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Honduras: Responding to emergencies within emergencies
MSF expands operations to meet the growing needs
People in Honduras are experiencing emergencies within emergencies. Their vulnerabilities are, in many cases, no longer due to temporary circumstances but a more persistent situation. MSF advocates to alleviate suffering in humanitarian crises. This year the organization has already started two new emergency response projects.
In 2020, a year of profound turmoil for global health, the humanitarian situation in Honduras became critical due to the combined impacts of the COVID-19 pandemic, the double disaster of Hurricanes Eta and Iota, as well as the exodus of thousands of people who seeking security.
Doctors Without Borders/Médecins Sans Frontières (MSF) has expanded its medical humanitarian operations to respond to the growing needs.
Reaching out to survivors of violence in Tegucigalpa
In Tegucigalpa, MSF’s mental health project for survivors of violence and sexual violence provided counseling services over the telephone as well as digital health promotion related to mental health care and COVID-19 prevention.
In June, taking necessary health and safety measures, the teams returned to provide care to patients at the Nueva Capital Health Center, the Alonso Suazo Health Center, the Escuela Universitario Hospital and the Integrated Center of the Public Ministry.
According to the National 911 Emergency System, as of September 30, 2020, 76,520 calls for help were reported for domestic, family and sexual violence
During the COVID-19 lockdown, there was a considerable increase in the number of calls.
The helplines made it possible to reach survivors of violence who had difficulties getting to the clinics due to financial limitations or because of living with the abuser.
MSF psychologist Carmen Moncada provides mental healthcare in MSF’s project in Tegucigalpa, which focuses on care for survivors of violence, including sexual violence.
Maintaining these services during the COVID-19 pandemic requires strategies that enable victims of violence and sexual violence to access medical and psychological care, without legal obstacles.
Seeking care for sexual violence should be considered a priority medical emergency.
Expanding access to healthcare in Nueva Capital
In March 2021, MSF carried out the successful handover to government of the Nueva Capital Health Center.
The organization worked with the community in Nueva Capital, a neighborhood on the outskirts of Tegucigalpa, starting in 2017 to support construction of the center.
The aim was to improve access to health care for this community, which includes large numbers of people who are displaced, suffering from high rates of violence, and excluded from the health system.
From the opening of the health center in June 2018 to the handover in March 2021, MSF carried out 33,410 medical consultations, helping 12,150 people.
This health center managed by MSF provided comprehensive care, including mental health care for 2,165 people and social work with 1,032 people.
Regarding sexual and reproductive health, teams provided 5,067 family planning consultations, 2,019 prenatal check-ups, 641 postnatal check-ups and 697 cervical cytology screenings.
At this center, 1,080 mental health patients were survivors of violence and sexual violence.
The greatest achievement in the community was to improve their access to health services, coupled with constant awareness-raising work related to issues of violence and sexual violence.
Working with communities in Choloma
This project in the city of Choloma provides a range of services focused on sexual and reproductive health, sexual violence and mental health.
Comprehensive medical care is offered at the Maternal and Child Clinic (known by its initials in Spanish as CMI), together with the community clinic in different neighborhoods in Choloma.
The goal is to reduce maternal and child mortality.
From March to May 2020, this team provided emergency care at the Maternal and Child Clinic and gradually restored all services.
In 2020 alone, this health facility provided 2,355 family planning consultations, 4,768 prenatal consultations, 573 postnatal consultations and psychological care for 1,059 people.
It is currently considered a leading health facility for humane childbirth.
"At the end of 2020, the CMI was operating at full capacity and assisted 919 births"
This year, MSF began transferring services from the Maternal and Child Clinic to the Ministry of Health, after more than four years of operations under its coordination.
In Choloma, MSF services will begin to have a broader community-based approach to provide health services for situations of sexual violence to the most vulnerable people, including women and girls of reproductive age and adolescents.
Using this same approach, in February, efforts began in San Pedro Sula to improve access to medical and psychological health care for transgender people and men who have sex with men (MSM).
A mobile team will offer health services for sex workers, including care for victims of violence and sexual violence, and sexual and reproductive health care.
The evolving response to COVID-19
COVID-19 arrived in Honduras on March 20, 2020.
By June, the country's hospitals were full and there was a lack of care rooms equipped to provide dignified and high-quality medical care for Hondurans.
