Invisible War: Central America’s

Forgotten Humanitarian Crisis

Jason Cone and Marc Bosch Bonacasa

A Salvadoran father of four was told by gang members that they would kill
his two daughters after he refused their extortion demands. A 27-year-old lesbian
from Honduras was gang raped in her home, ostracized by her family, forced to
leave behind her child born of rape, and later hunted by gangs because of her
sexual orientation. An unaccompanied 16-year-old Honduran boy fled forced
gang conscription, was raped along the road in Mexico, and is now battling
sexually transmitted infections.
These are just a few of the individuals who have sought shelter at La 72, an
albergue, or hostel, in the small town of Tenosique, Mexico, 40 miles north of
225
the Guatemalan border. It sits on the front line of a burgeoning forced displace-
ment crisis with 500,000 people fleeing annually from countries of the Northern
Triangle of Central America (NTCA)—El Salvador, Guatemala, and Honduras.
Our organization, Doctors Without Borders/Médecins Sans Frontières
(MSF), runs a clinic inside the La 72 shelter, among other locations along the
Central American migration route through Mexico. A three-person team—a
doctor, psychologist, and social worker—attend daily to the medical and mental
health needs of the people. But they are overwhelmed both by the sheer numbers
of patients and the horrific reasons for people’s flight from their homes. The
managers of the shelter also feel the pressure. “We have gone from a migration
center to a refugee camp,” said Ramón Márquez, the director of La 72.1 In 2017,

Jason Cone is the Executive Director for Doctors Without Borders/Médecins Sans Frontières (MSF)
in the United States. He has led the organization’s engagement with the U.S. government, spearheaded
campaigns to increase access to pneumonia vaccines, and conducted risk assessments and context analyses
in South Sudan, Gaza and the West Bank, Mexico, and Myanmar.

Marc Bosch Bonacasa has worked with Doctors Without Borders/Médecins Sans Frontières (MSF)
since 2000 in Ecuador, Angola, India, Zimbabwe, Colombia, Mexico, and Yemen. He is currently Head
of Operations for Latin America in MSF-Spain.
Copyright © 2018 by the Brown Journal of World Affairs

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 Jason Cone and Marc Bosch
the shelter took in 7,950 people from the NTCA.2 But in the first three months
of 2018, the shelter had already received 3,800 people.3
The number of refugees and asylum seekers from the three countries of the
Northern Triangle has seen nearly a tenfold increase since 2011, according to the
UN High Commissioner for Refugees (UNHCR).4 Asylum applications from
NTCA nationals were 45 percent higher between January and June of 2017 as
compared to the same period from 2016.5
While global attention has been focused on the rising numbers of refugees
fleeing wars in the Middle East and desperate people crossing the Mediter-
ranean, the Northern Triangle is an often-overlooked epicenter of the forced
displacement crisis. The high level of violence in the Northern Triangle ranks
alongside that of the world’s deadliest war zones, according to reports by the
United Nations and the International Institute for Strategic Studies.6 Though
the Northern Triangle is not a war zone, the attacks that people have suffered
in the region and along their migration route through Mexico are comparable
to the situations MSF has encountered in over 40 years of working in conflict
areas around the world. Murders, kidnappings, threats, recruitment by non-state
armed actors, extortion, sexual violence, and forced disappearances are daily
threats facing people in the region.
226 The evidence gathered by MSF through our medical clinics along the
Central American migration route in Mexico illustrates a humanitarian crisis
that demands increased levels of both aid and compassion. The stories of our
patients stand in sharp contrast to the prevailing political discourse on U.S.
immigration. President Trump has portrayed Mexicans and Central Americans
as, at best, stealing jobs from U.S. citizens and, at worst, murderers and rapists
preying on society.7
The Trump administration’s policy initiatives over the past year further
endanger hundreds of thousands of people forced to flee Central America, as
well as many others already in the United States who are now threatened with
deportation. These policies build on bipartisan failings, including 40 years of
U.S. interventions in Central America, that have continued to destabilize the
region and feed a pattern of forced displacement. Starting with the Carter ad-
ministration, then drastically escalating under President Ronald Reagan, the
U.S. government spent more than $6 billion on direct military assistance and
training for the Salvadoran armed forces and police in an effort to back the Sal-
vadoran government against left-wing groups.8 The 12-year conflict left 75,000
dead and more than 1.5 million people displaced. The Reagan administration’s
support of Contra rebels against the Sandinista government in Nicaragua led

