FORTALEZA, Brazil — Our driver took out a pistol and placed it under his right thigh, signaling things were about to get unexpectedly interesting. As we got out of the car in front of a favela named Cidade de Deus (City of God), a squad of four elite members of the state’s military police fanned out in front, weapons drawn, to secure our approach. Their black guns and green uniforms blended in with the bare red bricks and faded cement walls that symbolize poverty in Brazil.
Dogs barked menacingly as we walked through a narrow alleyway. Pen in hand and outfitted in shorts and a tee-shirt, I must have provided quite a sight to anyone who dared peek out their windows. Colonel Hideraldo Luiz Bellini, a six-foot-three retired military police intelligence officer sporting a black mustache, beckoned me forward to show yet another abandoned house, the third in as many minutes. Entering the building and climbing to the second floor, we were met by a dirty couch and a toy pig in a chef’s costume on a dilapidated TV stand, its eyes bulging as if in recounting quite a story. More than a dozen bullet holes framed an open window behind it.
The squad leader of our armed escort explained that the neighborhood had been taken over by a gang in a gun fight with a rival faction a few days earlier. Many residents were being forced out of their homes or were leaving because of fear.
Within 15 minutes, we were back in the car. Even with an armed and specially trained escort, we hadn’t ventured more than 100 yards through the first row of shacks. Within seconds of driving off, Colonel Bellini notified me that we’d entered another faction’s territory—a mere block away. An invisible, ever-shifting line deadlier than many international borders.
I’d told myself before coming to Brazil that I would not write about its gang violence, let alone enter a favela, the subject of too many voyeuristic YouTube videos. However, it soon became clear that it would not be possible to accurately portray the barriers to health care and social services, especially for those living on the street or in poorer communities, without acknowledging the rising presence of armed criminal gangs—locally called factions—which have become an everyday reality over the past decade for many in the state of Ceará in Brazil’s northeast.
The first sign of the problem came when I was visiting this city’s newly minted Estação do Cuidado (Care Station). The low-threshold welcome center in Fortaleza’s central district offers social service referrals, basic mental and physical health care, group sessions, judicial advice, arts education, showers, a washing machine and an outdoor space to pass the time for up to 100 people a day. Located next to the city’s largest open drug scene, the flagship initiative was inaugurated last fall with national, state and municipal officials present.
The staff described how clients were often unable to access the services of the sister city-run center three blocks up the road because that area was dominated by a different faction. At other times, faction members would show up in front of a line of people waiting for services and order everyone to disperse.
To understand the situation better, I met Nara Goes, who works as a local representative of the national Justice Ministry’s drug agency (SENAD). A psychologist by training, she spent her early career conducting street outreach to youths in the poor neighborhoods of Fortaleza and further south in Rio de Janeiro and Salvador, the capital of the state of Bahia.
She explained that factions’ influence had increased significantly over the past 10 years across Ceará and its capital. In many instances acting as the de-facto rulers, they created parallel governance structures that now decide what drugs may be sold to whom, and who may access which government services, as well as provide food to the poor and distribute “justice” through independent tribunals.
To highlight their control over the population, Nara recounted a story from her post-doctoral research in Caucaia, a town 10 miles north of Fortaleza, where she studied drug consumption trends. “From one week to the next, people stopped using drug inhalants such as sniffing glue and I couldn’t figure out why,” she said. “It turned out the faction members decreed a ban because they dubbed it bad for people’s health. They wanted people to be using only the drugs they sold, which were primarily cannabis and crack.” Harsh punishments would also be given out to anyone who sold to pregnant women.
Colonel Bellini, my guide into the Cidade de Deus favela, confirmed Nara’s account. During his 30 years of active service, he saw the first factions from Rio and São Paulo arrive in the early 2010s. Their appearance spurred the creation of rival home-grown factions. After a couple years of deadly street warfare in 2015—which saw multiple murders a day across the Fortaleza metropolitan area—the factions agreed to a peace that has since mostly held, although sporadic disputes persist in certain neighborhoods.
“Not only are they creating parallel governments but they’re also creating parallel economies,” the colonel said, sighing as we grabbed coffee at his mother’s house nearby after our visit to the favela. He estimates that for the larger factions operating in the state, drug trafficking now comprises less than 50 percent of their revenues. A growing portion is made through racketeering and fraudulent business activities as they transform into mafias.
The activities include the time-tested extortion of local business in territories they control, charging from 1,000 reais ($185) to 30,000 reais a month to continue operating. They have also begun restricting essential services such as internet access to companies that pay kickbacks, running profitable gambling rings and creating legal businesses as fronts to launder their money.
