Haiti: Violence Against Health Care in Conflict 2024

1EPIDEMIC OF VIOLENCE: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2024 2EPIDEMIC OF VIOLENCE: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2024 Letter from the Chair Assaults on health care in conflicts around the world reached new levels of horror in 2024, exceeding 3,600 incidents, 15% more than in 2023. They consisted of air, missile, and drone strikes; shelling; tank fire; shootings; arson; the looting and takeover of health facilities; and the arrest and detention of health workers.  As the descriptions in this report show, each incident brings terror, trauma, and - in too many cases - injury, untreated illness, destruction and death. By far the largest number of attacks on health care – more than 1,300 – took place in Gaza and the West Bank, far more than we have ever reported in one conflict in one year, including more than double the number of health workers killed. Gaza properly drew global attention for the ferocity and relentlessness of assaults on health care. But we must also reckon with the more than 2,300 attacks in other conflicts, including the hundreds in each of  Ukraine, Lebanon, Myanmar and Sudan. The cumulative number of attacks over the course of wars that began in the past three years include  more than 1,500  in Myanmar since the military coup in 2021; close to 2,000 in Ukraine since the Russian invasion of Ukraine in 2022, and more than 500 since the outbreak of war in Sudan in 2023.  This onslaught of violence has been accompanied by attempts by perpetrators to limit legal protections  for health care and civilians in war, driven, as the International Committee of the Red Cross (ICRC) puts it, by a desire to have more “leeway to kill and detain.”  Israel has sought to dilute legal requirements of precaution and proportionality during conflict.  The new U.S. secretary of defense has called for “a law of war for winners.” Simultaneously, campaigns to delegitimize the International Criminal Court (ICC) are underway. The newly inaugurated U.S. president Donald Trump imposed sanctions on ICC staff and even their families for having charged Israelis with war crimes. In 2023, Russia’s Duma passed legislation criminalizing cooperation with the ICC or any foreign court or ad hoc tribunal that seeks to hold Russians to account. Hungary announced its plan to withdraw from the ICC, falsely alleging political bias. These terrible developments threaten to make a mockery of  the 10th anniversary of Security Council Resolution 2286 in 2026 and the 50th anniversary of the Additional Protocols of the Geneva Conventions (the law protecting health workers and civilians during armed conflict) in 2027. If this resolution and law are to be more than words, the current approach to protection, amounting to mere admonitions, must be replaced by centering accountability, accompanied by the political will to drive it.    That is the approach long taken by the Coalition, and recently taken by a report In the Line of Fire, issued in November 2024 by the World Health Organization and the World Innovation Summit for Health. It called for a new alliance of member states, UN agencies, and NGOs. It recognized that the renewal of long-ignored commitments could not possibly suffice. Instead, UN agencies, international organizations, NGOs, and civil society organizations must  rally together to take tough action, including outreach to the International Criminal Court, to impose consequences on the perpetrators of violence. Actions must include states cutting off arms transfers to perpetrators of attacks and employing  the power of universal jurisdiction to prosecute.  If the laws of humanity are to be upheld and the carnage is to end, governments and all concerned citizens everywhere must find the political courage and will to act. Len Rubenstein Chair, Safeguarding Health in Conflict Coalition Executive Summary | Full Report | Recommendations | Methodology | Data 3EPIDEMIC OF VIOLENCE: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2024 Haiti OVERVIEW The Safeguarding Health in Conflict Coalition (SHCC) identified 39 incidents of violence against or obstruction of health care in Haiti in 2024, compared to 42 in 2023. In these incidents, three health workers were killed and four were kidnapped. Health facilities were attacked on 20 occasions. Violence, massacres and gang conflict continued to impact health services in 2024. Rising armed violence in health facilities remains a concern despite a decline in kidnappings. Haiti’s health care system is on the verge of collapse as violence forces facility closures and