Amicus Curiae Brief — Markwayne Mullin, Secretary, Department of Homeland Security, et al., Petitioners v. Dahlia Doe, et al.

No. 25-1084

IN THE

Supreme Court of the United States

__________________

DONALD J. TRUMP, PRESIDENT OF THE UNITED STATES, et

al.,

Petitioners,

v.

FRITZ EMMANUEL LESLEY MIOT, et al.,

Respondents.

__________________

On Writ of Certiorari Before Judgment to the United

States Court of Appeals for District of Columbia Circuit

__________________

BRIEF OF MÉDECINS SANS FRONTIÈRES

USA, INC. D/B/A DOCTORS WITHOUT

BORDERS USA AS AMICUS CURIAE

IN SUPPORT OF RESPONDENTS

__________________

Khala James

COVINGTON & BURLING LLP

Salesforce Tower

415 Mission Street, Ste 5400

San Francisco, CA 94104

(415) 591-6000

Jeffrey E. Sandberg

Counsel of Record

Abby C. Wright

Larissa Davis

Matthew C. Quallen

COVINGTON & BURLING LLP

One CityCenter

850 Tenth Street NW

Washington, D.C. 20001

(202) 662-6000

jsandberg@cov.com

Counsel for Amicus Curiae

i

TABLE OF CONTENTS

Page

TABLE OF AUTHORITIES ....................................... ii

INTEREST OF AMICUS CURIAE ............................1

INTRODUCTION AND SUMMARY ..........................2

ARGUMENT ...............................................................4

I. Haiti Is Suffering a Widespread Humanitarian

Crisis.......................................................................4

A. Violence Is Inescapable for Those Living in

Haiti. .................................................................5

1. Armed Groups Subject Communities to

Sweeping and Indiscriminate Daily Acts

of Violence....................................................8

2. Armed Groups Employ Sexual Violence

to Expand Their Control. ..........................15

B. Haiti Faces Complex Public Health

Emergencies. ...................................................21

1. Haiti Cannot Provide Adequate Health

Services to Its Citizens. .............................22

2. Severe Disease Outbreaks Threaten

Haiti’s People. ............................................25

II. The District Court’s Stay Protects Haitian

TPS Holders. ........................................................27

CONCLUSION ..........................................................28

ii

TABLE OF AUTHORITIES

Page(s)

Center for Strategic & Int’l Stud. (CSIS),

Haiti Embarks on Another Rocky Political Transition (Feb. 9, 2026)............................... 7

Dánica Coto, Human Rights Watch Details

Deaths from Police Drone Attacks in

Haiti, Associated Press (Mar. 10, 2026) ........... 12

Fed. Aviation Admin., Notice to Airmen

(NOTAM) KICZ/A0024-26 (Mar. 2, 2026) .......... 4

Gangs Set Fire to Haiti’s National Soccer

Training Center in Croix-des-Bouquets,

Haitian Times (Feb. 4, 2026) ............................ 10

Global Initiative Against Transnational

Organized Crime,

From Criminal Governance to

Community Fragmentation: Addressing

Haiti’s Escalating Crisis (Sept. 18, 2025) .......... 6

Christopher Hernandez-Roy & Juliana

Rubio, CSIS, CSIS Briefs:

The Gender-Based Violence Crisis in

Haiti (Sept. 2024) .............................................. 15

Human Rights Watch, World Report 2026:

Events of 2025 (2026) .................. 5, 7, 8, 9, 10, 11

Immigration & Refugee Board of Canada,

Haiti: Treatment of Haitians Nationals

Who Return to Haiti (Aug. 14, 2025) ................ 11

iii

Int’l Comm. of the Red Cross, Haiti: Making

Impossible Choices in a Health-Care

System on the Verge of Collapse (Oct. 23,

2025) .................................................................. 22

Int’l Crisis Grp., Locked in Transition:

Politics and Violence in Haiti (Feb. 19,

2025) .................................................................... 6

Int’l Crisis Grp., Undoing Haiti’s Deadly

Gang Alliance (Dec. 15, 2025) .............. 6, 8, 9, 10

Int’l Rescue Comm., Haiti’s Gang Violence

Crisis: What to Know and How to Help

(Feb. 12, 2026) ..................................................... 3

Caroline Kapp, The Devastating Use of

Sexual Violence as a Weapon of War:

Three New UN Reports Detail Atrocities

in Ethiopia, Haiti, and Ukraine, Think

Global Health (Nov. 2, 2022) ............................ 18

Médicins Sans Frontières (MSF):

Closed Ports, Empty Shelves: Haiti

Urgently Needs Medical Supplies (May

21, 2024) ............................................................ 24

Haiti: Escalating Violence in Bel Air,

Port-au-Prince (Jan. 8, 2026) ........................ 5, 14

Haiti in Crisis: What to Know (Jan. 23,

2025) .................................................................... 2

Medical Supplies Arrive in Haiti After

Three-Month Disruption (June 21, 2024) ......... 24

iv

Port-au-Prince: Over 100 Patients

Admitted in Just Two Weeks as Violence

Escalates (Jan. 22, 2026) .............. 14, , 15, 22, 23

Press Release, MSF Announces

Permanent Closure of Our Turgeau

Emergency Centre in Port-au-Prince

(Oct. 15, 2025) ................................................... 14

Press Release, MSF Outraged by Police

Attack on Ambulance and Execution of

Patients in Haiti (Nov. 13, 2024) ...................... 13

Sexual and Gender-Based Violence in

Port-Au-Prince, Haiti

(Jan. 2026) ................................... 8, 15, 16, 19, 20

A US Judicial Ruling on Temporary

Protected Status Reflects Haiti’s

Deepening Crisis (Feb. 3, 2026) .................... 3, 27

Where We Work: Haiti (2025) ........................... 13

Guy Metayer, Criminal Gangs in Haiti and

Power Structure, 13 Class, Race & Corp.

