A race against time to treat victims of sexual violence in Costa Rica

Every day, hundreds of people arrive in Costa Rica after surviving sexual violence in the Darién Gap—one of the most dangerous land migration routes in the world.

An MSF worker talks with migrants who have exited the Darien Gap in Costa Rica

Costa Rica 2024 © MSF

Content warning: This article contains references to physical and sexual violence. 

Doctors Without Borders/Médecins Sans Frontières (MSF) is working in Paso Canoas, southern Costa Rica, where our teams, together with local partner Cadena, are providing medical care to people who have experienced sexual violence while migrating through the Darién Gap.

Over the last month, 135 people who crossed the Darién—a treacherous stretch of jungle that straddles Colombia and Panama on the Central American migration route—have been identified as victims of sexual violence.

“On one part of the route, on the Panamanian side, some boatmen came out and tried to rape me,” María* explained. “They groped me and left several bruises on my body where they squeezed me looking for the money.” 

“They stole almost everything I had for the trip,” said María. “Another woman who was with me was not so lucky; they took her to a tent and raped her.” 

María told her story to the MSF team at the Estación Migratoria del Sur, or Southern Migration Station (EMI Sur), in Costa Rica, where she arrived with her husband and daughter after surviving “a horror movie in the Darién jungle.” 

MSF workers care for migrants exiting the Darien Gap in Costa Rica.
Every day, hundreds of migrants arrive in Costa Rica after crossing the Darién Gap, a jungle bridging Colombia and Panama. In the facilities of the Estación Migratoria del Sur (EMI Sur), MSF expanded access to medical and psychological care services.
Costa Rica 2024 © MSF

“[For] several days we saw dead people, dangerous animals, horrible rivers, cliffs [where] you have to hold on tight to the rocks, because if you fall, they will never get you out of there again,” said María. “And then there are the people who hurt you so much.”

Prompt treatment is critical to mitigate physical and mental health effects

María is one of 81 victims who in the last month received comprehensive medical and mental health care after being sexually assaulted while crossing the Darién Gap. MSF teams had been providing treatment to sexual violence victims on the Panamanian side of the Darién until we were forced to suspend activities in Panama in mid-March. Since then, providing treatment has become more complicated and it takes much longer for people to receive the urgent assistance they require to mitigate the negative impacts on their physical and mental health. 

Since mid-April, MSF and Cadena have been working in EMI Sur to expand access to medical and psychological services for people who have experienced sexual violence. 

An MSF worker assists survivors of the Darien Gap crossing in Costa Rica.
In mid-April MSF began an intervention to facilitate access to medical and psychological care services for migrant survivors of sexual violence at the Estación Migratoria del Sur (EMI Sur),
Costa Rica 2024 © MSF

“Our activities are focused on raising awareness, actively identifying cases, and providing comprehensive assistance to victims of all types of sexual violence,” explained Karen Chacón, an MSF psychologist at EMI Sur. “In these first weeks, we have noticed that few people understand what sexual violence means and the importance of receiving specialized care to prevent further harm.” 

Fighting against stigma and prejudice 

During the course of the project, the teams identified 135 people who suffered some form of sexual violence after passing through the Darién. Of those, 54 refused the assistance offered. 

“These decisions are greatly influenced by the fact that people want to leave this space very soon to continue their journey,” said Chacón. “But also some victims prefer to remain silent to avoid prejudice and stigma because of what happened to them.” 

In MSF’s care space the team tries to ensure that, in addition to medical care, victims and patients can unburden themselves and recognize that they have been through a traumatic situation that can be alleviated by expressing their emotions and feelings. 

We try to make them understand that it is normal to feel constant fear, anxiety, worry, and to have sleep problems, but that it is key to attend to these symptoms before more time passes and they become more difficult to overcome.

Karen Chacón, MSF psychologist at EMI Sur

“We try to make them understand that it is normal to feel constant fear, anxiety, worry, and to have sleep problems, but that it is key to attend to these symptoms before more time passes and they become more difficult to overcome,” said Chacón. 

María chose to receive medical and mental health care, as she is pregnant and after the incident, she was in pain that made her fear for the well-being of her baby. Fortunately, she did not require assistance within 72 hours of the event because it was not a rape. Unfortunately, in two out of three cases in which rape occurs, victims do not make it to a point of care within this timeframe, when it is still possible to prevent sexually transmitted infections, HIV, or unwanted pregnancies.

In the coming weeks, MSF teams will continue to reinforce activities to identify people who have experienced sexual violence, prioritizing the most serious cases and those that have occurred more recently to try to prevent infections, especially HIV. 

“This is why we continue to insist on the importance of resuming our activities in Panama, where we can intervene more quickly to improve the response to this serious situation,” concludes Chacón.

About our work helping migrants crossing the Darién Gap

MSF teams served people exiting the Darién Gap in Panama  from March 2022 to March 2024. On March 4, the Panamanian government ordered the cessation of our medical activities for migrants transiting the gap, alleging that MSF did not have a proper collaboration agreement with the necessary authorities in place, despite our trying to renew said agreement since October 2023. 

In 2023, our teams in Panama provided 59,877 medical consultations (35 percent were patients under 15 years of age and 53 percent were women and girls), 2,978 mental health consultations, and 24,762 first-aid consultations to people exiting the Darién Gap.