In Haiti, nearly 150 people have been killed and scores have been injured in gunfights between warring gangs, as the latest wave of violence has paralyzed much of the sprawling capital, Port-au-Prince.

MSF said on Thursday that it had treated more than 96 people with gunshot wounds in its Port-au-Prince medical facilities since April 24.

“The number of trauma admissions received per week has tripled since mid-April, and the majority are very serious gunshot wounds requiring extensive care,” said Mumuza Muhindo, MSF’s head of mission in Haiti, in a statement on Thursday. “The Haitian people are in a very vulnerable situation.”

The National Human Rights Defense Network discovered earlier this week that up to 148 people had been killed during intense battles between the 400 Mawozo and Chen Mechan, two feared rival gangs.

During a bloody fortnight of fighting, gang members raped women and girls and burned people alive, according to a report released on Tuesday by the organization. Gangs murdered 47 people in one neighborhood before burning 17 of their bodies and burying the rest in mass graves.

The report claims that “a massacre of incredible cruelty was perpetrated,” and that authorities did little to stop the violence. “There was no reaction at the highest level of the state.”

According to charities working in the capital, many residents fleeing violence have arrived at makeshift shelters, sometimes just a few blocks from their homes, where they face little humanitarian assistance and risk exploitation.

Roadblocks have been erected in gang-controlled areas throughout Port-au-Prince, preventing ambulances and aid vehicles from moving. MSF reported that some patients they saw could only reach a hospital after a 24-hour delay due to gang-manned barricades.

According to analysts, the increase in violence is also due to a growing feud between the 400 Mawozo and G9 gangs, which erupted when the former invaded the latter’s territory.

“Occupying more territory would have given them more leverage to negotiate electoral votes and access to more businesses that can be extorted for protection,” said Louis-Henri Mars, founder and executive director of Lakou Lapè, a local peace-building organization.

Since its bloody independence from French colonists two centuries ago, Haiti, the world’s first black republic, has been plagued by violence, political instability, and foreign meddling.

Today, the situation is particularly bleak, as gangs continue to wage war on each other, the authorities, and civilian populations, often with the tacit support of political and business elites.

The country is still reeling from the effects of a series of overlapping crises that occurred last year. President Jovenel Mose was assassinated in his hillside home in July. A month later, an earthquake with a magnitude of 7.2 struck Haiti’s southern peninsula, killing over 2,000 people and destroying tens of thousands of homes.

Last autumn, a wave of kidnappings – of rich and poor alike – paralyzed much of the capital, while the deportation of over 10,000 Haitians from the United States’ southern border to Port-au-Prince exacerbated the unrest.

But scenes in the capital, where murder, kidnapping, and gun battles are commonplace, have rarely been so bleak.

“This is the worst violence-related crisis we’ve ever seen,” Fiammetta Cappellini, country director for the Italian aid organization AVSI, said. “More and more areas of the capital, which were previously thought to be’safe,’ are now battlefields; thousands of people are fleeing their homes.” After the extradition of Joly “Yonyon” Germine, a leader of the 400 Mawozo gang, to the United States on Tuesday, violence in the Caribbean country appears unlikely to abate. Germine was charged in the United States last October for his role in the kidnapping of 17 members of an Ohio-based missionary organization.

Cappellini went on to say that the international community had for far too long ignored Haiti’s plight. “Something has to be done now,” said the aid worker, who has been in Haiti for over a decade. “Before it’s too late, and the country descends into hell with no way out.”