pregnant women flee to the neighboring Dominican Republic to obtain care. Information on incidents of violence against health care in Haiti are compiled from open sources, information projects, aid agency data-sharing mechanisms and private sources. See Methodology for further information. Source: 2022-2024 HTI SHCC Health Care Data REPORTED INCIDENTS REPORTED INCIDENTS AND MOST COMMONLY REPORTED CONCERNS INCIDENTS WHERE HEALTH FACILITIES WERE ATTACKED  HEALTH WORKERS KILLED HEALTH WORKERS KIDNAPPED 39 20 3 4 42 10 1 10 3 1 33 12 2024 2022 2023 4EPIDEMIC OF VIOLENCE: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2024 THE CONTEXT Haiti has been plagued by violence since the assassination of President Jovenel Moise in 2021. This violence continued in 2024, with over 5,000 people killed and some 1,400 reported kidnappings by gangs vying for control of territory. Entire communities have reportedly been killed, while sexual violence is widespread and used to terrorize communities and enforce control. Gang violence has forced people to flee their communities, and in 2024 the number of internally displaced persons was over a million. With violence escalating in several neighborhoods in and around Port-au-Prince, on March 3, 2024, Haitian authorities declared a state of emergency in Ouest department. It was expanded to include the whole country in September 2024. In June and July 2024, a group of Kenyan police officers arrived in the country to help combat the rising violence. It is estimated that at least 5.5 million Haitians require humanitarian assistance, with just 42% of the USD 674 million that was needed being raised for Haiti’s humanitarian response. VIOLENCE AGAINST OR OBSTRUCTION OF HEALTH CARE IN 2024 Incidents of violence against or obstruction of health care were reported throughout 2024, and the numbers rose in February and March during coordinated attacks by armed gangs targeting key institutions, including hospitals, in Port-au-Prince. As in previous years, most incidents were recorded in Ouest department, especially Port-au-Prince arrondissement, while incidents also increased in Arbonite department’s Saint- Marc arrondissement. New incidents were recorded in the southern Nippes department in 2024. There were increasing reports of health centers being used as bases during armed confrontations and looted for supplies. Although reported kidnappings of health workers decreased, targeted killings persisted and patients in hospitals were also targeted. Most reported health care attacks in Haiti in 2024 were carried out by unidentified armed men, with gangs including Base 5 Secondes, Baz Gran Grif de Savien, G9, Kokorat San Ras, and Viv Ansanm implicated in some cases. Haitian police arrested patients receiving treatment inside hospitals and threatened health workers. Haiti Source: Safeguarding Health in Conflict Coalition 5EPIDEMIC OF VIOLENCE: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2024 The majority of incidents affected health care providers working for national health structures, with four incidents affecting INGOs and one a local NGO. 1 Health facilities attacked Clinics, health centers, and hospitals were attacked by gang members or unidentified men with guns on at least 20 occasions in 2024, compared to 10 incidents in 2023 and three in 2022. Medical supplies, equipment, and materials were robbed from hospitals and clinics in Ouest. Often, after being robbed, a facility was ransacked, or its energy systems, including solar panels, were damaged or set on fire. Hospitals and health centers in Haiti were also used as “battlegrounds” for gang violence where hospitalized patients were targeted and shot or stabbed by armed individuals. In some instances, hospitals were seized and used as bases for attacks on police. In April, armed individuals stormed the State University Hospital of Haiti, using it as a headquarters for engaging in fighting against police. 2 When police forces regained control of the hospital in July, it had been seriously damaged, with stripped beds, debris, and bullet-riddled walls. In other cases, armed perpetrators violently threatened hospital staff to force them to treat their injured associates. For instance, armed individuals held hospital staff at gunpoint in Arbonite department’s Saint- Marc arrondissement and demanded prompt medical attention for an injured gang member. 