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to between 60,000 and 80,000 deaths.9
Dire conditions have been further exacerbated in recent years by the almost
systematic deportation of Central American refugees, migrants, and asylum
seekers by Mexican and U.S. authorities. On January 8, the Trump adminis-
tration ended Temporary Protected Status (TPS) for approximately 200,000
Salvadorans living in the United States.10 TPS is a humanitarian program that
grants temporary lawful status and work authorization in the United States to
people whose countries have been affected by armed conflict, natural disaster,
or other extraordinary events. Salvadorans in the program now have until 9
September 2019 to leave the United States or face deportation.
The United States is sending Salvadorans back to one of the most violent
places in the world, putting them at risk of death. This decision violates one of
the most fundamental principles of international law, non-refoulement, which
guarantees the right of refugees and asylum seekers not to be returned to a
country where their life is at risk or where they are subject to persecution.11 In
survey and medical data from MSF’s programs in Mexico released last year, 55
percent of Salvadoran refugees and migrants reported being victims of blackmail
or extortion, 56 percent had a relative who had died due to violence, and 67
percent said they never felt safe at home.12
227
Our organization is urging the Trump administration to reconsider its deci-
sion, and we are calling on Congress to find a permanent solution that protects
hundreds of thousands of Salvadorans from deportation. For far too many of
the people affected by this decision, deportation is a matter of life and death.
Findings from our medical clinics and patient surveys along the Central
American migration route through Mexico underscore the gravity of the crisis.13
Thirty-nine percent of patients surveyed mentioned direct attacks or threats to
themselves or their families, or extortion or gang-forced recruitment, as the main
reasons for fleeing their countries. Of all Northern Triangle refugees and mi-
grants surveyed, 43.5
percent had a relative The United States is sending Salvadorans
who died due to vio-
lence in the last two
back to one of the most violent places in
years.14 Some patients the world, putting them at risk of death.
reported having been
kidnapped and beaten for days or even weeks for the purposes of extortion,
ransom, or intimidation of other migrants and refugees. Attacks often include
sexual assault.15
While there are certainly people leaving Central America for the economic

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 Jason Cone and Marc Bosch
opportunities up north, our findings show that rampant violence and lawlessness
are the main drivers of flight. Some of our patients described being forced to
abandon thriving businesses due to extortion and violence by criminal gangs.
Attempts to stem migration by reinforcing national borders and increasing deten-
tion or deportation, as we have seen in Mexico and in the United States, ignore
a genuine humanitarian crisis. Such misguided policies do not curb smuggling
and trafficking, but rather help drive migration underground and fuel greater
violence and extortion by criminals who profit from people’s desperation. 

Unprecedented Levels of Violence

Citizens are murdered with impunity, kidnapped, and extorted on a daily basis
in the NTCA. Non-state actors, such as criminal gangs, perpetuate insecurity
and forcibly recruit individuals into their ranks, often using sexual violence as
a tool of intimidation and control.
Around 150,000 people have been killed in the NTCA since 2006, averag-
ing more than 50 homicides per 100,000 people, more than triple the rate in
Mexico and more than 10 times the U.S. average.16 A global study on homicide
carried out by the United Nations Office on Drugs and Crime (UNODC) in
228 2013 placed Honduras and El Salvador first and fourth respectively on the list
of countries with the highest murder rates in the world.17
Disappearances have also become a grave concern, reaching levels unseen
since the civil war in El Salvador. Between 2010 and 2016, the prosecutor’s of-
fice received 23,000 reports of disappearances, as compared with the estimated
number of disappearances—5,500 persons—found by the Commission on the
Truth of El Salvador during El Salvador’s civil war.18
Across the Northern Triangle, small business owners, transport workers,
self-employed people, and even entire households are forced to pay “protection”
money to gangs. Some 79 percent of registered small businesses in Honduras
and 80 percent of the country’s informal traders report being extorted.19 A recent
survey in El Salvador has found that extortion is on the rise and now affects 22
percent of companies, but only 15 percent of all incidents are reported. In a
reported 76 percent of cases, gangs were behind the extortion.20
We talked to a Honduran family of five—representing three generations—
as they sat in a shelter in Mexico City watching television. The youngest daughter
cradled her two-week-old child. Just weeks earlier, she and her parents had fled
their hometown in Honduras after the maras—organized criminal gangs—had
imposed an 80 percent tax on her mother’s hair salon business. Facing immi-

