PORT-AU-PRINCE, Haiti (AP) — Aid efforts for Haitians enduring the gang violence ravaging their nation suffered a new blow with the kidnapping of an American nurse from New Hampshire and her young daughter, who were still missing Tuesday.

Gang warfare has increasingly plagued Haiti since the 2021 assassination of President Jovenel Moïse. The killing worsened criminal control of Haiti and today the innocent are regularly killed, raped and held for ransom. A local nonprofit has documented 539 kidnappings since January, a significant rise over previous years.

That number is almost certainly underreported in Haiti, where many people fear authorities in addition to the gangs. Hospitals and other aid organisations — often the only institutions in the country’s many lawless areas — have increasingly been criminals’ targets. Many service providers have been forced to close, leaving a growing number of people in this country of 11.45 million without access to healthcare, food, education and other basics.

Haitians, aid providers and outside observers worry that the kidnapping of New Hampshire native Alix Dorsainvil and her daughter will turn more of the nation into a no-go zone for anyone besides gangs and the populations they torment. The Christian organisation Dorsainvil works for, El Roi Haiti, has offered medical care, education and other basic services. The organisation released a photo of Dorsainvil smiling happily with her arm around her husband but provided no details about the mother and their daughter.

Dorsainvil was providing medical care in El Roi Haiti’s small brick clinic late last week in a gang stronghold of the country’s capital, Port-au-Prince, when armed men burst in and seized her, witnesses told The Associated Press. The captors have demanded $1 million in ransom, a standard practice by the gangs to get money to fund operations.

“(The kidnapping) is definitely going to have a chilling impact on the work that particularly smaller aid groups do in the country,” said Renata Segura, International Crisis Group’s deputy director for Latin America and Caribbean. “People are going to be thinking about it twice before returning to those communities.”

Smaller grassroots organisations like Dorsainvil’s are particularly affected, Segura said, because they have fewer resources to deal with the violence. People in Cite Soleil protested the kidnapping, carrying signs that read, “She is doing good work in the community. free her.” Protesters marched to the medical facility where Dorsainvil was kidnapped. It had closed doors.

Doctors Without Borders last month announced that it was suspending services in one of its hospitals because some 20 armed men had burst into an operating room and snatched a patient.

“There is such contempt for human life among the conflicting parties, and such violence in Port-au-Prince, that even the vulnerable, sick and wounded are not spared,” Mahaman Bachard Iro, the organisation’s head of programmes in Haiti, wrote in a statement. “How are we supposed to be able to continue providing care in this environment?

Residents of an adjoining neighborhood, Tabarre, were wondering Tuesday if aid groups’ temporary closures will become permanent.

“People are probably dying without basic services because they cannot afford to go to a private hospital,” 39-year-old bus driver Donald Saintilus said.

Hospitals have told the AP that they now see patients arriving in dire condition due to lack of medical care. The United Nations said in February that violence had “severely hampered” access to health services.