3 Health workers killed and kidnapped Four health workers were reported kidnapped in four incidents in Haiti in 2024, compared to 33 in 27 incidents in 2023 and 12 in six incidents in 2022. Doctors, including a gynecologist-obstetrician, were kidnapped by gunmen in or around major urban centers in Ouest department’s Port-au-Prince and Croix- des-Bouquets arrondissements, where gangs exert territorial control. Ransom payments were demanded in all recorded health worker kidnapping incidents. Kidnapped health workers were typically held for a few days before being released upon payment of a ransom. Three health workers were reported killed in three incidents in 2024, compared to one each in 2022 and 2023. Health workers were killed in targeted shootings, often at close range, by gunmen while leaving work, traveling home or driving. In two health worker killings, a family member of the victim was also shot and wounded. 4 The third victim was a doctor who was shot in the abdomen by armed gunmen while driving home. 5 The doctor sought treatment at a hospital, but an anesthetist was unable to reach the facility due to heavy gunfire nearby. She was transferred to another health facility, but later died. This factsheet is based on 2022-2024 HTI SHCC Health Care Data. Download the data here or on the Humanitarian Data Exchange (HDX). THE IMPACT OF ATTACKS ON HEALTH CARE The health care system in Haiti, particularly in Port-au-Prince, is on the brink of collapse as a result of the violence that has plagued the country for the past three years. In Port-au-Prince, almost 40% of health facilities have been forced to close as a result of insecurity, violence and looting. Many facilities that remain open have reduced their operations due to limited medication and medical supplies following lootings, Haiti 6EPIDEMIC OF VIOLENCE: VIOLENCE AGAINST HEALTH CARE IN CONFLICT | 2024 difficulties in acquiring supplies as a result of the closure of the international airport in November 2024, and insecurity and roadblocks that impede the transportation of supplies. Facilities that have remained open are difficult to access due to active fighting and roadblocks that restrict patients’ movement. Those who do make it to a facility risk being turned away due to lack of resources. As a result, pregnant and postpartum Haitian women are reportedly fleeing to the neighboring Dominican Republic in order to access maternal health care services. Health care providers have been forced to work in very insecure environments and often become targets of violence by armed groups who use intimidation tactics to demand payoffs from health workers, particularly hospital administrators. Additionally, health workers who work on the front lines and are therefore frequently in contact with actors involved in violence are at increased risk of becoming victims themselves. As a result of these conditions, around 40% of health care providers have fled the country. Many people in Port-au-Prince have moved to rural areas where resources are limited and their only option is to live in makeshift shelters. Displacement camps are overcrowded and their inhabitants lack adequate access to essential services, including food, clean water, and sanitation, increasing health- and protection- related risks. Haiti Facilities that have remained open are difficult to access due to active fighting and roadblocks that restrict patients’ movement. Those who do make it to a facility risk being turned away due to lack of resources. 1 Insecurity Insight. Safeguarding Health in Conflict Coalition 2024 Report Dataset: 2022-2024 HTI SHCC Health Care Data. Incident numbers 86377; 86376; 86375; 86092; 84468; 92452. 2 Insecurity Insight. Safeguarding Health in Conflict Coalition 2024 Report Dataset: 2022-2024 HTI SHCC Health Care Data. Incident numbers 63725; 46257. 3 Insecurity Insight. Safeguarding Health in Conflict Coalition 2024 Report Dataset: 2022-2024 HTI SHCC Health Care Data. Incident number 85893. 4 Insecurity Insight. Safeguarding Health in Conflict Coalition 2024 Report Dataset: 2022-2024 HTI SHCC Health Care Data. Incident numbers 46238; 85722. 5 Insecurity Insight. Safeguarding Health in Conflict Coalition 2024 Report Dataset: 2022-2024 HTI SHCC Health Care Data. Incident number 46238. The Safeguarding Health in Conflict Coalition is a group of more than 40 organizations working to protect health workers and services threatened by war or civil unrest. We have raised awareness of global attacks on health and pressed United Nations agencies for greater global action to protect the security of health care. We monitor attacks, strengthen universal norms of respect for the right to health, and demand accountability for perpetrators. https://safeguarding-health.com Safeguarding Health in Conflict Coalition 615 N. Wolfe Street, E7143, Baltimore, MD 21205 SHCC administrator, safeguardinghcc@gmail.com