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 Invisible War
nent death threats, and with their daughter eight months pregnant, the family
members left in the middle of the night for Mexico, abandoning everything
they had built in an instant. “We were wealthy by comparison and still couldn’t
escape the violence,” the matriarch of the family told us. “Even the taco sellers
get extorted.”21
Their story is frighteningly common. A significant number of individuals
MSF interviewed mentioned the lack of economic opportunities in their home
countries; however, they all also described personal exposure to a violent event as
triggering their decision to emigrate.22 The cycle of poverty and violence drives
many toward the treacherous path through Mexico.
MSF’s experience treating migrants throughout Mexico led the organization
to develop and implement a survey tool to measure an individual’s reasons for
fleeing and the health impacts experienced before and after embarking on the
route through Mexico.23 These findings, along with medical project data from
2015–2017, illustrate the significant physical and emotional impact of fleeing
insecurity at home and experiencing violence on the route north.
Just over half of those interviewed from the NTCA entering Mexico leave
their country of origin for at least one reason related to violence. For those fleeing
violence, 34.9 percent have reported more than one violence-related reason.24
229
Respondents were asked several questions about their experience with direct and
generalized violence in their home countries. Collectively, their stories show a
population continuously exposed to some degree of violence or targeted threats:

• 48.4 percent of the population from NTCA entering Mexico received a

direct threat from a non-family member (61.6 percent for Salvadorans).
• 45.4 percent of Hondurans and 56.2 percent of Salvadorans entering
Mexico lost a family member because of violence in the last two years
before they migrated.
• 31 percent of the Central Americans entering Mexico knew someone
who was kidnapped, and 17 percent knew someone who has disap-
peared and not been found.
• 75 percent of Hondurans and 79 percent of Salvadorans witnessed a
murder or saw a corpse in the previous two years.25

It is this kind of violence that has led many of the patients interviewed in
our clinics to admit that they have even pushed their own children to flee—
alone or with other children—to escape forced conscription into gangs. We
have seen firsthand that escaping the NTCA is not the end of the suffering for

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 Jason Cone and Marc Bosch
our patients. The findings related to violence in the survey are appalling—more
than half the sample population had experienced recent violence at the time they
were interviewed. Forty-four percent had been hit, 40 percent had been pushed,
grabbed, or asphyxiated, and 7 percent had been shot. Of the migrants and
refugees surveyed in Mexico, 68.3 percent of people from the NTCA reported
that they were victims of violence during their transit.
A significant number of male and female migrants in the surveys mentioned
the occurrence of sexual violence, rape, and sex in exchange for shelter, protec-
tion, or money. Out of the 429 migrants and refugees that answered questions
related to sexual and gender-based violence, 31.4 percent of women and 17.2
percent of men said they had been sexually abused during their transit through
Mexico. Women often initiate birth control prior to their migration knowing
the high risk of rape and unwanted pregnancy.26
MSF patients reported that the perpetrators of violence included members
of gangs and criminal groups, as well as the Mexican security forces responsible
for their protection. Our organization’s findings are all the more concerning when
considered alongside the escalating numbers of disappearances and murders in
Mexico, demonstrating the increasing dangers for migrants and refugees on the
migration route.27
230
Impact of Violence on Physical and Mental Health

Through MSF project data from more than 4,700 medical consultations in
2015 and 2016, a picture of an often harrowing and traumatic journey emerges.
Crossing Mexico from the NTCA is a constant battle for survival that can take
a severe physical and psychological toll. Migrants and refugees walk for hours
in high temperatures and on unsafe and insecure routes to evade authorities.
They often risk falling from cargo trains or enduring terrible conditions in
overcrowded trucks without food, water, or ventilation for hours.
A morbidity analysis based on MSF consultations during 2015 and 2016
showed that the most common health issues affecting migrants and refugees were
intentional traumas and wounds, impacting 24 percent of respondents. Other
common health issues included acute osteomuscular syndromes, affecting 20
percent; upper respiratory tract infections, affecting 18 percent; skin diseases,
affecting 11 percent; and unintentional physical trauma, affecting 3 percent. 28
Patients describe being tortured and abused by criminals and state agents
to extract ransom or to punish delayed payments. Others report that violence
is used to psychologically terrorize migrants and refugees to ensure that they do

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 Invisible War
not report crimes to authorities or try to escape.
An important facet of MSF’s work in Mexico is providing support for the
mental health needs of migrants and refugees. The data collected by the mental
health teams of the project during 2015 and 2016 reveal a worrying situation.
Out of 1,817 refugees and migrants treated by MSF for mental health issues
over the last two years, 92.2 percent survived a violent event in their country of
origin or en route that threatens their mental health and well-being.
Forty-seven percent of our patients survived “physical violence” as a
precipitating event for the mental health consultation. Injuries included gun-
shot wounds, blunt
force trauma from Crossing Mexico from the NTCA is a
kicks and punches,
constant battle for survival that can take
mutilation of body
parts during kidnap- a severe physical and psychological toll.
pings, wounds from
machete attacks, broken bones from baseball bat attacks, and wounds from
being thrown out of a running train.29 In most cases, incidents registered under
“physical violence” by MSF occurred along the migration route in Mexico.
Being a “victim of threats” (44 percent) and having “witnessed violence or
crime against others” (16.5 percent) were the third and fourth most common risk 231
factors.30 Witnesses to violence included patients forced to watch while others
were tortured, mutilated, and/or killed—often while kidnapped or extorted.
In 11.7 percent of the cases, mental health teams are seeing manifesta-
tions of post-traumatic stress disorder (PTSD). The rates documented in MSF
programs in 2015 and 2016 are well above rates in the general population,
which range from 0.3 percent to 6.1 percent. The PTSD rate among migrants
and refugees that MSF is documenting in Mexico is much closer to the rates in
populations affected by direct conflict (15.4 percent).31

