From ... in Health — Nov 25, 2024

Haiti: Scarce Protection as Sexual Violence Escalates

(Washington, DC, November 25, 2024) – Criminal groups in Haiti have intensified attacks against the population in recent weeks, including by subjecting girls and women to horrific sexual abuse, Human Rights Watch said today.

The international community should urgently increase funding to support a rights-based security response, and to improve the ability of the transitional government, as well as grassroots and international organizations, to address the needs of survivors, who have little access to protection and care services. Criminal groups control over 80 percent of the capital and surrounding areas, as the Haitian National Police and the severely under-resourced United Nations-authorized Multinational Security Support (MSS) mission struggle to restore security. Criminal groups have often used sexual violence to instill fear in rival territories. While fighting between these groups has decreased in 2024, attacks on the population, the police, and the country’s key infrastructure have increased, including through the widespread use of sexual violence. “The rule of law in Haiti is so broken that members of criminal groups rape girls or women without fearing any consequences,” said Nathalye Cotrino, crisis and conflict researcher at Human Rights Watch. “The international community should urgently increase funding for comprehensive programs to support survivors of sexual violence while ensuring that the transitional government and the Multinational Security Support mission have the resources needed to restore the rule of law, provide basic security, and rebuild the health and justice systems.” In July 2024, Human Rights Watch interviewed 58 people in Port-au-Prince, including survivors of sexual violence, human rights and humanitarian workers, transitional government officials, diplomats, and representatives from Haitian civil society and UN agencies. Researchers also conducted remote interviews with 36 people, including the former public health and population minister and healthcare professionals from Haitian and international organizations, and reviewed data and reports from the UN, Haitian, and international groups. Human Rights Watch contacted spokespersons of criminal groups through trusted intermediaries, but the groups’ spokespersons declined to comment. Between January and October, nearly 4,000 girls and women reported sexual violence, including gang rape, mostly committed by members of criminal groups, according to the Gender-Based Violence (GBV) sub-cluster, which includes grassroots women’s groups, international organizations, and government entities. According to the UN, the increase in cases involving children is 1,000 percent, compared to the same period in 2023. Human rights and humanitarian workers as well as government officials said this is most likely a fraction of the cases, as most go unreported. “The bandits don’t care about their age,” an aid worker said. “They rape because they have the power. Sometimes they do it for days or weeks.” Many [survivors] suffer from the effects of physical abuse and mistreatment or end up pregnant, with no access to medical, psychosocial, or legal services, even for those who end up contracting sexually transmitted infections, which affect a large number of survivors, particularly HIV. Many survivors are reluctant to report sexual violence or seek health care for fear of retaliation, survivors and humanitarian workers said. Many who seek care often cannot do so within the critical 72-hour window to access post-exposure prophylaxis and emergency contraception, either because many public medical facilities are closed due to the violence, or because they do not have the financial resources to go to private health centers, medical workers said. “These women are extremely vulnerable,” an international healthcare worker said. “They are trapped in poverty and struggle daily to survive. When they [suffer] the violence of rape, they also struggle to access protection and health care.” Haiti also has a total ban on abortion. “Haitian women and girls facing poverty resort to unsafe abortions, risking their lives,” said Pascale Solages, director of the women’s organization Nègès Mawon. “Unsafe abortions are the third leading cause of maternal mortality.” “I was raped by four men [in May] while walking down a street in Brooklyn [a neighborhood of the Cité Soleil commune in the capital, Port-au-Prince],” said a 25-year-old mother of four who had been looking for water for her children. “They were Gabriel’s men [from the G-Pèp criminal group].

