Médecins Sans Frontières reported in 2022 that its medical teams in Port-au-Prince were treating unprecedented numbers of gunshot wound victims as gang violence intensified and expanded into new neighborhoods. MSF facilities that had been established to provide trauma care in conflict-affected areas were operating at or beyond capacity, with surgeons performing multiple complex operations daily on victims of shootings, many of them civilians caught in gang crossfire.
The scale of armed violence that MSF was documenting in Port-au-Prince was, by the organization’s own assessment, comparable to conflict zones in some of the world’s most active war zones. The number of gunshot wounds, the severity of the injuries, and the systematic nature of the violence pointed to an armed conflict dynamic rather than ordinary criminal violence, even if the political classification of the situation remained contested.
MSF’s ability to reach patients was itself increasingly constrained by the security situation. Ambulance teams operating in gang-controlled areas faced risks of being caught in crossfire or targeted by armed groups suspicious of their movements. The organization reported multiple incidents in which its vehicles and staff were threatened or fired upon while attempting to provide medical care. Several facilities had to temporarily suspend operations due to direct security threats.
The organization called on all armed actors — gangs, police, and any other parties to the violence — to respect medical neutrality and ensure safe passage for healthcare workers and patients. They warned that the systematic targeting of healthcare in conflict settings was a war crime under international humanitarian law and that those responsible would be held accountable. In an environment of total impunity, such warnings had limited deterrent effect but maintained the principle of medical neutrality as a normative standard.