Limited Access to Protection in Mexico

Despite the extensive evidence that violence and insecurity are major drivers of
forced migration in Central America, few people are receiving legal protection
in Mexico or the United States. The Americas already have relatively robust
normative legal frameworks to protect refugees: the countries of Central and
North America either signed the 1951 Convention Relating to the Status of
Refugees or its 1967 protocol, and they all have asylum systems in place. Mexico
has been at the forefront of international efforts to protect refugees: its diplomats

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 Jason Cone and Marc Bosch
promoted the 1984 Cartagena Declaration on Refugees, which expands the
definition to those fleeing “generalized violence.”32
In 2010, the UNHCR established a guideline for the consideration of asy-
lum and refugee status for victims of gang violence, inviting concerned countries
to apply broader criteria to the refugee definition in the 1951 Convention.33
The UNHCR concluded that direct or indirect threats (harm done to family
members) and consequences (forced displacement, forced recruitment, forced
“marriage” for women and girls) constituted “well-founded grounds for fear of
persecution” and basis for the recognition of refugee status or the application
of the principle of non-refoulement.34
Mexico integrated the UNHCR recommendations and the right to pro-
tection stated in Article 11 of Mexico’s constitution into its 2011 Refugee Law.
This law considers broad inclusion criteria for refugees—detailing, alongside the
internationally recognized definition from the 1951 Convention, the eligibility
of persons fleeing situations of generalized violence, internal conflict, massive
violations of human rights, or other circumstances severely impacting public
order.35
Despite the relatively adequate legal framework and the goodwill expressed
in regional and international forums, the reality on the ground is extremely
232 worrying: seeking asylum, getting refugee status, or even securing other forms
of international protection, such as complementary measures in Mexico and
the United States, remains almost impossible for people fleeing violence in the
NTCA.
The number of undocumented migrants from the NTCA detained in
Mexico has been growing exponentially for the last five years, rising from 61,334
in 2011 to 152,231 in 2016.36 Migrants from the NTCA account for 80.7 per-
cent of the total population apprehended in Mexico during 2016. The number
of minors apprehended is extremely worrying, as it multiplied nearly ten-fold
in the last five years, from 4,129 in 2011 to 40,542 in 2016. Of children under
11 years old, 12.7 percent were registered as traveling through Mexico as unac-
companied minors (without an adult relative or caretaker). 37
The non-refoulement principle is systematically violated in Mexico, with
little regard for the exposure to violence and the deadly risks these populations
face in their countries of origin. In 2016, 152,231 migrants and refugees from
the NTCA were detained or presented to migration authorities in Mexico and
141,990 were deported.38 The often swift repatriations, which occur within
36 hours, do not seem to allow sufficient time for the adequate assessment of
individual needs for protection or the determination of a person’s best interest,

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as required by law.
Amnesty International (AI) found that 75 percent of those people detained
by Mexico’s National Institute of Migration (INM) were not informed of their
right to seek asylum in Mexico, despite the fact that Mexican law expressly re-
quires those detained to be informed of their rights. Public officials, meanwhile,
had assured AI that the requirement was being met.39 The human rights group
also found that 57 percent of detainees were interviewed for 10 minutes or less
before a deportation decision was made.40
Securing asylum in Mexico can be a prolonged process. Out of 8,788 re-
quests, only 5,954 were resolved in 2016, 3,076 of which were granted.41 Asy-
lum seekers must file requests within 30 days of crossing the border, and they
are kept in detention if arrested before applying. Many give up because of the
difficult conditions in detention centers, fear of being detained with members
of gangs or organized crime, or because they have no right to work while their
requests are being considered.42
Even in shelters, the threat of violence looms for many. A 47-year-old
man from Honduras fled his home country after gang members thought he
had witnessed a murder and might testify against the perpetrators. He had been
staying at La 72 shelter in Tenosique for several months when a group of men
233
arrived and started shouting his name. He had not told his name to anyone in
La 72 and feared that the gang members were searching for him. The shelter
team worked quickly to have him relocated to another shelter in Mexico City.43
Foreign undocumented victims or witnesses of crime in Mexico are entitled
by law to regularization on humanitarian grounds, along with assistance and
access to justice.44 In 2015, a total of 1,243 humanitarian visas were granted
by Mexico for victims or witnesses of crime from the NTCA.45 These numbers
seem impossibly low given that the vast majority of refugees and migrants (68.3
percent) surveyed by MSF report having been victims of violence and crime.
Lack of access to the asylum and humanitarian visa processes, lack of co-
ordination between different governmental agencies, fear of retaliation in case
of official denunciation to a prosecutor, expedited deportation procedures that
do not consider individual exposure to violence—these are just some of the
reasons for the gap between rights and reality.