Power 1 (2025) ..................................................... 8

Rachel Opota et al., UNICEF, A Silent

Crisis: The Long Healing Process of

Survivors of Sexual Violence in Haiti

(June 26, 2025) .................................................. 21

v

Sec’y of State Marco Rubio, Press Release,

Terrorist Designations of Viv Ansanm

and Gran Grif (May 2, 2025) ............................ 10

Ruth Seifert, The Second Front: The Logic

of Sexual Violence in Wars, 19 Women’s

Stud. Int’l Forum (1996) ................................... 18

UN Children’s Fund (UNICEF), Haiti’s

Children Under Siege: The Staggering

Rise of Child Abuse and Recruitment by

Armed Groups (Feb. 7, 2025) ...................... 16, 17

UN Children’s Fund (UNICEF),

Humanitarian Situation Report No. 8:

Haiti (Jan. 24, 2026) ........................................... 5

UN Int’l Org. for Migration (IOM), Violence

Triggers Record Displacements in Portau-Prince: Over 60,000 People in a

Month (Mar. 18, 2025) ...................................... 27

UN Integrated Off. in Haiti (BINUH),

Quarterly Report on the Human Rights

Situation in Haiti (January-March 2025)

(Apr. 30, 2025) ..................................................... 9

UN Integrated Off. in Haiti (BINUH),

Quarterly Report on the Human Rights

Situation in Haiti (April-June 2025)

(Aug. 1, 2025) .................................. 12, 15, 18, 19

UN Integrated Off. in Haiti (BINUH),

Quarterly Report on the Human Rights

Situation in Haiti (October-December

2025) (Jan. 30, 2026) ........................................... 9

vi

UN Integrated Off. in Haiti (BINUH) & UN

Off. of the High Comm’r for Human

Rights (OHCHR), Intensification of

Violence in Lower Artibonite, the Center

Department, and Regions Located East

of the Metropolitan Area of Port-auPrince: Major Risk for Haiti and the

Caribbean Subregion (Jul. 2025) ........................ 9

UN Integrated Off. in Haiti & UN Off. of

the High Comm’r for Human Rights

(OHCHR), Sexual Violence in Port-auPrince: A Weapon Used by Gangs to

Instill Fear (Oct. 2022).......................... 18, 20, 21

UN Off. for the Coordination of

Humanitarian Affs. (OCHA), Haiti

Humanitarian Needs and Response

Plan: Executive Summary (Dec. 2025) ............... 3

UN Off. of the High Comm’r for Human

Rights (OHCHR), Press Release, Haiti:

UN Human Rights Chief Alarmed by

Widening Violence As Gangs Expand

Reach (June 13, 2025) ..................................... 7, 8

UN Off. of the High Comm’r for Human

Rights (OHCHR), Restoring Dignity: A

Global Call to End the Violence in Haiti

(Apr. 7, 2025) ....................................................... 7

UN Off. on Drugs & Crime (UNODC), Tenth

Quarterly Report Under Security Council

Resolution 2692, Doc. No. S/2026/32

(Jan. 16, 2026) ................................. 7, 8, 9, 11, 12

vii

UN Population Fund (UNFPA), Addressing

Gender-Based Violence in Haiti (Jun.

2023) .................................................................. 16

UN Sec. Council, UN Integrated Off. in

Haiti, Report of the Secretary General,

Doc. No. S/2026/31 (Jan. 15,

2026) ............................................ 9, 10, 11, 12, 18

U.S. Dep’t of State, Haiti Travel Advisory

(2025) ................................................................... 4

US Extends Ban on Commercial Flight to

Haiti’s Capital Due to Gang Violence,

Associated Press (Mar. 4, 2026) ......................... 4

1

INTEREST OF AMICUS CURIAE1

Médecins Sans Frontières (“MSF”), also known as

Doctors Without Borders, is an independent,

international humanitarian organization that

provides medical assistance to people affected by

armed conflict, epidemics, disasters, and exclusion

from healthcare.2 MSF was created in the belief that

all people should have access to medical care

regardless of gender, race, religion, creed, political

affiliation, or national boundaries. Since its founding

in 1971, MSF has grown to an organization of more

than 67,000 staff. In 2024 alone, it provided 16.5

million outpatient consultations and admitted nearly

1.7 million patients to MSF facilities in seventy-five

countries. In recognition of its pioneering

humanitarian work, MSF was awarded the Nobel

Peace Prize in 1999.

MSF has engaged in extensive operations in Haiti

for thirty-five years, as the country has faced repeated

natural disasters, armed violence, political upheaval,

and public health crises. MSF currently runs seven

active projects in Haiti, including trauma centers;

primary medical and psychological care facilities;

water, sanitation, and hygiene services; maternity

care; and support for recent victims of sexual violence.

MSF has more than 1,800 full-time staff in Haiti with

1 This brief was not authored in whole or in part by counsel for

any party, and no person or entity, other than Amicus, its

members, or its counsel, made a monetary contribution to the

preparation or submission of this brief.

2 MSF comprises twenty-four associations based in countries

around the world. One of those associations is Médecins Sans

Frontières USA, Inc. d/b/a Doctors Without Borders USA.

2

recent annual expenditures of €48.3 million ($57.0

million USD).

MSF has an interest in this proceeding because it

is uniquely situated to provide this Court with realworld insight into the urgent challenges facing

persons living in Haiti. Few humanitarian

organizations operate in the country in the same

manner as MSF, and none can match its longstanding

role in providing medical services. MSF emphasizes—

in the strongest possible terms—that Haitian

nationals living in the United States cannot safely

return to Haiti.

INTRODUCTION AND SUMMARY

Haiti is currently among the most dangerous

places to live in the world. In the past four years, the

country has collapsed into widespread conflict. Dozens

of armed groups vie for control, collectively taking

over nearly all of Port-au-Prince and steadily expanding to areas outside the capital. These armed groups

use violence of all kinds, including heavy weapon attacks and sexual assault, as tools to terrorize and

control the communities in which they operate. Meanwhile, a resurgent cholera epidemic, recent natural

disasters (including another destructive hurricane in

October 2025), and widespread internal displacement

have contributed to an unprecedented public health

crisis in Haiti.3

As MSF’s CEO recently explained, “[h]umanitarian conditions in Haiti have not improved—they’re

3 See generally MSF, Haiti in Crisis: What to Know (Jan. 23,

2025), https://perma.cc/67NX-ZVSU.

3

actually getting worse.”4 Over the past year, MSF has

witnessed violence and public health crises overwhelm the country. MSF has cared for thousands of

Haitians who were victims of armed conflict, assault,

collective rape, and other violence, yet has not come

close to meeting the total need. The Haitian government, for its part, has no meaningful capacity to

protect its own citizens, much less to facilitate the safe

return and resettlement of nationals currently living

abroad.

MSF’s on-the-ground experience reflects that,

without question, Haiti is not a place to which TPS

holders can safely return. If immediately forced to go

back to Haiti, more than 350,000 TPS holders will face

life-threatening harm from violence, displacement,

and health crises. Some number of those forcibly returned men, women, and children will almost

certainly be killed, while many more will be seriously

injured, sexually assaulted, or compelled to join

armed groups to survive. Individuals returning from

the United States are subject to particular risk, as

they are often the direct targets of kidnapping for ransom and other violent crime.

4 MSF, A US Judicial Ruling on Temporary Protected Status Re-

flects

Haiti's

Deepening

Crisis

(Feb.

3,

2026),

https://perma.cc/YK76-CA7H [hereinafter MSF, February 2026

Statement]; see also Int’l Rescue Comm., Haiti’s Gang Violence

Crisis: What to Know and How to Help (Feb. 12, 2026),

https://perma.cc/5D24-2BYM (agreeing that “Haiti is facing one

of the world’s most severe humanitarian crises”); UN Off. for the

Coordination of

Humanitarian Affs.

