PORT-AU-PRINCE, Haiti (AP) — When machine gun fire erupts outside the barbed-wire fences surrounding Fontaine Hospital Center, the noise washes over a cafeteria full of tired, scrub-clad medical staff.

And no one bats an eye.

Gunfire is part of daily life here in Cité Soleil – the most densely populated part of the Haitian capital and the heart of Port-au-Prince’s gang wars.

As gangs tighten their grip on Haiti, many medical facilities in the Caribbean nation’s most violent areas have closed, leaving Fontaine as one of the last hospitals and social institutions in one of the world’s most lawless places.

“We’ve been left all alone,” said Loubents Jean Baptiste, the hospital’s medical director.

Fontaine can mean the difference between life and death for hundreds of thousands of people just trying to survive, and it offers a small oasis of calm in a city that has descended into chaos.

The danger in the streets complicates everything: When gangsters with bullet wounds show up at the gates, doctors ask them to check their automatic weapons at the door as if they were coats. Doctors cannot return safely to homes in areas controlled by rival gangs and must live in hospital dormitories. Patients who are too scared to seek basic care due to the violence arrive in increasingly dire condition.

Access to health care has never been easy in Haiti, the poorest nation in the Western Hemisphere. But late last year it suffered a one-two punch.

One of Haiti’s most powerful gang federations, G9, blockaded Port-au-Prince’s most important fuel terminal, essentially paralysing the country for two months.

At the same time, a cholera outbreak made worse by gang-imposed mobility restrictions brought the Haitian health care system to its knees.

The UN high commissioner for human rights, Volker Türk, said this month that violence between G9 and a rival gang has turned Cité Soleil into “a living nightmare.”

Reminders of the desperation are never far away. An armoured truck driven by hospital leaders passes by hundreds of mud pies baking in the harsh sun to fill the stomachs of people who can’t afford food. Black spray-painted “G9” tags dot nearby buildings, a warning of who’s in charge.

In a February report, the UN documented 263 murders between July and December in just the small area surrounding the hospital, noting that violence has “severely hampered” access to health services.

That was the case for 34-year-old Millen Siltant, a street vendor who sits in a hospital hallway waiting for a checkup, her hands nervously clutching medical paperwork over her pregnant belly.

Nearby, hospital staff play with nearly 20 babies and toddlers — orphans whose parents were killed in the gang wars.

Normally, Siltant would travel an hour across the city by colourful buses known as tap-taps for her prenatal checkups at Fontaine. There she would join other pregnant women waiting for exams and mothers cradling malnourished children in line for weigh-ins.

All the clinics in the area where she lives have closed, she said. For two months last year she couldn’t leave the house because gangs holding the city hostage made travel through the dusty, winding streets nearly impossible.

“Some days, there’s no transportation because there’s no fuel,” she said. “Sometimes there’s a shooting on the street and you spend hours unable to go outside … Now I’m worried because the doctor says I need to get a C-section.”