We are running several projects in El Salvador, a country with some of the highest levels of insecurity in the world.
Although not an active conflict zone, violence between gangs, and security forces has affected the population’s access to free and safe health services. Through community work, mental health care, and mobile clinics, we aim to reach people most in need.
The signing of 1992 peace agreements marked the end of an armed conflict in which around 75,000 people lost their lives and thousands more were forced to flee the country. A series of reforms and public policies that followed, as well as the deportation of thousands of Salvadorans from the United States, exacerbated existing inequalities and facilitated the emergence of violent gang crime. Tensions between the gangs and state security forces added fuel to the flames, with civilians increasingly on the receiving end of the violence. After the collapse of a peace process between 2012 and 2014, levels of homicidal violence escalated to beyond that of countries engulfed in ongoing armed conflict.
The cities of San Salvador, the capital, and Soyapango have some of the highest rates of violence in the country. People living in areas dominated by gangs live in constant fear of violence. They also face stigma, from the security forces in particular and from society in general, for living in these areas. Like thousands of others across Central America’s Northern Triangle, this has caused many people to leave their homes in search of a safer life elsewhere. They all too often suffer abuse and ill treatment en route to the United States and other destinations.
What we are doing in El Salvador
In 2017, we began assessing the health care needs in San Salvador and Soyapango. We found that, due to the dynamics of violence, access to services was limited and most of the population were living in fear.
In response, we set up a project to provide health care services to people affected by violence and unable to attend health centers, or afraid to do so, in District 6 in San Salvador (Tinetti, Concepción, El Paraíso, San Juan Bosco, and Barrio Lourdes) and in the northern area of Soyapango (Bosques del Río, Las Margaritas and Río Las Cañas).
Our 54-person team in El Salvador is working with community health promoters to raise awareness about health care and promote MSF services. Social workers support these activities, make referrals, and provide follow-up for patients.
In addition, we provide mental health support through psychologists who work out in the communities, providing psychological services, and facilitating psychosocial activities for patients. Our clinical psychologists support the Ministry of Health’s community family health units (Unidad Comunitaria de Salud Familiar; UCSF) for people who require our services. And our mobile teams provide weekly primary care to people who have difficulty accessing health centers, offering general medical care, sexual and reproductive health care, and clinical psychology services.
We provide services directly and free of charge. We act under the authorization of the Ministry of Health and in collaboration with the UCSF and other institutions working in the region, with the trust of organized communities and the support of local civil society and the local authorities.
Based on our experience of working with vulnerable populations in other countries, we are looking into what additional health care services we can provide in El Salvador, and at how we can work with other institutions to assist people forced to flee their homes, or people who have been repatriated from other countries.
We are already working to support the Salvadorian NGO Comandos de Salvamento, in coordination with the medical emergency system, to help address the need for pre-hospital care. Two ambulances and staff will assist the relief corps in places we cannot directly access.