The homicide rate in El Salvador ─ once the world’s highest ─ is declining, but other forms of violence continue to affect the Salvadoran population. Decades of fighting between rival gangs, their clashes with security forces and violence against people continue to have humanitarian consequences and hamper access to healthcare. People are unable to move freely between neighbourhoods in areas dominated by rival gangs, marginalised by the authorities, and struggle to obtain medical assistance. In some areas, dubbed ‘red zones’, health services remain suspended due to violence and threats towards health workers. Measures to curb the spread of COVID-19, such as lockdowns, exacerbated the situation in 2020.

During the year, we extended the emergency services we operate in Soyapango in partnership with the Emergency Medical System (a national ambulance service) to other stigmatised municipalities. These included Ilopango and some zones of San Martín, Tonacatepeque and Ciudad Delgado, which are difficult for emergency services to enter because of the violence. During the year, we made more than 2,580 emergency referrals.

Our mobile clinics assisted violence-affected communities in the capital, San Salvador, and in Soyapango by running health promotion activities with community leaders and health committees, and facilitating access for Ministry of Health staff. We also worked with state-run institutions and other NGOs to provide medical care to migrants, displaced people and deportees.

In response to the COVID-19 pandemic, we offered mental healthcare in isolation centres for deportees from Mexico and the United States. We also worked to alleviate the workload of the emergency services by supporting the transfer of COVID-19 patients with an additional ambulance.

When tropical storm Amanda hit El Salvador, we ran a mobile clinic to deliver medical and psychological care to the most affected communities and donated hygiene kits.