Making Central American hospitals safe for everyone: the case of Honduras

In Honduras, 3 791 murders were reported in 2017 alone. The EU launched the Safe Hospitals project to mitigate the impact of violence on healthcare delivery in the Central American northern triangle.

Levels of criminal violence in some Central American countries are comparable to countries at war. © EU

Central America holds the grim record of being one of the most disaster-prone regions in the world. Local communities are plagued by recurrent disasters, including earthquakes, volcanic eruptions, hurricanes, and other natural hazards.

Furthermore, poverty and extreme levels of violence compound a dire situation for people who are already vulnerable.

The region bears the humanitarian consequences of organised violence, a silent emergency forcing hundreds of thousands to flee the “northern triangle” countries of Guatemala, Salvador and Honduras. At least 487 000 people are internally displaced as a consequence of the pervasive violence in the three countries.

Due to the presence of approximately 54 000 gangs, the triangle records levels of criminal violence that are comparable to countries at war. Gangs are responsible for “brutal acts of violence, chronic abuse of women, the forced displacement of children and families, [and] driving Central American murder rates to highs unmatched in the world,” according to Crisis Group, which analyses violent conflict. Forced recruitment of children and school dropout are another plague linked to this phenomenon.

In Honduras, 3 791 murders were reported in 2017 alone. For a population of nine million people, this translates into a homicide rate of 42.8 per 100 000 inhabitants, a mortality rate similar to that of a major epidemic. The EU average is under one.

In Honduras, 3 791 murders were reported in 2017 alone. For a population of nine million people, this equates to a homicide rate of 42.8 per 100 000 inhabitants, a mortality rate similar to that of a major epidemic. © EU

© EU

No one is safe. In June and July 2018, three schools were attacked in Honduras, the Norwegian Refugee Council reported. Hospitals and health centres are also increasingly at risk.

“Our medical personnel are threatened every single day, particularly those working in emergency and orthopedic surgery,” says Dr Lilian Gallo, who manages the main hospital in El Progreso, a suburb of San Pedro Sula in Honduras, infamously dubbed the “murder capital of the world” because of record-high homicide rates in recent years. “We are constantly confronted with violence, and we treat gunshot or stab wounds on a daily basis,” Dr. Gallo explains.

The El Progreso hospital is part of the EU-funded, €600 000 regional “Safe Hospitals” initiative, which allows the World Health Organization (WHO) to strengthen the safety and security as well as the resilience capacities of medical personnel in 24 medical facilities across the region.

“It is crucial for health workers to be able to work in safe conditions.”

The European Commission has long supported Central Americans which has been affected by disasters of all kinds, funding €223 million in humanitarian aid since 1994 to respond to (or prepare for) hurricanes, droughts, earthquakes or volcanic eruptions.

But in recent years, the EU has increasingly looked at violence as posing an equally ominous threat to the well-being and resilience of vulnerable communities. This is why the EU and its humanitarian partners are providing more support to the vulnerable communities facing not just natural threats but also pervasive violence and poverty.

“It is crucial for health workers to be able to work in safe conditions,” says Urko Dubois, who coordinates the European Commission’s humanitarian programmes in Central America. “Our priorities are not only to grant secure access and safe working conditions for medical staff, but also to ensure that insecurity doesn’t affect the quality of care the patients receive,” he explains.

The violence affects schools, hospitals and health centres. © EU

In 2016, the EU launched the Safe Hospitals project to mitigate the impact of violence on healthcare delivery, to strengthen the safety and care capacities of health facilities of the Central American northern triangle. The initiative has developed protective measures and protocols to ensure the safety of patients and staff, as well as reinforce capacities of the health workers in a context that is simultaneously marred by recurrent natural threats.

The project run by WHO has provided specialised training to personnel enabling them to react to violent incidents. It has also upgraded the security infrastructure of the health facilities. “In the past, we had contingency plans only for disasters such as earthquakes or floods; but we had never considered violence as one of the major risks our personnel faces,” Dr. Gallo explains. “The project has allowed us to specialise in treating gunshot and stab wounds, but also to be more attentive to, and care for our own personnel’s security and mental health,” Dr. Gallo says.

Participating hospitals now display “No weapons allowed” signs. A national public campaign was also launched under the catchphrase “Health without harm” advocating for the respect and protection of medical facilities and professionals.

The quality of healthcare delivery has substantially improved, with funds invested in innovative coordination and response protocols.

“Training staff to tackle threats, be they from natural disasters or violence, is essential if we want to deliver quality healthcare to the vulnerable people we assist. It is only by taking this holistic approach and tackling all possible causes of risks, that we can ensure that our hospitals are truly ‘safe’,” concludes Urko.

By Hilaire Avril, Regional Information Officer, European Civil Protection and Humanitarian Aid Operations (ECHO)

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