When the dual disasters of Hurricanes Eta and Iota hit Honduras at the end of 2020, the Central American country was already reeling from the COVID-19 pandemic and an ongoing displacement crisis fueled by widespread violence. In response, Doctors Without Borders/Médecins Sans Frontières (MSF) has expanded its medical humanitarian operations to meet the deep and growing needs.
Reaching out to survivors of violence in Tegucigalpa
In the capital city of Tegucigalpa, MSF’s mental health project for survivors of violence—including sexual violence—shifted to telephone counseling services and digital health promotion related to mental health care and COVID-19 prevention. In June, taking necessary health and safety precautions, the teams returned to care for patients at the Nueva Capital Health Center, the Alonso Suazo Health Center, the Escuela Universitario Hospital, and the Integrated Center of the Public Ministry.
According to the National 911 Emergency System, as of September 30, 2020, 76,520 calls for help had been reported for domestic, family, and sexual violence. During the COVID-19 lockdown, there was a considerable increase in the number of calls.
The helplines made it possible to reach survivors of violence who had difficulty getting to the clinics due to financial limitations or because they lived with an abuser. Maintaining these services during the COVID-19 pandemic requires strategies that enable victims of violence and sexual violence to access medical and psychological care without legal obstacles. Care for survivors of sexual violence should be considered a priority medical emergency.
Expanding access to health care in Nueva Capital
In March 2021, MSF successfully handed over operations of the Nueva Capital Health Center to the government. Starting in 2017, MSF worked with the community in Nueva Capital, a neighborhood on the outskirts of Tegucigalpa, to support construction of the center. The aim was to improve access to health care for this community, which includes large numbers of displaced people and suffers from high rates of violence and exclusion from the health system.
From the opening of the health center in June 2018 to the handover in March 2021, MSF carried out 33,410 medical consultations, helping 12,150 people. This health center provided comprehensive care, including mental health care for 2,165 people and social work with 1,032 people. Of these, 1,080 patients were survivors of violence and sexual violence. Teams also provided 5,067 family planning consultations, 2,019 prenatal check-ups, 641 postnatal check-ups, and 697 cervical cancer screenings.
Working with communities in Choloma
The MSF project in Choloma provides a range of services focused on sexual and reproductive health, sexual violence, and mental health. Comprehensive medical care is offered at the Maternal and Child Clinic (known by its initials in Spanish as CMI), together with the community clinic in different neighborhoods in Choloma. The aim is to reduce maternal and child mortality.
From March to May 2020, the team at CMI provided emergency care and gradually restored the facility’s services. In 2020, 2,355 family planning consultations, 4,768 prenatal consultations, 573 postnatal consultations were carried out, and 1,059 people received psychological care.
CMI is currently considered a leading health facility for humane childbirth. At the end of 2020, the facility was operating at full capacity and had assisted 919 births. This year, MSF began transferring services at CMI to the Ministry of Health after more than four years of operations under its coordination.
In Choloma, MSF services will shift to a broader community-based approach to provide health services for situations of sexual violence to the most vulnerable people.
Using this same approach, in February efforts began in San Pedro Sula to improve access to medical and psychological health care for transgender people and men who have sex with men. A mobile team will offer health services for sex workers, including care for victims of violence and sexual violence and sexual and reproductive health care.
The evolving response to COVID-19
COVID-19 arrived in Honduras on March 20, 2020. By June, the country's hospitals were full and there was a shortage of care rooms equipped to provide dignified and high-quality medical care.
MSF installed a care unit with 20 beds for COVID-19 patients in the University Sports Center, where the team treated 139 patients, providing medical, psychological, and social work services for three months. This project helped provide critically needed care at a time when the hospital system was overwhelmed.
After more than a year of the pandemic, April 2021 became the second deadliest month in Honduras with 678 deaths. So far, the challenges of hospital capacity have not been overcome. However, national care circuits have been created with triage centers categorizing patients according to case severity in an effort to prevent overwhelming large hospitals.