(OCHA),

Haiti

Humanitarian Needs and Response Plan: Executive Summary 3

(Dec. 2025), https://www.unocha.org/attachments/9fa04d0c17c9-4fea-b6fd-5f0719234ab4/HTI_HNRP2026_Executive

Summary_EN_20251218.pdf

(agreeing

that

“Haiti’s

humanitarian crisis continues to worsen at an alarming pace”).

4

It is no surprise that the U.S. Department of State

warns against travel to Haiti in the strongest terms

possible: “[d]o not travel to Haiti due to kidnapping, crime, terrorist

activity,

civil

unrest,

and limited health care.”5 Indeed, in light of rampant

instability, the U.S. government does not currently allow commercial aircraft to fly to Port-au-Prince at all.6

The district court, reviewing the administrative

record, accurately described Haiti as “a country in

chaos and crisis.” J.A. 685. MSF submits this brief to

provide the Court with its firsthand experience of current conditions in Haiti, to explain the grave danger

that TPS holders will face if they are immediately

forced to return, and to urge this Court to leave undisturbed the district court’s order) staying the

termination of TPS status for Haiti.

ARGUMENT

I. Haiti

Is

Suffering

Humanitarian Crisis.

a

Widespread

Haiti is engulfed in violence, disease, and social instability. Amicus curiae MSF’s healthcare facilities

U.S. Dep’t of State, Haiti Travel Advisory (2025),

https://perma.cc/FGP8-ADZ8 (emphasis omitted); see id. (advising travelers to, among other things, “[e]stablish a proof of life

protocol with your loved ones . . . so that if you are taken hostage,

your loved ones can . . . be sure that you are alive,” and to “[l]eave

DNA samples with your medical provider in case it is necessary

for your family to access them”).

6 US Extends Ban on Commercial Flight to Haiti’s Capital Due

to Gang Violence, Associated Press (Mar. 4, 2026),

https://perma.cc/2357-7JBJ; Fed. Aviation Admin., Notice to Airmen

(NOTAM)

KICZ/A0024-26

(Mar.

2,

2026),

https://perma.cc/ZBV9-YBQD.

5

5

are routinely filled with victims of shootings, stabbings, burns, and sexual assault. Failing

infrastructure, extensive internal displacement, and

armed conflict make it difficult to render care, and

MSF staff and volunteers themselves struggle to

maintain their own safety. MSF’s medical convoys

have been attacked by armed groups and state actors

alike, and its staff have been held hostage by hourslong crossfires outside its facilities.7

In addition to the rampant violence, recurrent disease outbreaks are at among the worst levels in

memory. From every perspective, “Haiti’s multidimensional political, economic, humanitarian, and

human rights crisis” has only grown worse.8

A. Violence Is Inescapable for Those Living

in Haiti.

Since the assassination of Haitian President

Jovenel Moïse in 2021, a near-total breakdown of

Haiti’s government has left a power vacuum in which

dozens of armed groups now compete for control of the

7 See, e.g., MSF, Haiti: Escalating Violence in Bel Air, Port-au-

Prince (Jan. 8, 2026), https://perma.cc/5867-95RK (reporting recent incident in which the building used for MSF’s medical

activities in the Bel Air neighborhood “became a battlefield amid

intense fighting between an armed group and the Haitian National Police,” with “community volunteers . . . trapped there for

several hours before managing to escape”).

8 Human Rights Watch, World Report 2026: Events of 2025, at

198 (2026), https://perma.cc/K6BX-MJY2 [hereinafter HRW,

World Report 2026]; see also UN Children’s Fund (UNICEF), Humanitarian Situation Report No. 8: Haiti 1 (Jan. 24, 2026),

https://perma.cc/J6SX-HZ7L (“In 2025, Haiti descended into its

darkest chapter yet.”).

6

island nation.9 In early 2024, a loosely organized coalition of armed groups calling itself “Viv Ansanm”

besieged Haiti’s capital, Port-au-Prince, triggering the

then-prime minister to resign.10 Armed groups have

since gained control of all roads in and out of Port-auPrince and have carried out attacks on the airport,

forcing a stop to regular air travel.11 MSF staff observe that “[p]eople are fleeing in large numbers” to

escape not only gun violence, but also “kamikaze

drone” attacks causing mass civilian killings.12

The government has lost control. Political leaders

cannot reach basic agreements on how to proceed.13

Although Haiti again has a prime minister (following

expiration of a Transitional Presidential Council mandate last month), his power is severely limited, and

Int’l Crisis Grp., Undoing Haiti’s Deadly Gang Alliance 1-2

(Dec. 15, 2025), https://perma.cc/RRX6-P7LM [hereinafter ICG,

Deadly Gang Alliance Report]. Although often described as

“gangs,” these groups are essentially armed, criminal militias,

many equipped with weapons as powerful as those commonly

possessed by state actors. See, e.g., Global Initiative Against

Transnational Organized Crime, From Criminal Governance to

Community Fragmentation: Addressing Haiti's Escalating Crisis

(Sept. 18, 2025), https://perma.cc/54DG-FNP7.

10 ICG, Deadly Gang Alliance Report, supra, at i, 5-7.

11 Id. at i, 14-15.

12 Statement by MSF project staff. All quotations from MSF staff

are on file with counsel of record.

13 See, e.g., Int’l Crisis Grp., Locked in Transition: Politics and

Violence in Haiti 28 (Feb. 19, 2025) (explaining that “Haiti is paralysed” and that “[e]arly hope that an inclusive transitional

government would quickly tackle the country’s rampant insecurity … has faded”).

9

7

the country has no sitting legislature.14 National elections have not been held since 2016 and have

repeatedly been postponed due to violence and civil instability.15 In the meantime, “[a]rmed gangs have

consolidated into federated coalitions that exercise

control or influence over significant parts of the national territory,” funding their operations through

“arms and drug trafficking, fuel smuggling, migrant

exploitation, extortion and other unlawful activities.”16

The scale and scope of violence have only gotten

worse. The conflict, originally concentrated in Portau-Prince, has radiated outward throughout the nation. Violence—both by armed groups and their

opponents—kills and injures tens of thousands of people each year. William O’Neill, the UN High

Commissioner’s Designated Expert on Haiti, stated in

2025 that “[h]uman rights violations and abuses have

reached a scale and intensity that [he has] never seen

before in Haiti.”17

14 See Center for Strategic & Int’l Stud. (CSIS), Haiti Embarks

on Another Rocky Political Transition (Feb. 9, 2026),

https://perma.cc/F2YJ-KA8T.

