Health and Human Rights in El Salvador
Written by Jeffrey Thiele.
What do you do if you must cross gang lines in order to access necessary medical care or visit a hospital? This is a question people in El Salvador, particularly internally displaced people, are sometimes faced with. In El Salvador, access to medical care for victims of gang violence can be a highly complex issue influenced by concerns related to public safety, violence, gangs, and internal displacement.
Some countries recognize access to healthcare as a fundamental right, and have built the right to healthcare into their constitution. El Salvador is one of those countries. Unfortunately, the acknowledgement of a right does not always mean that you can easily exercise that right. One factor limiting many Salvadorans from exercising their right to healthcare is the violence present in the country.
Violence exists in many different forms in El Salvador – be it gang violence, police violence, or other forms of state violence – but the one common factor is that each form of violence puts the life and safety of its victims at risk. As Cristosal’s work in the country has shown, forced displacement has become a common, short-term solution to escape the threat of violence.
In a country that is so small and interconnected, the threat of violence for displaced people often restricts their mobility. Many internally displaced people minimize the time they spend outside their residence in order to remain invisible, to the point of foregoing a necessary medical consultation or errand for medications. As you can imagine, this can easily result in severe, even life-threatening, health consequences further down the road.
Even if internally displaced people do go to one of the country’s national hospital, this can also put them at risk. National hospitals are inherently public spaces, open to anybody. In El Salvador, public spaces are infiltrated by ‘invisible borders’, or implicit borders set by local gangs. Gangs monitor the public spaces in their territories, public hospitals included. Imagine having to avoid gang violence by navigating these invisible borders every time you go to a neighborhood park, walk down the street, or need to see a doctor. Internally displaced victims of gang violence must avoid both the gang who contributed to their displacement as well as rival gangs. Once someone has been displaced due to violence, something as simple as entering a health facility implies assuming the risk of being noticed by the gang that controls the surrounding territory.
In one case, a woman was put in critical condition after she was nearly killed by a local gang member. With her safety in mind, her family told all their acquaintances and neighbors that the victim had died, so that she could eventually leave the area to escape her aggressors. However, a nurse who worked in the hospital knew one of the victim’s neighbors and word soon got round to the aggressor that she was alive. Her stay in a public hospital caused the woman’s possible revictimization.
Forced internal displacement adds another layer of complexity regarding access to healthcare that must be addressed in any protective systems that the Salvadoran government implements. Currently, Cristosal is working with the Legislative Assembly to help create a law to protect victims of displacement. Considering that El Salvador’s population of internally displaced people faces a clear problem regarding healthcare access, part of this law must directly set out specific, long-lasting, and institutional solutions that address the health needs of one of El Salvador’s most marginalized populations.
Jeffrey Thiele is a Fulbright student researcher at Cristosal. He is studying the effect that forced internal displacement has on the health and healthcare access of those who are internally displaced due to violence in El Salvador.