At least three people have been killed when armed men in Haiti opened fire at journalists, police and medical staff during a briefing to announce the reopening of the country's biggest public hospital. Many others injured were injured in Tuesday's attack in the General Hospital in the capital Port-au-Prince. Pictures posted online appear to show several people injured or dead inside the building. The site had been recaptured by Haiti's government in July, after being occupied and destroyed by violent gangs that control much of the city. Journalists were waiting for the arrival of Health Minister Lorthe Blema when the shooting began. Reports say two journalists and a police officer were shot dead. "It felt like a terrible movie," Dieugo André, a photojournalist who witnessed the violence, was quoted as saying by The Haitian Times. "I have the blood of several injured journalists on my clothes." The attack is reported to have been carried out by members of the Viv Ansanm gang. In a video statement, the head of Haiti's presidential transitional council, Leslie Voltaire, said: "We express our sympathy to all the victims' families, in particularly to the Haiti National Police and all the journalists' associations. "We guarantee them that this act will not remain without consequences." The people of Haiti continue to suffer with unbearable levels of gang violence, despite the installation of a new transition government in April and the deployment of an international force led by Kenyan police officers six months ago. Haiti has been engulfed in a wave of gang violence since the assassination in 2021 of the then-president, Jovenel Moïse. An estimated 85% of Port-au-Prince is still under gang control. The UN says that as many as 5,000 people have been killed in violence in Haiti this year alone, and the country is now on the verge of collapse. In under a month, Mr. Trump will assume the presidential megaphone with Mr. Musk and Mr. Ramaswamy as his spending enforcers. But budget experts see little hope that the three will be able to meaningfully shift the nation’s fiscal trajectory. The Congressional Budget Office projects that the national debt will reach 166 percent of gross domestic product by 2054, up from about 99 percent of G.D.P. at the end of 2024. Skip to contentSkip to site indexSearch & Section Navigation Subscribe for $0.25/week Government Spending Bill Congress Averts Shutdown Biden Signs Spending Bill Trump Tried to Evade Shutdown Blame G.O.P. Spending Hawks Defy Trump Spending Fight Shows Limits of Trump Power to Change Fiscal Path Efforts to cut government spending and eliminate waste are dwarfed by the rising costs of the social safety net programs and interest expenses. Listen to this article · 8:12 min Learn more Share full article 1.6k The businessman Elon Musk carrying his son X Æ A-Xii Musk on his shoulders, followed by others, including Vivek Ramaswamy, on Capitol Hill this month. The businessman Elon Musk, with his son, and Vivek Ramaswamy on Capitol Hill this month. Budget experts see little hope that the pair, along with President-elect Donald J. Trump, will be able to meaningfully shift the nation’s fiscal trajectory. Credit...Haiyun Jiang for The New York Times Alan Rappeport By Alan Rappeport Reporting from Washington Dec. 24, 2024 Updated 6:15 p.m. ET When Elon Musk and Vivek Ramaswamy, the businessmen that President-elect Donald J. Trump tapped to lead his new Department of Government Efficiency, met with lawmakers in early December, they laid out their plans for cutting federal spending and eliminating waste. Less than two weeks later, they helped topple a 1,500-page spending bill and brought the federal government to the brink of a shutdown over objections to the billions of dollars of so-called pork spending in the legislation. But the streamlined package that lawmakers ultimately passed failed to offer spending restraint. During the negotiations, Mr. Trump even called for abolishing the nation’s statutory debt limit, which Republicans have long used as a tool for forcing painful budget cuts. The frenzy demonstrated the clout that Mr. Musk and Mr. Ramaswamy have as they establish their new waste-cutting enterprise. But the outcome also underscored the limits the initiative will face as it tries to curb spending. In recent decades, the federal government has become increasingly sprawling and Congress has become more fractious, making it difficult to put a dent in a national debt that has topped $36 trillion. Advertisement SKIP ADVERTISEMENT In under a month, Mr. Trump will assume the presidential megaphone with Mr. Musk and Mr. Ramaswamy as his spending enforcers. But budget experts see little hope that the three will be able to meaningfully shift the nation’s fiscal trajectory. The Congressional Budget Office projects that the national debt will reach 166 percent of gross domestic product by 2054, up from about 99 percent of G.D.P. at the end of 2024. Image Representative Thomas Massie, wearing a badge that shows the rising national debt. Representative Thomas Massie with a badge showing the rising national debt during a congressional hearing in September. Credit...Tom Brenner for The New York Times “They have no authorities whatsoever,” said Douglas Holtz-Eakin, who served as the chief economist in President George W. Bush’s Council of Economic Advisers. “They don’t control the scope of government. They don’t control the size of government.” Mr. Holtz-Eakin, who also served as the director of the Congressional Budget Office, noted that Congress has the power of the purse and suggested that the Department of Government Efficiency would be little more than a think tank. Advertisement SKIP ADVERTISEMENT “They have the bully pulpit, but that’s truly it,” he said. Mr. Musk and Mr. Ramaswamy have said that they want to cut $2 trillion of federal spending over an unspecified period of time by shrinking government agencies and eliminating fraud and waste. That is nearly the size of the 2024 fiscal year deficit alone and just a sliver of $20 trillion that the U.S. economy is projected to borrow over the next decade. House Republican leaders have floated a pledge to cut spending by $2.5 trillion in “mandatory” spending, which typically goes toward programs such as Medicaid and food stamps, and to raise the debt limit in separate legislation next year. The United States spent $6.7 trillion in 2024, including more than $800 billion on the military. But the bulk of the country’s spending comes from mandatory programs including Social Security and Medicare, along with soaring interest expenses. Those costs are expected to continue rising as the population ages and more people begin claiming retirement and health care benefits. Mr. Trump has pledged not to cut entitlement programs and Republicans are loath to slash military spending. That leaves scant space to scale back the biggest drivers of the debt. Advertisement SKIP ADVERTISEMENT “While it’s good to improve the efficiency and effectiveness, to the extent that you are not focusing on the 50 percent of the federal spending, which is entitlement programs, you’re not really going to make a big dent in our debt and deficits,” said William Hoagland, a senior vice president at the Bipartisan Policy Center. Image