Mexico’s southwestern Guerrero state is not only facing the COVID-19 pandemic but also an increase in violence that is affecting the physical and mental health of thousands of people.
For those living in isolated communities, access to health services is either very limited or nonexistent due to confrontations between more than 40 armed groups vying for control of the territory. Parts of the Guerrero mountains have become battlefields where people are trapped or forced to flee amid the crossfire. Thousands of families have been displaced.
Since 2016, Doctors Without Borders/Médecins Sans Frontières (MSF) mobile clinics have traveled to some of these communities to provide medical and mental health care. Our teams have cared for hundreds of families affected by violence in different regions of the state.
“The epidemic of violence is something that is affecting different communities, mainly due to clashes between organized crime groups over the cultivation of poppies and avocados. These are two [major sources] of income, and the groups fight over that income,” says Alberto Macín, manager of MSF’s mental health activities in Guerrero.
A few days ago, MSF assisted people who had been forced to leave their community in the Tierra Caliente region at the beginning of 2020. In July, in the middle of the COVID-19 pandemic, residents were able to return to rebuild their town after a truce was called between the armed groups.
"People are now mainly confronted with the consequences of their displacement. They are having to deal with everything that returning to the community and starting from scratch involves," says Gabriela Peña, an MSF psychologist in Guerrero.
Onelia Ayala, a local vendor, remembers how hard it was for her family to rebuild everything.
"The community was devastated—a garbage dump,” she says. “There were dead animals here, all the houses were open, looted, torn down and dirty, and there were pools of blood in the lagoon. It was bad," she says.
Some families have also suffered the loss of loved ones in the fighting, or to migration. It is estimated that 70 percent of the population has been able to return, while the rest have remained in other nearby states, such as Morelos, or have sought asylum in the United States.
"I think they are unlikely to come back," says Onelia. "In my brother's case, he doesn't want to. It's distressed him a lot—he is very affected."
Omar Rojas, a remote high school teacher, says several of his students left, some to seek asylum in the US.
“Others went to Mexico City or to the municipal capital, depending on their circumstances," he adds.
Although Guerrero, like the rest of the country, has been affected by the COVID-19 pandemic, the most isolated rural communities visited by MSF had no detected cases. However, our teams take extreme precautions to avoid contagion and train health center staff and the general public on protective measures, such as the use of face masks and proper handwashing.
"To protect itself from COVID, this community closed its borders at the beginning of the pandemic," says Bonnie Vera, an MSF doctor who is assisting a community trapped by violence for over two years in Costa Grande. "We had to rethink our entry into the communities and, as of August of this year, we resumed the provision of care through mobile clinics, taking all measures necessary to avoid contagion."
MSF’s medical and psychological services are the only options people have for receiving treatment, where the health of the community has already been greatly affected by the lack of resources.
"The health center has been closed for two years and two months,” says Pablo Costilla, a farmer and rancher. “If, for example, women are going to give birth here, there is a midwife who takes care of them and, fortunately, they have been alright so far. But if there are complications, it is risky, because it takes four or five hours to get to the city from here."
In addition to the lack of medical care, people live in constant fear.
"Neighboring communities have left out of fear and had to migrate to the United States to seek political asylum," says Narciso Torres, a community leader and environmental activist.
"Most people went because they had been threatened—everyone who was threatened left. Sometimes we are calm. Sometimes we are uneasy and distrustful, scared and fearful, wondering when they will come to kill us."
Mental health care is an essential need in these communities.
"Imagine the impact on the population of living in isolation, unable to move freely, and in a state of hypervigilance,” says Macín. “In this community, there are a large number of children who haven’t had teachers. These are bright, active children, playing and having fun, but uneducated and living in constant fear that they cannot leave their community because they are also at risk."
