Two days before Christmas, Dr. Pierre S. Prince took an exciting new job as director of Haiti’s largest public hospital, which the United States spent tens of millions of dollars renovating and is so deep in gang territory that it has been closed for a year.

Prince, a thoracic surgeon, looked forward to returning to the State University Hospital of Haiti, which had been ravaged by the 2010 earthquake that decimated the country’s capital.

He did his residency there and was going to oversee a new wing, a 500-bed facility with nearly $100 million in renovations and a range of services, including operating rooms, orthopedics and a maternity and neonatal unit.

On Christmas Eve, as he headed to work, gangs attacked a news conference scheduled to announce the hospital’s partial reopening, killing a police officer and two reporters, and injuring seven other journalists.

The reopening never happened.

The situation worsened last month: Videos that circulated on social media and were verified by The New York Times showed an older building at the general hospital, as it is commonly known, engulfed in flames. Gang members had apparently set it on fire.

“The doctors are scared, and our residents and interns are depressed,” Prince, 57, said. “Some of them have left. The morale is very low.”

The hospital’s fate underscores the desperate conditions facing Haiti and its international donors as they try to rescue Port-au-Prince from the control of armed gangs, which have targeted foreign-financed health facilities.

Haiti, where the United Nations says about 20% of its 10 million people are enduring acute levels of hunger and 1 million have fled their homes because of violence, is particularly dependent on foreign aid and had been receiving up to $400 million a year from the United States.

But as Elon Musk takes an axe to U.S. foreign aid around the world and dismantles the U.S. Agency for International Development, programs such as the continued renovation of the general hospital in Port-au-Prince are in the crosshairs.

The hospital’s new wing, which USAID helped pay for, was already plagued by large cost overruns and a decade of construction delays. Now, it is being battered by repeated assaults from criminal groups as Haiti’s capital has become a lawless quagmire despite billions of dollars in international aid.

“The general hospital is sort of like a case study on how it goes wrong,” said Jake Johnston, a researcher at the Center for Economic and Policy and Research who wrote “Aid State,” a blistering account of how billions in international aid failed to bolster Haiti’s public institutions. “And they never finished the work, and the general hospital is closed for all these other reasons.”

Haiti’s general hospital was built next to the presidential palace in downtown Port-au-Prince by the U.S. Army Corps of Engineers during the U.S. occupation of Haiti, from 1915-34.

For years, many patients were gunshot and torture victims. In a country where politicians and wealthy elites travel to the Dominican Republic or Miami for health care, the general hospital served the overwhelmingly poor masses.

“It housed the only dialysis machines in the country,” said David Ellis, an American who runs a medical helicopter service in Port-au-Prince. “It was, when open, the most comprehensive surgical center in the country.”

It was so badly damaged in the 2010 earthquake that no one was able to treat the hundreds of severely injured people gathered outside, their bloody mangled limbs exposed to the dusty air.

Renovating the hospital was one of the first projects approved by an international reconstruction committee formed to rebuild Haiti after the earthquake. France committed $40 million, the United States $25 million.

After a series of delays and contract disputes, it was slated for completion in June 2023 — nine years later than planned.

At the same time, the political situation in Haiti deteriorated precipitously. The president was assassinated in 2021, and kidnappings and killings soared.

In July 2022, USAID increased its contribution by $10 million because the Haitian government could not pay its share, according to a 2023 report by the Government Accountability Office, a congressional watchdog agency.

The hospital was just one of several projects the GAO examined that ended up over budget. The United States spent $2.3 billion to support Haiti’s reconstruction in the decade after the quake, and only half of the eight major projects that the GAO reviewed were completed.

While a key power plant and 900 homes were built in Port-au-Prince, two projects, including building a new port, were scrapped when costs soared and two others — including the general hospital — were still ongoing.

Technical and political disputes caused significant delays and cost overruns at the hospital, the GAO said.

But the hospital limped along, half-open, while work on the new wing stalled.

Then a year ago, a coalition of gangs banded together to attack police stations, prisons, hospitals and communities. Gangs set homes on fire. And entire neighborhoods, including the downtown area that is home to the hospital, cleared out.

With the area too perilous, the more than 800 people who work at the hospital have been paid to stay home for nearly a year.

Even though police barracks are nearby, gangs plundered the general hospital. The governments of the United States, France and Haiti had already spent about $90 million on it. Electrical wiring, plumbing and equipment were stolen, although much of the new medical equipment had not yet been installed, Prince said.

The damage was estimated at $3 million to $4 million and could set the project back an additional two years — if the security situation ever improves enough for the hospital to reopen, he said. Now, Prince says they are scouting for a new temporary place to work.

Under the Trump administration’s new push to eradicate foreign aid, funds for most projects financed by USAID were frozen, although a judge recently ruled that the agency had to fulfill past contracts.

Asked about the hospital’s status, the U.S. State Department, which has assumed control of the aid agency, said it would conduct a review with the goal of “restructuring assistance to serve U.S. interests.”

“Programs that serve our nation’s interests will continue,” the State Department said in a statement. “However, programs that aren’t aligned with our national interest will not.”

The Haitian Ministry of Health did not respond to requests for comment.