MSF MEXICO CITY / NEW YORK / RIO DE JANEIRO / BARCELONA MAY 2017 © ANNA SURINYACH ANNA © FORCED TO FLEE CENTRAL AMERICA’S NORTHERN TRIANGLE: A NEGLECTED HUMANITARIAN CRISIS When you have no strength left, when you no longer have anyone around to help you keep going, when you have lost all hope, when fear and distrust are your only travel companions, when you can’t take another hit, when you have lost your identity, when you feel that your dignity has been missing since the last time you were assaulted, or the last time they forced you to undress —it is during these moments when you need to take a seat, regain your strength, and build the confidence to talk to people and let them help you. Carmen Rodríguez MSF Mental Health Referent in Mexico Cover: Migrants and refugees cross the Suchiate River to enter Mexico from Guatemala in 2014. © ANNA SURINYACH 2 MSF FORCED TO FLEE CENTRAL AMERICA’S NORTHERN TRIANGLE MEXICO - Transmigrant project - Migration roads and medical data United States Migration roads Ruta Centro: De Tierra Blanca a Querétaro ± Mexicali Mexico City Ruta Noreste: De Querétaro a Ciudad Acuña )" Tijuana Ruta Noroeste: De Querétaro a Tijuana Guatemala Ciudad Juarez Ruta Norte: de Querétaro a Puerto Palomas Nogales Agua Prieta Ruta Sureste: De Tenosique a Tierra Blanca LEGEND Ruta Suroeste: De Tapachula a Tierra Blanca Altar )" Capital City United States Lake Transmigrant project, town of interest Consultation (nb) Pontchartrain G CONTENT (! Health facities 10,000 Ojinaga International boundary Ciudad Acuña Coastline Hermosillo Piedras Chihuahua Negras Guaymas Nuevo Laredo 1,000 Golfo de California 100 Reynosa 4 6 Matamoros 8 Monterrey Topolobampo Torreón Saltillo Gulf of Culiacan Mexico Gomez Farias Durango Ciudad Victoria Felipe Pescador Mazatlan Puerto San Luis Zacatecas Altamira Potosí G (! Tampico Aguascalientes Tepic Guanajuato San Luis Potosi Irapuato Querétaro G (!G nb consult: 546 Guadalajara Salamanca (! Tequisquiapan MH Bojai + Lecheria/Tultitlan, Apaxco, Huehuetoca Celaya (!G 02/2015-10/2015 nb consult: 7597 (!G Bah’a de MED+MH Celaya Lecheria )"(!G Apizaco Campeche SOURCES nb consult: 312 2013-06/2015 Admin : ICRC, GADM (!G Puebla Cordoba Places : OCHA MH Tenosique Mexico Roads : OSM (!G Tierra Blanca nb consult: 4455 Medical : MSF 03-12/2016 (!G Orizaba Waterbody : DCW nb consult: 68 !G Coatzacoalcos elevation: SRTM (!G MED+MHINTRODUCTION: City ( EXECUTIVE SUMMARY MH NORTH 02-12/2016 Tierra blanca NORTHERN TRIANGLE PACIFIC PROPERTIES CAI/Integral care centre 07-10/2014 OCEAN Palenque Document Name : nb consult: 733 (!G CARING FOR REFUGEES OF CENTRALG AMERICA:MEX_comm_BM_TransmigrantProject_A3L_240116 Medias Aguas (! Creation date : 24-Jan-17 MED+MH Created by : 11/2015-11/2016 Matías Romero Tenosique MSF GIS Unit - [email protected] (!G Juchitan Print format : A3 Landscape AND MIGRANTS (!G UNPRECEDENTEDConfidentiality : MSF Intern alLEVELS access only Ixtepec (!G Frontera SCALE (!G ArriOFaga VIOLENCE1 :8OUTSIDE,225,000 1 cm = 82.25 km Ixtepec (!G Comalapa 0 75 150 300 km Arriaga A WAR TZONEapachula nb consult: 19882 MED+MH 01-05/2013 Guatemala Guatemala Total number of consultation: 33 593 Find more maps on mapcentre.msf.org This map is for information purposes only and has no political significance. The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by MSF. 13 18 20 MSF PROJECT DATA 2015-2016: BARRIERS TO HEALTH CARE LIMITED ACCESS TO EXPOSURE TO VIOLENCE PROTECTION IN MEXICO AND ITS IMPACT ON HEALTH 22 26 28 ANNEX 1 RISK FACTORS 29 ANNEX 2 REACTION SYMPTOMS LIMITED ACCESS CONCLUSION: 30 TO PROTECTION ADDRESSING THE GAPS ANNEX 3 IN THE UNITED STATES SURVEY METHODOLOGY 31 ANNEX 4 LIST OF ACRONYMS FORCED TO FLEE CENTRAL AMERICA’S NORTHERN TRIANGLE MSF 3 © ANNA SURINYACH ANNA © Migrants travel through Mexico on a cargo train, known locally as “The Beast.” teams have witnessed and documented a pattern of violent displacement, persecution, sexual violence, and forced repatriation akin to the conditions found in the 1 deadliest armed conflicts in the world today2. For millions of people from the NTCA region, trauma, EXECUTIVE SUMMARY fear and horrific violence are dominant facets of daily life. Yet it is a reality that does not end with their forced flight to Mexico. Along the migration route An estimated 500,000 people cross into Mexico every from the NTCA, migrants and refugees are preyed year1. The majority making up this massive forced upon by criminal organizations, sometimes with the migration flow originate from El Salvador, Honduras, tacit approval or complicity of national authorities, and and Guatemala, known as the Northern Triangle of subjected to violence and other abuses —abduction, Central America (NTCA), one of the most violent theft, extortion, torture, and rape— that can leave them regions in the world today. injured and traumatized. Since 2012, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) has been providing medical and mental health care to tens of thousands of migrants and refugees fleeing the