Over the years, political violence in Guatemala has been the most serious obstacle to progress in health care. Since 1980, open war has been going on between the army and various leftist guerrilla factions fighting for power. Although the foundation has maintained strict neutrality, at least a dozen health promoters have been killed in indiscriminate army counterinsurgency actions. In 1983, gunmen killed a Guatemalan doctor working at the clinic; later the same year, the director of the loan program disappeared. This violence has disrupted the foundation's work and forced a cutback in the health promotion program. Health conditions in the highlands have worsened lately because of the social dislocation and economic damage caused by the fighting. Enduring progress will be impossible until peace and security are established. In the past two years, the war has subsided and the army has ceded power to an elected civilian president; these changes offer hope for the future, but lasting peace will come only with social justice, land reform, and an end to the exploitation of the poor. In a sense, these are the most urgent medical priorities.