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People in Haiti face a massive health crisis, as the destruction caused by Hurricane Matthew has cut off communities and forced them to live in inhuman conditions.
Around 1.4 million people are in need of aid, particularly those living in isolated mountain villages, which are the most difficult to reach.
Médecins Sans Frontières/Doctors Without Borders (MSF) has prioritised these villages, as they have the least access to healthcare, clean water, food and reconstruction material.
For the injured in these villages, access to healthcare is almost nonexistent. Nearly three weeks after the hurricane, many people still suffer from conditions such as infected wounds and fractures.
Without skilled and repeated care, broken bones may lead to disabilities and infected wounds can be fatal.
In many instances, MSF teams have been the only aid teams able to access these isolated populations. To reach them, personnel have brought mobile clinics via cars, helicopters and hired donkeys.
"Our mobile clinic headed to Lopino, a village in the mountains that can only be reached by helicopter," says Dr Danielle Perriault, working with MSF in Haiti. "Like most villages in Grand Anse, Hurricane Matthew left a trail of destruction here.
"The streets are bordered by fallen trees and debris, and the valley is covered in trees torn in half."
To add to the emergency, stocks of medical equipment are dwindling because access to these communities by road is blocked. This is exacerbated by the fact that 23 health centres were damaged or partially destroyed.
"It’s been two weeks that these people have painful injuries or broken bones without treatment," says Dr Perriault. "Fractures, whether simple, complicated or open, are sometimes stabilised by traditional healers.
"You can all too well imagine the suffering of people left without care for two weeks. And there are still so many people we haven’t reached yet."
Hurricane Matthew left around 175,000 people displaced, as their homes and communities were literally ripped apart by the storm.
Liselle Beloni, from Lopineau near Jérémie, recalls bringing her 80-year-old grandmother and 15-year-old son to an MSF clinic.
Their home had collapsed on top of them.
“The wind blew a piece of metal sheeting of the house and fell down on them," says Liselle. "They could barely move, and the room filled with water.
"When the storm had ended, I rushed back home and found our home damaged and both of them injured. They had open bruises on the feet and the back of the head.
"My son was hurting and I could not even give him enough to eat. My mother’s injuries were causing her so much pain, especially when pus got into her ankle wound.
"She couldn’t walk and barely wanted to eat. There was no way to get her to the hospital like this.
"I took them immediately to the (MSF) clinic when I heard about it."
While many people have started to rebuild shelters or makeshift homes, the poor quality of material available means that these shelters are no protection against torrential rains.
This is predicted to largely affect people's health, exposing them to the spread of diseases such as malaria, dengue and pneumonia, worsened again by the lack of access to care.
According to Office for the Coordination of Humanitarian Affairs (UN OCHA), 800,000 people in Haiti are at an extreme level of food insecurity.
Food is one of the most urgent needs in these villages, with several MSF teams reporting seeing people who have had almost nothing to eat since the hurricane struck.
"The lack of food adds to the patient’s trauma," says Dr Perriault. "Several days ago, I treated an elderly woman with severe burns on her hand. As she refused an injection against the pain, I tried to distract her by talking about her family.
"She had lost her two children and was now the only caretaker for her two grandchildren.
"Her only worry during the treatment was the reality that when she left the clinic, she would go home with no food to feed her grandchildren."
In addition to the destruction of foodstocks, the damage on crops and difficulty to transport goods mean that prices have risen significantly.
MSF is very concerned on the impact this will have on the general health status.
While the number of cholera patients MSF treats in its cholera treatment centre in Port à Piment is decreasing, there is a risk that cholera may increase again and progress into areas that were less affected by the hurricane.
Clean water is essential to avoid cholera, and if clean water and shelter are not provided soon, cases are likely to rise.
MSF treated 190 suspected cholera patients since the beginning of the crisis, and has installed water reservoirs, distributed over 500,000 chlorine tablets (to disinfect water), and cleaned water sources.
MSF remains vigilant in controlling the spread of cholera, and believes widespread vaccination is an opportunity to curb transmission in affected areas.
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