Though relatively small in geographic terms, Guatemala has an exceptionally rich biodiversity, resulting from, among other factors, its abundance of water. It is also a country of enormous ethnic diversity, with 43.75% of the population self-identifying as belonging to one of the 25 Mayan peoples, or as Garifuna, Xinka, Creole or Afro-descendant. Yet despite Guatemala’s official status as a multicultural society, exclusion, discrimination and structural racism continue to persist (IWGIA, 2023).
Guatemala is the largest economy in Central America, with a growing gross domestic product (World Bank, 2023). Nevertheless, 56% of the population lived below the poverty line in 2020. According to the latest official data, the Gini Index ranked Guatemala the tenth most unequal country in the world in 2014 (World Bank, 2023) and in 2022 it had one of the region’s lowest Human Development Indices (1,67), ahead of just Honduras and Haiti (PAHO, 2022). Likewise, the region, as part of Central America, is highly vulnerable to the climate crisis, and the range of meteorological events that affect the country is expected to intensify in the coming years (IPCC, 2022).
The overall indicators for maternal and infant mortality are on a downward trend (PAHO, 2022). In terms of universal health services coverage, Guatemala has made progress, but has remained at a mid-range level of access for the last 20 years, well below the level of all other countries in the region and even neighbouring countries like Honduras and El Salvador (WHO and World Bank, 2023). Universal health coverage is currently estimated at 58.6% (WHO, 2021).
The main barriers to universal access to health in Guatemala are funding costs. In 2020, public expenditure on health accounted for 2.48% of GDP and 15.86% of total public expenditure, while the population’s direct expenditure on health was 56.29% of total health expenditure (WHO, 2021), with one of the most troubling issues the extremely high cost of essential medicines. Secondly, there are organisational barriers, including: inadequate hours of service, lack of adherence to schedules, poor management of waiting lists and lack of coordination in providing health services. Some of the most challenging indicators of universal access include hypertension monitoring and service capacity, which includes the availability of health staff, hospital beds and the degree of incorporation of international health standards (WHO, 2023). Like in other countries, there is substantial inequality in terms of the availability of health services between urban and rural areas of Guatemala.
On the other hand, the Guatemalan government continues to have reservations about the international consensus on sexual and reproductive rights, specifically with regard to access to abortion care (UN, 2023). Restrictive legislation remains in place, allowing abortion only in cases of risk of death for the mother, which limits the overall progress in universal health coverage. According to the Observatorio de Salud Reproductiva (Reproductive Health Observatory), there were more than 43,000 births to teen mothers ages 15 to 19 and more than 15,000 to girls ages 10 to 14 from January to August 2023.
Pervasive violence has resulted from the limited progress made in transitional justice processes in the aftermath of the internal armed conflict. In 2022, eight people died violently every day in Guatemala. Homicides increased 6.2% over the previous year, with 85.5% of the victims reported to be men. At least four women and girls were reported missing every day (Infosegura, 2022). One third of missing persons between 2019 and 2022 were minors between the ages of 15-19 and 10-14 (43% and 24%) respectively (IEPADE, 2023). Cases of women and girls reporting gender-based violence, rape/aggravated rape, human trafficking and femicide reached their highest levels in the last seven years in 2021.
The country is experiencing a profound institutional crisis, particularly acute in the last six years, in addition to the diverse aspects of the crises and challenges described above. According to CIVICUS Monitor, the civic space in the country was rated as “repressive” in 2022, in view of the increased criminalisation of journalists, justice operators and human rights defenders. CIVICUS says that “In Guatemala, people and organisations undertaking crucial work to stamp out corruption and document human rights abuses have done so at great personal risk. They face criminalisation, threat of detention, harassment and attacks. The downgrade in its civic space ratings highlights this worrying deterioration”.
In 2023, Guatemala’s elections were thrown into chaos after state bodies interfered with electoral institutions like the Supreme Electoral Tribunal and with candidates, as well as “the unacceptable persecution, harassment and intimidation of more than 125,000 Guatemalan citizens who exercised an ethical and democratic commitment to their country as polling station members, reviewers and data-entry clerks, whose names the Public Prosecutor’s Office requested from the TSE for unknown reasons” (European Union Election Observation Mission). The coming months will be crucial in terms of guaranteeing “respect for the will of the voters expressed unequivocally at the ballot box”, as stated by the EU Observation Mission, among other international and local stakeholders, who are engaged in an ongoing protest, led by indigenous organisations.
There has been regrettably little involvement of the international community in the various crises affecting Guatemala, to the extent that the country’s food and violence crisis has for years been considered a forgotten crisis, the result of high risk and vulnerability paired with limited availability of humanitarian aid and lack of international media attention.
According to the Humanitarian Response Plan, five million of the country’s 17.6 million people will need humanitarian aid in 2023, a year-on-year increase of 32%. Crisis/emergency food and nutrition insecurity affects 4.6 million people. Nearly 2 million people have humanitarian needs related to acute malnutrition.
These needs are compounded by internal displacement, as well as Guatemala’s role as a country of origin, transit, destination and return of migrants, including refugees and applicants for refugee status, with a total of 2.6 million people in need of protection and humanitarian assistance (OCHA). As in previous years, Guatemalan civil society organisations demanded transparency in migration policies in 2023, policies that are highly influenced by the United States’ externalisation of borders policy. Meanwhile, according to IWGIA, family remittances remained one of the major drivers of the economy, rising from USD 1.6 billion in 2002 to USD 18 billion in 2022, surpassing the volume of total exports estimated at USD 15 billion in 2021.
According to OCHA, at the close of the third quarter of 2023, the funding required to cover the needs identified in the Humanitarian Response Plan in Guatemala barely reached a fifth of the estimated USD 126 million, 84.6% of which came from the United States. Resources are focused on responding to needs in education, protection, food security and temporary emergency shelter, while other sectors like health and nutrition are virtually unfunded.