MSF installed a care unit with 20 beds for COVID-19 patients in the University Sports Center, where the team treated 139 patients, providing medical, psychological and social work services for three months.
This project helped provide critically needed care at a time when the hospital system was overwhelmed.
"After more than a year of the pandemic, April 2021 became the second deadliest month in Honduras with 678 deaths. The first deadliest month was July 2020 with 840 deaths."
So far, in Honduras, the challenges of hospital capacity have not been overcome.
However national care circuits have been created with triage centers categorizing patients according to case severity, in an effort to avoid the saturation of large hospitals.
MSF decided to support the care circuit through activities at the University Sports Center, with three ambulances available to take patients from the triage center to the hospitals and reduce waiting times.
A patient could wait up to 12 hours at a triage center during periods when hospitals were saturated, although the average transfer time was 4 hours, according to research by the MSF Tegucigalpa team.
MSF has prepared nine psychologists to provide telephone assistance to COVID-19 patients who are hospitalized.
At the community level, this project will have 10 health educators to carry out activities to raise awareness and provide information in areas where there are high rates of infection.
Facing the impacts of climate change with a Planetary Health approach
The floods at the end of last year caused by Hurricanes Eta and Iota affected some 3 million people, and left 55,435 people in shelters.
MSF’s humanitarian response, through its team in Choloma, initially focused on emergency needs.
The organization donated medicines to the Ministry of Health, deployed a team to deliver basic kits and evaluated conditions in the shelters.
MSF also worked with the contingency committees to act in coordination with international organizations and the Honduran government.
During the second stage of the emergency, in December, MSF set up mobile teams to provide medical and psychological care and health promotion. Teams visited 79 shelters in Choloma, in Cortés department.
Over 14 days, MSF carried out 767 medical consultations, 81 group mental health sessions and 71 individual counseling sessions.
Teams also provided hygiene kits, water donations, biosafety equipment and medicines (including contraceptives), helping 13,260 people.
Reducing the impact of floods
In March 2021 MSF started the northern project to provide humanitarian assistance to people affected by Hurricanes Eta and Iota.
With a team of 140, MSF will assist people living in the municipalities of Choloma, La Lima, Villanueva, and San Manuel, in the department of Cortés, and El Progreso, in the department of Yoro.
One component of this project aims to improve access to mental health services, offering care in response to the material and emotional losses caused by the floods, psychosocial support related to COVID-19, and care for the consequences of violence, including sexual violence.
In addition, comprehensive vector control activities and a dengue monitoring system have been implemented in strategic health centers to help reduce the risk of disease outbreaks.
Vector-borne diseases in this area include dengue, Zika, and chikungunya.
In Choloma and San Manuel, fumigation activities are underway.
Logistics activities will also be implemented to improve water and sanitation systems and rehabilitate some health structures.
At the community level, health educators will raise awareness about vector-borne disease prevention, psychosocial education, and violence and sexual violence.
The Honduran exodus and other migration patterns
MSF in Honduras does not have a project focused on migration, but it has provided medical care to Hondurans who joined the migrant caravans.
In October, after opening the Honduran borders with Guatemala, 4,000 migrants participated in a caravan that departed from the town of Corinto.
These people received comprehensive medical assistance from two teams that provided 55 individual medical consultations and 166 group consultations in six hours.
In addition, the teams provided health information to 500 people and delivered 103 medical kits.
The losses due to Hurricanes Eta and Iota drove people to join a new caravan of some 8,000 Hondurans that departed in January 2021, despite the threat of police checkpoints and the risk of COVID-19.
MSF responded with four mobile teams to provide medical and psychological care to the migrants.
Teams distributed 3,070 medical kits for adults, pregnant women and children.
"MSF advocated for the dignified and safe treatment of migrants"
The organization expressed concern over the acts of violence of security forces against the people of the caravan in the community of Chiquimula, Guatemala.
Migration across this country is not limited to Hondurans on the move, but includes an increase in the number of migrants and refugees from other countries in transit hoping to reach the United States.
Since February, the border cities of Honduras and Nicaragua have seen between 50 to 1,000 migrants and refugees a day, most of them with health conditions resulting from the long journey and hardships experienced during their crossing through the Darien Gap, a dangerous jungle on the Panamanian border.
This is MSF’s most recent emergency response in Honduras.
As of April, teams have made four visits to the municipality of Trojes, providing medical care to 326 people, psychological care to 100 people, and delivering 350 hygiene kits to families.