PORT-AU-PRINCE, Haiti – Skinny youths in ragged T-shirts crowd menacingly around the barred kitchen door of a city-run nursing home, waving empty bowls and demanding some of the sardines and mashed corn that the elderly residents depend on.
"Thieves! Thieves!" 68-year-old Exume Fleurentis yells from a dusty porch nearby, swinging a broken crutch over his head.
Hungry themselves, the youths ignore the partially blind man. They scamper off after kitchen workers give them some food, leaving a little less for the residents of the Asile Commune.
Food is just one of the challenges for the Asile home, as well as for elderly Haitians scattered through the mud-prone camps of tents, tarps and bed sheets that barely cover hundreds of thousands left homeless by the January 2010 earthquake that killed more than 300,000 people.
In Port-au-Prince's crowded encampments, about 20 percent of elderly quake victims are going hungry a year after the disaster, according to a survey by HelpAge International, a network of non-profits that helps disadvantaged elderly people across the globe. About 11,000 older Haitians living in camps were interviewed. More than 2,300 reported eating just one meal a day or less.
Things were supposed to be getting better at Asile Commune, a two-story concrete building surrounded by tarps and tents that shelter about 2,000 quake victims on the edge of the Bel-Air slum.
The old age home drew worldwide attention when Associated Press journalists visited after the quake and found dozens of seniors sleeping in the dirt among running rats and begging for water. Six residents died in the quake, and three more died soon after, apparently from hunger and exhaustion.
Stirred to response, British-based HelpAge assumed day-to-day management of the nursing home, taking over from the Port-au-Prince government. The group brought in a full-time doctor, two nurses, medicine, wheelchairs, walkers and other aid.
Conditions steadily improved — for a while. But after six months, municipal authorities ordered HelpAge to leave. The aid group said the mayor had demanded it pay the salaries of city workers at the home.
"Unfortunately, we have not been allowed to work at the Asile Commune since August after the mayor expelled us from the site," said HelpAge spokeswoman Caroline Graham.
Mayor Jean-Yves Jason Muscavin declined to speak to AP reporters who stopped by his office twice. He did not respond to several phone messages and texts for him over several days.
Now some residents say they haven't seen a doctor in months. Staffers have no syringes, antibiotics, latex gloves or other supplies. There is no nurse at night. Security is minimal. Dried excrement litters one vacant room.
Residents have little to occupy their time, most just sprawled listlessly on cots.
"We have nurses around during the day, but it's like not having any nurses at all. They don't do anything," said Fleurentis, his voice thick with frustration. "One time I was very sick with stomach pains and the nurses never even bothered to give me a pill. Why? There are no pills!"
Seventy-five-year-old Roseana Delon complained that she has not received any medication or seen a doctor in months. She fingered a loose bandage on her left leg, which she said has lost all feeling.
"I would be happier if I could go to a hospital and get my leg and foot amputated," Delon said weakly.
Employees, too, are frustrated. They say the city owes them three months of back pay.
"We care about people here and we do the best we can. If it were just for the salary, I would have left here long ago," said longtime caregiver Eline Darisma.
He said two elderly residents died of cholera about three months ago due to unsanitary conditions, prompting the city to create a "cholera treatment center" — a large tent with a couple of plastic buckets inside.
But Darisma said that if a client falls ill, the patient is put into a group taxi and sent to a hospital.
In the days after the deadly quake, a few thousand refugees took up residence in the nursing home's courtyard and many remain. Some have even commandeered vacant rooms in the nursing home to escape life in a tarp on flood-prone ground.
It's a pattern repeated elsewhere: Where people are desperate, they often shunt the weakest and oldest aside.
Elderly Haitians are unusually vulnerable because they have no government social security system. "So elderly people are mainly dependent on their children and relatives," said Cinta Pluma, a spokeswoman for Oxfam in the Caribbean country. And aid groups stopped distributing meals months ago in the sprawling camps.
In a vast camp occupying the Petionville Club golf course, Lisbonne Nicolas spends her days resting on plastic detergent bags laid out on the dirt. In her 90s, she is relatively lucky; she had a daughter and two grandchildren at hand.
Nearby, 69-year-old Alfred Saint Louis alone cares for his wife, Dieula, who is partially paralyzed. He said they have not gotten any help from aid groups or neighbors for more than half a year. He makes a little money mending clothes with an old sewing kit and said he still has some savings to buy supplies in makeshift markets that dot the encampment.
When his wife needs medicine, he treks a mile (more than a kilometer) on a dirt track through the camp to reach a clinic that sells drugs.
"It is difficult," he said, "but I have to keep it up or else my wife will die."