Voices from the Pandemic: A Looming COVID-19 Outbreak in Tijuana

Dr. Hannah Janeway and Tamaryn Nelson jointly document the plight of asylum seekers on the U.S.-Mexico border. This is part of an ongoing series of first-person reports from PHR-affiliated health care workers providing care for at-risk populations during the coronavirus pandemic.

At first, they cannot hear me from beneath the mask, so I take a few steps backward to ensure I am six feet away and lower it. Then my voice carries like a shock wave. I have their full attention now, as I go over COVID-19 statistics and prevention strategies. Deaths in Italy and New York. Hospitals not having ventilators and uncertainty about supply in the United States, one of the richest countries in the world.

This is not the first migrant shelter in Tijuana, Mexico where I have spoken on these stark realities, nor will it be my last. Pre-pandemic, my patients in this border city already had high risks to their health due to violence from organized crime, barriers to accessing healthcare and difficult living conditions. I know their stories from the Saturdays that I have spent here inside the shelters treating their wounds and rashes, or from my contact with them at the clinic I help run downtown. Their trust flows in my direction, which is why being the bearer of bad news to them is so hard.

“How many of you have used the Mexican health care system?” I ask. “If you get sick, do you think they will care for you well? Do you think they will be able to save your life?” Heads are shaking “no” now. They know, as I do, that Mexico’s already overburdened public health care system and its scarce resources may not reach them.

The shelter’s director starts speaking, trying to impress upon them the gravity of the situation. I am looking out at a sea of faces, individuals and families who have fled unimaginable violence – gang rapes, torture, murders, and hangings – to now face a pandemic in some of the most precarious conditions.

The director continues. Her strong voice communicates her conviction about undertaking this largely unrecognized and risky work. She’s speaking about how much she cares, about why she doesn’t want the migrants leaving the confines of this shelter, where they are huddled together in tents with no space to turn. Social distancing in these conditions feels near impossible to us all in this moment. And then they start to cry in unison, a powerful unleashing of emotion from these most resilient people, as they face yet another challenge to their existence.

I have been working part-time in Tijuana for over a year now. Every day feels as pressing as today, but the long-term prospects for these asylum seekers have never seemed worse. Every outbreak of infectious disease I have seen in these crowded, cramped shelters has spread like wildfire. Varicella, mumps, norovirus. And now the threat of COVID-19.

It is not surprising that media reports show that Tijuana is one of the epicenters in Mexico, with more than 1,240 confirmed COVID-19 cases and more than 290 registered deaths, but estimates suggest that the limited testing available here masks much higher numbers. As a physician from the United States, I have had to wrestle with this and with the knowledge that our country has created a situation where families are essentially trapped at the border, waiting for the pandemic to blaze through these communities.

The U.S. administration has accelerated its inhumane treatment of asylum seekers since the COVID-19 pandemic. Until early April, the United States subjected asylum seekers arriving at U.S. border crossings to “metering,” a process illegal under international law that limits the number of people allowed to enter the United States each day to make their case for protection. Some asylum seekers waited up to a year simply to cross and present their case. Even when these asylum seekers were finally able to do so, most of them were then sent back to Mexico through the so-called “Migrant Protection Protocols” policy, which required asylum seekers to await the processing of their case in Mexico. This left asylum seekers with no access to immigration lawyers and exposed them to alarming levels of violence.

When the coronavirus became widespread in the United States in April, the Trump administration banned all non-essential travel across its borders, which effectively shut down the asylum process on the U.S.-Mexico border and left thousands of asylum seekers dangerously exposed to this pandemic. This political move masked as a public health policy has trapped asylum seekers in a country they do not know, in one of the most dangerous cities in the world, without access to adequate health care, housing, or economic opportunities.

As a doctor, I will do what I can in the face of this crisis, as the inevitable wave of COVID-19 infections sweeps through migrant communities on both sides of the border. But, until the U.S. government revokes the unlawful and abjectly cruel policies that deny asylum seekers the right to seek protection, they will remain at high risk of infection and death from COVID-19 and from a range of other diseases that can sicken or kill people who lack access to care.

Every day, I witness firsthand how the coronavirus knows no borders, and I am convinced that discriminatory immigration policies will not stop its spread. If the United States really wants to end this pandemic, we must prioritize public health strategies driven by science and respect for human rights. We should not be using the pandemic as a pretext to refuse the right to asylum for those seeking a safe haven.

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