Shrinking Protections in the United States

The situation for migrants, refugees, and asylum seekers is even more restrictive
in the United States, where the political environment has grown overwhelmingly

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 Jason Cone and Marc Bosch
hostile.
At the June 2017 Conference on Prosperity and Security in Central America
in Miami, humanitarian issues were conspicuously absent from the agenda. Then
Secretary of Homeland Security John Kelly said the conference was intended
to tackle migration issues at the source, even as he acknowledged in an April
2017 speech that violence was driving people to flee and described the Central
American migration route as “a course that rivals Dante’s journey to hell.”46
The tenor of the speeches at the conference foreshadowed what was to
come. The Trump administration has stepped up immigration enforcement,
detention, and deportation. In August, the Department of Homeland Secu-
rity terminated a program that allowed minors fleeing violence in El Salvador,
Guatemala, and Honduras to settle in the United States, ending travel hopes
for more than 2,700 children awaiting approval. In September, the Department
of Homeland Security formally rescinded the Deferred Action for Childhood
Arrivals (DACA) program that has given temporary protection to more than
800,000 children brought illegally into the United States. In January 2018, the
administration revoked Temporary Protected Status (TPS) for Salvadorans in
the United States; and in May the TPS designation for some 80,000 Hondurans
was terminated.47
234 The Immigration and Nationality Act (INA), the United States’ main body
of immigration law, does not embrace the same breadth of criteria as the Mexican
legal system. The definitions of asylum seeker and refugee reflect those stated
in the 1951 Convention.48 On paper, the law does not take into consideration
contextual changes in the NTCA, recommendations formulated through the
UNHCR, or regional
Under the existing procedure, it is mechanisms such as the
extremely difficult for those fleeing Inter-American Conven-
tion on Torture or the
violence in the NTCA to obtain asylum UN Convention against
or refugee status in the United States. Transnational Organized
Crime. Under the exist-
ing procedure, it is extremely difficult for those fleeing violence in the NTCA to
obtain asylum or refugee status in the United States. Success depends on many
factors, including good legal representation, something that many asylum and
refugee applications simply do not have.
According to the UNHCR, by the end of 2015, 98,923 individuals from
the NTCA had submitted requests for refugee or asylum status in the United
States.49 Nevertheless, the number of asylum grants to individuals from the

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NTCA has been comparatively low given the high number of people fleeing
violence, with just 9,401 granted asylum status from Fiscal Year (FY) 2011 to
FY 2016.
The United States does not have an effective system in place to facilitate
refugee recognition of individuals from NTCA when they are in their country of
origin or during the transit process in Mexico. Although overall deportations by
the Immigration and Customs Enforcement agency (ICE) are reported to have
fallen slightly between 2016 and 2017, deportations are stemming from more
ICE arrests. In FY 2017, ICE conducted 226,119 deportations. The propor-
tion of deportations which resulted from ICE arrests increased from 65,332, or
27 percent of total deportations, in FY 2016, to 81,603, or 36 percent of total
deportations, in FY 2017.50
Many returnees who fled violence fear returning to their neighborhood.
According to the UNHCR, some returnees remain identifiable by gang members
near the reception centers and elsewhere, and some returnees have been killed
by gangs shortly after their return.51

A History of Failed Policy

All regional actors have a role to play in the current humanitarian crisis in 235
Central America, but the United States bears particular responsibility. Over the
past 35 years, under Republican and Democratic administrations, U.S. policy
decisions have sown the seeds of this crisis. At the height of the Cold War, the
Reagan administration’s support for Contra rebels in Nicaragua and repressive
governments in El Salvador and Guatemala contributed to political turmoil and
the exodus of more than a million refugees.
The Reagan administration considered the vast majority of Central Ameri-
cans arriving in the United States as “economic migrants.” As a result, approval
rates for Salvadoran and Guatemalan asylum cases were under 3 percent in 1984,
in contrast to the much higher approval rates for those fleeing U.S. enemies
in Iran, Afghanistan, and Poland at that time.52 In this respect, the politics of
refugee protection have changed little over the decades. 
Some of the most powerful transnational criminal gangs currently wreaking
havoc in the Northern Triangle—including MS-13 and the 18th Street Gang—
originated in Los Angeles and grew out of a wave of U.S. deportations ordered
by the Clinton administration in the late 1990s.
The Illegal Immigration Reform and Immigrant Responsibility Act of 1996
changed U.S. immigration laws by making minor offenses such as shoplifting

