“Populations in lockdown”: Caring for people trapped by violence in Mexico


Mexico 2019 © Juan Carlos Tomasi/MSF

Mexico’s Guerrero state, on the Pacific coast, is convulsed by frequent clashes between criminal gangs, security forces, and local police. Violence permeates every aspect of life in Guerrero and has dire consequences for the health—both mental and physical—of people who live here. Doctors Without Borders/Médecins Sans Frontières (MSF) mobile teams visit communities across the state, bringing lifesaving medical services to people who would otherwise not be able to reach it.

Every Monday, three MSF mobile teams leave the city of Iguala de la Independencia to travel to different municipalities in Guerrero. An exploratory team goes to places where violence has recently occurred to assess the medical needs. The other two, each with an established route, head to villages that have already been evaluated, where they will offer medical and psychological services.

“We often find populations in lockdown, who cannot get to larger urban centers because they are surrounded by armed gangs that threaten them or because the existing tensions block them,” says Serge St. Louis, MSF project coordinator in Guerrero. The teams return to the towns until people once again feel safe traveling for care, and MSF continues to monitor these areas in case mobile services are needed once more. 

“We work in cooperation with the Ministry of Health to identify the places we need to access and negotiate our entrance with the residents [or] with the health committee, if there is one,” says St. Louis. Community members help to coordinate the MSF teams’ visits, often using health centers or school classrooms left empty due to the fighting.

MSF’s eight-person teams comprise doctors, psychologists, nurses, and logisticians/drivers. “Our aim is to arrive as soon as possible—within seven days of an event—in order to prevent the development of more serious pathological conditions, both physical and mental,” explains Carlos Arias, the project’s medical lead. “When we arrive in an emergency situation, we might have to deal with injured patients in critical condition. In the case of mental health, we try to avoid a normalization of emotions and pathological disturbances, which end up turning into anxiety or depressive disorders.” 

Services include monitoring of pregnant and post-partum patients, family planning, psychosocial support, and specialized care for victims of sexual violence. “In Guerrero, we focus on responding to emergencies, making referrals to health centers or hospitals, offering mental health care, and operating mobile clinics that, depending on the situation, can visit a population a couple of times, for two months, or up to six or seven times,” says Arias. 

In addition to the mobile clinics, MSF also runs a psychosocial and mental health care project in Acapulco, one of the largest cities in Guerrero that now has one of the highest murder rates in the world.

In 2018, the mobile teams visited 26 communities affected by violence, mostly in Guerrero’s Tierra Caliente, Norte, and Centro regions. In 2019, they also began working in Costa Grande and plan to monitor the situation across Guerrero state throughout the year.