PORT-AU-PRINCE, HAITI -- 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 Moise. The killing worsened criminal control of Haiti and today the innocent are regularly killed, raped and held for ransom. A local non-profit 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 organizations -- 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 health care, 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 organization Dorsainvil works for, El Roi Haiti, has offered medical care, education and other basic services. The organization 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 US$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 organizations 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 organization'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 neighbourhood, 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.

Segura, of the International Crisis Group, said fewer women have given birth in hospitals, which could boost infant and maternal deaths. She also said that gangs have been trying to provide aid services to the communities they terrorize in an effort to project a sort of Robin Hood image.

The international community has attempted to address Haitian disorder in the past, with some success, and Kenya's Foreign Ministry said Saturday that it had offered 1,000 police to help train and assist the Haitian National Police "restore normalcy in the country and protect strategic installations."

U.S. State Department spokesman Matthew Miller wouldn't provide details Monday on what was being done to locate and recover Dorsainvil and her daughter. Haitian authorities have not responded to multiple called and messages from the AP.

"Obviously, the safety and security of American citizens overseas is our highest priority. We are in regular contact with the Haitian authorities. We'll continue to work with them and our U.S. government interagency partners, but because it's an ongoing law enforcement investigation, there's not more detail I can offer," Miller wrote in a statement Monday.

In a video for the El Roi Haiti website, Alix Dorsainvil describes Haitians as "full of joy, and life and love" and people she was blessed to know.

Dorsainvil graduated from Regis College in Weston, Mass., which has a program to support nursing education in Haiti. Dorsainvil's father, Steven Comeau, reached in New Hampshire, said he could not talk.

In a blog post Monday, El Roi Haiti said Alix Dorsainvil fell in love with Haiti's people on a visit after the devastating 2010 earthquake in the Caribbean. It said the organization was working with authorities in both countries to free her and her daughter.

"Please continue to pray with us for the protection and freedom of Alix and her daughter. As our hearts break for this situation, we also continue to pray for the country and people of Haiti and for freedom from the suffering they endure daily."

------

Janetsky reported from Mexico City. Michael Casey in Boston contributed to this report.