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 Jason Cone and Marc Bosch
and unlawful overstaying in the country causes for deportation.53 Following
its passage, the Clinton administration began deporting illegal immigrants,
many with criminal convictions, back to the region. Many experts contend that
gang-deportees “exported” a Los Angeles gang culture to Central America and
recruited new members from local communities.54
Between 1998 and 2014, U.S. authorities deported almost 300,000 im-
migrants with criminal records to Central America. In El Salvador specifically,
deportations between 1996 and 2002 led to the return of thousands of Salva-
doran gang members who had fled their homeland during the war.55
Although U.S. policies sought to curb criminal activity by breaking up
Los Angeles gangs, the long-term effect was an increase in violence across Cen-
tral America, particularly in El Salvador. A recent analysis by the International
Crisis Group (ICG) comparing U.S. deportation figures and homicide data
from El Salvador powerfully illustrates the rise in killings that followed mass
criminal deportations.56 Between 1993 and 2013, approximately 40 percent of
the deportations to El Salvador were criminal. The ICG analysis found that the
return of deported criminals to El Salvador significantly increased homicides
and reduced primary school attendance. Estimates show that for an increase
of 1,000 criminal deportees per municipality, homicide rates increase by four
236 murders per 100,000.57

Reversing Course

With the United States planning once again to step up deportations of Central
Americans, including violent criminals, it is crucial that the people who have
been harmed or threatened by these criminal gangs have access to protection.
 Now is the time to reverse the devastating course of U.S. engagement
in the Northern Triangle and break the cycle of failed policies authored under
Republican and Democratic administrations alike that have only served to harm
people in the region. At a minimum, the U.S. government must stop mass
deportations of people back to the Northern Triangle and enact legislation to
provide permanent protections to Salvadorans and Hondurans previously liv-
ing under Temporary Protected Status designations and Hondurans currently
protected under the TPS program. Furthermore, more humane conditions
for people must be ensured while their cases are processed, including access to
medical and mental health care services. 
There also needs to be an expansion of foreign aid in support of establish-
ing safe and humane alternatives to the detention of refugees and migrants

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 Invisible War
who have fled to Mexico. The vast majority of the more than 100 albergues are
privately funded, faith-based centers that range from comprehensive centers to
“beds for the night”—a striking contrast to the typical humanitarian response
in countries receiving similar numbers of refugees and migrants.
The government of Mexico, for its part, must immediately cease the sys-
tematic deportation of Northern Triangle citizens and provide better alterna-
tives to detention. It must also protect and expand medical, mental health, and
sexual violence care services for migrants and refugees, all of which are supposed
to be provided under current Mexican law. Stronger regional mechanisms are
needed to ensure that people fleeing violence are able to access protection in
both Mexico and the United States.
The fallout from decades of dangerously misguided U.S. policies in the
region—with the massive suffering these choices have wrought and all the moral
responsibility this history entails—demands a response that meets the immediate
humanitarian needs of Central Americans. It will take years to address longer
term issues of security and economic development, but hundreds of thousands
of vulnerable, preyed-upon people need help now. WA

Notes
237
1. Ramón Márquez, Director of La 72 shelter, interviewed by Jason Cone, Tenosique, Mexico, July 2017.
2. Ramón Márquez, Director of La 72 shelter, e-mail message to author, January 2018.
3. Ramón Márquez, Director of La 72 shelter, e-mail message to author, April 2018.
4. United Nations High Commissioner for Refugees, North of Central America Situation 2017 Mid-Year
Update (Geneva: UNHCR, 2017), http://reporting.unhcr.org/sites/default/files/NCA%20Situation%20
-%20Operational%20update%20-%20Mid-Year%202017%20-%20September%202017.pdf.
5. Ibid.
6. 2013 Global Study on Homicide, https://www.unodc.org/documents/gsh/pdfs/2014_GLOBAL_HO-
MICIDE_BOOK_web.pdf (Vienna: United Nations Office on Drugs and Crime, 2014); Armed Conflict
Survey 2017 (London, IISS, 2017), http://www.iiss.org/en/publications/acs/by%20year/armed-conflict-
survey-2017-8efc/acs-2017-02-introduction-9b09.
7. Tal Kopan, “What Donald Trump has said about Mexico and vice versa,” CNN, August 31, 2016,
https://www.cnn.com/2016/08/31/politics/donald-trump-mexico-statements/index.html.
8. “The History of Committee in Solidarity with People of El Salvador,” CISPES, http://cispes.org/
section/history-cispes.
9. “Understanding the Iran-Contra Affair,” Brown University, https://www.brown.edu/Research/Un-
derstanding_the_Iran_Contra_Affair/timeline-nicaragua.php.
10. Office of the Press Secretary, Homeland Security, “Secretary of Homeland Security Kirstjen M.
Nielsen Announcement on Temporary Protected Status for El Salvador,” January 8, 2018.
11. “Article 33 of the 1951 Convention Relating to the Status of Refugees,” UNHCR, http://www.
unhcr.org/en-us/publications/legal/419c75ce4/refugee-protection-international-law-scope-content-
principle-non-refoulement.html.
12. Forced to Flee Central America’s Northern Triangle: A Neglected Humanitarian Crisis (Médecins
Sans Frontières, 2017), http://www.doctorswithoutborders.org/sites/usa/files/msf_forced-to-flee-central-
americas-northern-triangle_6.30.pdf.