15 HRW, World Report 2026, supra, at 202.

16 UN Off. on Drugs & Crime (UNODC), Tenth Quarterly Report

Under Security Council Resolution 2692, Doc. No. S/2026/32, ¶ 3

(Jan. 16, 2026) [hereinafter UNODC, January 2026 Report]; see

also Global Initiative Against Transnational Organized Crime,

Brokers and Patrons: Unstitching Gangs From Haiti’s Political

Fabric (Mar. 2026), https://perma.cc/Y2BZ-BWE9 [hereinafter

GITOC Report].

17 UN Off. of the High Comm’r for Human Rights (OHCHR),

Restoring Dignity: A Global Call to End the Violence in Haiti

(Apr. 7, 2025), https://www.ohchr.org/en/stories/2025/04/restoring-dignity-global-call-end-violence-haiti; see also UN OHCHR,

Press Release, Haiti: UN Human Rights Chief Alarmed by

8

And as discussed in a recent MSF report, brutal

sexual violence has come to pervade the conflict, with

women and girls of all ages raped in collective attacks.18

1. Armed Groups Subject Communities to

Sweeping and Indiscriminate Daily

Acts of Violence.

As the district court recognized, Haiti is “a country

in full-blown conflict.” J.A. 686 (citation and internal

quotation marks omitted). Armed groups—and the

various security and vigilante forces trying to stop

them—have created pervasive internal violence that,

but for its lack of organization, would readily be described as civil war.19 Armed groups currently control

an estimated 90% of Port-au-Prince and much of its

surroundings.20 These groups target specific neighborhoods and key transportation routes that connect

to the capital, enabling the groups to operate illegal

Widening Violence As Gangs Expand Reach (June 13, 2025),

https://www.ohchr.org/en/press-releases/2025/06/haiti-un-human-rights-chief-alarmed-widening-violence-gangs-expandreach (“UN Human Rights Chief Volker Türk said today that the

human rights crisis in Haiti has plummeted to a new low[.]”).

18 See MSF, Sexual and Gender-Based Violence in Port-AuPrince, Haiti (Jan. 2026), https://perma.cc/9LQD-RLN6 [hereinafter MSF, Sexual and Gender Violence Report].

19 ICG, Deadly Gang Alliance Report, supra, at i, 2-3, 6-7; see also

Guy Metayer, Criminal Gangs in Haiti and Power Structure, 13

Class, Race & Corp. Power 1 (2025).

20 UNODC, January 2026 Report, supra, ¶ 6 & map 1; HRW,

World Report 2026, supra, at 199.

9

checkpoints, engage in extortion, and control the flow

of food and supplies.21 AB

These armed groups are also actively spreading beyond the capital.22 In the Artibonite and Centre

Departments, armed groups have swept in and “targeted key highways, coastal municipalities[,] and

strategic land border crossings.”23 In entering a new

area, armed groups engage in brutal, often indiscriminate showings of force by killing, assaulting, or

forcibly displacing thousands of residents.24 They also

“embrace[] a scorched-earth approach,” destroying

21 UNODC, January 2026 Report, supra, ¶ 8; ICG, Deadly Gang

Alliance Report, supra, at 11; UN, Quarterly Report on the Human Rights Situation in Haiti (January-March 2025), at 5-6

(Apr. 30, 2025) https://perma.cc/76M6-G9VJ; UN OHCHR, Situation of Human Rights in Haiti, Doc. No. A/HRC/61/74, ¶¶ 1415 (Mar. 23, 2026), https://perma.cc/W2J9-T2N8 [hereinafter

OHCHR March 2026 Report].

22 UN Sec. Council, UN Integrated Off. in Haiti (BINUH), Report

of the Secretary General, Doc. No. S/2026/31 ¶¶ 13-16 (Jan. 15,

2026) [hereinafter UN Integrated Office in Haiti, January 2026

Report]; OHCHR March 2026 Report, supra, ¶ 5; GITOC Report,

supra, at 4, 8-10 (discussing armed groups’ creation of “franchises” throughout the country).

23 UNODC, January 2026 Report, supra, ¶ 11 & map 2; see also

UN Integrated Off. in Haiti (BINUH), UN Off. of the High

Comm’r for Human Rights (OHCHR), Intensification of Violence

in Lower Artibonite, the Center Department, and Regions Located

East of the Metropolitan Area of Port-au-Prince: Major Risk for

Haiti and the Caribbean Subregion 4 (Jul. 2025),

https://perma.cc/SR2Q-76ZH.

24 See, e.g., HRW, World Report 2026, supra, at 198 (explaining

that armed groups’ violence “is deployed strategically not only to

extract rents, but also to expand influence, contest authority in

areas under formal State administration[,] and enforce coercive

systems of criminal control”); UN, Quarterly Report on the Human Rights Situation in Haiti (October-December 2025), at 10-11

(Jan. 30, 2026), https://perma.cc/L6R5-ZMMS.

10

homes, schools, hospitals, and public buildings during

their campaigns.25 As the U.S. Secretary of State has

acknowledged, these armed groups effectively seek to

create “a gang-controlled state where illicit trafficking

and other criminal activities operate freely and terrorize Haitian citizens.” J.A. 676 (citation omitted).26

Reflecting the armed groups’ expanding reach, a

January 2026 report by the UN Integrated Office in

Haiti noted a sharp increase in killings outside Portau-Prince.27 Between January and November 2025,

authorities reported almost 2,000 homicides in the

outlying departments of Artibonite and Centre, or

roughly double the corresponding figure in 2024.28

Armed groups recently massacred dozens of people in

eight rural towns in the Artibonite department.29 According to some analysts, Haiti now has the “highest

homicide rate in the world.”30

Kidnapping is an ever-present threat. As armed

groups jockey for resources and control, individuals

25 ICG, Deadly Gang Alliance Report 14; see, e.g., Gangs Set Fire

to Haiti’s National Soccer Training Center in Croix-des-Bouquets, Haitian Times (Feb. 4, 2026), https://perma.cc/J67F-J5A6

(reporting on armed groups’ intentional destruction of the FIFA

Goal Center, “one of the country’s most important institutions for

youth development”).

26 See Sec’y of State Marco Rubio, Press Release, Terrorist

Designations of Viv Ansanm and Gran Grif (May 2, 2025),

https://perma.cc/4ZZR-45YA.

27 UN Integrated Office in Haiti, January 2026 Report, supra, ¶¶

3, 13, 15.

28 Id. ¶ 14.

29 André Paultre & Frances Robles, Dozens Killed in Haiti Massacre as International Force Trickles In, N.Y. Times (Apr. 4,

2026), https://perma.cc/T4YX-977M.

