Report: No way out

Executive summary

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The epidemic of violence and the deterioration of economic and social conditions in the Central American countries of El Salvador, Honduras and Guatemala have forced large numbers of people to head north to Mexico and the United States in search of safety and security. Every year, hundreds of thousands of people continue to be forced to flee to escape death threats, physical assault, sexual violence and confinement. Increased displacement across the region coupled with sharply reduced options for international protection have created a humanitarian crisis that demands a coordinated humanitarian response. Governments in the region must place the well-being of individuals at the center of their migration policies.

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 displaced people along the migration route through Mexico. MSF teams have personally witnessed the human costs of increasingly brutal migration policies in the region, as documented in our 2017 report Forced to Flee Central America’s Northern Triangle. We have gathered some of the most comprehensive medical data available on migrants and refugees from Central America. Our findings underscore the urgent need for adequate health care, support, and protection for people in their home countries and along the migration route through Mexico.

This latest report is based primarily on data and testimonies gathered from our patients along the migration route over the past two years, starting in January 2018. Of the 480 people interviewed as part of a structured survey, 97.9% were from the Northern Triangle of Central America (NTCA) —comprising Honduras, Guatemala, and El Salvador. The violence suffered by people living in the NTCA is comparable to that in war zones where MSF has been working for decades.

Nearly half (45.8 %) of the migrants and refugees interviewed in 2018 in several MSF health care posts in Mexico mentioned at least one event involving exposure to violent situations as a key reason for deciding to leave their home countries. More than one-third of those who had fled due to violence were initially internally displaced for the same reason. On their journey to find safety, many of our patients experienced additional threats. Of those interviewed, 57.3 % were exposed to some kind of violence along the migration route.

Harsh migration policies introduced by the US and Mexico in recent years have increased the dangers for an already vulnerable population. Patients also describe an increase in the predatory violence perpetrated by criminal organizations operating along the migration route. 

The aggressive migration policies adopted by the US and Mexico mean that more and more people are trapped in a vicious circle. Time and again, people seeking safety are being treated like criminals —detained, deported, and often sent back to the same violent conditions that they were trying to escape. Despite national and international legal obligations requiring states to protect people fleeing violence and persecution, the US government has implemented a series of measures limiting access to asylum —including the so-called “Migrant Protection Protocols” (MPP), which force asylum seekers to remain in Mexico to wait out their legal proceedings. The US government has also put pressure on Mexico and other countries in the region to curb migration and prevent asylum seekers from arriving at its southern border.

Central American asylum seekers and migrants find themselves with no way out, trapped by a series of barriers in conditions that threaten their mental and physical health. Regional governments have failed to guarantee that vulnerable people are assisted and protected.

With this report, MSF seeks to expose the devastating effects that the criminalization of migration is having on people fleeing violence and poverty in the NTCA. Seeking safety is not a crime. Over the course of seven years providing medical aid to people along the migration route, we have witnessed terrible suffering as well as extraordinary resilience among our patients. People affected by violence and extreme poverty in Central America, irrespective of their legal status or the country in which they find themselves, must have access to medical care, protection and humanitarian assistance.

Key findings 

Summary of key findings based on MSF medical data and survey results

Violence in the NTCA and reasons for fleeing:

• 61.9 % of the migrants and refugees interviewed by MSF had been exposed to a violent situation in the two years prior to leaving their home country.
• Almost half (42.5 %) of those interviewed reported the violent death of a relative in the last two years, 16.2 % had a relative who was forcibly disappeared, and 9.2 % had a relative kidnapped.
• Of those interviewed, 35.8 % had been threatened for extortion, 26.9 % had been victims of some kind of assault, and 5 % had been victims of torture in the two years prior to leaving their country.
• Of those interviewed, 45.8 % mentioned at least one event involving exposure to violent situations as a key reason for deciding to migrate. The most frequently reported violence-related reasons were direct assaults on themselves or their families (20.8 %), extortion (14.9 %), other threats (14.3 %), attempted forced recruitment by gangs (10.5 %), and confinement (5.5 %). People traveling with children more often reported leaving on the grounds of violence (75.8 %).
• More than a third (36.4 %) of the migrants and refugees who mentioned that they had fled due to violence had initially been internally displaced for the same reason.
• Of the migrants and refugees interviewed, 52.3 % had already tried to migrate at least once before. Of these, 82 % had been deported at least once before.
• Of the 2,353 people who received a mental health consultation in MSF clinics in El Salvador between January 2018 and September 2019, 62 % had suffered from exposure to violence as a precipitating factor; 23.3 % of all cases were related to intentional physical violence (assault, rape, or torture).

Violence against migrants and refugees in Mexico:

• Of those interviewed, 57.3 % had been exposed to some kind of violence along the migration route through Mexico.
• During their transit through Mexico, 39.2 % were violently attacked and 27.3 % were threatened or extorted.
• 5.93 % reported witnessing a death after entering Mexico; in 17.9 % of cases the cause of death was murder.
• Of the 3,695 people who received MSF mental health consultations at health care posts for the migrant population in Mexico between January 2018 and September 2019, 78 % had suffered from exposure to violence as a precipitating factor. With regard to the type of violence to which they had been exposed, 24.7 % presented risk factors associated with intentional physical violence (assault, sexual violence, and torture).
• In the first nine months of 2019, the number of sexual violence cases (277) treated by MSF in Mexico more than doubled —increasing by 134 % compared to the same period last year (118).
• Eight out of every 10 people (79.6 %) treated by MSF in Nuevo Laredo during the first nine months of 2019 reported being a victim of violence. 43.7 % of patients said they had experienced violence in the seven days prior to their consultation.
• 8.6 % of the people seen in our mental health program in Nuevo Laredo between January and September 2019 had been victims of kidnapping, and 63 % of those said they had been abducted in the seven days prior to the consultation.
• In September 2019, out of 41 patients in Nuevo Laredo who were returned to Mexico by the US under the Migrant Protection Protocols (MPP), 18 had been kidnapped recently (43.9 %) and an additional five patients (12.2 %) had been the victim of an attempted kidnapping. In October, the percentage of kidnappings among those sent to Mexico under the MPP program increased to 75 % (33 of the 44 new patients).

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