Mexico: “They need to leave, because there is no other choice”

MSF mobile clinic services in Guerrero include follow-up for pregnant and post-partum women, family planning services, and psychosocial care. Special attention is paid to survivors of sexual violence.
Mexico 2019 © Juan Carlos Tomasi/MSF
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Doctors Without Borders/Médecins Sans Frontières (MSF) medical coordinator Carol Bottger discusses how regional migration policies affect the patients MSF cares for along the transit routes through Mexico.

A year ago, we began to see a change in the people traveling north through Mexico. [Rather than single men, we started to see] more families, more women, more unaccompanied minors—which makes medical care more complex.

To this group of patients, we must add the category of deportees, who are more numerous now. Some have been in the US for 5, 10, or 20 years and suddenly find themselves deported at the border, without any social or family ties in Mexico. Many have chronic health problems, or have been transferred from jail to the border. In many cases, it could be said that they are suffering from post-traumatic stress.

And now we must also add the category of people who have experienced it all: violence in their country of origin and in transit. And then, some of them who have reached the United States and been returned under the program known as “Remain in Mexico”—or, more cynically and officially, the Migrant Protection Protocols (MPP)—suffer from acute, very intense stress.

They are in fear of reliving the horror they have just experienced, precisely when they thought they had left it behind and achieved a certain level of safety. They suffer from the uncertainty of returning to a very violent place, where the threat of being quickly captured by criminals is very real, and being kidnapped, extorted, et cetera. They also fear being returned to an unknown city in Mexico, because they are often returned 1,000 kilometers away to a completely different city, where they had never planned to end up.

The complexities and differences between these different groups of patients are vast, with one common denominator: their suffering is universal.

Policies of persecution

On the northern border, we see many women who are victims of sexual violence and trafficking. We see unaccompanied minors who are victims of sexual and physical violence. When the migrants reach the southern border between Guatemala and Mexico they are coming from a situation of violence. However, when they reach Mexico, their feeling is that of expectation—they have managed to leave and get to Mexico at least.

The majority know that a much more dangerous trip in Mexico is about to start, but they still hold on to that expectation. When we see them on the northern border, this threat of danger has materialized and it exceeded what they imagined, with much more serious consequences, both on the physical and psychological levels.

Before, migration routes and flows were “known.” Now, in the face of such repressive policies, the flows of people fleeing north have not diminished, but they are becoming invisible—and therefore much more vulnerable. They have changed their usual places to cross the border or places of arrival in communities. They have changed their means of transport.

People are more vulnerable when they feel persecuted: they are going to fear becoming visible when they need to go to the doctor, for example. They will gravitate more towards human trafficking networks. These are policies of persecution, policies that kill.

“I’ve heard stories that sometimes keep me awake at night”

The first thing that surprised me was to find Mexico City was quiet, compared to what I had read. But what soon caught my attention, and what I carry with me, was to discover that where we are working today, in migration projects and in areas like Guerrero state, the population does suffer a very serious situation of violence, with such severe effects on their health that I would never have imagined. I’ve heard stories that sometimes keep me awake at night.

At our comprehensive care center in Mexico City, the Centro de Atención Integral (CAI), the vast majority of our patients are migrants who have suffered terrible situations of violence in their country of origin and/or during their journey. Most of them are identified in southern Mexico, and MSF supports their movement to the capital, where the center is located.

Our aim is to alleviate suffering and help them to recover physically and mentally to continue their journey or personal project. That is why we feel very satisfied when a patient wants to leave after an average of six months. That is a success. All of our patients are in need of protection. Many of them belong to the LGBTQI community. Some have suffered torture or even mutilation, trafficking, confinement, kidnapping, and extortion.

Most patients suffer from severe mental health symptoms, with a somatization of these problems [physical symptoms] that require attention. Others also need specialized care for the physical violence suffered. The patients’ medical and mental health issues are usually very complex, requiring many consultations and time to heal. To this we must add that patients are almost always accompanied by their family members, whose mental health can also be moderately or severely affected.

“Each intervention is different because each population or violent episode is different”

We are looking to provide medical aid in violent places with high crime rates. We are present in Guerrero state, but we are also going to try to reach out to other places, like Michoacán, where we know there are needs among people who experience violence.

We work with mobile clinics and intervene for varying periods of time, offering comprehensive care including medical and psychological care and referrals. Each intervention is different because each population or violent episode is different, with different access to health services depending on the area. There are mobile clinics that arrange to go to a place and will remain for six months; in others, they stay four months; or there are places where a single intervention may be enough. 

These are victims of violence and victims who lack protection. I remember some people in Guerrero, a family made up of only children, whose parents probably disappeared because of organized crime. They were victims of sexual violence. The older sister, age 14, was forced into sex work to support her siblings. We managed to offer them some protection, with an aunt, as well as offering them some self-care techniques.

A lack of protection is common. We met many people from Guerrero on the northern border, seeking protection across the border, in the United States. People run away from danger. Just as Salvadorans flee from gang violence, the profile of Mexicans who flee is the same: they flee from trafficking, violence, family kidnappings…They need to leave, because there is no other choice. The worst injustice is that they don’t find any protection.