“Little Hospitals”: The Regime’s Strategy to Inflate Nicaragua’s Hospital Network
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Displaced Indigenous women face language and cultural barriers that leave them caught between precarity and violence
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Cindy Daineli is a Nicaraguan Indigenous woman of the Miskitu ethnic group who arrived in Costa Rica in 2023, fleeing the invasion of a group of settlers into her community located in Puerto Cabezas, on Nicaragua’s North Caribbean coast. She left behind her family, her culture, and the forest to start a different life in another country. But more than 850 kilometers away, her life continues to be marked by violence.
Being a woman, Indigenous, and a migrant in Costa Rica is “difficult,” warns Daineli, who still struggles to communicate in Spanish.
She recalls that when she arrived in Costa Rica, she knew nothing and barely spoke Spanish. Even so, she found a cleaning job in a nursing home. There, the supervisor—another Nicaraguan—abused her authority and Daineli’s vulnerability, forcing her to do work that should have been done by several people.
“I had to change the clothes of about thirty elderly people who were sick, put on their socks, put on their diapers… When I finished all that, I had to clean the rooms, collect trash, pick up the diapers, throw away the dirty things,” Daineli remembers, speaking in Spanish that has improved over time.
Despite knowing her labor rights were being violated, Daineli tried to keep her job. Everything changed when the nursing home administrator made a surprise visit. It was already midday and she had not yet finished cleaning. Seeing the disorder, the boss questioned the supervisor, who immediately blamed Daineli.
The supervisor “said I hadn’t done anything in the morning and that I was just standing there with my phone,” Daineli recalls. She adds that she tried to defend herself, but “she didn’t even let me speak” and “right there she fired me.”
Like Daineli, displaced Nicaraguan Indigenous women in Costa Rica live in a situation of “vulnerability” and are victims of different “forms of violence,” explains Susana Marley Cunningham, known as Mamá Tara (Grand Mother), a defender of Indigenous rights in Nicaragua and coordinator of the organization “Voices in Indigenous Resistance in Exile.”
Mamá Tara warns that although the Costa Rican state has welcomed more than 190,000 Nicaraguans fleeing violence in their country, expressions of “xenophobia” persist in Costa Rican society, especially against those who do not speak Spanish. “There is a kind of rejection or discrimination,” she emphasizes.
In schools, “if you can’t explain yourself well in Spanish, they won’t enroll you,” and in hospitals, “even if they have medical insurance, they don’t treat them—they brush them off,” warns Cunningham, who is originally from the Wangky Maya territory, Cabo Gracias a Dios, and has been exiled in Costa Rica since December 2021.
Mamá Tara also recounts cases of Indigenous women whose children have been taken away by the National Child Welfare Agency (PANI) “for not caring for them properly.” But she explains that this is not intentional neglect; rather, these women live in precarious conditions and lack the resources to provide adequate care.
“They (PANI) have their standards, and we (Indigenous people), perhaps because of our culture, are not caring for children the way we should… Let’s say it frankly. With so many children, there’s no way to provide better care. So this is also a process where Indigenous mothers learn a bit with PANI’s guidance,” the Indigenous leader emphasizes.
Cunningham highlights that reality is harsher for Miskitu women than for men of the same ethnicity. While men adapt to construction work, most women have no employment, care for their children, and depend entirely on their partners.
Adela Flores is another Nicaraguan Indigenous woman living in Costa Rica since 2023. In exile she has learned to speak Spanish, apply for asylum, request a work permit, and obtain a criminal record certificate. “I have all my papers,” she says proudly.
For three years, Flores has worked hard to regularize her immigration status, but that has not been enough to rebuild her life in Costa Rica. During this time she has not secured stable employment, so she lives confined in a rented room in La Carpio, a peripheral neighborhood of the Costa Rican capital, and depends financially on her partner.
Here in Costa Rica, “my man supports me,” Flores says. “He has a steady job, but I don’t. I stay at home, in the room all the time. So he’s the one who supports me.”
With the money her husband earns working in construction, “we pay the rent, buy food, he pays for his transport, and there’s almost nothing left. A little remains, and we send it to Nicaragua,” she explains.
Flores admits that overcoming the language barrier has been difficult, but says that when looking for work, “I explain myself, I say I’m Miskitu, I’m from Nicaragua, I came here to work.” Even so, “I don’t have a job,” she insists.
Sometimes she gets “little cleaning gigs,” but “it’s not enough,” she laments.
Economic dependence is just one of the reasons why “most” Nicaraguan Indigenous women in Costa Rica are victims of “gender-based violence,” warns Nicaraguan sociologist Elvira Cuadra of the Center for Transdisciplinary Studies of Central America (CETCAM).
