“There’s a big need for psychological services here,” says MSF psychologist Brenda Villacorta. “If you come with a gunshot wound we can treat the injury, but you don’t always see the psychological wound associated with that. I see issues with unresolved grief, anxiety and depression disorders, [and] sexual and domestic violence.” In Nueva Capital, violence is a fact of life. Many people in this community, if they are lucky enough to find work, commute to jobs in Tegucigalpa—risking mugging, kidnapping, or worse on the way.
Today, 54-year-old Ilma has come to the clinic with stomach problems. She has lived in Nueva Capital since 2004, when she and her husband left their home in Honduras’s La Paz department and came to Tegucigalpa looking for work. He eventually found a job as a security guard. “At the beginning life was easy for us,” she says. “We got married and had a child. Then things got bad. My husband was shot and murdered by men trying to rob the business he was guarding. Now I live with my son alone.”
Ilma’s son, now an adult, does accounting work for a factory in Tegucigalpa. She fears for his safety as well. “It’s difficult to live in Nueva Capital,” she says. “My son has been assaulted many times. Most times he’s left without even enough money for transport. He wants to go back to La Paz; it’s safer there but the economic situation is not good.” With few options, Ilma and her son, like many others in Honduras, are trapped in a cycle of violence and exclusion. Despite the risks, she has considered making the journey north to build a new life in the United States. “I know about the dangers of traveling to the USA, and as poor people we don’t have the means to go in a legal way,” she says. “But I don’t feel safe in Tegucigalpa.”
In order to adapt services for people on the move, MSF is implementing a new survey at its projects in Honduras to screen for people who have been forced to leave their homes and to assess their medical and psychological needs. When they arrive for their appointments at MSF clinics, patients are asked to complete an anonymous questionnaire about their displacement status. Together with demographic data, the results of the survey will help MSF teams to tailor health services to those who need care the most.
Though the survey has just begun, MSF psychologist Jorge Alberto Castro, who works at the MSF clinic within Tegucigalpa’s Alonso Suazo Health Center, believes that displacement related to violence is on the rise in Honduras. “The number of internally displaced people is growing,” he says. “These people need to move—if they don’t, they’ll go through the same traumas again and again and again.
Northwest of Tegucigalpa, near the industrial hub of San Pedro Sula and the border with Guatemala, lies the city of Choloma. Choloma is the third largest city in Honduras, with an official population of some 250,000 people, though the actual figure is likely much higher. Home to many factories, known locally as maquilas, the city attracts people from across the country who come here looking for work. But low wages and abysmal working conditions mean that many still live in poverty.
Crime is both endemic and rampant in Choloma, and, as in Tegucigalpa, women and girls are often most at risk. Here, too, MSF teams offer mental and sexual and reproductive health care services, with a focus on care for survivors of sexual violence. In spring 2017 MSF teams began supporting a local Ministry of Health clinic in Choloma that was struggling with budget and staff limitations. The facility now provides sexual and reproductive health services and emergency care, and helps pregnant women avoid overcrowded public hospitals. Elsewhere in Choloma, MSF outreach teams provide preventive and curative services, including health education and counseling, twice weekly at another clinic in the La López neighborhood.
The sky over the La López clinic is clearing after torrential rains as MSF psychologist Ámbar Assaf gazes out through the bars of the heavy iron gate to the street beyond. At the edge of the clinic’s sandy parking lot, chickens scratch in the wet grass by the fence. Assaf is here to work her afternoon shift at the clinic, but fears that the storm might keep patients away.
“People here are deeply affected by violence, especially women,” she says. “The patients I see are mostly young women between 15 and 35 years old. Physical violence, psychological violence—sexual violence is extremely common. I see a lot of women who suffer from depression because they’ve experienced violence and normalized it as a defense mechanism.”
MSF in Honduras in 2017