PORT-AU-PRINCE, Haiti (AP) -- A spike in violence has deepened hunger and poverty in Haiti while hindering the very aid organizations combating those problems in a country whose government struggles to provide basic services.
Few relief workers are willing to speak on the record about the cuts -- perhaps worried about drawing attention following the October kidnapping of 17 people from Ohio-based Christian Aid Ministries -- 12 of whom remain held hostage.
But several confirmed, without giving details, that they had sent some staff out of the country and have been forced to temporarily cut back aid operations.
Gang-related kidnappings and shootings have prevented aid groups from visiting parts of the capital, Port-au-Prince, and beyond where they had previously distributed food, water and other basic goods.
A severe shortage of fuel also has kept agencies from operating at full capacity.
"It's just getting worse in every way possible," said Margarett Lubin, Haiti director for CORE, a U.S. nonprofit organization.
"You see the situation deteriorating day after day, impacting life at every level," Lubin said, adding that aid organizations have gone into "survival mode."
Few places in the world are so dependent on aid groups as Haiti, a nation frequently called "the republic of NGOs." Billions of dollars in aid have been poured through hundreds – by some estimates several thousand – of aid groups even as the government has grown steadily weaker and less effective.
Shortly after the July 7 assassination of the president, Prime Minister Ariel Henry assumed leadership of a country still trying to regain political stability. Nearly all the seats in parliament are vacant and there's no firm date yet for long-delayed elections, though Henry said he expects them early next year.
Less than a dozen elected officials are currently representing a country of more than 11 million people.
And in the streets, the gangs hold power.
More than 460 kidnappings have been reported by Haiti's National Police so far this year, more than double what was reported last year, according to the United Nations Integrated Office in Haiti.
The agency said Haitians are "living in hell under the yoke of armed gangs. Rapes, murders, thefts, armed attacks, kidnappings continue to be committed daily, on populations often left to fend for themselves in disadvantaged and marginalized neighborhoods of Port-au-Prince and beyond."
The agency added: "Without being able to access these areas under the control of gangs, we are far from knowing and measuring the extent of these abuses and what Haitians really experience on a daily basis...
"Humanitarian actors have also limited their interventions due to the security risks to their staff and access challenges," it added.
Large organizations like the U.N. World Food Program have found alternate ways to help people, such as using barges rather than vulnerable trucks to ferry goods from the capital to Haiti's southern region. But smaller organizations don't always have such means.
World Vision International, a California-based organization that helps children in Haiti, told The Associated Press that it has relocated at least 11 of 320 employees as a result of the violence and is taking undisclosed security measures for other staff.
Water Mission, a South Carolina nonprofit, said it's exploring relocating to other areas in Haiti and it said kidnappings and overall violence have forced it to change staffing plans to ensure people's safety.
"These issues sometimes result in slower progress in our ongoing safe water project work," the organization said. "However, we continue with our work despite any temporary interruptions that arise."
The difficulties come at a time of growing pleas for help. A magnitude 7.2 earthquake in mid-August destroyed tens of thousands of homes and killed more than 2,200 people. The country also is struggling to cope with the recent arrival of more than 12,000 deported Haitians, the majority from the U.S.
In addition, more than 20,000 people have fled their homes due to gang violence this year, according to UNICEF, with many living in temporary shelters amid extremely unsanitary conditions and the pandemic. The U.N. agency estimates it needs $97 million to help 1 million people in Haiti next year.
Among them is Martin Jean Junior, a 50-year-old who used to resell scrap metal. He said his house was set on fire in mid-June amid fighting between police and gangs.
"I have been in the streets since," he said as he lay on a blue sheet he had spread on the hard floor of a Port-au-Prince school temporarily converted into a shelter.
Things could soon get even worse: A prominent gang leader warned Haitians this week to avoid the embattled community of Martissant because rival gangs will fight each other in upcoming days.
"Even the dogs and the rats won't be saved. Anything that moves, trucks, motorcycles, people, will be considered allies of Ti-Bois," the gang leader known as "Izo" said in a video, referring to a rival gang. "Martissant is declared a combat zone, and those who ignore this warning will pay with their life."
Most already avoid the area for fear of being kidnapped, shot or having cargo looted. That has largely cut off the country's southern peninsula because the main highway runs through the neighborhood.
Those recently killed by crossfire in Martissant include a nurse, a 7-year-old girl and at least five passengers aboard a public bus. The violence forced the aid group Doctors Without Borders in August to close an emergency clinic that had served the community for 15 years.
Liman Pierre, a 40-year-old mechanic, said he recently had to cross Martissant to go to work and saw four dead people, including two elderly neighbors and the motorcycle driver transporting them.
"The criminals kill with impunity and abandon the dead to the dogs," he said. "Those who aren't devoured by dogs are set on fire, pure and simple. This can't be."
For now, Pierre is sleeping on the streets of Port-au-Prince because he fears having to cross Martissant to get back home: "You don't even get the opportunity to visit parents and friends who are in difficulty."
"The state doesn't exist," Pierre said. "Criminals have been in power for over six months. It is December, and we do not see the light at the end of the tunnel."