PORT-AU-PRINCE — Montreal physician Paul Fillion braces himself for the unexpected every morning when he goes to work at the only hospital in Cité Soleil, the toughest slum in Haiti.

The hospital’s only latrine is an open sewer. There is no potable water or electricity, and thugs steal the fuel that powers the generator. There is only one blood-pressure pump and, until recently, no thermometers. Oxygen masks and antibiotics routinely go missing, only to reappear in the chaotic, filthy markets outside the hospital’s green iron gate, where they are hawked for a fraction of their value. The government hasn’t paid the nurses in months.

But the real challenge of working at the 64-bed Choscal hospital is the presence of chimères, the gangs once supported by former president Jean-Bertrand Aristide. They remain the de facto rulers in this slum city of 400,000, where there is virtually no state presence.

“Most doctors are too frightened even to come here on their own,” said Dr. Fillion, 50, who is here on a short-term contract with Médecins du Monde Canada. “We are deep in chimère country. It is difficult to work without having good relations with them. And it is hard to know whom to trust.”

During the uprising, the hospital looked after many gang members who came in with shotgun wounds expecting VIP treatment.

Despite the end of the uprising and efforts to disarm them, many of these gang leaders remain armed, and experts say it will be next to impossible to integrate them into any form of civilian life. Yet the doctors in Cité Soleil know they cannot afford to alienate these clients and their families.

The hospital is the only lifeline for dozens of expectant mothers and children who file into the waiting room every day. Routine problems such as diarrhea and respiratory infections can be fatal here because of chronic malnutrition and poor immunity. Then there are children who are abandoned here, such as twin girls Loveli and Lovela, only a few days old, who were brought here from an orphanage in Petit Goave, 50 kilometres outside Port-au-Prince.

When they came in, the fragile two-pound babies needed oxygen. But the hospital has no pediatric oxygen masks, so Dr. Fillion’s Haitian colleague, an energetic woman named Dr. Armide Jeanty, had to fashion adult ones to size using white medical tape.

“It is so common for mothers to abandon their babies here. We have at least several every month. They leave their kids at the hospital and just never come back. They have no money to support them,” says Dr. Jeanty, who has worked at the hospital for eight years.

Many international non-governmental organizations left Haiti for security reasons in the weeks before Mr. Aristide stepped down, and the hospital shut down for six days during the armed rebellion that led to Mr. Aristide’s ouster. But Médecins du Monde stayed.

Dr. Fillion and the other doctors here desperately hope other non-governmental organizations will set up in Cité Soleil, because the needs are so great: People live in huts made out of pressed garbage; pigs and dogs forage with ragged children in the trash heaps; and many are ill with respiratory infections, asthma and diarrhea.

“There has been an emergency situation here for months, and now that Mr. Aristide is gone, people finally recognize this,” said Elenore Senlis, who oversees Médecins du Monde’s Canadian mission in Port-au-Prince.

Funded by grants from the Canadian International Development Agency and the Quebec government, Médecins du Monde helps to operate the emergency clinic, as well as a program to prevent HIV-positive pregnant women from transmitting the disease to their babies.

Haiti receives more Canadian aid than any other country in the Americas, a total of $587-million since 1968. Canada recently pledged an additional $7-million in emergency assistance. Yet it can be difficult to see any long-term improvement. International organizations such as the World Bank and the Inter-American withdrew altogether after the disputed elections of 2001 that eventually led to Mr. Aristide’s downfall, although they have now begun to disburse loans again.

In a report assessing Canadian aid from 1994 to 2002, CIDA concluded that projects such as democracy building and police training have met with only limited success. It recommended Canada terminate aid to public institutions and concentrate on programs that meet basic human needs, such as a national immunization project and the Cité Soleil health efforts.

Haiti ranks 150th out of 174 countries on the United Nations’ human-development index, making it one of the poorest countries in the world.

In the face of all this, Dr. Fillion and Dr. Jeanty maintain their good cheer, knowing that without their presence at Choscal hospital, the people of Cité Soleil would be even worse off. Dr. Fillion looks down at Loveli and Lovela, lying side by side in rusted iron cribs, tiny fists curled, eyes just beginning to open as they struggle to hang on to life.

“I think they’re going to make it,” he says softly.