To my question of how the government and police are responding to those alarming developments, Bellini is the first to admit to rampant police corruption. With a combined membership of around 50,000 in the state, faction members outnumber two-to-one the state’s roughly 22,000 military police charged with securing the streets. And while my pacifist senses might have been impressed by the deterring semi-automatic rifles shouldered by our armed escorts, the squad leader had been quick to clarify that his elite team was often outgunned by factions with military-grade automatic weapons.
Unfortunately, politicians, particularly municipal officials, are increasingly co-opted by faction leaders who promise votes and financial kickbacks in return for municipal contracts and being left alone. Colonel Bellini decried the justice system as little better, and with only 1 percent of judges dismissed for malpractice across Brazil last year, the rising dominance of factions doesn’t look set to abate anytime soon.
After finishing coffee and saying goodbye to his mother, Bellini drove me to a posto de saude, a primary care clinic that is part of Brazil’s universal health care network, close to the favela we’d just visited. Brazil enshrined health care as a constitutional right in 1988 during redemocratization after its 21-year dictatorship. The state-run system, known as the SUS, serves Brazilians from inner cities to rural villages in the Amazon rainforest free of charge. At the clinic, we talked to the on-site coordinator who asked to stay anonymous.
She confirmed that many residents of nearby neighborhoods served by the clinic are unable to come in person due to fear of faction orders limiting their movement. That can happen when a health clinic is in a neighborhood controlled by another faction or because a patient must cross another faction’s territory to reach the clinic. The magnitude of the difficulty became apparent when Bellini explained that in some areas, faction affiliation is delineated not by neighborhood but street.
“We do our best to bring our services to people’s homes but sometimes it’s simply too dangerous for our teams to go out,” the care coordinator told us. These heroic domiciliary care workers are often the only access to care for patients with chronic diseases such as hypertension and diabetes.
As we talked, the clean and orderly clinic was bustling with activity. We stood in the center of the welcome area, where dozens of people waited for their appointments. A mother with a newborn, an older gentleman in a collared shirt. Walking back to the colonel’s car, I remarked about the municipal police vehicle parked in front of the gate. “That’s to dissuade factions from killing rivals or people marked for death by faction tribunals outside the clinic,” he explained matter-of-factly as he shut the car door.
Across the countries I’ve studied so far, a person’s neighborhood always affects one’s access to care, but that traditional barrier is much greater here. To understand how the state plans to ensure health care access to those living under faction rule, I turned back to Nara, the national drug agency representative.
“We’re going to need more mobile teams, many more,” she told me bluntly. Her office is currently looking to train more domiciliary care workers. While factions do not target health workers, more than a few have been hit by “lost bullets” leading many to question their career choice. To help counter such fears, Nara’s office and Brazil’s universal health care system are focusing on recruiting people from the communities they serve.
Nara was concerned but optimistic; her previous work in faction-controlled neighborhoods in Rio de Janeiro gave her confidence that this model of providing domiciliary care will work here, too: a tacit acknowledgement that the factions and their control are here to stay. Forty years after the fall of the country’s brutal military dictatorship, the unfortunate reality is that many citizens live under a new form of martial law.
Many Uber drivers I spoke with believed the problem to be lax criminal laws that allegedly let arrested people go free. The reality isn’t so straight-forward. The prison system is over capacity. At the national level, Brazil imprisons nearly 240,000 more people than it has space for, creating cruel conditions inside. The country is host to the fourth-largest prison population in the world at just over 900,000 inmates. The equivalent of 428 prisoners per 100,000 Brazilians are incarcerated—a number that has tripled in the past 25 years. It’s a rate significantly higher than the Netherlands’ 64 and Portugal’s 115 but lower than America’s 541 per 100,000.
Colonel Bellini argues that part of the problem has to do with police going after only easily replaceable street-corner sellers while the criminal organizations’ leadership lives in the city’s wealthiest neighborhoods untouched. Moreover, he explained, “prisons are where these factions were created and sending more young men to that environment simply funnels them deeper into the academy of crime.”
He believes the problem to be that often the only presence of the state in poor communities is law enforcement. Instead, he feels, there should be a greater presence of health care, social services and education, especially job apprenticeship programs that can offer financial incentives equal or larger to what faction membership offers.
While Ceará is considered a leader in public education, many young people continue to fall through the cracks. Of the 3,272 victims of violent crime who died last year, approximately 85 percent had not finished high school. And for the diligent students who finish their studies, compensation for one’s achievements is not always forthcoming. Recent graduates face the reality that education doesn’t necessarily lead to good paying jobs. Approximately 50 percent of the state’s workforce is informally employed, which usually means a salary below the official minimum wage of 1,518 reais per month.
