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.
US migration policies that trap, endanger and deport people
Policies that the US have initiated - and which Mexico has implemented - include the Migrant Protection Protocols (MPP), better known as the 'Remain in Mexico' policy, where asylum seekers to the US, arriving at the US/Mexico border, are turned back to Mexico to await their asylum process there, leaving them trapped and extremely vulnerable in some of the world's most dangerous cities.
In addition, the US has signed bilateral agreements each with Honduras and El Salvador, which effectively push the responsibility for protection for migrants and asylum seekers on to the two countries - who are least able to afford protection to people.
We call 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
From January to August 2019, MSF teams in projects serving migrants, asylum seekers and returnees across the region have provided:
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 September 2019, the United States and El Salvador signed an agreement that is part of a comprehensive strategy by the Trump Administration to shift US asylum and protection responsibilities to other governments in the region. El Salvador is not able to guarantee protection even for its own citizens.
In 2018, MSF teams returned to El Salvador for the first time since providing aid in the wake of Hurricane Ida in 2009. MSF resumed operations starting with opening community health and mental health clinics, in places where access to health services has been affected by violence in neighbourhoods in San Salvador and Soyapango. Of the people who have received mental health support during 2019, nearly 60 per cent have been victims of violence or have lost a family member due to violence.
In Soyapango, we partner with Comandos Salvamento, an emergency medical service group in El Salvador, to reinforce the local ambulance service. Another MSF medical team works with other NGOs and national institutions in their shelters for displaced and returned people with protection needs in El Salvador.
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.
In 2019, the government of Honduras signed a deal with the United States government effectively barring people travelling through Central America and Mexico from applying for asylum in the US, among other points that have not been fully revealed to the public.
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 several 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. An MSF team provides basic healthcare and mental healthcare to as many as 60,000 people from the region.
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, our teams oﬀer provide maternal and mental healthcare at a Ministry of Health clinic.
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 healthcare to migrants and refugees along the migration routes through Mexico since 2012.
Many of the people we treat need medical and mental health support due to the extreme violence, threats, rape, 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 basic healthcare as well as treatment for acute and chronic diseases whenever possible.
In Mexico we work in several shelters all along the migrant route (locations vary depending on both the influx of people and the different roads they choose). We are currently present in (from south to north):
- In Tenosique, the first town after crossing the border from Guatemala, MSF teams are working in a shelter run by the Franciscan religious order, in which we provide basic medical assistance and mental healthcare.
- Tapachula is one of the main ports of entry into Mexico. Our teams are assisting counterparts identify people who are potential victims of torture and extreme violence, to refer them to the specialist centre in Mexico City (see below). MSF teams also provide mental healthcare to support counterparts in shelters overwhelmed given the high volume of people arriving in Tapachula.
- Working through a mobile clinic, a doctor, a nurse, a psychologist and a social worker assist migrants in a shelter and on the railroad in Coatzacoalcos. The town is known for being a transit point where travellers usually take a break before continuing their journey aboard the Beast, the freight train that connects the southern and northern borders of Mexico.
- The brutal violence endured by many migrants and refugees in the NTCA triangle and along the migration route in Mexico, prompted us to open a Centre for Integral Attention in Mexico City in July 2017. MSF teams offer medical and mental health, referrals to specialist care, and offer social work services, including lodging, food, and activities for social reintegration, at the centre, established to care for the most serious cases of victims of extreme violence, torture, and inhumane, cruel and degrading treatment.
- Reynosa, a northern industrial city in Tamaulipas, right at the border with McAllen, Texas, is home to more than 600,000 people and has been affected by extreme levels of violence during the past decade. It is a common rest stop for many Central American migrants hoping to gain entry to the US, and is 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 offer basic healthcare, mental healthcare and social work services to local people, and offers care to migrants and deportees at two shelters and at the Tamaulipas Institute for Migrants (ITM). As of March 2019, there has been a change in the flow of people in the city as authorities began to implement a waiting list for asylum seekers operated by one of the shelters where we have activities. This caused overcrowding in the only facility in the city dedicated to receiving migrants. People who could not get into the shelter have been living in apartments, hotels or houses rented in a highly dangerous city.
- Matamoros is a northern city on the border with Brownsville, Texas. During every second month
Deportations are organised by the US-Mexican authorities to be done in even-numbered months (February, April, June, etc) to Reynosa and in odd-numbered months (January, March, May, etc) to Matamoros, in order not to exceed the reception capacities of both cities., the teams provide care for migrants and people who have been deported at two shelters. In August 2019, the implementation of the Migration Protection Protocols began in Matamoros, forcing asylum seekers to return from the US to Mexico to await legal proceedings. Since the implementation, our teams have witnessed an average of 100 people returned per day to the city, which has a lack of infrastructure to receive them, since the shelters do not have enough capacity. People stay in makeshift tents on the bridge at the border. MSF provides these people with psychosocial and basic healthcare.
- Nuevo Laredo is an official port of entry into the US from Tamaulipas state, where migrants face the highest exposure to kidnapping and extortion of all areas in which we work. It is one of the major points of repatriation of Mexican nationals on a daily basis and, since July 2019, is also a designated point to return people under the MPP. We have highlighted the danger of forcing people to remain in cities like Nuevo Laredo. Here, our teams assist migrants in several shelters across town, as well as at other points, such as the Instituto Tamaulipeco para los Migrantes. We provide care through our medical doctor, psychologist and social worker.
- We have opened our own centre in Mexicali to provide assistance, including medical and psychological care, to migrants, refugees and newly deported people. The team consists of a medical doctor, psychologist and health promoter, who regularly visits the dozen shelters and migrant centres in the town.
- Monterrey, a main migrant hub on the northeastern route, currently receives people returned under the MPP and is experiencing a spike in claims for asylum in Mexico. Our teams help identify people to potentially refer to the centre in Mexico City, train counterparts in the detection and the referral of victims of torture and monitoring the migration situation. MSF teams also provide mental health services.