This story isn’t new, but it’s still happening. Migrant women consistently leave their home countries with the hope of reaching the United States. On the road, they encounter fear, hunger and violence. They come from countries such as Honduras, El Salvador and Guatemala, and have to cross more than 3,000 miles on foot from Mexico to reach the US border. For some women and girls, being raped is the price of the trip.
In addition to this scourge of sexual aggression, the victims are often not treated in public hospitals, due to their status as irregular migrants. They often depend on non-governmental organizations to obtain treatment, contraception, or psychological support. One of those organizations is Doctors Without Borders. The entity has identified sexual violence along migratory routes as one of the most heinous problems in Mexico and Central America. Last year, the medical NGO handled 61 direct cases of sexual assault and more than 3,200 for consultations on sexual and reproductive health.
The first obstacle that these women face to get medical assistance begins at the hospital’s door, explained Elena Vargas, a Nicaraguan doctor who has settled in Mexico. “From there, you open your mouth, the security guard at the medical center hears that you’re a foreigner and bye. Complete rejection.”
Those who manage to get past this stage meet those in charge of the medical bureaucracy, who are required to open up files on each new patient. “Very few are sensitized and trained enough to know that migrants also have the right to medical services,” Vargas pointed out. The final stage is the medical staff, where the girls and women often receive care that is “poor, to say the least.”
Vargas – who went into exile from Nicaragua after the 2018 protests – explained that sexual violence has become one of the most tangible problems affecting migrant women.“Early care is essential. Ideally, cases are treated in the first 72 hours, when we can prevent [unwanted] pregnancy… and when we can also give some prophylaxis (preventative medicine) in the event that the attacker was HIV positive.”
However, the doctors don’t always manage to reach them before three days have passed. In 2022 such a rapid response was achieved in just five cases. This is partly because many women don’t know what to do when they are sexually assaulted. “Where do migrant women go when they have something like the flu? They know. But [what about] when it’s an issue as sensitive and as stigmatizing as sexual violence?” Vargas asked.
Doctors Without Borders is in charge of helping with the medical aspect of treatment, including giving them access to the necessary pills and psychological consultations, or referring them to centers where they can get other services. Of these, there are very few places they can turn to. Vargas mentioned that, in Mexico City, they only have one public reference clinic, in the Condesa neighborhood.
“They have their doors open for migrants, but [this is] a very exceptional [facility],” she said. In addition, personnel from the clinic often accompany migrants to navigate the health system. In other cases, they resort to social workers and interpreters – for women who speak French, Portuguese, or Haitian Creole – to help the migrant women.
“But how many people can have access to this type of accompaniment? There are many migrants. We have limited resources – we need a response from the state, [this issue can’t] remain in the hands of NGOs, and civil society,” Vargas warned.
The framework to deal with this issue varies from country to country. In Honduras, for example, in December 2022, Doctors without Borders succeeded – after many years of lobbying the Ministry of Health – in ensuring that emergency contraceptive pills be offered to victims of sexual violence. Honduras was the only remaining country on the continent that had not yet approved this measure.
In El Salvador, the NGO faces a system that criminalizes abortions, including involuntary ones. In Nicaragua, Daniel Ortega’s regime expelled Doctors Without Borders – along with most NGOs, such as the International Red Cross – from the country, leaving a healthcare vacuum that the public healthcare system cannot fill.
“In Nicaragua, abortion is prohibited in all cases, regardless of whether it’s the product of sexual violence, or whether the fetus [has] malformations. In addition, there’s a rampant sexual abuse of girls, who are forced to give birth when they are 11 or 12-years-old,” Vargas said.
But sexual violence is just the tip of the iceberg. A 2021 report published by Mexico’s National Institute of Public Health and the National Autonomous University of Mexico found that 29% of migrants are victims of physical, psychological, or sexual violence. Most abuses go unpunished. Fear of being repatriated and mistrust in the authorities results in only one in 10 cases being reported.
In total, Doctors Without Borders has treated 24,600 migrants between Honduras, Guatemala and Mexico.
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