Costa Rica: A race against time to treat victims of sexual violence in the Darién Gap

Médecins Sans Frontières (MSF) is working in southern Costa Rica, where our teams, together with local partner Cadena, are providing medical care to people who have experienced sexual violence. Over the last month, 135 people who have crossed the Darién Gap – the treacherous stretch of jungle that straddles Colombia and Panama on the Central American migration route – have been identified as victims of sexual violence.

“On one part of the route, on the Panamanian side, some boatmen came out and tried to rape me,” María* explains with the calmness of someone who has become accustomed to living close to the horror. “They groped me and left several bruises on my body where they squeezed me looking for the money.”

“They stole almost everything I had for the trip,” says María. “Another woman who was with me was not so lucky; they took her to a tent and raped her.”

María tells her story to the MSF team at the Estación Migratoria del Sur (Southern Migration Station – EMI Sur) in Costa Rica, where she arrived with her husband and daughter after surviving “a horror movie”.

“It was several days where we saw dead people, dangerous animals, horrible rivers, cliffs that you have to hold on tight to the rocks, because if you fall, they will never get you out of there again,” says María. “And then there are the people who hurt you so much.”

She is one of 81 victims who in the last month have received comprehensive medical and mental health care after being sexually assaulted while crossing the Darién Gap. MSF teams had been providing treatment to sexual violence victims on the Panama side of the Darién, until we were forced to suspend activities in Panama in mid-March. Since then, providing treatment has become more complicated and it is taking much longer for people to receive the urgent assistance they require to mitigate the negative impacts on their physical and mental health.

Since mid-April, MSF and Cadena have been working in EMI Sur to expand access to medical and psychological care services for people who have experienced sexual violence.

“Our activities are focused on raising awareness, actively identifying cases and providing comprehensive assistance to victims of all types of sexual violence,” explains Karen Chacón, one of the psychologists on the MSF team at EMI Sur. “In these first weeks, we have noticed that few people understand what sexual violence means and the importance of receiving specialised care to prevent further harm.”

During the development of the project, the teams identified 135 people who have suffered some form of sexual violence after passing through the Darién, but 54 of them have refused the assistance offered.

“These decisions are greatly influenced by the fact that people want to leave this space very soon to continue their journey,” says Chacón. “But also some victims prefer to remain silent to avoid prejudice and stigma because of what happened to them.”

In MSF’s care space, the team tries to ensure that, in addition to medical care, victims/patients can unburden themselves and recognise that they have been through a potentially traumatic situation that can be alleviated by expressing their emotions and feelings.

“We try to make them understand that it is normal to feel constant fear, anxiety, worry and to have sleep problems, but that it is key to attend to these symptoms before more time passes and they become more difficult to overcome,” says Chacón.

María did want to receive medical and mental health care, as she is pregnant and after the incident, she was in pain that made her fear for the well-being of her baby. Fortunately, she did not require assistance within 72 hours of the event because it was not a rape. However, in two out of three cases where sexual penetration does occur, victims do not make it to a point of care within this time frame, when it is still possible to prevent sexually transmitted infections, HIV, or unwanted pregnancies.

In the following weeks, MSF teams will continue to reinforce activities to identify people who have experienced sexual violence, prioritising the most serious cases and those that have occurred more recently to try to prevent infections, especially HIV.

“This is why we continue to insist on the importance of resuming our activities in Panama, where we can intervene more quickly to improve the response to this serious situation,” concludes Chacón.