They didn’t used to do this, but now they do whatever they want to all of us. I couldn’t go to the doctor; I didn’t have money.” Escalating criminal violence, including attacks on and looting of hospitals, has pushed the health system to the brink of collapse, leaving fewer than 30 percent of health facilities operational in the capital, according to the former public health and population minister. This significantly hinders sexual violence survivors’ access to crucial healthcare services. Poverty exacerbates the situation, with over 64 percent of Haiti’s population of 11.7 million living on less than US$3.65 per day, according to the World Bank. “I live on the street with my children,” said a 27-year-old woman who is nine months pregnant and a mother of three. “Sometimes we go three or four days without eating... After they [G9 criminal group members] raped me, I was in very bad shape. I fell sick with a vaginal infection, but I didn’t have money to go to the doctor.” Médecins Sans Frontières (Doctors Without Borders or MSF), which has provided free emergency care across Port-au-Prince for over 30 years, suspended its activities on November 20. This decision followed attacks by “self-defense” groups on MSF ambulances, patients, and medical personnel, as well as death and rape threats against MSF staff from members of the Haitian National Police.

The attacks and threats against MSF stem from allegations by some members of the Haitian police and “self-defense” groups that the organization provides medical support to members of criminal groups, disregarding, as MSF has stated, that the organization “provides care to everyone based solely on medical needs.” MSF has often been the only option for assistance for victims and survivors in areas controlled by criminal groups.

The suspension is set to affect a weekly average of more than 1,100 outpatients, including over 80 survivors of sexual and gender-based violence, who are unable to access public hospitals due to closures or private hospitals, which victims typically find inaccessible or unaffordable. Grassroots women’s organizations also provide health care, psychological support, temporary shelter, education, and reintegration and legal assistance for survivors of sexual violence, often with the support of UN agencies and other international organizations.

These groups have very limited resources and most are only able to operate in government-controlled areas. Many of them have also been affected by the recent escalation of violence, leading them to suspend their activities. UN experts have warned that Haitian authorities have also undermined and underfunded state institutions responsible for providing essential services and protecting human rights. While the new transitional government has prioritized reopening closed health institutions and ensuring better access to justice for victims, senior government officials said that it lacks adequate financial resources. Restoring basic security conditions is also essential to combat sexual violence. Haiti’s partners should urgently provide the necessary resources for the MSS mission to operate effectively.

The UN had only received 17 percent of the required $16 million needed to strengthen and expand access to essential services for girls and women as of September.

The UN’s human rights office in Haiti has been supporting the formation of specialized judicial units to investigate and prosecute those responsible for serious crimes, including sexual violence, but the transitional government should issue an official decree establishing them so they can be fully operational. “The transitional government should prioritize protection and comprehensive care for survivors of sexual violence,” Cotrino said. “The US, the European Union, Canada, and other concerned governments across Latin America and beyond should provide financial support to help the government and aid groups meet these needs.” For more details, accounts from victims, and recommendations, please see below. Survivors of sexual violence are referred to here without full identification or with pseudonyms to protect their privacy. According to the United Nations, the expansion of criminal group activity in Haiti has contributed to a sharp rise in gender-based violence, including sexual violence, primarily targeting girls and women. Grassroots and international organizations similarly indicated an alarming rise in the number of reported rapes between April and June 2024, particularly in Carrefour, Cité Soleil, Croix-des-Bouquets, Delmas, Gressier, and Port-au-Prince municipalities—areas largely controlled by criminal groups—where some facilities have reported to the UN receiving up to 40 rape victims per day. In 2023, criminal groups regularly used rape as a “weapon of terror” to “punish” girls and women from territories controlled by rival groups. Human Rights Watch documented numerous cases of rape, primarily in Brooklyn, Cité Soleil, where there were intense clashes between two major coalitions, the G-Pèp federation, which controlled Brooklyn, and the G9 alliance, which controlled the surrounding neighborhoods and aimed to expand its territory. Members of the G9 frequently gang raped girls and women from Brooklyn to instill fear and punish them for living in the area controlled by the rival group. By late February, the formation of the “Viv Ansam” alliance of major criminal coalitions, including the G9 and G-Pèp, shifted the dynamics. As clashes between the groups decreased, criminal groups have expanded the use of sexual violence, making it widespread, including against girls and women seeking refuge in informal sites after being displaced. “Criminal groups abuse anyone [in their territories] for any reason, as they are the authority,” a Haitian security expert said. “Leaders, mid-level members, and rank-and-file members all rape girls and women just because they can, and nobody stops them.” Girls and women are intercepted in public spaces while on foot or using public transport. Criminal group members take them to nearby locations, usually semi-destroyed and abandoned houses, where they threaten, beat, and rape them. Many are gang raped. Human rights and humanitarian workers have reported cases of women and girls being raped in broad daylight on public buses and in the streets. “Two months ago, when I was begging for food on the street, three men from Gabriel’s group [G-Pèp] grabbed me ... and threw me face down on the ground.

