Sam Antoine was born a migrant. His mother, Merlande was eight months pregnant when she embarked on a journey to cross the Darién Gap with her family, traveling for four days through dense jungle, rivers and cliffs on land controlled by armed groups. Merlande was traveling by way of Chile, where she had lived as a domestic worker and found life unsustainable after fleeing violence in her home country, Haiti.
“The cost of living is very high there,” she said. “Everything is expensive—food, rent. Without papers, you cannot get a good job and, although we tried to legalize our situation, it was impossible.”
More than 127,000 migrants crossed the Darién Gap between January and April 2023, five times more than in the same period in 2022. After Venezuelans, Haitians are the second largest group migrating this route, with 28,610 crossing in the first three months of this year. They are joined by migrants from countries both near and far, including Ecuadoreans, Chileans, Chinese, Indians, Afghans, Syrians, and others trying to reach the United States.
“In the jungle they?? stole $1,300 dollars from us. They left us without any money. But we were only robbed,” she clarified, because robberies are often accompanied by kidnapping, rape and murder in the deadly Darién Gap.
Humanitarian organizations including Doctors Without Borders/Médecins Sans Frontières (MSF) as well as government entities in Colombia and Panama have repeatedly denounced conditions along the Darién Gap route, where migrants face violence and risks related to the harrowing journey itself, such as drowning, fractures, gastric and skin diseases. Despite repeated warnings about the dangers faced along the Darien, there is still no safe and dignified route for migrants.
Treating chronic conditions on the move
Merlande arrived in Panama with preeclampsia, a life threatening pregnancy complication which can cause dangerously high blood pressure and other symptoms. As a result, she had to give birth prematurely and by caesarean section. Between January and April 2023 alone, MSF carried out 499 prenatal consultations at the two temporary migrant reception centers for migrants crossing the Darién Gap.
"We have seen an increase in diagnoses of chronic conditions that need special treatment,” said Priscila Acevedo, an MSF field doctor. “People with heart disease, people who need insulin, people with blood pressure problems, and people who faint due to rising temperatures, lack of food, or severe dehydration.” A person’s health condition does not seem to be a determining factor in their decision to embark on the route to the United States. “We have even received people without mobility in their legs, with cerebral palsy and with senile dementia,” explained Acevedo.
Between January and April 2023, MSF treated 669 people with diagnoses of chronic conditions such as diabetes, high blood pressure, and asthma. During the same period in 2022, that number was 262.
Carlos*, a 62-year-old Colombian migrant, has diabetes and high blood pressure, as well as heart problems. For two days during his journey, he had only water, a couple of biscuits, and medication his wife had given him. He burst into tears describing the experience as he sat in the waiting room of a health post in Lajas Blancas. “I thought at various times that my heart was not strong enough to endure that path. It is something that I do not wish on anyone, not even on my worst enemy," he said.
Along with Carlos and Merlande, MSF met an Afghan man who lost his leg in the war, an Afghan family traveling with a blind woman, a Colombian woman with one hand recently operated on for a fracture, and several older adults.
Centers built for 800 people receive up to 2,000 daily
"Excuse me, where can I get some drinking water?” asked a six-year-old Venezuelan girl in a low voice. The answer is that there isn't any.
The 30,000-liter water tank is not enough for the average of one thousand migrants who arrive daily to the indigenous community of Bajo Chiquito and then to the reception center in Lajas Blancas. Its huts and dormitories can accommodate about 800 migrants, but up to 2,000 are arriving each day in the Darién Gap, many staying more than one night.
“There has also been an increase in the number and severity of pneumonia and diarrhea,” said Dr. Priscila. “The conditions are not ideal for sleeping or for preventing diseases.”
Last December, a group of UN rapporteurs described the conditions as "precarious and unhealthy," pointing out alack of private, secure spaces for women and children despite high rates of gender-based violence.
In February, 39 migrants died while traveling from the Darién temporary reception centers to the center in Planes de Gualaca in Chiriquí, on the other side of Panama, which borders Costa Rica.
In April, MSF learned about the case of Kelly, a 33-year-old Colombian migrant, who began her journey after surgery for a broken hand. The doctor's only follow-up instruction was for Kelly to have the screws removed in less than a week, but when she arrived at the reception center in San Vicente her hand was infected. “They took me to the hospital and said that I had to see the orthopaedic surgeon and have an X-ray, but I was afraid that they would leave me there, without money or communication, so I left,” she explained.
Kelly was promised that there would be a daily bus for the most vulnerable people: “a bus for those who had no money, those who were raped and so on, and they put me on a list, but there were no free seats. I've been here a week and I'm going to keep waiting," she said.
She was traveling with a friend and her three children. None of them were able to pay the $40 to get to the border with Costa Rica, and on the way they were attacked twice. “In the first attack, about 30 armed men who spoke another language came and grabbed whoever they could. They wanted to take my 6-year-old boy so I grabbed him and started running, and they shot at me,” said her friend. “But the second time, we could not save ourselves. They appeared on the other side of the river when we were crossing it. Where were we going to run to?” she says. They were left with only a few clothes and a cell phone that the armed men did not see.
Currently, a free bus leaves every 10 days to transport people who have been stranded at the reception center for more than 10 days, and every now and then space is made for people with special vulnerabilities, although the criteria is unclear.
Needs accumulate as rainy season begins
José Rafael Cumare was injured early on in his journey across the Darién Gap. “About an hour after crossing into Panama, I jumped into a waterfall and there was a stone under the water and I hit and fractured my foot,” he explained, lying in a cabin while MSF teams check the swelling in his leg. Crawling, he found branches to use as crutches to complete the journey, which took him 13 more days. These difficulties are aggravated by the rainy season, which has just begun. According to the National Migration Service, at least 10 people died on the route during the last two weeks of April.
MSF reiterates the need for Colombian and Panamanian authorities to guarantee safe routes for migrants for the expansion of services in temporary migrant reception centers. Migrants must be guaranteed security, decent spaces for overnight stays, access to drinking water and food, appropriate hygiene and sanitation conditions, as well as access to justice.