The Price of Bukele’s State of Emergency in El Salvador

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Human Rights

A group of alleged gang members is presented to the media by police authorities in El Salvador on Jul. 20 as a demonstration of the effectiveness of the war against gangs waged in this Central American country under a state of emergency. But families of detainees and human rights organizations warn that in many cases they have no links to criminal organizations. CREDIT: National Civil Police

A group of alleged gang members is presented to the media by police authorities in El Salvador on Jul. 20 as a demonstration of the effectiveness of the war against gangs waged in this Central American country under a state of emergency. But families of detainees and human rights organizations warn that in many cases they have no links to criminal organizations. CREDIT: National Civil Police

SAN SALVADOR, Aug 5 2022 (IPS) – The body of Walter Sandoval shows a number of dark bruises on his arms and knees, as well as lacerations on his left eye and on his head – signs that he suffered some kind of violence before dying in a Salvadoran prison, accused of being a gang member.

The evidence of the beating is clear in photographs that Walter’s father, Saúl Sandoval, showed to IPS.

Walter, 32, was one of those who died in Salvadoran prisons after being detained by the authorities in the massive raids that the government of Nayib Bukele launched at the end of March, under the protection of the decreed state of emergency and the administration’s fight against organized crime and gangs.

The young man, a farmer, died on Apr. 3, in the parking lot of the hospital in Sonsonate, a city in the west of the country where he was transferred, already dying according to the family, from the police station in Ahuachapán, a city in the department of the same name in western El Salvador.

He had been transferred to the police station after his Mar. 30 arrest in the Jardines neighborhood of the municipality of El Refugio, also in the department of Ahuachapán.

“They tortured him in the dungeons of the Ahuachapán police station,” his father told IPS.

He added that his son had been hanging out with friends, getting drunk. A few minutes later, a police patrol picked him up on charges of being a gang member, which the family vehemently told IPS was not true.

“He never received medical assistance, he died in the hospital parking lot,” the father added.

“They tortured him in the dungeons of the Ahuachapán police station. He didn’t receive medical assistance, he died in the hospital parking lot.” — Saúl Sandoval

He says the only explanation he has for why the police detained Walter is because “they wanted to get the day’s quota.” What he meant is that police officers are apparently supposed to arrest a specific number of gang members in exchange for benefits in their assigned workload.

Deaths like Walter’s, if the participation of police is confirmed, are the most violent and arbitrary expression of the human rights violations committed since the government began its plan of massive raids, in what it describes as an all-out war on gangs.

Since late March, the Salvadoran government has maintained a state of emergency that suspended several constitutional guarantees, in response to a sharp rise in homicides committed by gang members between Mar. 25 and 27.

In those three days, at least 87 people were killed by gang members, in a kind of revenge against the government for allegedly breaking an obscure under-the-table agreement with the gangs to keep homicide rates low.

The state of emergency has been in place since Mar. 27, extended each month by the legislature, which is largely dominated by the ruling New Ideas party. Since then, violent deaths have dropped to an average of three a day.

Among the constitutional rights suspended are the rights of association and assembly, although the government said it only applies to criminal groups that are meeting to organize crimes. It also restricts the right to defense and extends the period in which a person may be detained and brought before the courts, which is currently three days.

The government can also wiretap the communications of “terrorist groups”, meaning gangs, although it could already do so under ordinary laws.

After the state of emergency was declared, homicides dropped again to around two or three a day, and there are even days when none are reported.

But some 48,000 people have been arrested and remanded in custody, accused by the authorities of belonging to criminal gangs. And the number is growing day by day.

However, the families of detainees and human rights organizations complain that among those captured are people who had no links to the gangs, known as “maras” in El Salvador, which make up an army of a combined total of around 70,000 members.

On Jun. 2, rights watchdog Amnesty International stated in an official communiqué that “Under the current state of emergency, the Salvadoran authorities have committed massive human rights violations, including thousands of arbitrary detentions and violations of due process, as well as torture and ill-treatment, and at least 18 people have died in state custody.”

But President Bukele, far from being receptive to criticism, dismisses and stigmatizes the work of human rights groups, referring to their representatives as “criminals” and “freeloaders” who are more interested in defending the rights of gang members than those of their victims.

Walter Sandoval is one of the young men who have died with signs of torture in El Salvador's prisons under the state of emergency in force in the country since the end of March. The police captured him without any evidence linking him to gangs, said the young man's family - part of a pattern that has been documented by human rights organizations. CREDIT: Courtesy of the Sandoval family

Walter Sandoval is one of the young men who have died with signs of torture in El Salvador’s prisons under the state of emergency in force in the country since the end of March. The police captured him without any evidence linking him to gangs, said the young man’s family – part of a pattern that has been documented by human rights organizations. CREDIT: Courtesy of the Sandoval family

Silent deaths and torture

The local human rights organization Cristosal has documented nearly 2,500 cases of arrests which, according to the families, have been arbitrary, with no basis for their loved ones to have been detained under the state of emergency.

The organization has also monitored press reports and social networks and has carried out its own research to establish that, as of Jul. 28, some 65 people had died while detained in the country’s prisons or in police cells as part of the massive police raids.

