The signing of 1992 peace agreements marked the end of an armed conflict in which around 75,000 people lost their lives and thousands more were forced to flee the country. A series of reforms and public policies that followed, as well as the deportation of thousands of Salvadorans from the United States, exacerbated existing inequalities and facilitated the emergence of violent gang crime. Tensions between the gangs and state security forces added fuel to the flames, with civilians increasingly on the receiving end of the violence. After the collapse of a peace process between 2012 and 2014, levels of homicidal violence escalated to beyond that of countries engulfed in ongoing armed conflict.
The cities of San Salvador, the capital, and Soyapango have some of the highest rates of violence in the country. People living in areas dominated by gangs live in constant fear of violence. They also face stigma, from the security forces in particular and from society in general, for living in these areas. Like thousands of others across Central America’s Northern Triangle, this has caused many people to leave their homes in search of a safer life elsewhere. They all too often suffer abuse and ill treatment en route to the United States and other destinations.
What we are doing in El Salvador
In 2017, we began assessing the healthcare needs in San Salvador and Soyapango. We found that, due to the dynamics of violence, access to services was limited and most of the population were living in fear.
In response, we set up a project to provide healthcare services to people affected by violence and unable to attend health centres, or afraid to do so, in District 6 in San Salvador and in the northern area of Soyapango.
Our teams are working with community health promoters to raise awareness about healthcare and promote MSF services. Social workers support these activities, make referrals and provide follow-up for patients.
In addition, we provide mental health support through psychologists who work out in the communities, providing psychological services and facilitating psychosocial activities for patients. Our clinical psychologists support the Ministry of Health’s community family health units (Unidad Comunitaria de Salud Familiar; UCSF) for people who require our services. And our mobile teams provide weekly primary care to people who have difficulty accessing health centres, offering general medical care, sexual and reproductive healthcare and clinical psychology services.
We provide services directly and free of charge. We act under the authorisation of the Ministry of Health and in collaboration with the UCSF and other institutions working in the region, with the trust of organised communities and the support of local civil society and the local authorities.
Based on our experience of working with vulnerable populations in other countries, we are looking into what additional healthcare services we can provide in El Salvador, and at how we can work with other institutions to assist people forced to flee their homes, or people who have been repatriated from other countries.
We are already working to support the Salvadorian NGO Comandos de Salvamento, in coordination with the medical emergency system, to help address the need for pre-hospital care. Two ambulances and staff will assist the relief corps in places we cannot directly access.
We worked in El Salvador during armed conflict in the 1980s. Our teams provided primary healthcare, water and sanitation services, and distributed essential relief items to refugees and people on both sides of the conflict. Prosthetics were also provided to people left disabled during the war.
When Hurricane Mitch hit the country in 1998, we ran emergency and primary healthcare services and distributed essential relief items. Our teams also played a role in the prevention of subsequent natural disasters and the promotion of health in relation to waterborne diseases.
We launched a disaster response care programme when the country was hit by earthquakes in 1986 and 2001, and most recently intervened in the wake of Hurricane Ida in 2009, providing mental healthcare, supporting mobile teams, facilitating water and sanitation services, and distributing essential relief items.