Mortality, violence and access to care in two districts of Port-au-Prince, Haiti

BACKGROUND: Towards the end of 2006 open conflict broke out between United Nations forces and armed militia in Port-au-Prince, Haiti. Fighting was most intense in the district of Cité Soleil. METHODS: A cross-sectional, random-sample survey among the conflict-affected populations living in Cité Soleil and Martissant was carried out over a 4-week period in 2006 using a semi-structured questionnaire to assess exposure to violence and access to health care. Household heads from 945 households (corresponding to 4,763 people) in Cité Soleil and 1,800 household (9,539 people) in Martissant provided information on household members. The average recall period was 579 days for Cité Soleil and 601 days for Martissant. RESULTS: In Cité Soleil 120 deaths (21 children) were reported (CMR 0.4 deaths/10,000 people/day; <5 MR 0.5 deaths/10,000/day) while in Martissant 165 deaths (8 children) were reported (CMR 0.3/10,000 people/day; <5 MR 0.2/10,000 people/day). Violence was reported as the main cause of adult mortality in both locations (mainly gunshot wounds) accounting for 29.2% of deaths in Cité Soleil and 23% of deaths in Martissant. 22.9% of families in Cité Soleil and 18.6% in Martissant reported at least one victim of violence. Destruction of property and belongings was common in both Cité Soleil (52.4% of families) and Martissant (14.9%). Access to health services was limited, with 11% (22/196) of victims of violence in Cité Soleil and 23% (49/212) in Martissant unable to access care due to insecurity or lack of money. DISCUSSION: Extrapolating to the total population of these two districts some 2,000 violent deaths occurred over the recall period. Among the survivors, violence had lasting effects in terms of physical and mental health and loss of property and possessions.