NTCA’s extreme violence and traveling along the world’s largest migration corridor in Mexico. Through violence assessment surveys and medical and psychosocial consultations, MSF 2 _The Geneva Declaration on Armed Violence and Development. Global Burden of Armed Violence 2015: 1 _ Source: UNHCR MEXICO FACTSHEET. February Every Body Counts, October 2015, Chapter Two, 2017. Last visited 18 April 2017. Data compiled by http://www.genevadeclaration.org/fileadmin/ UNHCR based on SEGOB and INM official sources. docs/GBAV3/GBAV3_Ch2_pp49-86.pdf 4 MSF FORCED TO FLEE CENTRAL AMERICA’S NORTHERN TRIANGLE Despite existing legal protections under Mexican In 2015, MSF carried out a survey of 467 randomly law, they are systematically detained and deported. sampled migrants and refugees in facilities the Nearly 98 percent of NTCA citizens were captured organization supports in Mexico. We gathered by immigration authorities in 2015, with devastating additional data from MSF clinics from 2015 through consequences on their physical and mental health. December 2016. Key findings of the survey include: The findings of this report, based on surveys and Reasons for leaving: medical programmatic data from the past two years, come against the backdrop of heightened — Of those interviewed, almost 40 percent immigration enforcement by Mexico and the United (39.2%) mentioned direct attacks or threats States, including the use of detention and deportation. to themselves or their families, extortion or Such practices threaten to drive more refugees gang-forced recruitment as the main reason for and migrants into the brutal hands of smugglers or fleeing their countries. criminal organizations. — Of all NTCA refugees and migrants surveyed, 43.5 percent had a relative who died due to From January 2013 to December 2016, MSF teams violence in the last two years. More than half have provided 33,593 consultations to migrants and of Salvadorans surveyed (56.2 percent) had a refugees from the NTCA through direct medical care relative who died due to violence in this same in several mobile health clinics, migrant centers and time span. hostels —known locally as albergues— across Mexico. — Additionally, 54.8% of Salvadorans had been Through these activities, MSF has documented the the victim of blackmail or extortion, significantly extensive levels of violence against patients treated in higher than respondents from Honduras or these clinics, as well as the mental health impact of Guatemala. trauma experienced prior to fleeing countries of origin and while on the move. Violence on the Journey: Since the program’s inception, MSF teams have expressed concern about the lack of institutional and — 68.3 percent of the migrant and refugee government support to the people it is treating and populations entering Mexico reported being supporting along the migration route. In 2015 and victims of violence during their transit toward 2016, MSF began surveying patients and collecting the United States. medical data and testimonies. This was part of an — Nearly one-third of the women surveyed had effort by MSF to better understand the factors driving been sexually abused during their journey. migration from the NTCA, and to assess the medical — MSF patients reported that the perpetrators of needs and vulnerabilities specific to the migrant and violence included members of gangs and other refugee population MSF is treating in Mexico. criminal organizations, as well as members of the Mexican security forces responsible for their The surveys and medical data were limited to MSF protection. patients and people receiving treatment in MSF- supported clinics. Nevertheless, this is some of the most comprehensive medical data available on According to medical data from MSF clinics from migrants and refugees from Central America. This 2015 through December 2016: report provides stark evidence of the extreme levels of violence experienced by people fleeing from El — One-fourth of MSF medical consultations in Salvador, Honduras, and Guatemala, and underscores the migrants/refugee program were related to the need for adequate health care, support, and physical injuries and intentional trauma that protection along the migration route through Mexico. occurred en route to the United States. — 60 percent of the 166 people treated for sexual violence were raped, and 40 percent were exposed to sexual assault and other types of humiliation, including forced nudity. — Of the 1,817 refugees and migrants treated by MSF for mental health issues in 2015 and 2016, close to half (47.3 percent) were victims of direct physical violence en route, while 47.2 percent of this group reported being forced to flee their homes. FORCED TO FLEE CENTRAL AMERICA’S NORTHERN TRIANGLE MSF 5 The MSF survey and project data from 2015-2016 and ability to seek protection in Mexico and the show a clear pattern of victimization—both as the United States. impetus for many people to flee the NTCA and as part of their experience along the migration route.