Jose Aguirre Giler never imagined his brother’s work as a doctor in a rural Ecuadorian town would end in kidnapping attempts and deadly gunfire. His youngest brother, Steven, had a bright future ahead of him after graduating from medical school in 2023 and beginning a government-mandated year of service at a health center in Guayas, a southwestern province plagued by drug gang violence. “He helped anyone who needed help,” Jose says.
The first kidnapping attempt was in November 2023 when Steven was on his way to work, the Health Ministry said. His brother said the attack failed when the attackers’ car was damaged and Steven escaped. Anonymous threats with demands for money followed.
Six months later, on May 14, the 25-year-old was fatally shot during his morning commute. Criminals tried to kidnap Steven from his car and he resisted, Jose says. “It was the worst day of our lives.”
Steven was one of more than 19,000 people killed in Ecuador since a wave of violence with ties to gangs involved in drug trafficking, broke out in coastal areas in 2020. He was also one of a growing number of doctors in the country who medical guilds say have been targeted by extortionists, further endangering the country’s overburdened health care system.
Those who work in rural areas or on the outskirts of urban centres appear to be at particularly high risk. Federation of Rural Health Professionals told the Guardian it had received more than 760 reports of doctors being threatened by criminals to extort money in 2024. It said it typically receives no more than 20 such reports a year.
“In the short term, it’s a huge increase,” said Dr. Jose Luis Aguirre (no relation to Steven), the federation’s president.
The Ministry of Health and the Ministry of the Interior say they plan to protect doctors by setting up permanent police presence in priority health centers and sending officers to accompany doctors working in remote areas. But fear of extortion is already forcing medical professionals to resign, says the president of the Ecuadorian Medical Federation, Dr. Wilson Tenorio. That threatens to worsen the country’s ongoing health crisis, as medical centers face severe shortages of supplies and medicines — a problem blamed by guilds on budget cuts, corruption and unpaid government debts to health systems.
“All of this means that the outlook for the professional practice of health care in Ecuador makes us incredibly concerned,” says Tenorio.
A UN report on the global drug trade published in June Violence on the rise in Ecuador to a recent cocaine production boom in neighboring Colombia and Peru. The coasts of the small South American country are a vital starting point for secret shipments to the largest cocaine markets: the US and Europe.
Last year, extortion was the most reported crime in the country, according to the Ecuadorian Observatory of Organized Crime, with the number of cases increasing from 1,282 in 2020 to almost 22,000 in 2023 – a 17-fold increaseIt is seen as an effective, low-risk way for illegal groups to raise money while using fear to gain territorial control.
Doctors are targeted because of their relatively high salaries. For example, doctors who complete their required year of rural service under the Ministry of Health make $986 per month – about three times the average income of rural workers.
“They come with different types of clothes, sometimes a recently purchased car… so that attracts a lot of attention,” says Dr. Jose Luis Aguirre.
Steven’s killing was particularly painful for his family, as the government knew about the threat against him in November, but the health ministry says it has taken action to help.
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After the attempted kidnapping, Steven was given eight days off and allowed to be transferred from the medical station where he worked, the ministry said. But the transfer was temporary and lasted only until early February.
The ministry also says that Steven verbally requested to be sent back to the medical center where he worked when he was first targeted, a claim that Steven’s brother disputes.
Luis A Torres, a physician 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 have been removed from their workplaces by the ministry after threats of extortion, only to be sent back shortly after.
“They take them away for a moment, but then immediately send them back into the wolf’s mouth,” Torres says.
The health ministry told the Guardian that doctors completing their national service year can request to be sent to a new location if they are targeted by criminals, but the first step is to file a report with the police. That is problematic, Torres said, because many fear the extortionists will retaliate.
It’s a fear Steven’s family knew firsthand. Jose said they didn’t tell police about the first attempt to kidnap Steven because “we didn’t want to play with the mafia.”
Now, medical guilds are seeking updates to the regulations that govern the nationwide annual requirement. One suggestion some doctors have floated is to make it optional rather than mandatory. But that could lead to a reduction in services for the 6.3 million rural Ecuadorians the program was designed to help.
“Having a good heart doesn’t matter if having a good heart means they 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 coffin through the streets of his hometown in Guayas province, followed by dozens of mourners, some holding white balloons.
His entire family was proud of him for graduating from medical school, his brother says. He is remembered as the “wisest” among them, and as the one who played guitar, enjoyed card games and had a soft spot for dogs.
The loss of their youngest son – and one of Ecuador’s newest doctors – has cast a lasting shadow over the Aguirre Giler family’s future prospects.
“I couldn’t believe it, I thought it was a lie,” Jose says, recalling the morning he heard his brother had been murdered. “Such a good person. How could they hurt him?”