PORT-AU-PRINCE, Haiti — To reach the hospital, the mothers traveled the front lines of a gang war, bringing sick babies during lulls in gun battles and passing corpses along the way.
They had no choice: Cholera, resurgent in Haiti, had come for their children.
“I didn’t want to come, because I was so scared,” said Benette Regis, clutching her 5-year-old son, Lovelson, as he vomited, his frail body at war with cholera. “But I knew he could die.”
Cholera is soaring across the globe, as a record number of outbreaks have strained already reeling health systems in regions including Africa and South Asia.
But cholera’s resurgence is a particularly cruel turn of fate in Haiti, which in February declared victory in eliminating the disease after battling it for more than a decade.
Now, that triumph has been snatched away by the same forces plunging the nation into extraordinary depths of chaos and despair: armed groups that have turned vast swaths of the capital into lawless hellscapes of violence — and a government unable to take control.
In October, the country registered its first case of the disease in three years, and cases have spiked since then.
Haiti has experience beating back cholera, which spreads through contaminated water and is relatively easy to treat with simple rehydration. But the health authorities cannot deliver the most basic care in poor neighborhoods where gangs have choked off access to the outside world, preventing doctors from entering and leaving the sick to die at home.
“There are areas of the country where nobody would set foot in,” said Dr. Jean Pape, the director of GHESKIO, a local health provider that operates two cholera treatment centers in Port-au-Prince, the Haitian capital. “They are afraid to get kidnapped, they are afraid to get killed.”
“It’s very sad,” he added, “because it’s a simple disease and there are simple ways to intervene, yet the authorities and the medical teams are unable to do their work.”
The battle against cholera has been stymied by several intertwined crises.
In September, armed groups took control of Haiti’s biggest port, blocking the delivery of fuel across the country for nearly two months and setting off a chain of events that created ideal conditions for the spread of disease.
Trash collection ceased entirely in parts of Port-au-Prince, the capital, turning streets of urban shantytowns into rivers of squalid mud and creating mountains of garbage next to food markets.
The nation’s water utility stopped functioning normally and clean water became scarce in its large slums. Thousands fleeing violence took refuge in a public park near the airport in Port-au-Prince, where many slept next to human waste before the authorities recently forced everyone out.
Hospitals reduced their services, lacking the fuel needed to keep machines working. Oxygen supplies were left stranded at ports, killing newborns unable to breathe on their own. The number of ambulances on the streets plummeted.
The United Nations reported last month that for the first time ever, hunger, which has long haunted Haiti, had reached “catastrophic” levels in the Cité Soleil neighborhood — a designation of the most extreme hunger possible that has left thousands facing famine-like conditions. Some residents say they resort to drinking rainwater and making meals out of boiled leaves.
The devastation gripping Haiti has shocked a country accustomed to agony.
“This is not a typical humanitarian crisis at all,” said Jean-Martin Bauer, the country director for the World Food Program in Haiti. “It’s something much worse.”
Last month, the Haitian government made a remarkable request for armed intervention from abroad to confront its cascading challenges, but it remains unclear whether any countries will send troops.
Gas stations opened recently for the first time in about two months in Port-au-Prince after the police finally took control of the main fuel terminal. But even that relief came with the potential for fresh pain: Fuel, doctors fear, will make people more mobile, whipping cholera through the country at a faster rate.
“We were already in a system on its knees,” said Moha Zemrag, the deputy head of mission for Doctors Without Borders in Haiti. “Now,” he added, “cholera unfortunately will spread quicker than the health system will be able to answer to it.”
Since October, the disease has killed more than 100 people and sickened 8,000 more — though experts say the official numbers probably understate the disease’s true toll.
Simply getting to the Doctors Without Borders hospital in Cité Soleil, a sprawling and desperately poor neighborhood in Port-au-Prince, can be perilous. The hospital sits on a gravel road that separates territory controlled by rival gangs — a front line that became a slaughterhouse when fighting between the two groups broke out in July.
