Central American migrants and asylum seekers already suffer from mental health issues stemming from the violence they are fleeing, but US and regional immigration policies are making matters much worse, according to a new report by Doctors Without Borders (Medecins Sans Frontieres, or MSF).

Violence both in the home country and Mexico is a key precipitating factor in alarming levels of symptoms of mental illness among migrants and asylum seekers from Honduras, El Salvador and Guatemala, according to a report published on Tuesday by the international humanitarian medical organisation.

"The violence to which Central American migrants and refugees are exposed has a clear impact on their mental health," MSF said in its report.

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The publication, No Way Out, draws on thousands of mental health consultations conducted by MSF in Central America and Mexico, interviews with personnel, and a survey of 480 migrants and asylum seekers at five shelters along migrant routes in Mexico.

"The main afflictions that we see, clinically speaking in terms of mental health, are classically PTSD, post-traumatic stress disorder, and depression and anxiety," Gordon Finkbeiner, coordinator of MSF's Migrants Project in Mexico, told Al Jazeera.

'Targeted in Mexico'

Of the hundreds of migrants and asylum seekers surveyed between January 2018 and September 2019, 61.9 percent had been exposed to at least one violent event in the two years prior to leaving their home country, including the violent death (42.5 percent) or disappearance (16.9 percent) of a relative.

During the same period, more than half of the thousands of migrant mental health consultation patients in Mexico presented moderate or serious symptoms, primarily related to anxiety, PTSD and depression.

"The violence suffered by people living in [Honduras, Guatemala and El Salvador] is comparable to that in war zones where [MSF] has been working for decades," according to the organisation.

Migrants, most of them asylum seekers, sent back to Mexico from the US under the Remain in Mexico programme, officially named Migrant Protection Protocols (MPP), wait in line for a meal outside the Human Repatriation office in Matamoros, Tamaulipas, Mexico [File: Loren Elliott/Reuters]

But the violence does not stop there. Of the hundreds of migrants and asylum seekers surveyed at shelters in Mexico, 57.3 percent had been exposed to some kind of violence along the route in Mexico, 39.2 percent had been violently attacked, including cases of sexual assault, and 27.3 percent had been threatened or extorted.

"Migrants are being perceived by organised crime around Mexico very often as a target for extortion. They're being seen as merchandise in a certain sense," said Finkbeiner.

"Mexico is clearly not safe for migrants, and 'Remain in Mexico' makes matters only worse, much worse," he said.

Kidnappings

Under the "Remain in Mexico" policy, officially known as the Migrant Protection Protocols, the US returns asylum claimants to Mexico while their cases are processed. More than 60,000 predominantly Central American asylum seekers have been returned to Mexico since implementation began just over a year ago.

"What we are currently seeing is that migrants who are being returned to Mexico to await their court dates under this 'Remain in Mexico' programme are being presented to organised crime on a silver platter, really," said Finkbeiner.

In Nuevo Laredo, a Mexican city across the border from Texas, MSF teams have witnessed kidnappings of migrants and asylum seekers right outside shelters and at bus stations. The pastor in charge of a Nuevo Laredo migrant shelter and one of his colleagues were kidnapped last year and have not been seen since.

Of the 44 new MSF patients who received mental health consultations in October 2019 in Nuevo Laredo, 75 percent had been kidnapped in the week prior to the consultation. They had all been returned under the Migrant Protection Protocols.

"We have been seeing the tendency growing but that spike was particularly pronounced. Ever since then, the majority of people we are attending [in Nuevo Laredo] have been kidnapped in the few days prior to the consultation," said Finkbeiner.

The constant threat of violence leaves a profound mark on an individual's mental health, which can sometimes go undetected due to stigmatisation and the lack of institutional resources for identifying and treating cases. MSF

According to the Guiding Principles of Migrant Protection Protocols, people with "known physical/mental health issues" are "not amenable" to the protocols. Human rights groups, however, have documented the return of asylum seekers, including children, with known serious medical conditions, including cancer and seizure disorders.

The US Department of Homeland Security did not respond by the time of publication to Al Jazeera's request for comment on what would constitute known mental health issues.

"The constant threat of violence leaves a profound mark on an individual's mental health, which can sometimes go undetected due to stigmatisation and the lack of institutional resources for identifying and treating cases," according to MSF.

Migrants and asylum seekers Al Jazeera spoke to have often addressed the anxiety that comes trying to navigate the dangerous journey to the US-Mexico border.

Manuel* fled extortion-related death threats in Honduras last year and is making his way north through Mexico with his wife and their five children, aged four through 16. But now they confront the possibility they will be forced to remain in Mexico and face more of the violence they fled.

"Mexico is a country that makes a lot of money from migrants, from kidnapping and extortion," Manuel told Al Jazeera.

MSF is calling for an immediate halt to the US removal of asylum seekers to third countries, including forcing people to wait in Mexico, among other demands of the governments of the US, Mexico and northern Central America.

"People are being put at risk," said Finkbeiner. "People fleeing violence should not be criminalised and should not be greeted with guns. People's needs should be put at the centre of the immigratory policies."

*The individual's name has been changed at their request to protect their identity.