food include skipping meals, early and forced marriages, dropping out of school, and child labour (PI 11/01/2023; IRC 07/04/2023). At least one in five children in Haiti suffers from acute malnutrition (WFP 31/03/2023; STC 11/04/2023) . Around 47% of the population was undernourished in 2020 (WB accessed 10/05/2023 b) . Current numbers are likely much higher, as UNICEF predicted that gang violence would lead to a 30% increase in cases of malnourished children compared to 2022 (UNICEF 11/05/2023). Among the reasons for this increase are a lack of clean water, rising food prices, and gang violence restricting food supplies from reaching certain communities (UNICEF 05/08/2022; UN 01/11/2022) . 1  The end of Moïse’s term was the subject of discussions in Haiti and in the international community. Some considered that his term should have ended on 7 February 2021, but others affirmed that it should have ended on 7 February 2022, given that he assumed the presidency late because allegations of irregularity delayed the elections for more than a year (NPR 04/01/2017; CFR 14/07/2021). COMPOUNDING FACTORS Political crisis Haiti has not had a functional election since 2019. In 2016, the country elected Jovenel Moïse as President, and he took office in February 2017. Presidents in Haiti have a five-year term (USDS 2019). In 2021, Moïse was assassinated, and the former Prime Minister, Ariel Henry, took over his office (NPR 19/07/2021). The country’s last legislative elections were held in 2015 and 2016. The next general elections were scheduled for October 2019 but postponed multiple times. First, budgetary problems in congress delayed the elections (EIU 05/11/2019). The elections were rescheduled to September 2021, but Ariel Henry postponed them after dismissing the electoral administration members (Al Jazeera 28/09/2021). In February 2022, Henry pledged to hold elections in 2023. In December, he changed plans again, announcing a transition plan to hold elections in February 2024, months after breaking the Montana Accord, a negotiation between the de facto president and a coalition of Haitian NGOs, politicians, and civil society members (Brookings 03/02/2023). After the first five months of 2023, there are doubts as to whether this will be possible (PL 23/03/2023) . In practice, Haiti currently does not have a democratically elected candidate in office: Ariel Henry acts as the leader of the executive, but he is not an elected president, and his alleged term ended when Moïse’s term was supposed to end.1 The term of the last senators in office ended in January 2023, so there is no longer a functioning legislative branch (NPR 18/01/2023). Besides the crisis over the lack of democratically elected officials in the executive and legislative branches, a rift between Ariel Henry and the judicial system has deepened since Moïse’s assassination. In August 2022, a group of judicial investigators, after claiming that Ariel Henry had obstructed investigations to find the person responsible for the Moïse’s death, linked him to the assassination (The Hill 02/08/2022; BBC 14/09/2021). Just hours after the investigation became known, Henry fired the chief public prosecutor who had accused him and appointed someone else to the post, despite the constitution stating that this could only be done by the president (Al Jazeera 15/09/2021). Days later, Henry replaced the justice minister (Al Jazeera 16/09/2021). In March 2023, Henry appointed all eight judges who sit on the Supreme Court, which was not functioning. This decision, while helping to make the paralysed judicial system functional, led to even less of a balance of power in Haiti, with fewer constraints on the president than before (The Haitian Times 07/03/2023). Briefing note | 02 June 2023 10 The independence of the judiciary in Haiti has been undermined since 2021 when then- president Jovenel Moïse arbitrarily removed three Supreme Court justices (HRW 22/02/2021). This confrontation between Henry and the judicial system has contributed to the paralysis of the judiciary, as the decrease in personnel is slowing down decisions. Gangs have unleashed a wave of violence against judges and lawyers, resulting in many courts stopping the holding of hearings or trials. The courthouse is located near a gang-dominated slum, and gangs target lawyers who go there with kidnapping or murder. Some gangs use hearing or trial days to enter the courthouse and free their allies (France 24 09/04/2022). Clerks, judges, and other judicial branch officials