Violence against medical staff and increased levels of mental illness are taking a toll on Juarez.
People gathered for a candlelight vigil in remembrance of high school students who were killed at a party [Reuters]
by: Chris Arsenault/AlJazeera
It is another day at the office and Dr Arturo Valenzuela Zorrilla pedals his bike past a checkpoint guarded by heavily armed police and into the hospital where he works, hoping none of his co-workers will be killed or kidnapped today.
In Juarez, one of the world's most violent cities, the people who promise to do no harm are facing deadly attacks.
"We have moral rules to follow, we attend any patient who asks for help, but sometimes it is a trap for kidnapping," Zorrilla says during an interview at the Centro Medico de Especialidades. "Three or four doctors were killed last year and around 11 were kidnapped."
A gritty border town with about 1.3 million residents, Juarez is the most violent city in Mexico - with more than 3,100 murders in 2010.
A war between various cartels over lucrative drug smuggling routes is at the root of much of the killing.
Doctors, like other professionals and some lower class residents, are kidnapped by drug gangs and held for ransom. "In a few cases, the victims have been killed even when they pay," Zorrilla says.
About 2,000 physicians have fled the city in the last four years, according to estimates from Leticia Chavarria, the president of the Juarez Doctors' and Citizens' Committee.
In December, 4,000 health professionals across the city staged a 24-hour strike, protesting against the lack of safety, after gunmen kidnapped and later killed Dr Jose Alberto Betancourt Rosales.
While police guard a checkpoint outside the hospital, there is no protocol for dealing with kidnapping or armed attacks on medical staff, Zorrilla says.
"What should we do? Who should we call if someone gets kidnapped? These are plans that we must have," he says, adding that planning for safety becomes even more complicated when "much of the population doesn't trust the security forces" because of inefficiency and corruption.
Doctors in the city have been holding strikes and protests since December 2008 and their actions have gained wide popular support, pushing authorities to set-up the checkpoint outside the hospital, Zorrilla says.
Across town, at the offices of Juarez's Red Cross, director general Doctor Raul Rodriguez Tavares estimates that five per cent of the patients his group treats are injured in gang-related activity, up from just one per cent five years ago.
"The idea that civilians are hit in the crossfire between gangs is a fear around the city, not just here," says Tavares.
Sometimes wounded gangsters arrive at a health centre seeking treatment. When doctors begin operating, assailants show up for the final kill.
"It has happened once or twice to the Red Cross where gangs came here to kill an injured person," says Tavares. "They came to the emergency room and finished the job," he says, adding that only the intended target was hit. This is not always the case.
Shopping till you drop, dead
On Thursday, a gang armed with automatic weapons stormed a municipal government office at a popular shopping mall, hoping to rob an armoured truck. One police officer died in the shootout, which seriously injured several civilians.
After the gun battle, police closed one entrance to the mall, creating a security cordon around a shopping area. But people continued strolling through the rest of the complex, with parents pushing strollers beside an ice-cream stall and supermarket, less than 5 metres from the yellow police tape.
"Do you know how long this tape will be up?" one shopper asked. "I need to pick up my shoes and pay my property registration."
Casual acceptance of everyday murders may be a basic coping mechanism, but the city and its problems are pushing some people over the edge.
"Mental problems really started growing in Juarez three years ago," says Pastor Jose Antonio Galvan, who runs a mental rehabilitation clinic on the city's dusty outskirts.
He estimates that 300,000 people in Juarez are facing mental or spiritual illnesses.
"For every person who is executed here, 40 people, including friends and family members, are affected by the ripples," says Galvan, describing the stress residents face.
Ten thousand orphans are victims of the narco war, he says. Ninety per cent find refuge with other family members, but the remainder become "the next generation of hit-men and criminal minds".
But the drugs themselves, rather than just the violence they spawn, make the problem worse.
"The dealers were transporting drugs to the US, but it was hard to get them through, so they started selling very cheaply in Juarez. The use of drugs increased mental problems, hard."
At the shelter, people are crammed into dimly lit rooms with a putrid smell. They cover themselves with blankets, almost stacked on top of each other, as some groan or whimper. A lack of adequate funding for the centre is a major problem.
The shelter houses about 100 people, including more than 20 addicts. The rest have incurable mental problems or other issues.
Galvan is himself a recovered addict. Like most consumers of illegal narcotics, he got addicted to cocaine, PCP and a host of other drugs in the US, not Mexico. He lived on the streets of American cities, covered with lice, until getting deported.
"Mexicans cross the border with the American dream. People start making money and then [some] get into drugs and blow their minds," he says.
Prevention and education, not militarisation, are key to fixing the problem, he says, estimating that it will take 15 years to stabilise the violence in Juarez.
A study by the Rand Corporation, sponsored by the US government, supported the pastor's conclusions.
Comparing various drug control strategies - treatment, domestic enforcement, interdiction, and source country control - the study found money spent on domestic drug treatment in the US was 23 times as effective as "source country control", otherwise known as militarisation.
To achieve a one per cent reduction in cocaine consumption in the US, the country would have to spend either $34m on treatment, $250m on domestic enforcement, almost $400m on interdiction, or around $800m for source country control, according to the widely cited 1994 study.
The new paradigm
"Cigarette consumption in the US was high in the 1990s," says Zorilla. "The government thought about the cost and started educating people about quitting smoking, and rates of addiction have dropped drastically," he says, adding that nicotine, the drug in cigarettes, is more addictive than heroin on a gram-per-gram basis.
While supporting education and prevention, the doctor takes the analysis of the drug problem one step further.
"When alcohol was prohibited in the US in the 1920s, Chicago was something like how Juarez is today: government corruption and police corruption," he says, aruging for legalisation and control of drugs, particularly marijuana.
"Cartels gain 60 per cent of their profits through the sale of marijuana; it is prohibited, I think because it makes some people rich."
"The whole world has a bad strategy for fighting drugs," Zorrilla adds. "This is a health problem, not a criminal problem."