[BONESSI] Port-au-Prince, Haiti. With a population of around 500 thousand people, it is about the size of the city of Atlanta .

For about the last two years, these neighborhoods have been living under protracted armed violence and suffering from the absence of basic services like safe drinking water, and emergency healthcare.

The International Committee of the Red Cross team working in Port-au-Prince has seen a substantial increase in armed violence. This has a had a direct and devastating effect on the population living there.

[Sound of gun shots]

The level of violence has made it even more difficult for Haitians to have access to basic healthcare. Some hospitals have shutdown, while others struggle to stay open because of how difficult it is for hospital staff to get to work. And while making emergency calls, ambulances must past through areas vulnerable to ongoing violence and territories controlled by different groups.

Since the beginning of this year, thousands of people have been killed, injured, and kidnapped due to the violence—it’s akin to what we see in areas of conflict around the world.

Today we hear from a Haitian Red Cross volunteer about their work on an ambulance service despite the violence and lack of medical infrastructure. And learn about how the ICRC is working with the volunteers in communities to ensure better access to emergency healthcare when people need it most.

I’m Dominique Maria Bonessi, and this is Intercross, a podcast that offers a window into the work of the ICRC and shares the stories of those affected by armed conflict and other situations of violence.

[INTERCROSS MUSICAL INTERLUDE]

[BONESSI] Jonathan Gilles graduated medical school in 2021. He’s been serving as a volunteer with the Haitian Red Cross for almost a decade.

[Dr. Jonthan Gilles speaking in French with English voiceover] “I was motivated to work specifically in the ambulance service because, as a doctor, I could use my personal and professional experiences to serve this community. Once, we had to pick up a patient who had been shot in the back of the head.  After giving her first aid, we had to take her to get a CT scan. It was a bit far from the hospital. We then brought her back to the hospital with the scan results in hand. All along the way, we had to ensure her well-being and monitor her vital signs. We also provided emotional support to comfort her since she was conscious.  I’ll always remember that.”

[BONESSI] Since early 2021, the ICRC has been working with Dr. Gilles and other Haitian Red Cross workers and volunteers to mobilize first aid and ambulatory services.

[Sound of ambulance siren]

[BONESSI] That includes training first aid workers and ensuring they have the equipment and know-how to stabilize, transfer and treat patients affected by armed violence.

Dr. Gilles says the Red Cross’s ambulances are able to reach the city’s worst affected areas. It’s one of a couple of operators in Haiti that includes the National Ambulance Center. He says the majority of patient that require transport in an ambulance are serious and are usually related to the armed violence.

[GILLES] “Usually bullet wounds and knife wounds… There are also certain illnesses that require an oxygen tank during the journey.”

[BONESSI] The time it takes to arrive at the hospital depends on several factors: block roads, check points, gun fire, and other security issues. But with a limited number of ambulances, and at times, access to areas controlled by armed groups, most Haitians make the difficult journey on their own.

[GILLES] “In the vast majority of cases, patients go to the hospital on their own. In other cases, they may die.”

[Ambulance sound abruptly stops]

[BONESSI] If they are unable to reach someone via ambulance, Dr. Gilles says, they provide verbal first-aid steps over the phone to ensure patients can arrive in the best condition possible at the nearest hospital.

While the Red Cross does their best to get as many people to the hospital as possible, we know that getting care doesn’t end there, and there can be other barriers to care once they arrive at the hospital.

To understand how the ICRC is working with Dr.Gilles and the Haitian Red Cross on the ground to strengthen the entire process for those who don’t have access—from the initial first aid, to ambulance transport to the hospital, and then the standard of care they receive when they get there safely–I’m going to turn to an interview with Mickael Payet, the ICRC’s former health coordinator in Haiti.

But first, have a listen to our sister podcast, Humanity in War, Hosted by Elizabeth Rushing.

[Humanity in War Trailer plays]

———————————————————————————————————————————————————–

[BONESSI] Mickael Payet was ICRC’s health coordinator in Haiti up until just recently. I spoke with Mickael on the last day of his mission and asked him about how ICRC works with the Haitian Red Cross, including its volunteers like Dr. Gilles, from who we heard at the top of the show.

[MICKAEL PAYET] “We work collaboratively to maintain their ambulance service but also in operational communication about the protection of the medical mission in order to respond to the population needs in a secure manner in a vulnerable, volatile and fragile environment.”

[BONESSI] Could you give me an overview of the health situation in Haiti?

