Mexico, Honduras & El Salvador: A Multidisciplinary COVID-19 response
Mexico, Honduras and El Salvador have been responding to the COVID-19 emergency for the last six months and all three countries are now showing a decreasing number of cases. Doctors Without Borders/Médecins Sans Frontières (MSF) teams continue to meet the medical needs of people excluded from health systems, such as migrants, asylum seekers and victims of violence, whose situations have worsened during the pandemic. This is done through mobile clinics, support shelters, hospitals, and the management of COVID-19 centres and ambulances.
The additional layer of COVID-19
Mexico has become one of the epicentres of the pandemic in Latin America, along with Brazil and Peru. It has the fourth most deaths from COVID-19 of any country in the world. It is estimated by NGO reports, such as Amnesty International, that more than 100,000 health workers have been infected by the disease; many now feel stigmatized as a result of their work, which has resulted in attacks and discrimination. In July, the country began to gradually relax its containment measures, bringing the country into a ‘new normal’ in which business and industry could recover. Since August 17, the country continues to see a decrease in infections for the fifth consecutive week.
The de-escalation of the lockdown is being done according to a traffic light colour scheme. While the worst affected areas are Mexico City, and Mexico, Guanajuato, Nuevo Leon and Tabasco states (where MSF has activities in Tenosique city), some of these have been classified as ‘orange’ or ‘yellow’ states. There have been 26,861 confirmed cases* in Tamaulipas state, where MSF runs COVID-19 treatment centres in the cities of Reynosa and Matamoros, and is supporting infection, prevention and control (IPC) measures in migrant shelters in Nuevo Laredo. The teams have recorded a decrease in the number of cases in both cities, but are preparing for a possible resurgence of patients. There have been 16,454 confirmed cases* in Guerrero state, where the MSF project has resumed regular activities while also helping health centres and hospitals to implement IPC measures.
In mid-March, the Honduran government declared an emergency situation, limiting people’s freedoms and movements. The Cortes department, in north of the country, is the worst affected region with 31.3 percent* of confirmed COVID-19 patients. After three months of confinement, and despite an increase in the number of cases in June, on June 8, the economy was reopened in various municipalities, mainly rural and agricultural, as part of an ‘intelligent reopening of the economy’. Hospitals and health centres from all over the country have reported a lack of personal protective equipment (PPE) and resources to care for patients. Various national and international news outlets have reported on cases of corruption surrounding mobile hospitals brought by government.
El Salvador followed a similar response to Honduras, locking down many parts of the country in mid-March. Since the beginning of the outbreak, El Salvador has reported 27,009 cases and 788 deaths*. The capital, San Salvador, is the epicentre of the outbreak. Health centres and hospitals have suspended outpatient consultations. This has left treatment for patients with chronic illnesses, and those in need of family planning services, prenatal and postnatal consultations, mental health support and community activities neglected, specifically areas where they have historically been affected by violence. There is a clear lack of access to basic healthcare services. The Ministry of Health has reported an increase in teenage pregnancies with almost 3,000 cases during the lockdown. Until August 21, there had been a 13-day decreasing trend in COVID-19 cases.
Five Ways MSF is is currently responding
1. Mobile teams and clinics
MSF COVID-19 mobile teams are working in different parts of Mexico to establish biosafety protocols (IPC and water and sanitation management) in COVID-19 hospitals, community hospitals and health centres. These protocols will help to guarantee the safety of healthcare staff and patients. The team has worked in Mexico City, Guerrero and Oaxaca states, and is now working in Tabasco state.
In El Salvador, MSF ambulance services dedicated to transporting COVID-19 patients have continued to operate in order to alleviate the workload of the public emergency system. MSF mobile clinics continue in communities in San Salvador and Soyapango that have been affected by violence. MSF continues COVID-19 prevention health promotion activities. MSF is providing mental health care at an isolation centre for people that have been deported from Mexico and the US, while evaluating other centres and shelters for possible interventions.
2. COVID-19 Centres
In Matamoros and Reynosa, near Mexico’s northern border, MSF is caring for mild to severe patients in two COVID-19 centres installed in each city campus of the state university. Both centres have space for 20 severe patients that require concentrated oxygen and have isolation areas for mild and suspected patients who do not have a place to isolate themselves. These patients could be migrants, returnees, people without a home or people that do not have enough space in their houses to isolate from their families. The centres have established a comprehensive healthcare system where patients can receive medical and psychosocial care services.
In Tegucigalpa, the Honduran capital, MSF has opened a treatment clinic for patients with severe COVID-19 at the National University sports facility. The objective of this project is to prevent hospitals in the metropolitan health system from becoming overcrowded and to care for patients in a comprehensive way, including mental health, social work and health promotion services.
3. Migrant shelters
Asylum seekers and migrants face a worsening situation during the COVID-19 pandemic due to uncertainty of their asylum seeking process to be continue, stigmatization and precariousness regarding hygiene and lack of space in shelters. Reflecting this, in Nuevo Laredo, northern Mexico, MSF is assessing all migrant shelters where more than 200 people are isolating and is implementing any relevant IPC measures. Basic healthcare and psychosocial support are provided to shelter’s residents, staff and also sometimes to members of the surrounding communities.
In Reynosa and Matamoros, MSF’s mobile clinic team offers comprehensive healthcare services (including medical, health promotion, mental health and social work) in shelters for migrants and asylum seekers. The teams have adapted their activities since March and have developed triages to detect possible COVID-19 cases and refer them to MSF COVID-19 centres or other facilities if needed.
In Tenosique city, in the southern state of Tabasco, MSF continues to offer comprehensive basic healthcare (both medical and psychological support) to migrants at the La 72 shelter. MSF has also assessed and implemented IPC measures and psychosocial care in 15 migrant shelters in Mexico City and another in Mexico State.
4. Migrant route
A multidisciplinary COVID-19 intervention team (health promoter, psychologist, logistician, WATSAN and IPC manager) has been formed to provide technical support, training and advocacy in decision-making on COVID-19 prevention and control in migrant shelters along the Mexican migration route. This team is also providing psychosocial support to migrants and staff with suspected or confirmed (or in contact) with COVID-19.
In Matamoros, MSF is caring for asylum seekers in an improvised camp that was established due to the Migration Protection Protocols (MPP) while people are waiting for their US asylum hearings. MSF has a comprehensive healthcare team with health promotion activities that included COVID-19 prevention, and a medical team that has established a triage system to detect possible COVID-19 cases.
5. Support lines
A hotline and WhatsApp number has been set up so that MSF psychologists provide psychological care remotely to migrants and refugees across the country, and to people isolated by violence in Guerrero.
In Tegucigalpa and Choloma, Honduras, MSF has set up two mental health phonelines for survivors of violence and sexual violence. At the moment, an increase in mental health consultations has been reported by MSF psychologists.
- Learn more about MSF’s response to the journey refugees and asylum seekers experience
- Learn more about the impact of COVID-19 on MSF’s medical humanitarian work
*Data is current as of September 14, 2020