Latest Public Health Threats to Migrants at the US Southern Border

There are two crises at the US southern border. The first arises from the sudden need of hundreds of thousands to seek safety outside their country; the second arises from a series of policies the US government has implemented to deter them by any means necessary. The latter is a clearly stated preference: in a leaked July 26, 2019, e-mail to Customs and Border Protection (CBP) officers regarding reducing successful asylum applications at ports of entry, a National Security Council official wrote, “My mantra has persistently been presenting aliens with multiple unsolvable dilemmas to impact their calculus for choosing to make the arduous journey to begin with.”¹

This description is apt, given the newest policies targeting asylum seekers, particularly “metering” and the migrant protection protocols (MPP), which together have created a refugee crisis in Northern Mexico. Beyond focusing on detention and removals for asylum seekers, metering and MPP attempt to prevent asylum seekers from entering US territory altogether. The Trump administration claims it does so without violating nonrefoulement, a principle enshrined in international law that prohibits returning asylum seekers to a country where they would likely face persecution. However, these policies have instead threatened public health, abandoning asylum seekers to live in unsanitary, underresourced conditions across Northern Mexico, where they are exposed to violence reminiscent of the threats they are fleeing.

METERING AND MPP

Metering was introduced in 2016 at select US–Mexico ports of entry and scaled systematically since April 2018. Per US law, anyone who crosses US borders (even without authorization) can apply for asylum, and previous policy allowed asylum seekers to await claims adjudication while residing in the United States. To slow down the number of claims, CBP officers at the US–Mexico boundary line now require all asylum seekers to place their name on a list. Asylum seekers are then required to wait in Mexico until their name is called. The number of people called each day varies significantly, ranging from zero to 40 a day per port of entry—despite the 21 000 individuals on the metering list as of November 2019.² The expected wait in Mexico is up to six months before asylum seekers can officially file an initial claim.²

Once allowed into the United States to file for asylum, many asylum seekers are immediately returned to Mexico under MPP, otherwise titled “Remain in Mexico.” MPP, phased in over 2019, requires non–Mexican-origin immigrants from Spanish-speaking countries and Brazil (excluding unaccompanied minors) to remain on the Mexican side of the border pending their court hearing. Although Mexican asylum seekers are exempt from this policy, the CBP has still reportedly sent some Mexicans back into Mexico to await court dates. Even after their initial claim, asylum seekers often wait another six to nine months before their hearings.³ Beyond those on the metering list, an additional 57 000 to 62 000 individuals have been returned to Mexico under MPP, including at least 16 000 children, 3400 of whom were younger than five years and 481 younger than one year.³ Even after this process, asylum seekers’ chances of success might be curtailed by a new “asylum ban” and “safe third country agreements” (explained further in the box on p. 799).²

BOX 1— Emerging Policies for Asylum Seekers at the US Southern Border.

Metering	Asylum seekers must wait on Mexican side of border before submitting claims with the US government.
MPP	Individuals who submit asylum applications are returned to Northern Mexico to await case processing by the US government.
Asylum ban	US asylum is prohibited for individuals who have not been previously rejected for asylum by countries they had transited before arriving at the US southern border. This is limited to those who arrived at the border after July 16, 2019 (date of ban announcement) by a subsequent court decision.2
Asylum cooperative agreements (“safe third country agreements”)	Asylum seekers from Guatemala, Honduras, or El Salvador can be physically relocated from a US port of entry to any of those three countries to apply for asylum provided by those nations. Asylum seekers cannot be sent to countries of origin. As of February 19, 2020, 634 Salvadoran and Honduran asylum seekers have been sent to Guatemala, with only 14 ultimately requesting asylum.
Prompt asylum claim review/humanitarian asylum review process	MPP-exempt asylum seekers are put in expedited review cases while in CBP custody, sometimes having as little as 30–60 min to seek legal counsel before initial asylum interviews.

Note. CBP = Customs and Border Protection; MPP = migrant protection protocols.

THREATS TO PUBLIC HEALTH

Asylum seekers’ primary health risks arise directly from their physical, financial, and social vulnerability across Northern Mexico, which has a concentrated and destabilizing drug cartel presence. As of January 2020, according to Human Rights First, there were 816 recorded reports of rape, extortion, kidnapping, torture, and other violent attacks against asylum seekers, including 136 attempts to kidnap children.³ A survey of immigrants in Mexican shelters found that one in four immigrants had been threatened with violence.⁴ These reports are likely an underestimate, given limited monitoring. Furthermore, local Mexican law enforcement officials have been implicated in extortion attempts, and there is significant distrust of officers.

The sense of endangerment is so pervasive that those in MPP have petitioned immigration officials to remain in the United States while awaiting hearings, citing a fear of returning to Mexico as well as their country of origin.^3,4 Even those who report having been assaulted in Mexico are denied protective entrance into the United States, ironically at times because they had not filed incidents with the police.⁴ Some asylum seekers who fail to appear in court because they were kidnapped have lost their cases in absentia.³ Others attempt to cross outside official ports of entry; in September 2019, a Honduran mother and daughter returned under MPP drowned trying to swim the Rio Grande river.³

The second risk to health arises in the informal refugee camps arising at ports of entry. There are internationally funded, Mexican-run shelters operating several miles from the border, where food and medical care may be provided. However, these shelters lack the capacity for the number of migrants that need them. Moreover, many migrants are too fearful to venture far beyond ports of entry, because they might be targeted by violence or they might miss being called off a metering list. These conditions have led to large tent encampments at ports of entry, numbering as large as 2000 individuals, as in the case of Matamoros.³ Unlike formal refugee settlements following international security and sanitation guidelines, migrants at ports of entry are in continued danger, and reports indicate difficulty accessing clean running water and limited toilet availability in camps, with asylum seekers washing clothes and bathing in the Rio Grande.^3,5

The Department of Homeland Security policy exempts “vulnerable populations” and those with “known physical/mental health issues” from MPP. However, the CBP has sent clearly vulnerable individuals back into Mexico. In one case, a woman who was 8.5 months pregnant began experiencing contractions on the US side of the border. She reported that CBP officers took her to a US hospital, where her labor was medically terminated, and then returned her to Mexico.³ Furthermore, CBP has reportedly medically screened individuals on the day of their court appearances, returning them to Mexico with postponed court dates if they determine them to be symptomatic of minor illnesses such as lice or rhinorrhea.⁵ Others have also been returned after expressing fear of being attacked in Mexico because of their sexual orientation, gender identity, or gender expression.³

Many asylum seekers at the US southern border come from Central America, often fleeing threats of violence, and a number already suffer from symptoms of depression and posttraumatic stress disorder.⁶ Recurrent vulnerability to violence risks exposing asylum seekers to further trauma, which could have long-term consequences, particularly for children. This is above and beyond the risk of epidemic disease spread, particularly during the current COVID-19 outbreak.

On February 28, 2020, a federal appeals court issued an injunction barring the US Department of Homeland Security from continuing MPP, only to change course hours later, allowing the program to remain at the request of the federal government while it made an emergency appeal to the Supreme Court.⁷ The Supreme Court upheld the program on March 11, 2020, pending a full appeal at a future undetermined date. Meanwhile, the US government continues to enforce an unethical policy that forces families to choose between decrepit and dangerous conditions in Northern Mexico and the perilous conditions in the countries they fled, in essence still violating the principle of nonrefoulement US authorities have claimed to uphold. The most effective way for the United States to address this public health crisis is to honor its commitment to international norms and reinstate orderly, safe mechanisms of processing asylum claims at its southern border.