But amid the violence and volatility, staffers from the UN sexual and reproductive health agency, UNFPA, are doing their utmost to protect girls from unintended pregnancy and saving the lives of women trying to give birth in the most difficult circumstances.
A gang-led blockade at the country’s principal fuel terminal in the capital Port au Prince, has led to riots and severe shortages for weeks.
Around three quarters of major hospitals are without power and unable to function, and there are shortages of medicine, oxygen and life-saving equipment. With public transport options nearly non-existent, health workers can no longer commute and there are now only three ambulances functioning in Port-au-Prince – with close to none running in the rest of the country.
Gang violence has been surging across Haiti since July this year, with hundreds of people killed, raped and kidnapped and more than 25,000 driven from their homes in the capital in search of shelter – the majority of them women and children.
Now amid an almost complete lack of basic services, including functioning health centres, access to safe drinking water, sanitation facilities and refuse collection, a cholera outbreak is threatening the health and lives of millions of already vulnerable and impoverished people.
The water-borne disease causes acute diarrhoea that can be deadly if left untreated within the first few hours: So far 18 have died and there are over 250 suspected cases.
Cholera threat to newborns
Without medical facilities or skilled health workers, among the most at risk of not receiving the critical care they need are some 29,000 pregnant women and their newborns – especially if they now contract cholera.
A further 10,000 obstetric complications could go untreated, and thousands of women and girls exposed to high rates of sexual violence and abuse have been left without protection services.
Call of duty
“My professional commitment is to save lives, to prevent more young girls and women from becoming pregnant unintentionally and from dying during childbirth,” said Judline, a nurse and UNFPA community worker in Port-au-Prince.
“I work with a team of community officers, coordinating mobile clinics where women and adolescent girls can access reproductive health services,” she explained.
Amid the violence and insecurity, she has continued to visit the displacement camps when it is safe to do so, helping to ensure women and girls receive the critical care they need.
Judline and her team identify and monitor pregnant women who may experience complications and refer women and girls who have suffered violence to support services.
Reluctant to speak
While conducting outreach in one of the camps, Judline met a 15-year-old girl called Nardine. “She was very reluctant to speak to me, but eventually told me she was in the third trimester of her pregnancy,” she recalled.
Realizing the young woman was going into early labour, Judline walked with her for over two kilometres to reach the La Paix University Hospital, where Nardine safely gave birth to a baby girl.
Haiti already has the highest level of maternal mortality in Latin America and the Caribbean, with the latest upsurge in violence and instability dangerously compromising the lives of thousands of pregnant and lactating women, especially those in displacement camps.
UNFPA continues to provide gender-based violence response and protection through mobile health clinics and referring cases to appropriate health facilities for clinical and psychosocial care where possible.
Survivors of abuse
However, some 7,000 survivors of sexual violence will be unable to access medical and psychosocial care and thousands more are at risk if protection mechanisms break down and essential services are forced to close.
I see myself as a bearer of hope, an immediate ear for vulnerable women and girls
UNFPA has distributed hundreds of maternal and dignity kits to women and girls who lost everything as they fled their homes in Port-au-Prince, and has worked with partners to install solar power supplies at hospitals and health centres.
This has improved cold-chain facilities to store vaccines and medicine, and enabled critical maternity services to continue in 12 locations across the country – but solar power alone cannot keep hospitals fully functioning.
‘I cannot abandon them’
Despite the risks to their own safety, Judline said her team will ensure pregnant women and girls have access to clean water and provide treatment for those with cholera. “I cannot abandon them,” she said.
“I see myself as a bearer of hope, an immediate ear for vulnerable women and girls who are crying out for help.”