30 HRW, World Report 2026, supra, at 198.

11

throughout the country are at risk of being captured

for ransom, extorted, or having their property destroyed.31 As plaintiffs in this case have observed and

others have documented, the threat of ransom kidnapping is particularly high for persons who have spent

time in the United States; armed groups perceive returnees as having access to substantial amounts of

money and specifically single them out as targets for

threats and violence.32

Those who oppose the armed groups further contribute to the violent chaos.33 Numerous private

security companies and vigilante “self-defense” organizations “function outside formal structures” and

beyond government control.34 Innocent bystanders

are routinely hit by stray bullets and killed or injured

by explosive drones used in private and government

31 UN Integrated Office in Haiti, January 2026 Report, supra, ¶

15.

32 See Decl. of Fritz Emmanuel Lesly Miot (“Miot Decl.”) at 4-5,

Miot v. Trump, No. 25-CV-02471 (D.D.C.) (Dkt. 81-2); Decl. of

Rudolph Civil at 3 (Dkt. 81-3); Decl. of Marcia Merline Laguerre

(“Laguerre Decl.”) at 6-7 (Dkt. 81-5); Decl. of Vilbrun Dorsainvil

at 7-8 (Dkt. 81-6); accord, e.g., Immigration & Refugee Board of

Canada, Haiti: Treatment of Haitians Nationals Who Return to

Haiti (Aug. 14, 2025), https://perma.cc/7SC3-WPFZ (reporting

interviews with multiple Haitians reflecting that “society views

returnees who have lived abroad for an extended period of time

as wealthy,” which “puts them at risk to be held for ransom by

either criminal groups or individual criminals”).

33 Statement by MSF coordination staff, Haiti; HRW, World Report 2026, supra, at 198; OHCHR March 2026 Report, supra, ¶

7; GITOC Report, supra, at 4 (identifying “tripartite configuration in which gangs, armed vigilante brigades[,] and state forces

compete”).

34 UNODC, January 2026 Report, supra, ¶ 29.

12

attacks.35 Government forces themselves engage in intentional violence: in just one quarter of 2025, police

summarily executed at least 46 people without due

process,36 and an “extremely high” number of people

have been killed or injured by police operations.37

Armed groups, in turn, respond in increasingly organized ways, “routinely unit[ing] against Haitian and

international security forces, pooling personnel, firepower and logistics.”38

Given this intense, chaotic violence, Haiti is one of

the most dangerous places in the world for MSF’s

teams to operate. Armed groups and their opponents

alike operate without apparent regard for MSF’s medical and humanitarian mission. Accounts from

medical staff at MSF’s trauma hospital in Tabarre,

who treated victims of the September 2025 “kamikaze” drone attack in the Simon Pelé neighborhood,

reveal a pattern of Haitian police stopping ambulances for extended periods of time, increasing the

likelihood that victims will succumb to their injuries:

35 UN Integrated Off. in Haiti, Quarterly Report on the Human

Rights Situation in Haiti (April-June 2025), at 13 (Aug. 1, 2025),

https://perma.cc/7BY4-RBU4 [hereinafter UN Quarterly Report

on Human Rights in Haiti (Q2 2025)]; UN Integrated Office in

Haiti, January 2026 Report, supra, ¶ 17; OHCHR March 2026

Report, supra, ¶ 6; GITOC Report, supra, at 18-19; see Dánica

Coto, Human Rights Watch Details Deaths from Police Drone Attacks in Haiti, Associated Press (Mar. 10, 2026),

https://perma.cc/447T-Z8BW (reporting that “[d]rones operated

by Haitian security forces and private contractors have killed at

least 1,243 people and injured 738 others”).

36 UN Quarterly Report on Human Rights in Haiti (Q2 2025), supra, at 13.

37 Id. at 12; UN Integrated Office in Haiti, January 2026 Report,

supra, ¶ 22.

38 UNODC, January 2026 Report, supra, ¶ 7.

13

The first victim of [the drone] attack was

a patient between 30 and 40 years old;

she had extensive wounds to her limbs

(right arm and right leg). She was conscious but showed signs of hemorrhagic

shock and also had an abdominal wound.

During her transfer to Tabarre (MSF

hospital), the police stopped the ambulance for more than twenty minutes. The

Haitian National Police (PNH) then inspected the vehicle, searching for

suspected gang members, while she was

inside. The staff of the Haitian State Ambulance (CAN) were also subjected to

verbal abuse during this time. The

woman inside unfortunately died.39

In another incident, a second ambulance transferring a child and parents was stopped by police for 15

to 18 minutes, endangering the patients.40 And on one

particularly egregious occasion, police and members

of self-defense groups attacked an MSF ambulance,

executed two MSF patients, and tear-gassed MSF

medical staff.41

As a result, MSF sometimes must suspend, or even

permanently close, operations at facilities to ensure

39 Protection of Civilians in Haiti: Drones (MSF internal docu-

ment); Testimony of Simon Pelé (Oct. 17, 2025) (MSF internal

document).

40 Id.

41 MSF, Where We Work: Haiti (2025), https://perma.cc/2D8W58DT; see also MSF, Press Release, MSF Outraged by Police Attack on Ambulance and Execution of Patients in Haiti (Nov. 13,

2024),

https://www.msf.org/haiti-msf-outraged-attack-ambulance-and-execution-patients.

14

the safety of its staff, volunteers, and patients.42 Indeed, for over a year, MSF has been unable to operate

its own ambulance service due to repeated threats and

attacks on MSF vehicles.43 Given the near-complete

lack of safe emergency transport, “many critically injured patients arrive late” and with “worsened

injuries because they were unable to access care earlier.”44

The violence has only grown worse in recent

months. “Despite severe constraints people face trying

to access care, MSF teams have recorded a marked increase in patients with violence-related injuries.”45 As

MSF recently reported, in the first two weeks of January 2026 alone, MSF treated more than 100 people

injured by violence at MSF’s hospital in the Drouillard

neighborhood of Port-au-Prince, including 66 with

gunshot wounds.46 That two-week figure alone “far exceed[ed] the monthly average” for gunshot wound

admissions at the same hospital in 2025.47 “The trend

42 See, e.g., MSF, Press Release, MSF Announces Permanent Clo-

sure of Our Turgeau Emergency Centre in Port-au-Prince (Oct.

15, 2025), https://www.msf.org/msf-announces-permanent-closure-our-turgeau-emergency-centre-port-au-prince; MSF, Haiti:

Escalating Violence in Bel Air, Port-au-Prince (Jan. 8, 2026),

https://perma.cc/5867-95RK (reflecting January 2026 further

suspension of “all [of MSF’s] activities in Bel Air until further

notice”).

43 MSF, Port-au-Prince: Over 100 Patients Admitted in Just Two

Weeks

as

Violence

Escalates

(Jan.

22,

2026),

https://perma.cc/VZ36-3DP6 [hereinafter MSF, Over 100 Patients Admitted in Just Two Weeks].