Cuadra, one of the authors of the study Displaced Nicaraguan Indigenous Women in Costa Rica: What They Feel, What They Think, and What They Have Lived, presented in late November 2025, emphasizes that—of the 678 women who participated—only 2% have formal employment in Costa Rica, and these are generally “very low-quality jobs where labor rights are often not respected.”
Most Nicaraguan Indigenous women “survive by carrying out informal economic activities,” and “a significant percentage do not produce enough to meet all their basic needs, so they have a high level of dependence on partners, husbands, or other relatives or people they live with,” the sociologist stresses.
La dependencia económica se suma al pasado de violencia que estas mujeres vienen arrastrando desde Nicaragua y que no ha sido atendido “de ninguna manera”, advierte Cuadra. Por esa razón, en Costa Rica, están expuestas a “muchas situaciones difíciles”, continúa.
Raquel is a Nicaraguan Miskitu woman exiled in Costa Rica who requested anonymity out of fear of reprisals against her relatives in Nicaragua. She arrived in Costa Rica in 2018, when protests against the regime of Daniel Ortega and Rosario Murillo were at their peak, and says the adaptation process has been “very hard.”
Upon arriving in San José, Costa Rica’s capital, Raquel stayed in La Merced Park. There she met someone who took her to a church where she received help, and later she moved into a boarding house in the Pavas area.
In the boarding house where Raquel lives, along with a group of Nicaraguan Indigenous people, she has witnessed other women of her same ethnicity being beaten by their partners.
“Here (in the boarding house) there are women who come and go. Their husbands beat them and they run between the rooms,” Raquel says. “In my little room, how many women have I taken in—they stay with me because they even get thrown out,” she adds.
She says that on two occasions she accompanied one of her neighbors to San Juan de Dios Hospital in San Jose after her partner beat her and tried to strangle her.
“We took her to San Juan Hospital because her husband was choking her, constantly abusing her. I would tell her: your life, your children, and then a man,” Raquel explains.
She adds that she herself has been beaten on several occasions when intervening in her neighbors’ conflicts, and that the neighbor’s husband threatened to do “many things” to her if she called the police.
Because of the violent environment she lives in, Raquel says she prays to God not to fall in love again, “because I’m seeing these things and I don’t want that.” “Women are not animals; they are human beings and deserve respect and the chance to move forward,” she reflects in Spanish, which has improved since going into exile.
The study conducted by Cuadra—together with the Center for Information and Health Advisory Services (CISAS) and the organization Isin Mairin Kupia Kumi Muskitia Nicaragua (IMATKUMN)—shows that Miskitu women in Costa Rica suffer various types of gender-based violence.
“We found that they experience verbal violence, economic or patrimonial violence, physical violence, sexual violence, and something we call blackmail,” the sociologist explains. But “when we ask them directly, they do not recognize that they are experiencing it,” she notes.
Of the 678 women surveyed, 74% said that since arriving in Costa Rica no man had made them feel bad through shouting, offensive words, phrases, or rude gestures; only 19% said yes. However, when asked to identify the aggressor, 41% pointed to a current partner, former partner, or another relative.
Physical violence is another form they face. While 77% did not recognize experiencing it, 16% said they had. Even so, 39% of those interviewed identified an aggressor, including a current partner, another relative, or a former partner.
Mamá Tara believes gender-based violence is deeply rooted in Nicaraguan Indigenous communities, which she links to the lack of psychological care for people who participated in the war of the 1980s.
“Men who lived through those ten years of war come with a violent mindset, and no one has taken them in, counseled them, or provided psychological follow-up. That’s why I tell you that violence exists in Indigenous families,” she emphasizes.
Nicaraguan Indigenous women also suffer a form of violence associated with their status as migrants, referred to in the CISAS and CETCAM study as “institutional violence.”
Cuadra explains that the Costa Rican system has undergone many changes, so Indigenous women often do not know, for example, how the asylum application process works. In addition, many do not speak Spanish, which sometimes results in denial of information or services.
“There are forms of institutional violence they are experiencing, but they are often not aware of them,” the sociologist warns. She adds that this is because “when they arrive in a condition of forced displacement, they have no access to information, they do not know their rights or the responsibility of institutions to provide protection given their situation.”
In February 2025, a group of NGOs in the Costa Rican capital announced that Miskitu Indigenous people could fill out asylum applications in their own language. However, this does not guarantee their social integration.
Cuadra warns that “there is a lot of denial of information, denial of services, and—in many cases—they are made to feel discriminated against, made to feel uncomfortable.”
*This report was produced with support from the DW Akademie journalism grant and the Institute for Press and Freedom of Expression (IPLEX). The grant is part of the global “Space for Freedom” project of the Hannah Arendt Initiative, sponsored by the German Federal Foreign Office.
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