As the migrant crisis at the U.S.-Mexico border intensifies, there are indications that many have experienced significant physical and psychological trauma. Some are survivors of domestic and gang violence, including sexual violence. Some are suffering medical neglect in over-crowded U.S. immigrant detention facilities or dealing with the psychological repercussions of the administration’s brutal family separation polices. But this is just one aspect of the dire health landscape for immigrant populations in the United States.
During my time working at a community health clinic in the border city of Brownsville, Texas, the health implications of U.S. immigration policy were at the front of my mind. The fear of being targeted for immigration enforcement actions while receiving treatment has a devastating effect on undocumented populations accessing their right to health.
The undocumented community tends to avoid interaction with official agencies or entities out of fear that, if their status were revealed, they would be deported. Many patients told me that they had put off seeking health services as long as they could. This was rooted in various factors, including fear and lack of knowledge about the complex health and insurance system, the need for documentation, and lack of resources.
Both Immigration and Customs Enforcement and Customs and Border Patrol have “sensitive location” policies which prohibit immigration enforcement from taking place in hospitals and clinics, in order to ensure that the patient’s life takes priority. However, many immigrant rights groups report that these policies are not consistently enforced, with immigration officials regularly staking out emergency rooms, waiting rooms, and even labor and delivery rooms – causing a chilling effect that discourages immigrants from seeking critically needed medical care.
Financial insecurity is also an important determinant of health for immigrants, both those with legal status and those who are undocumented. When we spoke about their lifestyle and eating habits, many presented symptoms of malnutrition and told me their food choices were based on what they could afford. Obesity is a common underlying cause of the symptoms and illnesses that patients came in with, including high blood pressure, Type 2 diabetes, and respiratory diseases. In Brownsville, 52 percent of the adult population are obese and 32 percent are overweight, meaning 84 percent of adults weigh more than they should. In addition, many showed high levels of stress and voiced concerns about their financial stability, the wellbeing and safety of their family, inadequate housing that was posing environmental risks, and their legal status. It was clear that, for many, their health was the least of their worries.
Serving an impoverished and undereducated area with thousands of immigrants of all legal statuses poses many challenges. The Brownsville Community Health Center, where I served, offers basic health care services at a reduced cost, or, sometimes, at no cost, depending on income. Patients are never turned away for their inability to pay; the goal is to treat everyone with respect and dignity and recognize the value of each life without asking for proof of immigration status or anything else that could limit the services offered. Unfortunately, this means that the waiting areas are always full and a visit to the doctor can take many hours. This also means that health care providers are sometimes unable to thoroughly talk through a patient’s situation with them, as they are trying to get to the highest number of patients every day.
There are limited facilities that provide these kinds of services in the region and there is a high demand for them, especially among undocumented immigrants. Even though these health care providers are doing extraordinary work and providing desperately needed services to extremely vulnerable communities, there is much to be done to ensure that immigrants in South Texas are able to enjoy their basic human right: access the highest attainable standard of health.
One positive sign is the increased recognition of the role of “sanctuary” hospitals and clinics – those with policies which strictly protect patients’ confidential health information and do not permit immigration enforcement from taking place in their facilities. These are an important innovation and a real tool for doctors and other health care professional to leverage in protecting patients’ rights and health.
Another is the growing number of medical professionals who are stepping forward through Physicians for Human Rights’ Asylum Network to provide pro bono forensic medical and psychological evaluations of asylum seekers. These evaluations can corroborate asylum seekers’ stories of having suffered violence in their countries of origin, and can thus help them to receive permanent legal status, which in turn helps them to access health care and all other needed services.
The U.S. immigration crisis presents a clear opportunity for clinicians to engage not only as health care providers but also as human rights advocates. It is essential that health care professionals stand with immigrants and other vulnerable patient groups to ensure that human rights and health are protected.
Aranza Caballero, a Harvard Mindich Service Fellow, served as an intern for Physicians for Human Rights from June 2018 to August 2018 and contributed to our Asylum Program work.