Mexico: Caring for people besieged by criminal violence in Guerrero state

An MSF health worker tends to a patient during a mobile clinic visit to a village in Guerrero state, Mexico.
MEXICO 2018 © Juan Carlos Tomasi/MSF
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Mexico’s Guerrero state, including the resort city of Acapulco, is among the most violent places in the country. Drug-related crime has left many people living in fear and isolation, cut off from basic medical services, particularly in the Tierra Caliente, Norte, and Centro regions. In response, Doctors Without Borders/Médecins Sans Frontières (MSF) runs mobile clinics in 11 communities across the state and in Acapulco city.  

Territory across Guerrero state is fought over by organized criminal gangs vying to control trade routes and towns, extort communities, and coerce people into joining. As a result, many schools across the state have closed, access to health care is limited, and, in some places, medical staff have left for good. The constant tension and fear threaten to destroy the social fabric across the region.

Insecurity and surges of violence have had a direct impact on medical care in rural towns. Many local health centers across the state are run by just one nurse who also sleeps at the facility. These nurses shoulder the huge responsibility of providing health care in their communities with very limited resources. In this context, monthly visits by MSF teams offer a lifeline.

"A lot of doctors don’t want to come anymore. The nurses do, thank goodness," says Bruno, a resident of Guerrero state who took his grandson to see an MSF doctor. “We haven’t had a doctor for four years, so the MSF visits are essential.” Eleven health centers in Tierra Caliente, Norte, and Centro remain closed. Some have been shut down for a few months, others for several years.

"Our house was attacked"

"We cannot go out or talk freely," says Juan, a 61-year-old farmer from Guerrero state who was treated by MSF psychologists. "We see things happen, but we cannot talk about them. Our house was attacked by armed men a few months ago. My sons, aged 10 and 11, were also there. They’ve been frightened and traumatized ever since. We can’t leave them alone anymore."

For months, ongoing violence has cut off Juan’s town from even the most basic services. The town’s municipal center, where the hospital and banks are located and where many people must go to receive benefits, are in the south of the region. But public transportation has been threatened by drug traffickers who want to divert all economic activity to their territory in Arcelia, in the north.

"If there’s a medical emergency, now we have to pay up to 1,500 pesos (about $76) to go in a private van," says Juan. "The public fare is a lot cheaper—around 60 or 100 pesos (about $3)." [The daily wage in the area is between 120 and 200 pesos, or $6 to $10]. "It's a terrible situation. Nobody wants to spend three-and-a-half hours on the road to reach public transportation. And we cannot go at night because of the risk of being attacked on the roads."

Traumatic scenes of violence

Abel is a young man in his twenties who was also treated by MSF psychologists. "Every so often we see corpses dumped in public places," he says. "It’s traumatic to see because people have been tortured and cut up. One day, when we were playing basketball, a group of armed men arrived at the court. They shot at us, threw us on the ground, and took away our mobile phones and money. Then they attacked us with machetes. They took my friend. They cut him up. First they cut off his leg, then his arm. He’d already passed out by the time they cut off his head."

The murder on the basketball court happened three years ago. Drug traffickers wanted to reassert their control over the town. The incident traumatized the whole village. The community police soon grew stronger, and they say the area is calmer now. But neighbors still talk about "what happened on the court" in whispers.

Abel talks about it openly and says he plans to emigrate to the United States soon. He can't take it anymore. The lack of opportunities, poverty, and the risk of being coerced into working for drug traffickers as a "hawk" (lookout) or sicario (hit man) have forced him to leave. Being a young man in Guerrero can be extremely dangerous.

Ghost towns

He's not the only one who has chosen to leave. Guerrero's illegal marijuana and opium trade, and the associated violence, have resulted in ghost towns across the region, left completely abandoned by communities. Both young people and entire families have gradually left.

In the town of San Felipe de Ocote, only animals remain. In January 2018, members of the community took up arms to defend themselves against drug traffickers after the kidnapping of a bulldozer driver who was repairing the road. But the community of 600 people could not withstand the onslaught of violence when the criminals arrived with reinforcements.

They had no choice but to leave, fleeing to nearby Apaxtla de Castrejón with only the clothes on their backs. The entire community is now staying in a social center, sleeping in classrooms, where they received psychological care from MSF teams. Many think they will never be able to return home. Now all they want is a plot of land where they can settle.

According to data from the Mexican Commission for the Defense and Promotion of Human Rights (CMDPDH), 7,598 people have fled their homes and villages across Guerrero over the last two years. Recently, similar displacements have happened in Laguna de Huanayalco, San Bartolo, Laguna Seca, and Ximotla.

A code of silence and an uncertain future

During a meeting with a local health committee in one of the towns in Guerrero, a dozen women described how insecurity had affected their communities. "There's fear, there's mistrust, there's no happiness anymore," said one of the attendees. "I used to go out at night without any hassle. But now we go straight home. I go to bed and I don’t know what will happen." The insecurity and uncertainty breed crushing anxiety. "We're a group of chickens in the coop; we don’t know who’s going to be grabbed next for the pot," said another woman. 

The committee's regular meetings mean that their members at least can build bonds with each other. "But there's still mistrust," another attendee says. "Even here, now, with what we say. You don't know who's going to misinterpret what's been said, and who they're going to tell." They look at each other and nod.

The testimonies in this story were gathered during interviews with patients at MSF mobile clinics held in Tetela del Río, Huautla, Puerto Colorado, Las Margaritas, Pueblo Viejo, Buenavista del Aire, Buenavista de Guadalupe, Totoltepec, Santo Tomás, Campo Morado, and Coronillas. Names have been changed to protect the safety of those quoted.