They raped me, and they didn’t care that I was pregnant,” said Aurelie G., 27, a Brooklyn resident. “I was too scared to resist.

They all had guns ... When they finished, they slammed my face against the pavement and insulted me, saying we are all theirs and they could do whatever they wanted with us.” Bridget C., a 14-year-old girl from the Croix-des-Bouquets commune, said she was abducted from her home and raped by members of the 400 Mawozo criminal group in late February: It was near 10 a.m. More than 10 bandits arrived ... Two grabbed me by my arms and dragged me to another house... [There], they took me to a room where there were six [other] girls.

They tied me to a chair ... five men raped me that day.

They hit me in the head with their fists several times ... I spent five days in that house and every day I was raped by different men ..

The other girls were also raped and beaten. Girls and women who have fled their homes due to violence are also raped in informal sites for internally displaced people “as a deliberate tactic to control women’s access to the scarce humanitarian assistance available,” UN Women said. Over the past two decades, the Haitian government has dramatically reduced investment in public health care. When adjusted for inflation and measured on a per capita basis, Haiti is one of only 16 countries that spent less on public health care in 2021 than it did in 2000.

The Ministries of Public Health and Population, the Status of Women and Women's Rights, and Justice and Public Security have a national plan to combat violence against women, including sexual violence, by 2027. This plan is largely supported by the UN and has as the coordination mechanism the Gender-Based Violence (GBV) sub-cluster. However, survivors of sexual violence continue to face limited or no access to essential public services, including protection and health care. “When a survivor of sexual violence arrives at a public facility, they receive immediate care,” the former public health and population minister said. “A screening process identifies their needs, followed by reactive care to address potential pregnancy risks and referrals for psychological assistance. Hygiene kits are provided when feasible [due to shortages] to support their well-being.

These services form a critical package aimed at addressing the complex needs of survivors.” However, not all victims can access the health system due to significant barriers.

The public system suffers from chronic underfunding, resource shortages, and critical staff deficits. Currently, only two of the country’s five public hospitals are operational, and even these struggle with inadequate medical equipment and personnel, as over 40,000 health workers have fled the country due to violence, according to the UN Integrated Office in Haiti (BINUH). Most private facilities have closed, and many victims cannot afford their services, human rights and humanitarian workers said. Many victims reach out to international and local organizations within the GBV sub-cluster to access protection and health services. However, despite members’ efforts, significant obstacles remain in coordinating an effective response.

The sub-cluster “produces systematic data on violent incidents, but it does not function effectively ... partly due to the rotation of officials serving as focal points, lack of clarity on roles, and uncertainty about available resources,” a humanitarian official said. In areas controlled by criminal groups, most health centers are inoperative. Before the recent suspension, MSF’s centers were often the only option for victim care, and even all of those were operating intermittently, including in Drouillard, Turgeau, Tabarre, and Carrefour, along with its mobile clinics, including in Cité Soleil. Since the suspension, MSF is only providing care to existing hospitalized patients and will no longer accept new admissions. “MSF is present but we have no other facilities to refer [victims] to for medical attention, much less psychological support,” a worker from Oganizasyon Fanm Vanyan an Aksyon (Brave Women in Action Organization or OFAVA), a Haitian women’s rights organization, said before MSF announced the suspension of its operations. “After I was raped, I got a vaginal infection, but I couldn’t go to the doctor because there were none nearby, and I didn’t have any money,” said Emanuela B., a survivor of sexual violence from Cité Soleil. Only a quarter of the reported survivors of rape can access health care within the critical 72-hour window for post-rape treatment, according to the UN Population Fund. “It is heartbreaking to see women arriving long after the assault, showing symptoms of sexually transmitted infections such as HIV that could have been effectively treated if they had had prompt access to health services,” a human rights worker said. “I’m infected with HIV,” said Ellie M., a 29-year-old sexual violence survivor, widow, and mother of four children who lives in Brooklyn. She was abducted and gang raped for five hours by armed members of the G9 criminal coalition. “Afterward, they shot me in the foot,” she said. “[When] I went to the hospital, [the doctors] discovered I was infected ... It was too late.

