“Patients have started to share very, very difficult stories since 2021,” says Diana Manilla Arroyo, MSF’s head of mission in Haiti.

“Survivors talk about two or four or seven, or up to 20 aggressors,” she says, adding that more women now say they have been threatened with weapons or knocked unconscious.

Women are also reporting more frequently that their assailants are under 18, she adds.

In a drop-in centre in another part of the city, four women – ranging in age from late 20s to 70 – describe being attacked in front of their children and husbands.

“Our neighbourhood was attacked, I went back home only to find my mum, my dad, my sister, all were murdered. They killed them and then burnt the house down, with them inside it,” one woman says.

After surveying her devastated home, she was about to leave the neighbourhood when she encountered gang members. “They raped me – I had my six-year-old with me. They raped her too,” she continues. “Then they killed my younger brother in front of us.”

“Whenever my daughter looks at me, she’s sad and crying.”

The other women recount attacks that follow a similar pattern – murder, rape and arson.

Sexual violence is just one element of the crisis that has engulfed Haiti. UN agencies say more than a tenth of the population – 1.3 million people – have fled their homes, and half the population faces acute hunger.

Haiti has had no elected leadership since the assassination of Moïse. A Transitional Presidential Council and a series of prime ministers it has appointed are tasked with running the country and organising elections.

Rival gangs have formed an alliance, turning their weapons on the Haitian state rather than each other.

Since we last visited in December, the situation has deteriorated. Hundreds of thousands more people have been displaced. More than 4,000 people have been killed in the first half of 2025, compared to 5,400 in the whole of 2024, according to the UN.

The gangs are estimated to have increased their control from 85% to 90% of the capital, seizing key neighbourhoods, trade routes and public infrastructure, despite efforts by a Kenyan-led, UN-backed security force.

We join the international force as they patrol a gang-controlled area, but within minutes, one of the tyres on their armoured vehicle is shot out and the operation ends.

Members of the force rarely leave their armoured vehicles. Experts say the gangs continue to acquire powerful weapons and maintain the upper hand.

In recent months, the Haitian authorities have contracted mercenaries to help wrest back control.

A source within the Haitian security forces told the BBC that private military companies, including one from the US, are operating on the ground, and using drones to attack gang leaders.

He showed us drone footage he says is of one gang leader, Ti Lapli, being targeted in an explosion. He says Ti Lapli was left in a critical condition, though the BBC has not been able to confirm this.

But around the city, the fear of the gangs remains. In many neighbourhoods, vigilante groups are taking security into their own hands, further increasing the numbers of young men with weapons on the streets.

“We’re not going to let them [the gangs] come here and kill us – steal everything we have, burn cars, burn houses, kill kids,” says a man using the name “Mike”.

He says he operates with a group in Croix-des-Prés, a bustling market area close to gang-controlled territory.

As gunfire rings out in the distance, no-one flinches. People here are used to it.

He says the gangs pay young boys to join, and set up checkpoints where they demand money from residents passing through.

“Of course everyone is afraid,” he tells us. “We feel alone trying to protect the women and children. As the gangs keep spreading, we know our area could be next.”

Humanitarian agencies say the situation is deteriorating and women are among the hardest hit, with many of them facing the double trauma of sexual violence and displacement.

Lola Castro, the regional director of the UN’s World Food Programme, says Port-au-Prince “is the worst place in the world to be a woman”.

Women here are also likely to feel the impact of cuts to humanitarian aid programmes, she adds.

Haiti has long been one of the largest recipients of funding from the US Agency for International Development (USAID), which President Donald Trump has slashed, dubbing it “wasteful”.

When we visited in June, Ms Castro said the WFP was distributing its last stocks of US-funded food aid.

Food provision protects women, she explained, because it saves them from having to be out in the streets begging or looking for food.

Humanitarian workers here also fear that cuts may soon affect support for victims of violence in places like the safe house where Helene lives.

And Ms Manilla Arroyo from MSF says funding for contraception has also been reduced: “Many of our patients already have children. Many of them are under the age of 18 with children. The risk of pregnancy represents many, many new challenges for them.”

Helene and other women in the safe house often sit and chat together on a balcony that looks out across Port-au-Prince, but many of them are too afraid to leave the security of its walls.

She does not know how she will support her young daughter as she grows up.

“I always dreamt of going to school, to learn and to make something of myself,” she says. “I always knew I’d have children, just not this young.”

[BBC]