[PAYET] “Yep, at the country level, and I would say that Haiti’s health system is fragmented, and underfunded. But the political landscape altogether with frequent natural disasters and catastrophes drained further the existing capacities. At last but not least, the lack of clean water and poor sanitation causes many diseases and the spread of disease and the cholera reappearance is a good example of this. More specifically in the capital of Port-Au-Prince where the ICRC works, the population and health services are severely impacted by the violence in Haiti, many facilities have stopped operating due to the insecurity and lack of personnel. All of that created a disruption in the chain of care and it is where we are focused on.”

[BONESSI] Can you define that term chain of care for me?

[PAYET] “The chain of care is a different step that the patient has to go through. It starts with the stabilization and the first aid, let’s say, and then the second step is the transportation to a medical facility and the last step would be the hospital service.”

[BONESSI] So, this is the essentially the chain that requires a patient to go from being in their community to being in a hospital and getting them getting them help and everything that surrounds that process?

[PAYET] “Exactly. And we are focused to improve and reinforce each step of this chain of care.”

[BONESSI] Are people in areas affected by armed violence able to access care or how difficult is it?

[PAYET] “Unfortunately, it’s really difficult for the population to access to healthcare. First because of a lack of medical structures to functioning in these areas affected by violence, but also because there is no state actor to assure the casualty transportation for example, so the population use motorbikes or wheelbarrows to get to the closest medical centers. Moreover, they face life risk when seeking care or when seeking for care because sometimes it means to cross opposition groups and to face risk of being arrested. And we observed several times during peak of violence that they cannot leave their neighborhood and Patients can take days until reaching an adequate care.”

[BONESSI] So for the ICRC what is our level of access and what is our level of acceptance by these Haitian communities?

[PAYET] “I have to say that within a year, we have done a huge progress in access and acceptance. We can observe now that through our actions and dialogue, the level of trust with community leaders and weapon bearers is really good. But this kind of relationship is still fragile, and we must remain cautious due to the high level of needs and expectations coming from affected communities.”

[BONESSI] How is the ICRC helping communities affected by armed violence in accessing healthcare, so what is our role here?

[PAYET] “The mission has been training community members in first aid and provided individual first aid kits. Then concerning the transportation, the ICRC supports informal actors in their action, but also provides medical items to the formal ambulance services. Concerning hospitals, ICRC supports six hospitals within the metropolitan area with medical items. The goal is for them to be able to perform war surgeries and to reduce the cost of care for people affected by armed violence. Last but not least, also the ICRC promotes protection of the medical mission through a humanitarian dialogue.”

[BONESSI] Do you have any personal stories or have someone in an affected population that stayed with you during your time here in Haiti?

[PAYET] “I have a story that is a good example of for achievement in the enforcement of the chain of care. For example, during the last peak of violence, a young child received a stray bullet in his head and he was timely taken care by a community member we trained in first aid and then he was transported by a religious figure that the ICRC supports and the priest contacted me to negotiate with the hospital director specialized in neurosurgery so that the child could be taken care of and he could be taken care of free of charge. As it’s this hospital is supported by the ICRC with medical items, they accepted and they took care of the young patient.”

[BONESSI] Wow, that’s really incredible. Recently Doctors Without Borders shut down a hospital in Port au Prince, after a group of armed men stormed the facility and kidnapped a gunshot victim. What is your hope for the future of healthcare in Haiti?

[PAYET] “First of all my hope is that the affected population can freely get access to medical care without risking their lives when trying to reach a medical structure and I also deeply hope that weapon bearers respect humanitarian principles and finally for medical facilities more specifically public hospital to be fully supported and frankly to be able to respond to the populations.”

[BONESSI] With many states in the international community worried about Haiti security situation in a state of paralysis, do you have a message for the international community?

[PAYET] “I would like to stress that arm violence is one of the reasons of the dire situation in Haiti but it’s not the only one. Needs are huge here and it needs a state collaborative approach but the bright side is that humanitarian work is in areas affected by violence it’s possible in Haiti as long as you are guided by impartial and neutral principle. I think progress is possible in Haiti, as I said, if we work collaboratively with other organizations everything is possible. Haiti needs also stability, political stability because without public services nothing would be possible.”

[BONESSI] Thank you, Mickael. After leaving Haiti, Mickael traveled to Somalia, where he’s now serving in a similar capacity.

Thank yous for this episode go to my communication colleagues in Panama and Haiti Crystal Madrid and Joachim James Peterson.

If you want to learn more about our work in Haiti you can visit us at intercrossblog.icrc.org. There you can also subscribe to our newsletter so you never miss a podcast.

You can also follow us on X.com, formerly known as Twitter, @ICRC_DC.

See you next time on Intercross.