Hundreds were killed and dozens of women were raped on the path since the violence exploded, according to the National Human Rights Defense Network, a local human rights group. The trickle of people who still walk down the road tend to hug the walls lining it to avoid being struck by bullets that can rain down at random.
On a recent Monday, arriving patients were greeted by a gruesome surprise: Two dead bodies had appeared within view of the hospital — a reminder of the terrors beyond its cement walls.
Inside the facility, even in a tent thick with humidity and the sounds of illness, Ms. Regis for once was calm. “I feel safe here,” she said.
Lovelson, Ms. Regis’s son, had started to feel ill a couple of days earlier, while a gun battle raged near their home. She thought it would be better to not to leave the neighborhood, but the nuns who run a small nearby clinic told her Lovelson would die without help from better-equipped doctors and paid for a motorcycle taxi to take her to the cholera treatment center.
“There was heavy shooting,” she said of the journey.
Cholera, which scientists say was first brought to Haiti more than a decade ago by United Nations peacekeepers, is caused by a bacterial infection and leads to relentless waves of diarrhea and vomiting. The treatment is straightforward — rehydration, intravenously in the more extreme cases — but has to be given quickly.
The disease can kill its victims within a day, especially children suffering from malnutrition who can quickly progress from dehydration to organ failure.
But making it to the Doctors Without Borders hospital in Cité Soleil is no easy feat in a place boxed in by men armed with weapons of war.
“All the severe cases arrive in the morning, because they cannot travel at night,” said Dr. Mouna Hanebali, a physician helping oversee the hospital. “There are many already dead when they arrive.”
The first suspected case of cholera at the hospital came by motorbike — a lifeless girl, 10-years-old, brought by her parents.
When staff members learned that the girl’s sister also had symptoms, they rushed to the family’s home. The teenage sister was already dead.
One of the easiest ways to prevent widespread death is to set up outposts to deliver oral rehydration inside the shantytowns where the most vulnerable live, experts said. Now that fuel is flowing throughout the country, it’s technically feasible to travel to those neighborhoods — but often only by risking lives.
“We need to get access to all the slums regardless of who controls them,” Dr. Pape said. “That’s what people are asking of us.”
Because gangs control most of Haiti’s capital, aid groups have to constantly negotiate for safe passage in and out of their territory. Sometimes gang leaders refuse them entry.
“They don’t respect the ambulances, they threaten employees,” said Johanne Gauthier, the head of a fleet of ambulances in Port-au-Prince, referring to the gangs. Ms. Gauthier said three ambulances had been hijacked this year.
Inside a treatment tent at the cholera treatment center in Cité Soleil, a thud broke through the moans of sick children, and nurses went running: a writhing 10-month-old baby, left on a bed by himself for hours, had plunged a few feet to the floor.
The boy’s mother had dropped him off in the morning and then rushed home. She came back with her second child, a 6-year-old boy, as fast as she could.
“I had to go check on my other son,” said the mother, Beatrice Medina. “When I arrived home, I saw my other son was just as bad.”
Nearby, a three-year-old boy wailed between bouts of sickness and reached out for his aunt’s hand. He had started feeling sick days ago, but relentless shooting forced his family to stay in their home. By the time his aunt and mother got him to the hospital — walking for more than an hour along a treacherous route — he needed an IV.
“When we walk, we always stay close to the walls so we can go down if we need to,” the aunt, Adelina Antoine, said.
Her nephew, Adams Orvil, stopped receiving nutritional supplements when violence forced a local clinic to shut down. The nurses said that he was severely malnourished, not that Ms. Antoine needed confirmation. The boy’s stomach was distended and his skin was stretched tautly over a skeletal face.
“His eyes now are going deeper into his head,” Ms. Antoine said.
She had planned to let her sister take a shift with Adams while she rested at home, but she had no idea whether she could make it back safely.
“You might be leaving and you are the victim,” she said. “No one is exempt.”
Andre Paultre contributed reporting from Port-au-Prince.