For people fleeing Guatemala, Honduras and El Salvador – the countries of the Northern Triangle of Central America (NTCA) – gang-related murders, kidnappings, extortion, and sexual violence are daily facts of life.
Central Americans fleeing violence often face more of the same along the migration route through Mexico. In 2017, MSF published a special report based on two years of research into the medical needs of refugees and migrants in the region.
Violence while on the move
The report, ‘Forced to Flee from the Northern Triangle of Central America, a Neglected Humanitarian Crisis’, examines medical data, patient surveys and testimonies gathered by MSF teams during two years of direct medical attention. The report illustrates the extreme level of violence experienced by people fleeing the NTCA, and the need for greater care and protection of people along the migration and refugee route.
MSF’s direct experience on the ground points to a broader humanitarian crisis in Central America. Despite the catastrophic conditions in the region, the US and Mexico generally treat people from the Northern Triangle as economic migrants, and have focused efforts on detention and deportation rather than on providing protection and support. MSF is calling on the US and Mexico to provide humane treatment to all refugees, asylum-seekers, and migrants and to stop deportations of vulnerable people back to a dangerous region.
In my country, killing is ordinary - it is as easy as killing an insect with your shoeA Honduran man, who fled after refusing gang members' demand for protection money, and later shot three times
The cities of San Salvador, the capital, and Soyapango, to the capital’s east, have some of the highest rates of violence in El Salvador. The majority of the population who reside in urban and marginal urban areas, dominated by gangs known as marras, live in constant fear of violence. This situation has caused many to leave their homes in search of a safer life elsewhere, like thousands of others across the Northern Triangle.
In 2018, MSF teams returned to El Salvador for the first time since providing aid in the wake of Hurricane Ida in 2009. We have now opened the first projects since regular activities were closed in 2001 and are providing health services for people who have been affected by violence and are unable to attend health centres, or are afraid to do so.
Through mobile health teams, MSF provides weekly primary care to people who have difficulty accessing health services. General medicine, sexual and reproductive health, and clinical psychology services are provided. Teams are working with community health promoters to raise awareness about healthcare and promote MSF services.
In addition, we provide mental health support through psychologists who work in the communities, providing psychological services and facilitating psychosocial activities for patients. We also run an ambulance service in the areas where high levels of violence prevent access for regular health providers.
One of the most violent countries in the world, many in Honduras are also seeking a better life and head north towards Mexico and the US.
The streets of major cities like Tegucigalpa, the capital, and San Pedro Sula are gripped by crime and conﬂict. Domestic and sexual violence are also widespread, with women and children bearing the brunt. Corruption, fear of retribution, and limited access to essential health services often leave victims with no protection and few choices but to leave home.
To address these issues, we launched our servicio prioritario, or priority service, to oﬀer emergency medical and psychological care to victims of violence. In cooperation with the Honduran Ministry of Health, this free and conﬁdential service has treated patients at two health centres and at Tegucigalpa’s main hospital since 2011.
Nueva Capital, on the outskirts of Tegucigalpa, is one of the most dangerous settlements in the area. Most people here live in deep poverty, without even basic government services like water, sanitation, and electricity. MSF recently rehabilitated a clinic originally built by members of the community in Nueva Capital’s sector two. A team provides primary and mental healthcare to as many as 60,000 people from the region.
With many being forced from home, we are having to adapt services for people on the move, and are implementing a new survey at our projects in Honduras to screen for people who have left their homes and to assess their medical and psychological needs. When they arrive for their appointments at MSF clinics, patients are asked to complete an anonymous questionnaire about their displacement status. Together with demographic data, the results of the survey will help our teams to tailor health services to those who need care the most.
In Choloma, northwest of Tegucigalpa, near the industrial hub of San Pedro Sula and the border with Guatemala, crime is both endemic and rampant. As in Tegucigalpa, women and girls are often most at risk. Here, too, our teams oﬀer mental and sexual and reproductive healthcare services, with a focus on care for survivors of sexual violence.
In early 2017, MSF teams began supporting a local Ministry of Health clinic in Choloma that was struggling with budget and staﬀ limitations. The facility now provides sexual and reproductive health services and emergency care, and helps pregnant women avoid overcrowded public hospitals. Elsewhere in Choloma, our outreach teams provide preventive and curative services, including health education and counselling, twice weekly at another clinic in the La López neighbourhood.
Those who make their way through Honduras and Guatemala and into Mexico do not ﬁnd any guarantee of safety.
It’s in this context that MSF teams have been providing medical and mental health care to migrants and refugees along the migration routes through Mexico since 2012. Between January 2013 and December 2016, we provided more than 33,000 consultations at mobile health clinics, migrant centres, and local hostels (albergues).
Our teams provide primary health care and psychosocial services at points along the migration route, treating patients at the La 72 migrant shelter in Tenosique, and at the Casa del Migrante shelter in Coatzacoalcos.
Many of our patients need medical and mental health support due to the extreme violence, threats, rape, or extortion or abuse suffered in their home countries. People also suffer from torture, kidnapping, and psychological abuse while they are on their journeys north, and once they reach Mexico. Treatment for women often includes medical and psychosocial care for victims of sexual violence. Teams provide primary care as well as treatment for acute and chronic diseases whenever possible.
The brutal violence endured by many migrants and refugees in the NTCA triangle and along the migration route in Mexico, has also prompted us to open a Centre for Integral Attention in Mexico City in July 2017. The Centre provides shelter, social and medical care, and psychological rehabilitation for survivors of torture or any other form of appalling abuse or persecution.
Reynosa, a border city home to more than 600,000 people on the banks of the Rio Grande, is a common rest stop for many Central American migrants hoping to gain entry to the US. It’s also one of the most violent cities in Mexico, convulsed by conﬂict between criminal cartels vying for territory. The presence of Mexican military police in the streets does little to ease the tension, which takes a heavy psychological toll on both permanent residents and migrants passing through.
Here, MSF teams provide medical and psychological care, along with social services, to both the local communities and to migrant communities, including those who are passing through. A team comprising a doctor, nurse, social worker, and psychologist work at a ﬁxed clinic, while mobile teams visit two migrant shelters, Casa del Migrante Guadalupe and Senda de Vida. Teams also work in a shelter for minors, Centro de Atención al Menor Fronterizo (CAMEF).
Teams have recently started working in shelters in the border town of Nuevo Laredo providing basic medical and mental health care to migrants and asylum seekers.