have held multiple protests against the poor state of the system (The Haitian Times 13/04/2022; PL 29/03/2023) . Political instability worsens criminal violence, since it prevents decisions from being taken to combat organised crime on a large scale. With no parliament and an unpopular president without constitutional authority, the measures are harder to put into practice (NPR 04/11/2022). The paralysis of the judicial system also aggravates the crisis in prisons. The country’s 20 prisons have the capacity for around 3,000 inmates but currently hold more than 11,000 people, 83% of whom had not been convicted as at 31 December 2022 (UNSC 17/01/2023). Several prisoners have died in prison from malnutrition or cholera, and there is a shortage of food, water, and sanitation facilities. Estimates indicate there is only 1 doctor for every 1,000 detainees (OHCHR 30/06/2021; The Guardian 23/06/2022). Without the real capacity to prosecute and imprison those responsible for the violence, the prospects for reducing the power of the gangs are reduced in the medium term. Sociopolitical unrest Since 2018, Haiti has been in the midst of multiple protests. Initially, the strikes were a response to the drastic gasoline price increase. They quickly evolved, and members of the opposition used them to call for the resignation of Jovenel Moïse and for a transitional government to be put in place after it became known that there was a corruption scheme financed with loans from Petrocaribe, a Venezuelan-funded programme related to the oil industry (France 24 18/08/2020; NUSO 12/2018) . In February 2021, a new wave of protests demanded that Moïse step aside from office as his term had ended that month. Moïse argued that since he had assumed office late, he was entitled to one more year in power (Africanews 09/02/2021; BBC 15/02/2021) . Later in the year, Moïse proposed a referendum to remove the veto on indefinite re-election, causing further protests (The Miami Herald 28/03/2021). Between 2018–2021, there were multiple protests across the country, with demands ranging from improved living conditions to the President’s resignation (Americas Quarterly 20/05/2021). With Ariel Henry in office, things were not much different. In 2022, citizens protested over rising energy prices and the drastic increase in the cost of living (Le Monde 17/09/2022). One year after the gang violence crisis escalated, armed groups blockaded some petrol terminals, creating shortages and leading to further protests (The Guardian 16/07/2022; PBS 04/10/2022). In 2023, protests have increased, in part because of gang violence. The police staged a protest that led to an attack on Ariel Henry’s house after gangs murdered several officers (VOA 26/01/2023; BBC 26/01/2023). Doctors and medical personnel have also protested against gang violence directed towards medical staff (Al Jazeera 15/03/2022; Haiti Libre 26/02/2023). During April and May, civilians staged riots, including killing and burning gang members in the streets (The Guardian 30/04/2023). Besides the already precarious law and order situation caused by gang violence, the Haitian state is also facing multiple issues that, given the looming humanitarian crisis, are unlikely to abate in the coming months. Cholera outbreak In February 2022, Haiti was declared cholera-free after three years without confirmed cases following the first outbreak in October 2010. In October 2022, two cases were confirmed in Port-au-Prince, and by January 2023, more than 20,000 suspected cases of cholera were identified nationwide (Vega Ocasio et al. 13/01/2023). As at 28 February 2023, more than 33,000 suspected and 2,400 confirmed cases had been identified across Haiti’s ten departments. Of these, 29,700 people required hospitalisation, and nearly 600 died (PAHO 03/03/2023). When cholera is properly treated, the case fatality rate (CFR) is usually less than 1%. In Haiti, the CFR is 1.77% (PAHO 03/03/2023; PAHO accessed 11/05/2023). Actual cholera figures are likely higher, as sociopolitical unrest, gang violence, and the fuel crisis make it impossible to have an adequate surveillance system (PAHO 03/03/2023). Gang violence and the fuel crisis prevent many hospitals from functioning and restrict medical personnel’s access to their workplaces, limiting care for the sick (MSF 10/05/2023). IDPs in makeshift sites are particularly at risk of contracting cholera, as they usually have few WASH facilities and consume contaminated water. One-third of IDP settlements have reported at