Nara believes the question of money is key. As a former street outreach worker, she remembers the case of one teenager debating whether to finish school or join a faction offering a starting wage of 1,000 reais a month—a competitive salary for informal low-wage workers in Brazil. “These kids,” she told me, “their biggest dream in life is to have a motorcycle, an iPhone, a girlfriend. They’re often not thinking past that.”
In an effort to match the allure of what factions offer, Ceará’s government has started piloting policies to pay students to stay in school and graduate. However, multiple people I spoke with described the effort as weak and insufficient. Furthermore, normal youthful insecurity has been turbocharged by social media where kids see highlight reels of faction members showing off their relative wealth while their own parents struggle to put food on the table.
In a country where 27 percent of the population lives under the World Bank’s poverty line (down from 32 percent in 2022), and where the richest 1 percent of the population takes in 27 percent of the nation’s income (one of the largest proportions in the world), ad hoc government programs seem like small comfort against an economy and judicial system weighed against those who aren’t at the top.
Unfortunately, in other cases, state services for youth actively worsen the situation. A report by Ceará’s state legislature’s Commission on Community Violence found that young people who were interned in the state’s care were several times more likely to be killed than those who were not. Other reports have found that 74 percent of adolescents in those programs were victims of violence bordering on torture, living in conditions that violated multiple human rights laws and lacked basic sanitary standards.
Thiago Holanda, staff director for the state legislative commission fighting to improve the situation, lamented the state of affairs. “But what can you expect?” he complained. “Prohibition doesn’t eliminate demand and supply of a lucrative industry; it simply takes it out of the state’s hands and into that of armed entrepreneurs.”
Ceará is strategically located as Brazil’s closest point to Europe, the United States and Africa—all top destinations for the cocaine smuggled from producing Andes nations. Cocaine demand and production have recently hit all-time highs. Fortaleza, Brazil’s fourth-largest city, also has one of the highest cocaine consumption rates in the country. While official numbers are hard to obtain, the result is billions of dollars in the hands of Brazilian organized crime—rivalling revenues of the nation’s biggest private companies.
The horrific consequence of Ceará’s drug-money-fueled turf war is a state-wide homicide rate of around 35 per 100,000, the third-highest in the country. That number rises to 79 homicides per 100,000 for those under 29 years old. In comparison, the Netherlands and Portugal have homicide rates lower than 1 per 100,000. In the United States, Mississipi has the highest state-wide homicide rate in the country at 19.4 per 100,000 while Utah has the lowest at 2.2 per 100,000.
Ceará is home to three of the top ten most violent municipalities in the country, including its most violent, with a disturbing rate of 80 homicides per 100,000. The capital Fortaleza averages a rate of 45 homicides per 100,000, which would rank third in the United States after St. Louis and Baltimore. The state governor claims that 90 percent of homicides in the state were due to faction warfare. Research shows that 5 percent were due to police shootings.
It’s worth noting that the exceptionally high homicide rates do not hold true across Brazil. In other states with significant drug selling and trafficking, such as São Paulo and Rio, the homicide rates are much lower: 6.4 and 14.1 respectively. Some government experts maintain that the domination of one faction in those states reduces inter-faction warfare.
The majority of those who survive gunshot wounds are assisted by social workers at one of Fortaleza’s large trauma hospitals. One was willing to talk to me but only on condition of anonymity. The social worker’s team helps victims of faction or police violence plan for life after discharge from the hospital. While a few identified themselves openly as faction members, many victims were simply at the wrong place at the wrong time during a shooting. Others broke a faction’s laws and paid the consequence: a shot in the hand for theft, a shot in the mouth for talking with the police. The social worker told me that a growing number don’t want to return to their homes for fear for their safety. In response, over the past five years, the state has created programs to try to resettle them in other areas.
In one emblematic incident of a faction’s control of the population, the social worker recounted the story of a woman who was badly beaten by a man who had stalked her after she rejected his advances at a party. The local faction leader would not let her go to the hospital or access services for battered women, because he didn’t want to bring police attention to the neighborhood. A week later, still in severe pain, she made a second request that the leader granted but on condition she seek only medical care for her wounds. At the hospital, she divulged little information. When asked about her assailant, she simply said that the faction had “taken care of it,” meaning the police were unlikely to find him alive.
A week after my visit to the Cidade de Deus favela, I got a text from a journalist friend informing me that the faction that had won over that territory had expanded its reach to several adjoining neighborhoods, killing rivals and kicking more civilians out in the process. I thought back to the older woman who greeted me with a surprised bom dia behind her iron fence as our military police group walked past. Has she been able to get her medication? Will she be able to soon?
Top photo: Entering the Cidade de Deus favela in Fortaleza
