TWO weeks after he was shot, doctors finally got the bullet out of Alex Gálvez. "They asked me if I wanted it as a souvenir," he said. "I said no. The police were not interested either."

Mr Gálvez was 15 when he was gunned down, victim of a gang willing to take out just about anybody from a rival territory.

The then teenager was, he said, "an almost homicide" in a country, Guatemala, where law enforcement routinely fails to check ballistics from actual killings.

Half a lifetime after Mr Gálvez was shot and things are no better. Earlier this year Guatemala announced its clear-up rate for homicide: three per cent. Want to get away with murder? Move to Central America.

The entire region - Mexico and the northern triangle of El Salvador, Honduras and Mr Gálvez's Guatemala - is suffering an epidemic of deadly and largely unpunished lethal violence.

Mexico will end this year with a record 24,000 killings. That is more than the America lost killed in action in the bloodiest year of the Vietnam War; more in a day than Scotland suffers in a year; and 100 times more than the death toll in last month's Mexico City earthquake, which commanded global headlines.

Of this year's homicides, an estimated half will be linked to gangs trafficking drugs in to the United States; even more, four out of five, will be carried out with guns or bullets from the United States

America is Central America's biggest trading partner. Its biggest export, argue critics, is murder.

Some civic society voices in Mexico and the rest of the region are now warning that the very fabric of their society is under threat from the rising tide of violence and corruption.

The clearest evidence of this, according to government critics such as Raúl Vera, the Bishop of Saltillo, in the state of Coahuila on the Texan border, can be summed up in one word: impunity.

Mexico was ranked fourth in the world last year for how easy it is to avoid conviction for crime, higher than Guatemala.

Family members at the scene of a double murder in Mexico

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Its political, law enforcement and judicial institutions have been eroded by the same crime gangs and criminality behind the murders.

Bishop Vera this month repeated his charge that authorities use "impunity as a government strategy."

Other civil society voices in Mexico and beyond want to see greater global support to shore up local institutions and make sure killers get caught and convicted.

The UN and Guatemala a decade ago signed a deal to set up an independent body to seek prosecutions of corruption officials and others.

The International Commission against Impunity in Guatemala (CICIG) this month helped the country's attorney general begin proceedings against the current mayor of Guatemala City, a former president, Álvaro Arzú.

This was the former third president of Guatemala to implicated by the CICIG on corruption cases. His case was launched after the murder of a man who ran a private jail as his person fiefdom. That man referred to Mr Arzú as "Senor Oro" or Mr Gold.

Relatively speaking, the killing is even worse in El Salvador, the most violent country in the world not involved in an actual war.

Its homicide rate is more than 100 times higher than Scotland. Last year the country had a day when there were no murders. That made international headlines; individual killings do not.

Guatemala

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El Salvador's violence swings up and down as gangs - often linked to California - fight for supremacy. Crime levels in the region react directly to what is happening in the US.

There is a theory that Mexico's current spike in offending may be linked with growing legalisation of cannabis in the rest of north America: crime groups, say some observers, are in a turf war to control supplies for alternative illicit products.

But Central America's killings also show that violence breeds violence.

For every organised crime murder, there is another which is not. Femicides in the region are now routine: Mexico has seen a spate of killings of women by strangers. But domestic violence, fuelled by a cocktail of drink, access to firearms and brutalisation through gangs, is rife across the region.

Last week academics and health experts from across the globe met in Ottawa, Canada, to look at best practice for violence prevention.

One Mexican delegate, Arturo Cervantes, a professor in public health and long-time anti-violence campaigner, joined other Central Americans in urging a rethink of America's relationship with its neighbours.

He told The Herald: "We are suffering from the failed social policies of the high income countries, especially the US. The structural violence will not stop unless we address these bigger issues."

Prof Cervantes

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Prof Cervantes was supported by Mr Gálvez at the conference. "Prevention of violence is most important," the gunshot victim said, urging better healthcare. "But prevention of death among victims of violence is also important."

Mr Gálvez was lucky; he was taken to America for rehabilitation. Now he runs a charity, Asociacion Transiciones, which provides prosthetics to gun victims. Was his bullet from America? "Probably," Mr Gálvez said. "They almost always are."

Comment: Why world should help Mexico as it spirals towards a failed state

By Arturo Cervantes

As in the rest of Central America, criminal violence and insecurity in Mexico are rapidly worsening.

Illegal firearms and ammunition, mostly made in the rich world, are pouring in to our country, helping to create a humanitarian emergency: mass murder.

Alarmingly most of these homicides will go unpunished. This is because Mexicans do not trust the government, the police or justice institutions.

The most recent Global Impunity Index reveals that 99 per cent of crimes committed in Mexico go unpunished. People report only 7 out of 100 crimes to police, and of these, less than 5 per cent result in convictions.

Executions, armed robbery, rape, kidnappings and extortions have become the norm for many cities. Around 76 per cent of adults are afraid of going out because they consider their cities insecure and 65 per cent report to have seen or heard delinquent or anti-social activities around their homes in the past year.

This is not normal; neither is impunity, but they have become our way of life.

Yet this is not just a story of Mexico or a Central America. It is about a global illicit arms trade, and about how low- and middle-income countries are suffering the failed social and economic policies of high-income countries.

A backswoods funeral in Mexico

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The consequences of this global chaos will certainly take several generations to repair, even if addressed immediately.

We all know that Mexican and Central American citizens have incapable governments and weak institutions that have not been able, for many decades, of controlling the traffic of guns and laundered money into their territories.

Firearms and drug trafficking organisations are wreaking havoc in their communities. Their impact is now so big we can measure it on a population wide level. Violence is now the biggest killer of men in Mexico aged between 15 and 44. Surveys suggest 29 per cent of Mexicans were a victim of crime during last year.

This is now a global health and development crisis.

If criminal violence, homicide and impunity are not reduced, there is a credible threat of the world’s 13th largest economy spiralling in to failed state.

The public health scientific community is keenly aware of the problem. But if the international community is serious about global development goals, including the drive to reduce homicides, it would should show some more determination in helping Mexico and Central America.

Prof Cervantes is chair of public health at Mexico’s Anáhuac University