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 Jason Cone and Marc Bosch
13. Ibid.
14. Ibid.
15. Ibid.
16. Easy Prey: Criminal Violence and Central American Migration (Brussels: International Crisis Group,
2016), Latin America Report no. 57, https://www.crisisgroup.org/latin-america-caribbean/central-america/
easy-prey-criminal-violence-and-central-american-migration.
17. 2013 Global Study on Homicide, 126.
18. Central America Caucus and Tom Lantos Human Rights Commission, “Forced Disappearances
during El Salvador’s Civil War and their Consequences Today” (Speech, Washington D.C., March 31,
2016), https://humanrightscommission.house.gov/sites/humanrightscommission.house.gov/files/docu-
ments/JPM%20Opening%20Remarks_El%20Salvador%20-%20Public.pdf.
19. Assessment Capacities Project,  Other Situations of Violence in the Northern Triangle of Central
America (Vienna: Center for Human Rights, 2014), http://www.centerforhumanrights.org/PFS_Petition/
Ex13_ACAPS_CANT_ConditionsRpt073114.pdf.
20. Extorsiones a la pequeña y micro empresa en El Salvador (San Salvador: FUSADES, 2016), http://
fusades.org/sites/default/files/extorsiones%20a%20micro%20y%20peque%C3%B1a%20empresa%20
de%20El%20Salvador.pdf.
21. Anonymous Patient, interviewed by Jason Cone and Marc Bosch, Mexico City, Mexico, March 2017.
22. Médecins Sans Frontières, Forced to Flee Central America’s Northern Triangle.
23. Ibid.
24. Ibid.
25. Ibid.
26. Interviewed MSF Staff, Tenosique, Mexico, July 2016.
27. “Mexico: More Than 25,000 Murders Reported In 2017,” Stratfor Worldview, https://worldview.
stratfor.com/situation-report/mexico-more-25000-murders-reported-2017.
28. Médecins Sans Frontières, Forced to Flee Central America’s Northern Triangle.
238 29. Ibid.
30. Ibid.
31. R.C. Kessler and B. Ustun, “The WHO World Mental Health Surveys. Global Perspectives of
Mental Health Surveys,” European Journal of Epidemiology 25, no. 4 (2010): 281; Zachary Steel et al.,
“Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among
Populations Exposed to Mass Conflict and Displacement,” Journal of the American Medical Association 302,
no. 5 (2009): 537–49.
32. Cartagena Declaration on Refugees, Colloquium on the International Protection of Refugees in Central
America, Mexico and Panama (Cartagena, Colombia: Colloquium on the International Protection of
Refugees in Central America, Mexico and Panama, 1984), https://www.oas.org/dil/1984_cartagena_dec-
laration_on_refugees.pdf.
33. Guidance Note on Refugee Claims Related to Victims of Organized Gangs (Geneva: UNHCR, 2010).
34. Ibid.
35. Ley sobre refugiados, protección complementaria y asilo político (Mexico City: Chamber of Deputies,
2011), http://www.diputados.gob.mx/LeyesBiblio/pdf/LRPCAP_301014.pdf.
36. Boletín Estadístico Mensual 2016. Eventos de extranjeros presentados ante la autoridad migratoria,
según continente y país de nacionalidad (Mexico City: Secretariat of the Interior, 2016),  http://www.
politicamigratoria.gob.mx/work/models/SEGOB/CEM/PDF/Estadisticas/Boletines_Estadisticos/2016/
Boletin_2016.pdf.
37. Ibid.
38. Ibid.
39. “Mexico: Migration Authorities Unlawfully Turning Back Thousands of Central Americans to Pos-
sible Death,” Amnesty International, January 23, 2018, https://www.amnesty.org/en/latest/news/2018/01/
mexico-migration-authorities-unlawfully-turning-back-thousands-of-central-americans-to-possible-death/.
40. Ibid.
41. Estadísticas 2013-2017 (Mexico City: Secretariat of the Interior, Comisión Mexicana de Ayuda

