Margaret Cruz

Mexico Border Health Crisis

Refugee and Immigrant Public Health
November 20, 2020

Mexico Border Health Crisis

I Background:

Immigrants and refugees travel very far from South American, and Central American

countries and Mexico to make it to the Southwest border of the United States (U.S). People may be

fleeing their home country to find safety due to violence, crime, poverty, natural disasters, and food-

insecurity. Many families are seeking safety in the U.S. and are running from tragic violence in their

home countries. Majority of people are from the northern triangle of AL Salvador, Guatemala and

Honduras. The Mexican border used to be a very rural inhabited area and has populated to 7.3 million

residents in 2010 (Healthy Border, 2020). The large number of families, new immigrations policies, and

social determinants of health are affecting the health and lives of residents at the U.S- Mexico border.

In the past families coming to the US could pass the border and await their hearing for

citizenship but that is no longer the case. When President Donald Trump went into office he was not

successful at building a wall at the Mexico and U.S border. Instead Trump applied many policies that

greatly affected families seeking safety in the U.S. Many of the policies Trump implemented are being

challenged in court. The policies were meant to improve the process of immigration with the influx of

families requesting asylum. Instead the policies have greatly impacted individuals seeking asylum, has

separated families and caused more trauma to people that have ran for their lives to safety. Policies

implemented at the border include metering, zero tolerance, Migrant Protection Protocols (MPP) or

informally remain in Mexico, Humanitarian Asylum Review Process (HARP), and the Prompt Asylum

Claim Review (PACR). The Department of Homeland Security (DHS) is in charge of the immigration

detention system. In the U.S. Immigration and Customs Enforcement (ICE) is running the more than 200

ICE detention centers within the U.S (National Immigrant Justice Center).

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Mexico Border Health Crisis
Refugee and Immigrant Public Health
November 20, 2020

A tactic CBP started using in 2018 metering and asylum turnbacks made it very difficult for

immigrants to have an opportunity to request asylum. Asylum seekers must wait months in Mexico

before the asylum process even starts (American Immigration Council, 2020). In 2018 the Department of

Homeland Security (DHS) set a new zero tolerance immigration policy that prosecuted all parents that

attempted to cross the U.S border with their children. Citizen Border Patrol (CBP) apprehends these

individuals and processes them as criminals. These ‘criminals’ must wait in jail until their case with

Department of Justice (DOJ) where they face prosecution and deportation. About half of individuals

jailed in detention centers are held in ICE for 2-4 years (Freedom for Immigrants, 2020). After a criminal

case is concluded, adult individuals are then transferred to U.S Immigration and Customs Enforcement

(ICE) to await an immigration hearing. Children are forced to be separated from their parents or family.

Children will be placed in the care of Refugee Resettlement (ORR) and detained until children have their

own immigration hearing.

In 2019 the Trump Administration set another new policy Migrant Protection Protocols (MPP),

or informally called “Remain in Mexico” where anyone attempting to enter the U.S. “illegally or without

proper documentation may be returned back to Mexico and wait outside the U.S. for the duration of

their immigration proceedings” (DHS, 2019). These individuals are given a notice with a date to appear

in court in front of a judge. Families and individuals are sent back to Mexico where there are thousands

of other people living in tents and rough conditions along the border. Many families are sent to a

humanitarian camp far from where they traveled to a port of entry. Many people do not make it to their

immigration hearing showing the inaccessibility to be granted permission to enter the US. Some people

may have no choice but to go back to their violent home country, some are sexually or violently abused

in the camps and have no choice but to flee. Due to how scarce conditions are along the Mexican border

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Mexico Border Health Crisis
Refugee and Immigrant Public Health
November 20, 2020

some children have no choice but to pass the border alone without their families are to be considered

entry into the U.S.

The trauma of fleeing ones country from violence, family separation, lack of basic necessities,

and an unknown future can lead to mental health issues such as anxiety, depression, and post-traumatic

stress disorder (PTSD), behavioral problems, as well as and physical health issues. Immigrants and

refugees already have been through traumatic events to make it to the Southwest border. Immigrants

are subjected to improbable conditions at the border, or in a detention facility. Immigrants are

subjected to a hot climate, no access to employment or job opportunities, limited access to medical and

mental health services, and little help from the U.S. government programs or services to help them.

Considering the large number of immigrants that are sitting at the border for a long time there is little

programs and services such as medical and mental health programs, government programs,

employment opportunities, and educational opportunities.

Most recently in October 2020 there was over 69,000 encounters at the Southwest border,

2,900 were inadmissible and 66,337 individuals were apprehended (November, 2020). Today DHS has

new measures to limit the spread of Coronavirus at the border. The CBP will not be detaining illegal

immigrants (or those without paperwork) in their holding facilities. The CBP is returning the immigrants

back to where they entered from, Mexico. If it is not possible to return someone to Mexico then they

are sent back to their country of origin (U.S. CBP, October 2020).

II Social Determinants of Health:

There are a number of social determinates of health that affect immigrants and refugees health

at the Mexican border. The first social determinate of health is environmental conditions such as

sanitation, air quality, shelter, and access to food, water, and medicine. Other environmental

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Mexico Border Health Crisis
Refugee and Immigrant Public Health
November 20, 2020

determinants include violence, crime, and abuse which can all affect an individual’s physical and mental

health. Many children may be taken away from their family which can affect children’s and parents

mental health. Some may be exposed to violence or sexual abuse while trying to make it to the border,

or while awaiting their hearing.