Some of the deceased showed obvious signs of beatings and physical violence, as was the case with Walter and other cases that have been widely reported in the media.

The official reports of these deaths received by family members are vague and confusing, such as that of Julio César Mendoza Ramírez, 25, who died in a hospital in San Salvador, the country’s capital, on Jul. 15.

The official report stated that he had died of pulmonary edema, i.e., his lungs filled with fluid, but also stated that the case was “being studied.”

Suspicions that the deceased were victims of beatings and torture during their imprisonment are not ruled out by their relatives or by human rights organizations.

“The cause of death given to the relatives in the hospital sometimes differs from the legal medical examination, and that leads one to think that something is going on,” lawyer Zaira Navas, of Cristosal, told IPS.

She added: “There are also families who say they were told it was cardiac arrest, but the victims have bruises on their bodies, which is not compatible (with the official version).”

And in the face of doubts and accusations that beatings and torture are taking place under the watchful eye of the State, the authorities simply remain silent and do not carry out autopsies, for example, which would reveal what really happened.

Navas remarked that, even within the state of emergency, “the detentions are arbitrary” because the procedure followed is not legally justified and many people are detained simply because of telephone complaints from neighbors – with which other human rights defenders coincide.

Another problem is that among these 2,500 complaints by families, about 30 percent involve detainees who have chronic diseases or disabilities or were receiving medical or surgical treatment, according to Cristosal’s reports.

The prison staff do not allow family members of the sick detainees to bring their medication, although in a few rare cases they have authorized it.

“We have seen deaths because it is presumed that they have been tortured, beaten, etc., but there have also been deaths of people who have not been given the medication they need to take,” Henri Fino, executive director of the Foundation for Studies on the Application of Law (FESPAD), told IPS.

Regarding the dubious role played by the government’s Institute of Legal Medicine (IML), in charge of conducting the forensic examinations to inform families about the cause of deaths, Fino said that in his opinion it has no credibility.

Especially, he added, now that members of the so-called Military Health Battalion have been stationed since Jul. 4 at several IML offices, presumably to assist in various tasks, including forensic exams, given the shortage of staff.

“What collaboration can they (the military) provide, if they are not experts, and the only reason they are in the IML is to exercise oversight?” Fino said.

Media war

Some of the people who have died in jails or prisons, who were arrested under the state of emergency, were described by the local media as victims of arbitrary, illegal detentions, in contrast with Bukele’s propaganda war claiming that all the detainees are, in fact, gang members.

The press has highlighted the case of Elvin Josué Sánchez, 21, who died on Apr. 18 at the Izalco Prison located near the town of the same name in the department of Sonsonate in western El Salvador.

The media have referred to him as the “young musician”, because he had been learning to play the saxophone, and they have described him as a decent person who was a member of an evangelical church in the area.

But according to neighbors, Sánchez was well-known as an active gang member in his native El Carrizal, in the municipality of Santa Maria Ostuma, in the central department of La Paz.

“They saw him well-armed on farms in the area, along with other gang members, and he told the owners not to show up there anymore, or they would kill them,” a resident of that municipality, who asked not to be identified, told IPS.

Contradictions like this have strengthened local support for Bukele’s insinuations that the independent media are in favor of gang members and against the government’s actions to eradicate violence in the country.

In fact, opinion polls show that a majority of the population of 6.7 million support the president’s measures to crack down on the maras.

But even though Sánchez was recognized by neighbors as a gang member, his arrest should have been carried out following proper procedures and protocols, based on reliable information proving his affiliation to a criminal organization.

This is something the police do not usually do in these massive raids where it is impossible for them to have the evidence needed on each of the nearly 48,000 detainees.

Nor did the fact that he had been a gang member merit him being beaten to death, since his human rights should have been respected, said those interviewed by IPS.


Study: Kidney function test not suitable for Africans

Researchers have discovered that a widely used blood test to detect kidney function is off the mark among African populations.

The serum creatinine test measures the amount of creatinine in your blood. According to the National Kidney Foundation, creatinine is: “A waste product that comes from the normal wear and tear on muscles of the body. Creatinine levels in the blood can vary depending on age and body size. A creatinine level greater than 1.2 for women and greater than 1.4 for men may indicate that the kidneys are not working properly. As kidney disease progresses, the level of creatinine in the blood rises.”

But a study by the African Research on Kidney (ARK) Disease Consortium, which sought to find the most accurate way to measure kidney function in African populations, compared the creatinine option with another benchmark test called the measured glomerular filtration rate (mGFR). 

Not fit for Africans

ARK researchers found that creatinine-based tests were inaccurate for predicting kidney disease in African populations. They refer to the test’s inability to account for the unique biological characteristics of African populations. The creatinine-based test was shown to be inaccurate for diagnosing kidney disease, and this may be because it does not account for “unique biological characteristics in African populations.”

