January 26, 2017

Doctors Without Borders/Médecins Sans Frontières (MSF) expanded activities in the Honduran capital, Tegucigalpa, and its sister city Comayagüela in 2016. In both cities MSF provides mental health care for victims of various types of violence, including kidnapping, extortion, assault, threats, and more.

"We are talking about people who have suffered directly from these violent acts," says MSF mental health supervisor Edgard Boquín, "but also about the relatives of those affected, as well as people who have witnessed murders or other violent acts, who are often forced to leave their homes and go into hiding."

In 2015, MSF teams provided mental health care to 158 patients, and in 2016 the number jumped to 340—an increase of 117 percent. However, given the extent of violence within Honduras, MSF teams estimate that there are many more people in need of support. "We know that this is just the tip of the iceberg," says Boquín.

The Consequences of Violence

Violence is commonplace in many parts of Honduras. As a result, many people fail to acknowledge both the short and long-term effects it has on their lives.

Witnessing and experiencing violence affects everyone differently, but many find it difficult to get back into the routine of life. "These events can be very traumatic and stop people from functioning normally," says Boquín. "Some symptoms appear very fast, such as acute stress, which manifests in feelings of anxiety. Some people have serious difficulties with their sleep patterns, including insomnia and nightmares. Others have flashbacks—or recurrent memories—during the daytime, making them relive the experience[s]."

MSF teams provide support to prevent these side effects from becoming more serious. "When people don’t receive care in time, they can develop severe depressive symptoms, acute anxiety, or episodes of post-traumatic stress, requiring psychiatric or medical support," says MSF mental health advisor Juan Carlos Arteaga.

MSF’s mental health teams provide individual sessions, group sessions, and activities such as psychosocial workshops. Most patients attend between one and eight sessions.

"We try to work on the emotions, feelings, and thoughts that people experience as a result of what happened to them," says Boquín. "We use cognitive behavioral therapy to help patients take the detrimental elements and replace them with positive coping tools, such as anxiety control, breathing, and relaxation techniques, or by making small life plans which will allow them to cope with their environment again."

Support Networks are Vital

Since 2011, MSF has provided its servicio prioritario, or priority service, in collaboration with the Honduran Ministry of Health. The service offers emergency medical and psychological care to victims of violence, including sexual violence. This free, confidential, one-stop service is available at two health centers and in Tegucigalpa’s main hospital.

MSF teams also provide patients with information about other types of assistance available to them from other providers, including safe houses, relocation options, social protection, and legal advice.

MSF’s experience shows that the more external support people have, the better their chances of recovery. "Patients can leave the clinic with a clear notion of how to improve their mental health, but if every day they face a threatening situation, with no way out, it’s far more difficult for them to recover," says Boquín. "Helping patients identify an external support network—for the care of their health or for other immediate needs—has produced very good results in their recovery."

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