Then [I learned] I was pregnant.” Ellie’s baby was not diagnosed with HIV at birth. Doctors advised her against breastfeeding to prevent infection, but she could not afford formula. When Ellie spoke to Human Rights Watch, the baby, then three months old, had developed red spots on her back, legs, and feet, and Ellie feared she may have contracted HIV. “The doctor gave me a card for monthly medicine, but it’s just for me, not for the baby,” she said. Survivors of sexual violence have almost no support to deal with the psychological impact of their experience. “[Survivors’] greatest need after medical care is mental health support,” said a psychologist from an international organization. “Women feel hopeless and are mentally affected by unimaginable suffering, horror, and pain ... We have patients with PTSD [post-traumatic stress disorder] who experience sleep disturbances, anxiety, eating disorders, despair, and suicidal thoughts.” Although Bridget C., 14, was provided with shelter, psychological support, and health care by a local group, she was suffering from PTSD symptoms when she spoke to Human Rights Watch, five months after criminal group members raped her: “I still have many nightmares about what those men did to me. I wake up in the middle of the night screaming in fear and sweating. Sometimes, I hide under the bed.” While some local organizations, mainly funded by the UN, operate shelters, they are unable to meet the high demand. “We receive many cases of young female victims of rape who become pregnant,” a representative of a local group said. “[They] often do not have a home or family. We can only provide shelter for them for a short time—one or two months—as we do not have enough resources to do this.” Survivors of sexual violence who become pregnant have no access to safe abortion services, as abortion remains criminalized, with the transitional government postponing until 2025 a proposal to decriminalize it up to 12 weeks of pregnancy. “Women are doubly victimized,” a humanitarian worker said. “They are raped, abused, left pregnant and ill ..

They have no access to safe abortion services.” Justice and reparations remain largely inaccessible for survivors of sexual violence. Criminal violence has also left the judicial system mostly inoperative. While the government has taken some measures to to address the demands of judicial staff who have been on strike, as well as to relocate certain court facilities, the main first-instance courts in Port-au-Prince and Croix-des-Bouquets are not functioning. Amandine P., a 34-year-old mother of five, was displaced from the Carrefour Feuilles neighborhood in Port-au-Prince following a violent attack in which she was raped and her husband was killed by members of the Grand Ravine criminal group. “I didn’t file a complaint because there’s no reliable or functional judicial system,” she said. “I’m in a really hopeless situation. I want justice, not just for me, but for the other victimized families.” Several civil society organizations, including the National Human Rights Defense Network (Réseau National de Défense des Droits Humains, RNDDH), have documented human rights violations by criminal groups and assisted victims in filing complaints. But they said that progress toward prosecuting the perpetrators has been minimal, with no notable advancements in Port-au-Prince. Impunity is the norm.

The lack of an official record of cases and the lack of a mechanism to assess the progress of investigations makes the situation worse. “Rape and gang rape are spreading across Haiti,” said Rosy Auguste Ducena, program director at RNDDH. “Sexual violence survivors are ignored by the judicial authorities, who fail to enforce accountability for these crimes or deliver justice. In Haiti, girls and women remain in constant danger.” Haiti requires a comprehensive strategy to protect and ensure access to essential services for survivors of sexual violence, involving both immediate actions and long-term strategies.

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