War between rival gangs in El Salvador, deemed the likely murder capital of the world, is preventing health authorities from combating the Zika virus outbreak afflicting the country, reports The Washington Post (WaPo).

Some news outlets have labeled the Central American country the world’s murder capital, reporting that, with 6,657 murders last year in a population of about 6 million, El Salvador has a homicide rate of 104 people per 100,000.

“In the capital of El Salvador, health workers are negotiating entry into violent, gang-run neighborhoods to fumigate and to educate residents about avoiding infestations,” notes the Post.

“Medical care involves delicate negotiations, including phone calls from imprisoned gang leaders,” it adds. “The gangs have agreed on occasion to do their own fumigation, using Health Ministry equipment.”

Meanwhile, some Salvadorian health ministry employees charged with fumigating pesticide to prevent the spread of the virus are being accused of being gang spies.

Claudia Muñoz, 46, a municipal employee who was participating in the fumigation of the San Jacinto neighborhood in the country’s capital of San Salvador, reportedly indicated that “teenagers, even children, will tag along behind health workers on their rounds and report back to gang leaders.”

“They think we are carrying information to the other gang,” she said. “They think we’re spies.”

In his 25 years on the job, health inspector Salvador Quintanilla has been assaulted three times, reveals the WaPo. 

The list of neighborhoods he can no longer go into “isn’t a list anymore,” he told the Post. “It’s practically a folder.”

Gang warfare is inhibiting efforts by the Salvadorian government to prevent the spread of the virus, which has been linked to microcephaly, a neurological disorder that causes babies to be born with abnormally small heads and children to suffer from seizures, developmental delays, intellectual disability, and feeding problems.

“In this web of slums, there are blocks where 8 in 10 houses are breeding sites for mosquitoes,” notes the Post, referring to the San Jacinto neighborhood. “The city is a patchwork of rival gang territories that are defended so fiercely that health authorities cannot enter some neighborhoods. In just the first three weeks of January, El Salvador recorded 2,474 new suspected Zika cases, nearly half of them here in the capital. Many infected pregnant women live in these densely packed southern neighborhoods.”

“About 40 percent of the area is difficult, though not impossible, to get to,” Julio Morales, director of the Unicentro hospital in Soyapango, another southern neighborhood in the capital, told the Post. He estimates that he is responsible for about 150,00 people.

Salvadoran officials have urged women to avoid pregnancy due to alleged links between Zika and microcephaly.

Across El Salvador, 122 pregnant women are receiving “regular doctors’ visits and home sonograms to detect early signs of microcephaly,” reports the Post. “The monitoring is part of a nationwide effort to combat an illness that is rapidly spreading across the Americas.”

“To fight the disease, Salvadoran authorities have launched a campaign to fumigate some 55,000 houses each week,” it adds. “Clinic workers hand out free packets of disinfectant for water supplies, and they lecture patients on mosquito prevention. Authorities are even giving people baby tilapia, hoping the fish will eat mosquito eggs and larvae living in water tanks.”

Homicides have skyrocketed since a truce between the country’s most notorious rival gangs 18th Street and MS-13 (Mara Salvatrucha) collapsed two years ago.

It does appear that El Salvador is the Wester Hemisphere’s murder capital and perhaps even the deadliest country outside a war zone.

“Government data show 6,657 people were murdered in the small country last year, a 70% increase from 2014,” reports USA Today. “The homicide rate of 104 people per 100,000 is the highest for any country in nearly 20 years, according to data from the World Bank.”

Meanwhile, the gang-plagued country is experiencing a Zika outbreak, with more than 6,000 suspected cases since the presence of the virus was confirmed in the country at the end of November, reports BBC.

The virus has also been associated with Guillain-Barre, a rare syndrome that causes the immune system to damage nerve cells, leading to muscle weakness and even paralysis, have been linked to Zika virus infections.

Transmission through sexual contact and blood transfusion has been confirmed.

El Salvador is among the 30 countries and territories listed by the U.S. Centers for Disease Control and Prevention (CDC) as countries afflicted by an outbreak of Zika.

The majority (26) of those countries are in the Americas. Brazil is home to the most confirmed Zika cases in the world.