MSF supports the care circuit through activities at the University Sports Center, with three ambulances available to take patients from the triage center to hospitals and reduce waiting times. A patient could wait up to 12 hours at a triage center during periods when hospitals were full, although the average transfer time was four hours, according to research by MSF’s Tegucigalpa team.
Nine MSF psychologists provide telephone assistance to hospitalized COVID-19 patients. At the community level, this project will have 10 health educators to raise awareness and provide information in areas where there are high rates of infection.
Facing the impacts of extreme weather and climate change
The floods at the end of last year caused by Hurricanes Eta and Iota affected some three million people in Honduras and left 55,435 people in shelters.
We are applying a planetary health lens to our humanitarian response activities here. The MSF team in Choloma initially focused on emergency needs. We donated medicines to the Ministry of Health, dispatched a team to deliver basic kits, and evaluated conditions in shelters. MSF also worked with contingency committees to coordinate with international organizations and the Honduran government.
In December, during the second stage of the emergency, MSF set up mobile teams to provide medical and psychological care and health promotion. Teams visited 79 shelters in Choloma, in Cortés department. Over 14 days, MSF carried out 767 medical consultations, 81 group mental health sessions, and 71 individual counseling sessions. They also provided hygiene kits, water donations, biosafety equipment, and medicines (including contraceptives), helping 13,260 people.
Expanding activities in the north
In March 2021 MSF started the northern project to provide humanitarian assistance to people affected by Hurricanes Eta and Iota. With a team of 140, MSF will assist people living in the municipalities of Choloma, La Lima, Villanueva, and San Manuel, in the department of Cortés, and El Progreso in the department of Yoro.
One component of this project aims to improve access to mental health services, offering care in response to the material and emotional damage caused by the floods, psychosocial support related to COVID-19, and care for the consequences of violence, including sexual violence.
In addition, comprehensive vector control activities and a dengue fever monitoring system have been implemented in strategic health centers to help reduce the risk of disease outbreaks. Vector-borne diseases in this area include dengue, Zika, and chikungunya. In Choloma and San Manuel, fumigation activities are underway. Logistics activities will also be implemented to improve water and sanitation systems and rehabilitate some health structures.
At the community level, health educators will raise awareness about vector-borne disease prevention, psychosocial education, and violence and sexual violence.
The Honduran exodus and other migration patterns
While MSF does not have a project focused on migration in Honduras, we have provided medical care to Hondurans traveling with the migrant caravans. In October, after the opening of the Honduran border with Guatemala, some 4,000 migrants joined a caravan that departed from the town of Corinto. Two MSF teams provided comprehensive medical assistance, including 55 individual medical consultations and 166 group consultations in six hours. In addition, the teams offered health information to 500 people and delivered 103 medical kits.
The losses due to Hurricanes Eta and Iota drove people to join a new caravan of some 8,000 Hondurans that departed in January 2021, despite the threat of police checkpoints and the risk of COVID-19. MSF responded with four mobile teams to provide medical and psychological care to the migrants. Teams distributed 3,070 medical kits for adults, pregnant women, and children. In addition, MSF advocated for the dignified and safe treatment of migrants. The organization expressed concern over the acts of violence of security forces against the people of the caravan in the community of Chiquimula, Guatemala.
Migration across this country is not limited to Hondurans on the move, but includes an increase in the number of migrants and refugees from other countries in transit hoping to reach the United States. Since February, the border cities of Honduras and Nicaragua have seen between 50 to 1,000 migrants and refugees a day, most of them with health conditions resulting from the long journey and hardships experienced during their crossing through the Darien Gap, a dangerous jungle on the Panamanian border. As of April, teams have made four visits to the municipality of Trojes on the Honduras-Nicaragua border, providing medical care to 326 people, offering psychological care to 100 people, and delivering 350 hygiene kits to families.