‘They send doctors back to the mouth of the wolf’: killing of graduate stokes fears for Ecuador’s medics

Jose Aguirre Giler never imagined his brother’s work as a doctor in a rural Ecuadorian town would end in kidnapping attempts and fatal gunfire. His youngest brother, Steven, had a bright future ahead of him after graduating from medical school in 2023 and starting a government-mandated year of service at a health centre in Guayas, a south-western province racked by drug gang violence. “He helped out anyone who needed help,” says Jose.

The first kidnapping attempt was in November 2023 as Steven was on his way to work, according to the Ministry of Public Health. His brother says the attack went awry when the assailants’ car was damaged, and Steven escaped. After that came anonymous threats demanding money.

Six months later, on 14 May, the 25-year-old was fatally shot during his morning commute. Criminals tried to abduct Steven from his car and he resisted, says Jose. “It was the worst day of our lives.”

Steven was one of more than 19,000 people killed in Ecuador since a surge of violence tied to gangs involved in the drug trade erupted in coastal areas in 2020. He was also one of a growing number of doctors across the country who physician guilds say have been targeted by extortionists, putting the country’s strained healthcare system at further risk.

Those serving in rural areas or on the outskirts of city centres appear to be especially at risk. The Federation of Rural Health Professionals told the Guardian it has already received more than 760 reports in 2024 of doctors being threatened by criminals in order to extort money. It said it usually receives no more than 20 reports like this in a year.

Steven was killed by criminals who tried to kidnap him while he was driving to work. Photograph: Aguirre family

“In the short term it’s a huge increase,” says Dr Jose Luis Aguirre [no relation to Steven’s family], the federation’s president.

The ministry of public health and the ministry of the interior say they are planning to protect doctors by setting up permanent police details in priority health centres and sending officers to accompany physicians serving in remote areas. But fear of extortion is already pushing medical professionals to resign, says the Ecuadorian Medical Federation president, Dr Wilson Tenorio. That risks exacerbating the country’s continuing health crisis with medical centres running critically short of supplies and medicine – a problem attributed by guilds to budget cuts, corruption and unpaid government debts to health systems.

“All of this means that the outlook in Ecuador for the professional practice of healthcare makes us incredibly worried,” says Tenorio.

A UN report on global drug trafficking released in June links Ecuador’s spike in violence to a recent cocaine production boom in neighbouring countries Colombia and Peru. The small South American country’s coasts are a vital departure point for clandestine shipments to cocaine’s biggest markets: the US and Europe.

Last year, extortion was the most reported crime in the country, according to the Ecuadorian Organized Crime Observatory. Cases jumped from 1,282 in 2020 to nearly 22,000 in 2023 – a 17-fold increase. It is seen as an effective, low-risk way for illicit groups to pull in finances while using fear to establish territorial control.

Doctors are being targeted because of their relatively high salaries. Physicians performing their required year of rural service under the Ministry of Public Health, for example, make $986 a month – about three times the typical income of workers in rural areas.

“They arrive with other types of clothes, sometimes a recently bought car … so this draws a lot of attention,” says Dr Jose Luis Aguirre.

Steven’s murder was particularly painful for his family because the government knew about the threat against him in November. The ministry of public health, however, says it took action to help.

After the attempted kidnap, Steven was given eight days off and allowed to transfer out of the medical station where he worked, according to the ministry. But the transfer was temporary, and only lasted until early February.

The ministry also says Steven made a verbal request to be sent back to the medical centre he was working at when he was first targeted – a claim that Steven’s brother disputes.

Luis A Torres, a doctor and vice-president of the National Association of Rural Doctors, says the issue of short-term transfers is not limited to Steven’s case. He knows other rural health professionals who were removed from their work site by the ministry after extortion threats, only to be sent back shortly after.

“They take them out for a moment, but then they send them right back to the mouth of the wolf,” says Torres.

Steven’s graduation day in 2023. Jose stands next to him in the blue suit. Photograph: Aguirre family

The ministry of public health told the Guardian that doctors performing their rural year of service can request to be sent to a new location if they are targeted by criminals, but the first step is filing a report with law enforcement. That is problematic, says Torres, because many fear the extortionists will retaliate.

It is a fear that Steven’s family knew first-hand. Jose said they did not tell the police about the first attempt to kidnap Steven because “we didn’t want to play around with the mafias”.

Now physicians’ guilds want updates to the regulations guiding the rural year requirement. One suggestion floated by some doctors is to make it optional instead of mandatory. But that could end up slashing services to the 6.3 million Ecuadorians in rural areas who the programme was created to help.

“Having a good heart doesn’t matter if having a good heart means they’re going to come and kill you or leave a child without a father,” says Dr Jose Luis Aguirre.

The day after Steven was killed, friends carried his casket down the streets of his home town in Guayas province as dozens of mourners, some holding white balloons, followed.

His whole family was proud of him for graduating from medical school, his brother says. He is remembered as being the “wisest” among them, and as the one who played guitar, loved card games and had a soft spot for dogs.

Losing their youngest son – and one of Ecuador’s newest doctors – has cast a lasting shadow over the Aguirre Giler family’s hopes for the future.

“I couldn’t believe it, I thought it was a lie,” says Jose, reflecting on the morning he found out his little brother had been killed. “Such a good person. How could they have hurt him?”