44 Id.

45 Id.

46 Id.

47 Id.

15

[of violence] shows no sign of slowing” in 2026, “highlighting the persistence and intensity of violence in

the capital.”48

2. Armed Groups Employ Sexual Violence to Expand Their Control.

Armed groups in Haiti are increasingly using organized sexual violence as a tool of combat and social

domination.49 As the UN has reported, and MSF likewise has witnessed, these groups have “systematically

resorted to gang rape” to “subjugate residents living

in areas under their control.”50 Armed groups frequently “have a stronger intelligence system” than the

government, and they use “extensive[]” premeditated

targeting to maintain control in these areas.51The severity of sexual violence in Haiti cannot be overstated.

Since opening a dedicated Port-au-Prince sexual violence clinic in 2015, MSF has treated more than

17,000 survivors, 98% percent of whom are women

and girls.52 And the numbers are increasing at an

alarming rate: “The number of survivors of sexual and

48 Id.

49 MSF defines sexual violence as “any unwanted sexual contact

without consent using force or coercion.” MSF, Sexual and Gender Violence Report, supra, at 3. MSF defines gender-based

violence “any harmful act that is perpetrated against a person’s

will, threats of such acts, coercion, and other deprivations of freedom based on socially ascribed gender differences between males

and females.” Id. This brief refers to both forms of violence as

“sexual violence.”

50 UN Quarterly Report on Human Rights in Haiti (Q2 2025), supra, at 3, 15; see also OHCHR March 2026 Report, ¶¶ 4, 10.

51 Christopher Hernandez-Roy & Juliana Rubio, CSIS, CSIS

Briefs: The Gender-Based Violence Crisis in Haiti (Sept. 2024),

https://perma.cc/7FL7-RKNK [hereinafter CSIS, Gender-Based

Violence Report].

52 MSF, Sexual and Gender Violence Report, supra, at 2.

16

gender-based violence who receive care at the clinic

has almost tripled from an average of 95 admissions

per month in 2021 to more than 250 in 2025,” according to MSF’s current head of mission in Haiti.53 Even

those extreme numbers seriously understate the scope

of the problem, given chronic underreporting of sexual

assault.54

Demonstrating the weaponized nature of sexual

assault, sexual violence involving armed perpetrators

has significantly increased. Prior to 2022, attacks involving armed perpetrators accounted for roughly

35% of the MSF clinic’s cases, but after 2022, that

number grew to 57%.55 MSF data reflect that instances of sexual violence occurring during broader

attacks on families or communities has increased

nearly fivefold since 2022.56 Now more than ever, even

children are targeted: according to UNICEF reporting, Haiti has witnessed a 1,000% increase in sexual

violence against minors between 2023 and 2025.57

53 Statement by Diana Manilla Arroyo, MSF Head of Mission.

54 The number of sexual and gender-based violence survivors in

all of Haiti vastly exceeds those who have been able to seek treatment through MSF. For instance, Haiti’s Single Health

Information System recorded 16,470 cases of sexual and genderbased violence in 2022 alone. UN Population Fund (UNFPA), Addressing Gender-Based Violence in Haiti (Jun. 2023),

https://perma.cc/N2FK-57K6. But underreporting makes determining the true extent of such violence “impossible” to know. Id.

55 MSF, Sexual and Gender Violence Report, supra, at 9-11.

56 Id. at 11 (citations omitted).

57 UNICEF, Haiti’s Children Under Siege: The Staggering Rise of

Child Abuse and Recruitment by Armed Groups (Feb. 7, 2025),

https://www.unicef.org/lac/en/press-releases/haitis-children-under-siege-staggering-rise-child-recruitment-armed-groups

[hereinafter UNICEF, Haiti’s Children Under Siege].

17

Sexual violence involving multiple perpetrators is

also now routine. From 2020 to 2021, 30% of the cases

in MSF’s Port-au-Prince clinic had involved multiple

perpetrators, but that number climbed to 58% between 2022 and 2025.58 On average, each such attack

has involved three perpetrators, but over 100 survivors were attacked by ten or more perpetrators.59 The

problem has only grown worse: a UN report addressing the second quarter of 2025 found that collective

rapes accounted for 85% of all sexual violence cases in

Haiti.60 In a majority of cases for which MSF provides

healthcare and treatment to female victims of sexual

assault, the victims were assaulted by multiple armed

perpetrators, and in many instances the victims had

previously suffered other such attacks.61

That sexual violence has essentially become a

weapon of war is demonstrated by a shift in the profile

of perpetrators and their targets. In prior years, sexual violence was usually committed by perpetrators

known to victims, such as intimate partners.62 Although MSF continues to see such cases, they are now

surpassed by the number of cases involving members

of armed groups.63 The demographics of sexual assault survivors has shifted as well; the age

58 Id. at 9.

59 Id. at 11.

60 Id. at 15; see also UN Integrated Office in Haiti, January 2026

Report, supra, ¶ 50 (reflecting that “[c]ollective rape remained

the predominant violation” in latter parts of 2025).

61 UNICEF, Haiti’s Children Under Siege, supra, at 13. Psychological scars remain long after an attack, particularly since many

women face community stigma after being sexually assaulted.

See id. at 1, 2, 12, 15-20.

62 Id. at 9.

63 Id.

18

distribution of survivors has become more even across

all age groups, with attacks on women aged fifty to

eighty years old increasing sevenfold since 2022.64

As armed groups spread, sexual violence follows.65

Studies by the UN and the Haitian NGO Nègès

Mawon found that rape often accompanies looting,

murder, and the destruction of property.66 Armed

groups target women and girls because they “hold the

families and community together,” and “physical and

emotional destruction [of women and girls] aims at destroying social and cultural stability.”67 Armed groups

thereby not only acquire physical territory but also

maintain psychological control.68

Horrific stories abound. As one example, in 2025,

five women and two men encountered an armed group

ransacking and vandalizing a car dealership.69 Multiple members of the armed group raped the women

64 Id.

65 Rampant sexual violence is a characteristic of countries expe-

riencing violent internal conflict or civil war. See, e.g., Caroline

Kapp, The Devastating Use of Sexual Violence as a Weapon of

War: Three New UN Reports Detail Atrocities in Ethiopia, Haiti,

and Ukraine, Think Global Health (Nov. 2, 2022),

https://perma.cc/UAK2-AVNB.

66 Id.

67 Ruth Seifert, The Second Front: The Logic of Sexual Violence

in Wars, 19 Women’s Stud. Int’l Forum 35, 39 (1996),

https://perma.cc/Q3HD-BQYG.

68 See UN Integrated Off. in Haiti (BINUH) & UN Off. of the High

Comm’r for Human Rights (OHCHR), Sexual Violence in Portau-Prince: A Weapon Used by Gangs to Instill Fear (Oct. 2022),

https://perma.cc/5ENV-J7SX [hereinafter BINUH & OHCHR,

Joint Report on Sexual Violence].