The ARK Consortium comprises researchers from the:

  • University of the Witwatersrand (Wits) in South Africa
  • The Medical Research Council/Wits-Agincourt Rural Public Health and Health Transitions Research Unit (Agincourt) in SA’s Mpumalanga province;
  • The Malawi Epidemiology and Intervention Research Unit (MEIRU)
  • The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit 
  • The London School of Hygiene & Tropical Medicine (LSHTM), UK

The scale of the problem in Africa

Kidney disease is silent in the early stages because many people only develop symptoms when their GFR drops below 30 to 45 millilitres (ml). This means that most people won’t know their GFR is lower than usual. This is why screening people with risk factors for kidney disease remains essential.

The study used population data from Burkina Faso, Ghana, Kenya, Malawi, South Africa and Uganda to estimate overall levels of kidney disease. The results suggest that kidney disease prevalence may be substantially higher in Africa than previously thought, increasing from 1 in 30 people to about 1 in 8 people.

Diversity of populations makes it difficult.

Dr June Fabian from Wits noted that the scale of kidney disease in Africa has been challenging to determine.

“The biodiversity of African populations means that what we find that applies in Southern Africa might not apply in West Africa. So, there aren’t a lot of studies that have looked at kidney disease in many African populations. We don’t have a lot of funding to do these studies, so a lot of the studies are often situated in a hospital with many HIV patients. So, they’ll report a high prevalence of chronic kidney disease, but it does not necessarily reflect what’s going on at the community level or in the general population.”

Fabian said population-based studies are required. But these are expensive and need a larger sample group. This is why there isn’t a lot of data from Africa. In addition, different criteria are used to determine the prevalence of kidney disease in other studies, making available data challenging to interpret.

“The point of our study was to try and standardise all of that. Because we did that, I think we can quite reliably say that the prevalence is between six and 12% depending on the country because people have different risk factors in different countries,” she explained.

Kidney function test flaws

Fabian explained how kidney function tests work to diagnose disease. 

“If you’ve got diabetes, and you go and see a primary health care nurse to test your kidneys, she’ll pull a tube of blood, send it to the lab, and the lab will measure the creatinine. And based on that, she’ll work out what we think the kidney function is.” 

This is done by estimating the glomerular filtration rate (GFR). The GFR is how much blood your kidneys are filtering through per minute. A high GFR means that the kidneys are working very well. 

“What we realised when we did this study is that kidney function in African populations is overestimated by using the creatinine test. We are reporting GFRs that are too high because these estimation calculations are based on studies done in high-income settings.” 

Before the ARK study, Fabian said the studies were done in countries like the US, Sweden, and Belgium. Very few studies have covered the African population looking critically at how kidney disease affects people.

“That is what we wanted to check in this study because a handful of really small studies showed that maybe the way it’s done in Europe doesn’t apply in Africa. This is because we are reading the kidney function as too high. If your GFR is less than 60, your kidneys filter less than 60 ml per minute. If the test pushes everyone up, we are not picking up people with those lower GFRs, which means we’re missing kidney disease.

Biological characteristics 

The “gold standard” refers to the method to measure kidney function that is currently working to diagnose kidney disease in Africa. Fabian said the problem is that it is expensive and impractical because a person must be there for six hours. 

“Because African Americans are big and have a lot of muscle, everyone assumes that everyone else in Africa is the same. Everyone thought that African populations have lots of muscle, and the creatinine would be high as they see it in African Americans. We found that people are quite small.”         

Fabian explained that another dependent factor is how much meat a person eats.

“If meat is regularly in your everyday diet, your creatinine will increase. In poorer communities, people often don’t have a lot of money and don’t eat much meat. Even in Bushbuck Ridge, women have very low creatinine, and we’re not sure exactly why. But in Malawi, people might eat meat once every two weeks or once a month. That is not the same as high-income settings where people eat meat almost daily.”

These kinds of factors are not considered during studies in high-income settings. Fabian emphasised the importance of doing this work in African populations. 

Risk factors of kidney disease 

“Your kidney function starts with your mom’s health. For example, if you’ve got a young mum with a pregnancy, who doesn’t get into antenatal care, delivers prematurely and might have diabetes or hypertension herself. All those factors impact your kidneys when you’re in the womb and are developing all the time, up to 36 weeks.” 

This means that if you’re born prematurely, at 33 weeks or so, and your mom never got antenatal care or was malnourished during the pregnancy, your kidney function will be impacted from the day you are born. 

“If you are stunted, your muscles don’t grow well, and you are malnourished. This carries over and impacts your kidney function later on in life. These are the kinds of things that don’t apply in high-income settings. We also see in poor communities that in adolescence, people go from being underweight, especially girls, to being quite overweight. And if that happens, that also puts you at risk of kidney disease because you’re at risk of becoming diabetic or developing high blood pressure later on in life.”

Too expensive 

Tests based on cystatin C worked better than creatinine to indicate poor kidney function. But it is not widely available in Africa.

The cystatin C test, which would be more suitable in Africa, costs around R320. This is three times more expensive than the widely-used but less accurate creatinine, at just R67.

“We know cystatin C is better in Africa, but relatively speaking, it’s a no-go in resource-poor settings,” says Fabian. 

The study’s findings suggest that moving from the creatinine test of kidney function to using cystatin C would be preferable. In addition, researchers said that it would also assist in ensuring accessibility and enabling doctors to use them should be a priority for Africa. – Health-e News