least one case of cholera. In 25% of all IDP settlements, at least one person has died from the disease (OCHA 23/04/2023). Briefing note | 02 June 2023 11 Embargo In October 2022, the UNSC established a sanctions regime against some responsible for the violence in Haiti, including Jimmy ‘Barbecue’ Chérizier, leader of G9, one of Haiti’s largest gang federations. The sanctions included asset freezes, travel bans, and an arms embargo in the country (UN 21/10/2022). Following these, other governments, such as the Canadian, British, and US Governments, announced their participation in the sanctions (Gov’t of Canada accessed 11/05/2023; Gov’t of the UK accessed 11/05/2023; US Department of the Treasury 05/04/2023) . Besides gang members, politicians accused of financing or receiving money from the gangs also face sanctions (InSight Crime 24/11/2022). While these sanctions are targeted at dismantling the collaboration scheme between politicians and gangs that has contributed to the expansion and strengthening of gangs, they can also have unintended effects. For instance, in the immediate aftermath of the sanctions, there were protests in Haiti with demonstrators holding up signs saying “down with the UN” or “down with foreign occupation” (DW 22/10/2022). While this disdain for the involvement of international responders also considers past experiences, sanctions could make it even more difficult for the international system to contribute to solving the humanitarian crisis in Haiti (CEPR 01/11/2022; The Guardian 19/10/2022). Natural disasters Haiti is prone to natural disasters, with little capacity to respond to them (Germanwatch 21/01/2021) . Haiti is one of the world’s most vulnerable countries to climate hazards, with about 96% of its population exposed to hurricanes, floods, and earthquakes (WB accessed 30/05/2023) . Its geographical position in a hurricane belt means that between June–November every year, during the Caribbean hurricane season, Haiti’s population is particularly exposed to flooding, mudslides, and other forms of hurricane damage (USAID 24/05/2022). Haiti has struggled to recover from damage to infrastructure from the multiple natural disasters it has faced over the past three years, including tropical storms, hurricanes, and earthquakes (ACAPS 01/11/2022). Some hospitals and schools have not received adequate repairs, further limiting the capacity to respond to the criminal violence crisis in several regions (UN 12/02/2022; Salesians 07/09/2022). The rainy season in Haiti normally starts in April and ends in October or November (WMO 08/2014) . As at May 2023, the rains had already started, accumulating waste in some communes. Garbage has blocked some areas, such as Brooklyn, restricting vehicle access. This accumulation poses risks of a resurgence of cholera and other diarrhoeal diseases, particularly in makeshift shelters, where some of these diseases are already present (OCHA 23/04/2023, 11/05/2023, and 11/05/2023) . Fuel and electricity crisis Haiti has experienced several periods of fuel crisis. In 2018, there were several mass protests in the country over rising fuel prices (Al Jazeera 08/07/2018). During the following years, the crisis deepened at times, either because of price increases or fuel shortages (OCHA 29/09/2022). Several factors are driving this fuel crisis, including subsidies that keep prices low but that the Government has been unable to pay (The Haitian Times 08/06/2022). At various times, gangs, which control the movement of goods through much of the capital, block trucks from leaving for other cities (Global Press Journal 08/12/2022). Violence and looting have also caused gas stations to close. In 2022, the G9 gang coalition blocked the country’s main terminal, Varreux, for two months, causing shortages and increasing fuel prices (DW 04/11/2022). The lack of fuel affects the humanitarian response in multiple ways. It increases the cost of mobilising humanitarian assistance within and between cities in the country (OCHA 29/09/2022) . The lack of fuel has also led to power and water cuts and telecommunication limitations (France 24 21/07/2022). Less than half of the Haitian population has permanent access to electricity (WB accessed 25/05/2023). Transport constraints have also restricted assessments, reducing the possibility of prioritising those with the most urgent needs (Devex 18/11/2021) . Briefing note | 02 June 2023 12 PRESENCE OF GANGS IN THE PORT-AU-PRINCE METROPOLITAN AREA, DECEMBER 2022 Source: OCHA (17/03/2023)