The next social determinate of health is limited access to medical and mental health services as

well as health promotion programs and education. While people await their hearing on the Mexican

border there is limited medical care, screenings, maternal and child health care, mental health care, and

health promotion programs. The last social determinate of health is the U.S’s immigration policies. The

new immigration policies that have been put into place have increased the traumatic events individuals

undergo. The policies make it incredibly difficult to keep families together and to easily access

immigration series.

III Current Approaches:

Healthy Border 2020: A Prevention and Health Promotion Initiative (HB) was developed to

improve the health of people at the U.S - Mexico border (Healthy Border, 2020). HB 2020 reviews

evidence based objectives, policy changes and interventions binational (U.S and Mexico). There are a

few priorities, objectives and strategies HB 2020 focuses on to increase the health of border residents.

Priorities include chronic and degenerative diseases, infectious diseases, maternal and child health,

addiction, mental health, and injury prevention.

The first priority is reducing chronic and degenerative diseases including obesity, diabetes,

heart disease, asthma and cancer (Healthy Border, 2020). Strategies include health promotion and

disease prevention activities, increase health screenings for diseases and cancer. The next priority from

HB 2020 is to reduce the number of infectious diseases including tuberculosis (TB), sexually transmitted

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Mexico Border Health Crisis
Refugee and Immigrant Public Health
November 20, 2020

diseases (STI’s) and HIV/AIDS, acute respiratory diseases, acute diarrheal disease, and diseases that are

preventable with vaccines. Strategies include creating a program with education and access to vaccines,

and advocates safe sex practices and the prevention of HIV/AIDS and STI’s.

The third priority of the HB 2020 is maternal and child health including teen pregnancy, neural

tube defects and maternal mortality. Strategies include using best evidence based practices to

encourage health promotion and to ensure access to essential resources and services. The last priority

from HB 2020 is mental health including addiction, depression, nd violence. Strategies include education

about drug use, training providers and increasing access to services.

IV: Health Promotion Program Recommendation to improve mental health of U.S- Mexico border

residents

a) Program goal: To improve the mental health of U.S – Mexico border residents for their duration

of stay by providing health promotion program interventions

b) Target Audience: All U.S – Mexico border residents seeking to claim asylum, refuge or to

immigrate in the U.S.

c) A measure to evaluate program effectiveness are surveys that evaluate social determinants of

health. Surveys can also help determine the status of someone’s mental health. Surveys can be

tailored by language to ensure it is culturally appropriate for all. Community challenges, needs

and resources available need to be assessed.

Community Needs Assessment:

1. Scope of the problem: Majority of residents have suffered physical and mental violence and

have no means of rehabilitation and support. All female domestic violence victims are

offered free mental health counseling in Mexico but this service is unknown and unused.

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Mexico Border Health Crisis
Refugee and Immigrant Public Health
November 20, 2020

2. Gather data: Rescue.org created an Emergency Assessment Report that indicates

psychological services are the hardest to access at the border.

3. Analyze the data: This assessment concluded that there were psychologists available for

individual counseling but there is a need for support groups and focus group activities.

4. Report and share findings: There is a lack and a need for facilitated support groups for

women, children and men. Children show the most need with 36 % of children being

exposed to gang violence and 28% exposed to sexual abuse (IRC, 2019). Support groups

should be in the same primary language for all participants.

V. Conclusion:

In order for the health and well-being for immigrants to change there needs to be major policy

changes. Until then humanitarian efforts, volunteers, and CBP are assisting. There are social

determinants of health that affect the health of border residents such as the environment, limited

medical and mental health services, and the U.S governments new immigration policies. These

individuals and families face many obstacles that affect their health. They endure traumatic events

including violence like gun shots or stabbing wounds, they have had family killed and they left

everything they knew behind to flee for safety. The toll all of the trauma can burden ones mental health

greatly.

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Margaret Cruz
Mexico Border Health Crisis
Refugee and Immigrant Public Health
November 20, 2020

Resources:

American Immigration Council. (2020). Policies Affecting Asylum Seekers at the Border: The
Migrant Protection Protocols, Prompt Asylum Claim Review, Humanitarian Asylum Review Process,
Metering, Asylum Transit Ban, and How They Interact. Retrieved online from
https://www.americanimmigrationcouncil.org/sites/default/files/research/policies_affecting_asylum_se
ekers_at_the_border.pdf

Department of Homeland Security (DHS). (October, 2020). Fact Sheet: DHS Measures on the
Border to Limit the Further Spread of Coronavirus. Retrieved online from
https://www.dhs.gov/news/2020/10/19/fact-sheet-dhs-measures-border-limit-further-spread-
coronavirus
Department of Homeland Security (DHS). (January 24, 2019). Migrant Protection Protocols.
Retrieved online from https://www.dhs.gov/news/2019/01/24/migrant-protection-protocols
Department of Homeland Security (DHS). (November, 2020). Southwest Border Migration FY
2021. U.S. Customs and Border Protection (CBP). Retrieved online from
https://www.cbp.gov/newsroom/stats/custody-and-transfer-statistics
Freedom for Immigrants. (2020). Detention by the numbers. Retrieved from
https://www.freedomforimmigrants.org/detention-statistics
Hollmann, B. (2020). The Lost Immigrant Children of the U.S. Department of Health and Human
Services: A Broken Program and a Path Forward. Retrieved from issue 1- Spring 2020. Found at
https://heinonline.org/HOL/Page?handle=hein.journals/thlp26&id=99&collection=journals&ind
ex=
International Rescue Committee (IRC). (May, 2019). Needs Assessment Report Mexico:
Northern Border. Retrieved online from
https://www.rescue.org/sites/default/files/document/3733/ircmexicoassessmentreport.pdf