Some aid groups aren't sure whether it's safe enough to fly in to Haiti. Others have already canceled trips. And Haiti's main public hospital is running low on water.
Even in the best of times, the General Hospital in Port-au-Prince doesn't have running water and has to truck it in.
But since violent protests and flaming roadblocks erupted in major cities around the country a week ago, the facility, which usually sees anywhere from 400 to 500 patients a day, has endured burning tires and police tear gas outside its doors, and on Saturday a thrown Molotov cocktail in its yard.
No one was injured, said Dr. Jessy Colimon Adrien, the hospital's executive director. But fed up with the hostile environment, Adrien on Monday shut down the last refuge for the capital's poor _ the emergency room.
"There is a lot of frustration because a doctor's mission is to save lives," she said. "(But) we cannot take any more new patients."
With Haiti once more in the throes of a popular revolt over a president's legitimacy, the violent unrest is beginning to take a humanitarian toll as protesters clash with police, stone ambulances and erect roadblocks shutting off major highways and roads.
"I'm afraid we are going to see many women with complicated pregnancies die unnecessarily," said Dr. Winfred S. Tovar, the founder and executive director of Mimsi International, a nonprofit that provides free pregnancy care to women in the country's rural south and operates a monthly mobile pregnancy clinic.
Tovar said the group has already seen the impact on one of their patients in St. Jean du Sud, where several roadblocks and violence in the city have made it impossible for patients to access hospitals for care. One patient who had a premature delivery at 33 weeks developed severely high blood pressure three days after returning home with the baby. The condition caused a massive stroke paralyzing her right side.
"She cannot breastfeed anymore, and her baby is starving. There is no way for the family to get to Les Cayes to buy baby formula to supplement the baby's needs," Tovar said. "There are many more patients suffering in the darkness as telecommunications fail and transportation becomes scarce."
They include a 13-month-old born with a hole between the two lower chambers of his heart and a 1-year-old without an anus awaiting lifesaving surgeries. So far, their chances look bleak as the situation is having ripple effects in the United States, where some aid groups aren't sure what to do, and others cut their visits short.
"We've been doing this since 2013 and have weathered government after government with demonstrations along the way," said Dr. James Wilentz, the co-founder of Haiti Cardiac Alliance, a medical charity that provides free pediatric care to heart patients in the country. "This is the first time we've had to abort a mission, leaving kids untreated."
On Sunday, after completing the first two of 15 heart surgeries on children who had been waiting for the group's arrival, Wilentz's team of volunteer surgeons found themselves dodging flying rocks as their van, escorted by armed security, swerved around fiery roadblocks along a tenuous Boulevard 15 October not far from the U.S. Embassy in Tabarre. Unaccustomed to the volatility, many were afraid, even those who had previously visited Iraq, said Owen Robinson, the charity's co-founder.
"Once you have volunteers who say "I don't feel safe; this isn't what I signed up for,' you have to respect that," Robinson said.
After selecting two of the most urgent cases and performing those surgeries the next day, Robinson packed up the 20 volunteers and their equipment and aborted the mission. Eleven kids, some still with IVs in their arms and wearing hospital gowns, were waiting _ including Dieukenson Normil, the 13-month old who couldn't be operated on because the procedure required a specialist to stay on to oversee his recovery in intensive care.
"I am going to be so angry if one of those kids dies because of this," Robinson said, noting that the child has a short time to live with his condition.
Said WIlentz: "(It's) such an irony that the failings of government, which require NGOs to compensate, are now compounded by the failure to protect the very NGOs who fill the roles the government should normally play."
Dr. Chad Perlyn and his three volunteer plastic surgeons did manage to finish all 26 of their surgeries on children with complex facial deformities. But it wasn't before they were forced to interrupt some of those surgeries to operate on police and protesters wounded by gunshots last Thursday.
Protesters in the town of Mirebalais had turned on police and tried to force themselves into the police station. Perlyn's group finally left Haiti a few days later after being escorted by armed security in the back of ambulances in a convoy.
"When we landed, we heard Thursday may be problematic, but I don't think anyone anticipated there to be a real issue," said Perlyn, a reconstructive and craniofacial pediatric surgeon at Miami's Nicklaus Children's Hospital.
But as the surgeons headed back to their hotel that Wednesday, Feb. 6, they saw roadblocks going up. On Thursday morning, things appeared to be uneventful. Then chaos erupted after a woman was killed by a truck driver and protesters turned their anger on police in the area.
"I counted 11 gunshots," Perlyn said. "The local staff was running one operating room and we were running a second. I was super proud we were there and able to help many of the protesters and police who were injured."
Somehow, they also managed to finish up the remainder of their surgeries, and with a visiting group from Yale University, were escorted back to Port-au-Prince, where they were taken to a safe house before being transported to the airport the next day.
"I've been to Haiti so many times. It was such a remarkable trip in terms of training and teaching, and watching our plastic surgeon fellow because there is only one plastic surgeon in the country," Perlyn said. "You watch that potential and then by the same token you see the opposite, the frustrations and desperation going on outside of this teaching hospital. It was such a stark comparison. That's what defines Haiti, that dichotomy."
Concerned about the deteriorating situation, the National Federation of Haitian Mayors on Thursday issued an appeal asking the opposition and protesters to allow for a humanitarian corridor so that ambulances, water trucks and other medical aid can get through to those in need. The appeal came on the same day that Haiti's prime minister, Jean Henry Ceant, confirmed to the Miami Herald that he's being pressured by President Jovenel Moise to resign.
"I will not resign," he said.
Ceant didn't say why he was being pressured, but political analysts believe that by pushing his prime minister to step down Moise hopes to lessen calls for his own resignation by Haitians angry over the skyrocketing inflation, corruption and the devaluation of their currency.
Thursday marked the eighth consecutive day of what Haiti's opposition is calling "Operation lock down Haiti." And while roadblocks were reported in some cities, the demonstrations were less intense than in previous days. Still, the mood remained one of uncertainty as anxious Haitians stayed holed up at home for fear of running into looters or angry demonstrators.
The embassies of the United States and Canada remained closed, and the United Nations in New York, which is in the process of downsizing its presence in the country, turned down an informal request by Haiti to increase the number of foreign police units on the ground. Instead, it called for the national stakeholders to de-escalate the situation through dialogue and to identify realistic solutions to restore public order within the framework of the country's constitution.
