Two days before last Christmas, Dr. Pierre S. Prince took an exciting new job as director of Haiti’s largest public hospital, which the United States spent tens of millions of dollars renovating and is so deep in gang territory that it has been closed for a year.
Dr. Prince, a 57-year-old thoracic surgeon, looked forward to returning to the State University Hospital of Haiti, which had been ravaged by the 2010 earthquake that decimated the country’s capital.
He did his residency there and was going to oversee a new wing, a 500-bed facility with nearly $100 million in renovations and a range of services, including operating rooms, orthopedics and a maternity and neonatal unit.
On Christmas Eve, as he headed to work, gangs attacked a news conference scheduled to announce the hospital’s partial reopening, killing a police officer and two reporters, and seriously injuring seven other journalists. The reopening never happened.
The situation worsened last month: Videos that circulated on social media and were verified by The New York Times showed an older building at the general hospital, as it is commonly known, engulfed in flames. Gang members had apparently set it on fire.
“The doctors are scared, and our residents and interns are depressed,” Dr. Prince said. “Some of them have left. The morale is very low.”
The hospital’s fate underscores the increasingly desperate conditions facing Haiti and its international donors as they try to rescue Port-au-Prince from the control of armed gangs, which have targeted foreign-financed health facilities.
Haiti, where the United Nations says about 20 percent of its 10 million people is enduring acute levels of hunger and 1 million have fled their homes because of violence, is particularly dependent on foreign aid and had been receiving up to $400 million a year from the United States alone.
But as Elon Musk takes an ax to American foreign aid around the world, and dismantles the U.S. Agency for International Development, programs like the continued renovation of the general hospital in Port-au-Prince are in the cross hairs.
The hospital’s new wing, which U.S. A.I.D. helped pay for, was already plagued by large cost overruns and a decade of construction delays. Now it is being battered by repeated assaults from criminal groups as Haiti’s capital has become a lawless quagmire despite billions of dollars in international aid.
“The general hospital is sort of like a case study on how it goes wrong,” said Jake Johnston, a researcher at the Center for Economic and Policy and Research who wrote “Aid State,” a blistering account of how billions in international aid failed to bolster Haiti’s public institutions. “And they never finished the work, and the general hospital is closed for all these other reasons.”
Haiti’s general hospital was built next to the presidential palace in downtown Port-au-Prince by the U.S. Army Corps of Engineers during the American occupation of Haiti, from 1915 to 1934.
For years, many patients were gunshot and torture victims. In a country where politicians and wealthy elites travel to the Dominican Republic or Miami for health care, the general hospital served the overwhelmingly poor masses.
“It housed the only dialysis machines in the country,” said David Ellis, an American who runs a medical helicopter service in Port-au-Prince. “It was, when open, the most comprehensive surgical center in the country.”
It was so badly damaged in the 2010 earthquake that no one was able to treat the hundreds of severely injured people gathered outside, their bloody mangled limbs exposed to the dusty air.
Renovating the hospital was one of the first projects approved by an international reconstruction committee formed to rebuild Haiti after the earthquake. France committed $40 million, the United States $25 million.
After a series of delays and contract disputes, it was slated for completion in June 2023 — nine years later than originally planned.
At the same time, the political situation in Haiti deteriorated precipitously. The president was assassinated in 2021, and kidnappings and killings soared.
In July 2022, U.S. A.I.D. increased its contribution by $10 million because the Haitian government could not pay its share, according to a 2023 report by the Government Accountability Office, a congressional watchdog agency.
The hospital was just one of several projects the G.A.O. examined that ended up over budget. The United States spent $2.3 billion to support Haiti’s reconstruction in the decade after the quake, and only half of the eight major projects G.A.O. reviewed were completed.
While a key power plant and roughly 900 homes were built in Port-au-Prince, two projects, including building a new port, were scrapped when costs soared and two others — including the general hospital — were still ongoing.
Technical and political disputes caused significant delays and cost overruns at the hospital, the G.A.O. said.
But the hospital limped along, half-open, while work on the new wing stalled.
Then a year ago, a coalition of gangs banded together to attack police stations, prisons, hospitals and communities. Gangs set homes on fire, and entire neighborhoods — including the downtown area that is home to the hospital — cleared out.
The former prime minister had to dodge gunfire during an official visit to the general hospital last year and was whisked away by his security detail while CNN cameras rolled.
With the area too perilous, the more than 800 people who work at the hospital, including doctors and nurses, have been paid to stay home for nearly a year.
“It seems that there is an intense desire to make us waste time,” said Dr. Stevens Gabriel, a resident surgeon who complained of not being reassigned to another facility to continue advancing his skills and training.
Even though police barracks are nearby, gangs plundered the general hospital. The governments of the United States, France and Haiti had already spent about $90 million on it. Electrical wiring, plumbing and equipment were stolen, though much of the new medical equipment had not yet been installed, Dr. Prince said.
The damage was estimated at $3 million to $4 million and could set the project back another two years — if the security situation ever improves enough for the hospital to reopen, he said. Now Dr. Prince says they are scouting for a new temporary place to work.
Eleonore Caroit, the French member of Parliament for citizens living overseas in Latin America and the Caribbean, who sits on the board of the development agency that helped finance the project, said drone footage was being used to assess damage from the recent fire.
“France is willing to do what it can to help,’’ she said, “but the situation is very complicated. My constituents tell me it’s never been this bad.”
Satellite imagery captured eight days after the fire by the commercial satellite company Planet Labs shows one older building charred and at least two others damaged.
Dr. Barth Green, the chairman of Project Medishare for Haiti, a Miami-based charity and a major supporter of health services in the country, said the attack was particularly dispiriting because the general hospital was where generations of nurses and doctors trained.
“That’s the national university hospital,” he said, “And so, by destroying this, it’s a symbol.”
The issue is critical: Only one of three major hospitals in the capital area is open. Of the 92 health facilities in the metropolitan area, only 39 are operational, according to the Pan American Health Organization.
Under the Trump administration’s new push to eradicate foreign aid, funds for most projects financed by U.S.A.I.D. were frozen, although a judge recently ruled that the agency had to fulfill past contracts.
Asked about the hospital’s status, the U.S. State Department, which has assumed control of the aid agency, said it would conduct a review with the goal of “restructuring assistance to serve U.S. interests.”
“Programs that serve our nation’s interests will continue,” the State Department said in a statement. “However, programs that aren’t aligned with our national interest will not.”
The Haitian Ministry of Health did not respond to requests for comment.
Responding to a post on X criticizing the billions spent in Haiti after the earthquake, Prime Minister Alix Didier Fils-Aimé agreed that much of the American assistance had been squandered.
“You’re right!!” he wrote in a message directed at Mr. Musk, “USAID spent billion (sic) on Haiti with no accountability. Haiti needs economic development and security, not corruption and cronyism.”
He added that he looked forward to working with President Trump to achieve economic prosperity for Haiti.
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