CITE SOLEIL, Haiti, April 22 (UPI) -- "Gunfire has been the soundtrack of Cite Soleil since I arrived," said Loris De Filippi, head of mission for Medicins Sans Frontiers, the international medical relief agency which operates two facilities in the heart of what is arguably the worst slum in the Americas.
MSF, also known as Doctors Without Borders, was until recently one of only two organizations willing to brave routine street battles between armed gangs and tank-embedded U.N. forces assigned to stabilize the shooting gallery of tin-and-cinderblock warrens at the water's edge of the Haitian capital, Port-au-Prince.
Waves of killings and kidnappings have besieged the city since former President Jean-Bertrand Aristide was forced into exile in Feb. 2004. The death toll has climbed past 2,000 lives in the meantime, and abductions averaged between six and twelve per day at their peak, according to police and human rights groups. Called the "deepest would in Haiti's belly" by U.N. envoy Juan Gabriel Valdes, Cite Soleil has been the epicenter of political and criminal violence.
De Filippi told United Press International that MSF's emergency care unit at Choscal hospital -- the only hospital in the slum -- had seen a "huge" increase in gunshot victims leading up to February's presidential ballot: 34 wounded in November, 80 in December and 103 in January -- 90 percent in the first three weeks alone -- before a relative calm set in. Over 50 percent of patients were women, children and the elderly.
MSF had already worked in Haiti for 15 years when it decided to re-open Choscal last August, performing some 12,000 medical consultations and 800 emergency procedures in the first three months as attacks in the sprawling shantytown neared fever pitch. The hospital had been abandoned a year before due to insecurity.
"We decided to intervene in Cite Soleil because we found it unacceptable that a population of 250,000 people, the size of a medium European city, caught in an epidemic of social, gang and political violence, could be left without any care to speak of," said De Filippi, an easygoing Italian who has worked in hot zones from Somalia to Kosovo.
"We always ask ourselves: are we putting in balance the risks we take with the lives we save," he said, noting the high turnover of MSF staff, particularly among surgeons. "Our ability to work in Cite Soleil is precarious... Sometimes security is an excuse not to go."
Choscal is a bleached compound with thick 15-foot high walls situated deep in the slum. Forbidden to leave after 5 p.m., MSF employees and volunteers must travel to and from the hospital in a convoy of Land Rovers, through gang-controlled neighborhoods built on trash whose concrete hovels are peppered with bullet holes.
MSF typically has 2 surgeons and three anesthesiologists on duty to man an emergency room, along with a medical coordinator and three or four local doctors for general consultations, maternity and pediactrics, all of whom pull 24-hour shifts. Double shifts, and bed shortages, are not uncommon when gunfire erupts.
"Between the end of December and early January we were full, performing surgeries around the clock," said Carlo Belloni, another Italian doctor with a bottomless reserve of energy. "The capacity here is unlimited... it's war surgery."
Stray bullets ripped through the second floor pediatrics ward one night in January, just missing sleeping patients. Pediatrics has since been moved to ground level, where it is protected by concrete filled steel drums. Quarter-sized pock marks were also found on the doors of two rooms where doctors once rested.
"That is heaven, this is hell," said Belloni, pointing to a Catholic-run primary school at the end of a dirt soccer pitch beyond the periphery of the MSF compound.
Although members of some aid groups have been shot and kidnapped in the past, MSF staff insist they have never been directly attacked.
"MSF has been most welcome here since the beginning," according to Reginald, MSF's Haitian-born security liaison with the Cite Soleil community. "They understand that we are only trying to help in a respectful manner without any political agenda whatsoever."
He explained that MSF officials met with gang leaders as violence intensified last June and July, calling on them to avoid stirring chaos and to permit free access by medical staff since "the first victims are always women and children."
MSF has also pleaded with the 9,500-strong U.N. Stabilization Mission in Haiti to cease launching incursions into the slum where residents now curse the blue-helmets. The mission, known by the acronym Minustah, has been criticized for heavy-handed tactics that have claimed scores of innocent casualties.
While MSF has provided medical relief to at-risk populations in more than 70 countries worldwide since its founding in 1971 by a group of French doctors, the Nobel Prize-winning organization's stated policy is to remain neutral from governments. If human rights abuses are encountered by field teams, violators are confronted and public information campaigns are waged to pressure them. Private donors account for more than 80 percent of MSF funding, which further ensures independence.
Belloni, who had operated on a domestic violence victim with five gunshots to the hands and feet the previous night, said the free emergency care administered by MSF was the least that could be done for people abandoned by their own government.
He said, however, that MSF care was often inadequate or too late as he checked the IV of a 6-year-old boy stricken with a lethal infection; hours later a white sheet silhouetted the child's lifeless body. And nearby, an advanced breast cancer patient whose torso was swollen and jaundiced waited for time to expire.
"We could discharge her as there is nothing more we can do, but then where would she go," said Belloni.
Class-based hostilities, official corruption and international neglect have conspired to make Haiti the poorest country in the Western Hemisphere. The average Haitian lives on less than $2 a day, with many forced to further degrade a once-fertile land turned scorched earth where 80 percent of inhabitants are unemployed and more than half are malnourished.
But February's landslide presidential victory of Rene Preval, a one-time Aristide protégé and heir to his impoverished support base, has salvaged hopes among Cite Soleil's forgotten residents that their woes may finally be addressed.
Polls opened again Friday for parliamentary elections, and Preval's Lespwa (Hope) party is expected to capture the largest number of seats when results are announced in about a week. Preval is slated to sworn in by the new government May 21.
The specter of violence invariably attends elections in Haiti, but aid workers say people of late have had little reason to feel intimidated.
"Cite Soleil was a war zone," said De Filippi. "Now the trouble has all but disappeared... We have passed from a state of constant emergency to stability."
The MSF mission chief cited a sharp drop to 20 gunshot victims in February, down from over a hundred the previous month, and about half as much in both March and April -- the result of normal criminality, not confrontations between armed gangs and U.N. forces.
Most impressive is that the people inside Cite Soleil are optimistic and "waiting to see what Preval will do," he said, with a number of international and local aid organizations circulating the slum to "evaluate the needs and moods of people." Food distribution and inoculation programs are up and running, and Choscal feels less like a bunker each day.
"The hospital is still full but people move freely," De Filippi said with a touch of disbelief. "It has been a major adjustment to have a normal setting for consultations and care."