the brown journal of world affairs

 Invisible War
a Refugiados, Mexican Commission for Refugee Aid, 2013), http://www.comar.gob.mx/work/models/
COMAR/Resource/267/6/images/ESTADISTICAS_2013-agosto2017.pdf.
42. Interviews, UNHCR protection officers, Tenosique, Mexico, July 2016; Interviews, UNHCR
Regional Office Personnel, Mexico City, July 2016.
43. Interview Honduran asylum seeker, Tenosique, Mexico, July 2016.
44. Ley General De Migración, Article 52 Section V-a (Mexico City: Secretariat of Parliamentary Services,
Chamber of Deputies, 2017), http://www.diputados.gob.mx/LeyesBiblio/pdf/LMigra_091117.pdf. See:
also Article 4 for a definition of the “victims” covered by the law.
45. Boletín Mensual de Estadísticas Migratorias 2015 (Mexico City: Secretariat of the Interior, 2015),
http://www.politicamigratoria.gob.mx/work/models/SEGOB/CEM/PDF/Estadisticas/Boletines_Esta-
disticos/2015/Boletin_2015.pdf.
46. “Home and Away: DHS and the Threats to America, Remarks Delivered by Secretary Kelly at
George Washington University Center for Cyber and Homeland Security,” Department of Homeland
Security, April 18, 2017, https://www.dhs.gov/news/2017/04/18/home-and-away-dhs-and-threats-america.
47. “Secretary of Homeland Security Kirstjen M. Nielsen Announcement on Temporary Protected
Status for El Salvador,” Office of the Press Secretary, Homeland Security, January 8, 2018, https://www.
dhs.gov/news/2018/01/08/secretary-homeland-security-kirstjen-m-nielsen-announcement-temporary-
protected; “Acting Secretary Elaine Duke Announcement on Temporary Protected Status for Nicaragua And
Honduras,” Office of the Press Secretary, Homeland Security, November 6, 2017, https://www.dhs.gov/
news/2017/11/06/acting-secretary-elaine-duke-announcement-temporary-protected-status-nicaragua-and.
48. United States of America, Department of Homeland Security, U.S. Citizenship and Immigration
Services, Immigration and Nationality Act, https://www.uscis.gov/ilink/docView/SLB/ HTML/SLB/act.
html. Section 101 (a)(42) and Acts 207, 208 and 209 is of specific interest for the question of asylum
and refuge.
49. Call to Action: Protection Needs in the Northern Triangle of Central America, UNHCR Discussion Paper
(Draft): A Proposal for a Strategic Regional Response (Geneva: UNHCR, 2016), http://www.refworld.org/
docid/577fbad64.html. 239
50. Fiscal Year 2017 ICE Enforcement and Removal Operations Report (Washington, D.C.: Depart-
ment of Homeland Security, U.S. Immigration and Customs Enforcement, 2017), https://www.ice.gov/
removal-statistics/2017.
51. Call to Action. For more information, see: Sarah Stillman, “When Deportation Is a Death
Sentence,”  New Yorker, January 15, 2018, https://www.newyorker.com/magazine/2018/01/15/when-
deportation-is-a-death-sentence.
52. Susan Gzesh, “Central Americans and Asylum Policy in the Reagan Era,” Migration Policy Institute,
2016, https://www.migrationpolicy.org/article/central-americans-and-policy-reagan-era.
53. “Illegal Immigration Reform and Immigrant Responsibility Act of 1996,” Department of Homeland
Security, https://www.uscis.gov/sites/default/files/ocomm/ilink/0-0-0-10948.html#0-0-0-1243.
54. Dennis Rodgers, Robert Muggah, and Chris Stevenson, Gangs of Central America: Causes, Costs,
and Interventions, An Occasional Paper of the Small Arms Survey 23 (Geneva: Small Arms Survey, 2009).
55. Mary Helen Johnson, “National Policies and the Rise of Transnational Gangs,” Migration Policy
Institute, https://www.migrationpolicy.org/article/national-policies-and-rise-transnational-gangs.
56. El Salvador’s Politics of Perpetual Violence, Latin America Report no. 64 (Belgium: International
Crisis Group, 2017), https://d2071andvip0wj.cloudfront.net/064-el-salvador-s-politics-of-perpetual-
violence.pdf.
57. Ibid.

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