69 UN Quarterly Report on Human Rights in Haiti (Q2 2025), supra, at 7.

19

before shooting them dead.70 On another occasion in

May 2025, the UN reported that members of an armed

group raped, shot, and burned the bodies of two

women residing in one Port-au-Prince neighborhood

after the women allegedly visited another neighborhood that the armed group had declared to be off

limits.71 On another occasion, women were raped for

days by multiple armed groups during a five-week

blockage of a major national road.72

Accounts from women treated by MSF make plain

the pain and suffering that this weaponized use of sexual violence has caused:

Since that day [on which I was raped], I

have found myself living on the streets.

They took my son . . . as well as his father. Since then, I have had no news of

them. I am on the streets with my four

children. I have nothing left, no one . . . .

When I returned to my house, they had

burned everything down. I had a son who

owned a motorbike taxi . . . it was burned

as well. My entire future is gone; sometimes, I even feel like hurting myself, but

my daughter always comforts me.

Woman, age 51.73

It was truly a tragedy. I had to flee my

home without being able to take anything with me. When I returned home to

70 Id.

71 UN Quarterly Report on Human Rights in Haiti (Q2 2025), supra, at 8.

72 CSIS, Gender-Based Violence Report, supra.

73 MSF, Sexual and Gender Violence Report, supra, at 12.

20

collect clothes for my children, I came

across an armed man who was there, in

the hallway. Immediately, he called a

group of armed men who joined him.

They raped me, beat me, and threatened

to kill me. I didn’t know if I was going to

live or die, terrified at the thought of

leaving my children behind. Woman, age

41.74

Survivor accounts documented by other humanitarian organizations similarly reveal the brutality

and viciousness of the ongoing sexual violence in

Haiti:

Rose, a mother of four and five-months

pregnant, was severely beaten and

raped, in the presence of her children, by

three heavily armed masked men. The

latter had forced their way into her home

during an attack launched against the

residents of [her neighborhood] . . . . Earlier that day, Rose’s husband had been

shot dead by members of the same gang.

Before leaving, the armed individuals set

her house ablaze, forcing Rose and her

children to sleep out in the open in a public space for many nights.75

[H]eavily armed gang members forced

their way into Marie’s home in Cité Soleil. After her husband was executed

with a gunshot to the head, the armed

74 Id.

75 BINUH & OHCHR, Joint Report on Sexual Violence, supra, at

3.

21

men forced her to lay on top of his dead

body, and then they raped her one after

the other in the presence of her children.

After the attack, the assailants set her

house ablaze. She and her children had

time to get out of the house before it was

completely burned down, together with

the body of her husband.76

After surviving sexual violence, many women flee,

only to face the risk of additional sexual violence in

makeshift camps for internally displaced persons:

“One night, I was lying somewhere in the camp when

I suddenly felt someone touch me. I stood up, surprised, and saw three men surrounding me. I

screamed, but no one came to help me. All three raped

me.”77

B. Haiti Faces Complex

Emergencies.

Public

Health

The rampant violence just described alone demonstrates that it is not safe for TPS holders to return to

Haiti. But Haiti also faces public-health emergencies

that independently make it a gravely dangerous place

to live. Haiti’s healthcare system has collapsed, at the

same time the country is facing a resurgence of cholera at levels unseen elsewhere in the Western

Hemisphere.

76 Id. at 9.

77 Rachel Opota et al., UNICEF, A Silent Crisis: The Long Healing Process of Survivors of Sexual Violence in Haiti (June 26,

2025), https://www.unicef.org/haiti/en/stories/silent-crisis.

22

1. Haiti Cannot Provide Adequate Health

Services to Its Citizens.

Haiti’s healthcare system has almost entirely

fallen apart. Armed groups pillage pharmacies, clinics, and hospitals, “leaving these areas with little

access to essential medicines.”78 Purposeful attacks

and looting between 2023 and 2025 have struck important healthcare facilities such as St. Francis de

Salles Hospital, Bernard Mevs Hospital, Hôpital Sanatorium, and the National Faculty of Medicine and

Pharmacy.79 Since the start of these attacks, “70% of

the capital’s public health facilities have closed, depriving 4.4 million people of access to health care.”80

Even where healthcare facilities remain operating,

they often cannot be accessed due to the facility’s location, fear of violence, or lack of funds.81 First,

“[t]here are very few hospitals run by the Haitian

state; most hospital facilities are private, and people

do not have enough money to pay.”82 The dearth of accessible healthcare extends well beyond Port-auPrince. For instance, MSF’s facility in Port-à-Piment

“is now one of the few facilities offering comprehensive

care” in the southern part of the country, and the only

78 Statement by Jean Marc Biquet, MSF Head of Mission.

79 Id.; see also MSF, Over 100 Patients Admitted in Just Two

Weeks, supra.

80 Int’l Comm. of the Red Cross, Haiti: Making Impossible

Choices in a Health-Care System on the Verge of Collapse (Oct.

23, 2025), https://perma.cc/9PNH-SXRN.

81 Statement by MSF psychologist, Mental Health Team, Port-àPiment, Haiti.

82 Id.

23

one in that region offering hospital services for newborns.83

Second, the presence of armed groups effectively

limits the ability of people to travel for treatment.84

Injured patients must “cross long barricades, navigate

blocked roads, and pass through neighborhoods under

fire to reach one of the few hospitals still operational.”85 And “[f]ear is a major barrier to life-saving

care.”86 As described by Betsie Lewis, MSF’s Humanitarian Affairs Manager in Haiti:

Over the past nine months, I have spoken with more than 50 Haitian

colleagues, patients, and community

members across the North, West, and

South of the country. What has struck

me most is the depth of psychological

strain people must endure simply to survive daily life. For patients and staff

alike, fear shapes every step of the decision-making process: whether to leave

home, accept a referral, travel at night,

or remain in medical care. As a result,

people increasingly self-restrict their

movements, even when services exist,

weighing the risk of seeking care against

the risk of not returning home alive.87

83 Statement by MSF project coordinator, Port-à-Piment, Haiti.

84 Statement by MSF Health Promotion Staff, Cité Soleil, Haiti.

85 MSF, Port-au-Prince: Over 100 Patients Admitted in Just Two

Weeks, supra.

86 Statement by advisor to MSF Head of Mission.

87 Statement by Betsie Lewis, MSF Humanitarian Affairs

Manager, Haiti.

24

In fact, “an average of 40% of [MSF] patients refuse necessary referrals to hospitals in other parts of

the city, out of fear of being caught in crossfire or accused of belonging to an armed group. This includes

elderly people and women with children.”88

Ongoing conflict similarly limits access to crucial

medical supplies. For example, in summer 2024,

armed violence prevented supplies from reaching

Port-au-Prince for three months, disrupting access

not only to basic supplies but also other crucial medicines like HIV treatment.89

MSF’s on-the-ground experience confirms that the

health-related fears expressed by plaintiffs are wellfounded. Many TPS holders would be particularly

vulnerable to illness or death if forced to return to

Haiti. As Mr. Miot explained, returning to Haiti

“would likely sooner or later be a death sentence”

because he has Type 1 diabetes, and reliable access to

insulin cannot be guaranteed.90 The same is true for

Ms. Noble, who suffers from spinal tuberculosis.

