On May 6, Médecins Sans Frontières (MSF) announced it had started to treat COVID-19 patients in Tijuana, in northwestern Mexico. Tijuana, which is on the border with San Diego, has the greatest number of cases in Mexico and one of the highest death rates.

“We will be providing support to health institutions [by] relieving the hospital burden in Tijuana,” said Maria Rodríguez Rado, MSF’s COVID-19 Emergency Response Coordinator in Mexico, according to the group’s website. “Through this support, we want to relieve the enormous workload of health workers who are responding to this pandemic and help alleviate the suffering of patients.”

The move is welcome. Across Central America, megacities such as Guatemala City, Tegucigalpa in Honduras, and Managua in Nicaragua are vulnerable to the rapid spread of COVID-19.

COVID-19’s disruption of well-resourced cities around the world, like London, Milan, and New York, raises concerns about the virus’ impact in some Central American cities, where a limited ability to respond is further hindered by crime, poverty, and a lack of suitable healthcare. Already spikes in fatalities rival the worst of the pandemic elsewhere, according to The New York Times.

With COVID-19 threatening to compound existing needs, humanitarian organizations face a new set of challenges as they move to respond in urban environments.

In cities like Tijuana, criminal organizations—such as the Tijuana and Sinaloa Cartels—are active where needs are most acute. More generally, humanitarian organizations have traditionally been less comfortable responding to crises in urban environments, often accused of not understanding the context of these urban environments. And they are less experienced in dealing with large concentrations of people in megacities.

Humanitarian Urban Response

A March 2018 panel on humanitarian action in urban environments hosted by ODI noted that a humble and open approach is needed when operating in places with a variety of actors. One of the buzz words from the humanitarian community is “adaptive management,” which refers to humanitarian organizations being innovative and agile in their programming.

The International Rescue Committee (IRC), which was one of the first organizations to respond to the upsurge in criminal violence in El Salvador, has adapted its women and girls’ programming from other contexts it works in, such as Greece and Sierra Leone, to be fit-for-purpose, ensuring that it reflects the environment and specific risks to women and children within the country.

Cultivating Criminal Connections

The success in reaching those most in need will require careful and long-term humanitarian access. Médecins Sans Frontières operates in many locations that require negotiating access with armed groups.

According to its Head of Mission in El Salvador, Stéphane Foulon, MSF has established good relations with the Ministry of Health, local community leaders, and with criminal gangs. While this may sound counterintuitive, the criminal connection means that they have been able to get into hard-to-reach locations controlled by criminal gangs. Many of the most direct security risks will be reduced by establishing and maintaining good relations with gangs and cartels.

Meanwhile, according to Aline Rahbany, Technical Director at World Vision, they have adopted a multi-dimensional approach to working in urban environments, which includes a citywide approach that works on multiple tiers from the neighborhood level to citywide engagement with urban actors, including local authorities and non-state actors, to influence policy and programs that impact the lives of the most vulnerable groups in the city. This approach and partnering with trusted intermediaries such as the church made it possible for World Vision to distribute aid in fragile and gang-controlled cities such as San Pedro Sula in Honduras.

Security Risks

The environment also poses a new series of security risks, which need careful management. Central America is among the most dangerous locations outside of a war zone. Violent crimes, kidnappings, and street crime are common. Particularly when operating in areas controlled by gangs, humanitarian organizations need to ensure that programming does not increase the security risks to staff. Beyond traditional security risk mitigation measures, NGOs will likely have to evaluate programmatic risks to staff.

To operate in a subregion such as the Northern Triangle, including Guatemala, El Salvador, and Honduras, World Vision’s Central America and Caribbean office found it was essential to achieve adequate “acceptance,” as part of the security approach. But the acceptance had to also be supported through traditional security monitoring and risk mitigation techniques by tools and processes.

As one example of the problem, according to a 2017 Crisis Group report, several NGO efforts in Honduras to finance small business opportunities in gang-run communities have been abandoned due to pressures from violent extortion rackets.

Meanwhile, because of the context, said Christopher Valdes, a Central America expert at Risk Advisory, it is important to know who you are dealing with. It could be a corrupt public official, a gang, or a powerful family. All of these pose potential compliance risks and need careful due diligence.

The contexts offer other risks as well. Organizations gathering large amounts of data on needy populations should realize that powerful elites may hack into the data. The Intercept last year highlighted the government’s use of disinformation, or information warfare, against rival groups.

Donor Fatigue

Beyond COVID-19, with growing humanitarian needs across cities in Central America, and further shocks likely to include climate disruption, internal displacement, corruption, and organized crime, donors need to accept that the situation will likely remain a crisis for the foreseeable future.

Talk of humanitarian donor fatigue is common across the aid and development sector. But a bigger issue in the region is a lack of donor engagement and interest, said Meghan Lopez, Regional Director for the International Rescue Committee in Latin America. The problem, she said, was that Central America and Mexico are traditionally seen as the U.S. backyard. Therefore, these areas tend not to receive many grants from European and other donors, which assume U.S. financial support for the region.

For now, the humanitarian crisis at the U.S.-Mexico border and the humanitarian crises in El Salvador, Guatemala, and Honduras are “incredibly under-funded” and will remain so, said Lopez. The entire international community, she said, needs to see COVID-19 in Central America as an international crisis “worthy of humanitarian funding.”

Donors need to accept that the situation across the Northern Triangle will likely remain in crisis for the foreseeable future. And humanitarian programming will need to straddle emergency responses, local resilience building, and partnerships with development organizations to ensure that programming helps improve the region’s resilience, opportunities, and security.