Returning her to Haiti, where she has no known

family and has not lived since she was two years old,

means sending her to a country that “has no

functional health care system to treat [her] health

issues.”91

88 Statement by advisor to MSF Head of Mission, Haiti.

89 MSF, Medical Supplies Arrive in Haiti After Three-Month Disruption (June 21, 2024), https://perma.cc/W7VS-GLBN; MSF,

Closed Ports, Empty Shelves: Haiti Urgently Needs Medical Supplies (May 21, 2024), https://perma.cc/EKS7-SQ6N.

90 Miot Decl. at 4-5.

91 Decl. of Marlene Gail Noble at 6 (Dkt. 81-4); see also Laguerre

Decl. at 7.

25

2. Severe Disease Outbreaks Threaten

Haiti’s People.

Haitians suffer from numerous communicable diseases that do not exist in the United States—most

notably, cholera. Cholera is caused by a bacterial infection of Vibrio cholerae, usually ingested through

water contaminated with fecal matter, which disrupts

the intestinal lining and produces severe diarrhea.

The resulting dehydration and loss of electrolytes can

trigger organ failure, disrupt heart rhythms, and lead

to hypovolemic shock and cardiovascular collapse.

Following the 2010 earthquake, Haiti experienced

what was then the worst cholera outbreak worldwide

in modern history, sickening more than 800,000 Haitians and killing approximately 10,000. Responding to

that outbreak required a sustained, international effort. MSF, for example, mobilized more than 1,150

international and Haitian staff to operate 21 temporary cholera treatment centers throughout Haiti.

Through that global effort, the first cholera outbreak

was eventually contained, but not until 2019—nine

years after it started.

Unfortunately, the conditions for widespread disease soon returned. As a result of recent violence,

roughly 12 percent of Haiti’s population—1.4 million

people—has been displaced from their homes, double

the figure recorded one year earlier.92 Many of these

displaced persons now reside in spontaneous, makeshift sites around Port-au-Prince and elsewhere.

These makeshift communities are overcrowded and

lack access to clean water and basic sanitation. As

MSF’s head of mission explained: “Stagnant water,

92 See, e.g., OHCHR March 2026 Report, ¶¶ 16, 48.

26

broken sewage lines, and the accumulation of trash

across the city create ideal conditions for outbreaks to

spread whenever the rains come.”

Cholera is now again resurgent. In 2022, MSF

opened three cholera treatment centers, which immediately reached full capacity, and distributed millions

of liters of clean water. Nonetheless, as of November

2025, the current epidemic has sickened more than

90,000 Haitians—a third of them children under the

age of nine—and has led to thousands of deaths. In a

two-month period between September and November

2025, a single outbreak in one neighborhood in Portau-Prince resulted in almost 400 cases and more than

a dozen fatalities.

Cholera outbreaks require prompt hospitalization.

With quick access to proper care, it is an easily treated

disease. Without such care, cholera can turn deadly in

a matter of hours. But, as explained, Haiti’s public

healthcare system is essentially non-functional, and

Haitians risk grave personal harm simply by seeking

to travel from one neighborhood or community to another for treatment.

Preventative efforts have proven equally difficult.

To respond to the 2010-2019 cholera epidemic, Haitians and international organizations, including MSF,

undertook a decade-long campaign involving administering oral vaccines, conducting laboratory testing

and diarrheal disease surveillance, expanding access

to clean water and sanitation, deploying over 10,000

volunteers trained on hygiene and sanitation practices, and opening almost 300 cholera treatment

centers. Those systematic interventions were possible

because Haiti at that time possessed a more functional government with comparatively little violence.

27

But similarly systematic interventions are not possible in Haiti today: the government controls only

limited territory; aid workers cannot easily access violence-plagued areas; patients cannot reach hospitals

or are too afraid to travel to them; and necessary medical supplies cannot reliably enter Haiti, meaning

rates of cholera and other transmittable diseases are

likely only to worsen.

II. The District Court’s Stay Protects Haitian

TPS Holders.

As the district court rightly concluded, Haiti is not

“on the brink of recovery” but rather is “a nation deep

in crisis.” J.A. 680, 687. Or as the UN’s Secretary-General put it just months ago: “The people of Haiti are in

a perfect storm of suffering.” J.A. 687 n.29 (alteration

omitted). Conditions remain dire, especially as

“armed conflict is only intensifying in residential areas.”93 Humanitarian organizations have little to no

spare capacity available to help care for returning

TPS holders.94 Extinguishing the district court’s stay

would likely mean death, injury, sexual assault, and

other profound harms for thousands of people forced

to return to Haiti. In MSF’s view, “[e]nding protected

status could not come at a worse time.”95

93 MSF, February 2026 Statement, supra.

94 See e.g., UN Int’l Org. for Migration (IOM), Violence Triggers

Record Displacements in Port-au-Prince: Over 60,000 People in a

Month (Mar. 18, 2025), https://perma.cc/8BGF-9C6Z (explaining

that “[r]esources are stretched thin, and humanitarian needs far

exceed the current response capacity”).

95 MSF, February 2026 Statement, supra.

28

CONCLUSION

MSF works in conflict zones, in areas stricken by

natural disasters, and throughout parts of the world

where epidemics routinely claim lives. Haiti has

suffered the peril of all three. From MSF’s first-hand

experience, it can confirm that current conditions in

Haiti prevent TPS holders from returning to the

country in safety.

Absent temporary protected status, TPS holders

may face immediate removal to Haiti. Once there,

they will face an extremely high risk of violence,

including kidnapping, rape, mutilation, and murder.

TPS holders may also become victims of one of the

country’s public health epidemics or die in the absence

of a functional healthcare system. This fate looms

large, particularly for individuals with pre-existing

medical conditions.

For the foregoing reasons, MSF respectfully urges

the Court not to disturb the district court’s stay of the

termination of TPS status for Haiti.

29

Respectfully submitted,

Jeffrey E. Sandberg

Counsel of Record

Abby C. Wright

Larissa Davis

Matthew C. Quallen

COVINGTON & BURLING LLP

One CityCenter

850 Tenth Street NW

Washington, D.C. 20001

(202) 662-6000

jsandberg@cov.com

Khala James

COVINGTON & BURLING LLP

Salesforce Tower

415 Mission Street, Ste 5400

San Francisco, CA 94104

(415) 591-6000

Counsel for Amicus Curiae

April 13, 2026