Table 3.
Policies Implemented to Address COVID-19 Disease Reduction and Risk Mitigation and Response from Asylum Seekers in Matamoros, Mexico
| Policy | Goal | Asylum seeker sentiment | Example quote or explanation |
|---|---|---|---|
| Information campaigns | Educate asylum seekers on the signs, symptoms, and disease reduction strategies of COVID-19 and other preventive measures. | Positive | HP08: “We always meet with the leaders and explain in detail all that we could do to avoid a pandemic in the camp: hand washing, using hand sanitizer, obligatory mask wearing, restricted entries. Thanks to these information sessions, we haven't had any problem with COVID.” -Physician and asylum seeker, Cuba |
| Increased hand hygiene stations | Installation of water tubs with soap at various camp locations to facilitate hand washing and improve hand hygiene access | Positive | HP02: “Our WASH team has done an amazing job putting handwashing stations and making sure everyone knows they are safe to access. The washer structure here is impressive.” -Emergency services project manager, the United States |
| Increased wash stations | Increased clean water washing stations for clothes and dishes | Positive | |
| Increased bathroom number | Increased number of porta-potties for camp residents, to comply with international WASH guidelines | Positive | HP06: “Sanitation is a big public health issue. It's been great to see hand washing stations, showers, porta-potties, clothes and laundry washing stations.” -Physician, the United States |
| Sanitation crews | Contracted crews of asylum seeker employees to conduct twice daily sanitations of portable toilets and communal sanitation areas to reduce disease transmission | Positive | This policy was appreciated by asylum seekers, as it increased sanitation measures and provided a stable income for a group of camp resident asylum seekers. |
| Access to soap and other disinfectants | Provided supplies of soap, hand sanitizer, bleach and other hygiene and cleaning supplies. | Positive | AS03: “There's always soap to wash hands and masks and hand sanitizer. You go to the bathroom and there's a huge bottle of sanitizer or soap that you can use.” -Asylum seeker, El Salvador |
| Mask distribution and sewing | Distributed masks to asylum seekers to reduce COVID-19 infection, and have established a cooperative where asylum seekers can make and sell masks | Positive | AS01: “At first they gave us a cleaning kit with little hand sanitizers and other supplies. There are a ton of masks. I even have a collection of different designs; it's basically an accessory now.” -Asylum seeker, El Salvador |
| Positioning medical personnel outside camp | With reduced entry restrictions for the camp due to COVID-19, non-residents could no longer access NGO health care services. To care for asylum seekers living outside of the camp, organizations established a satellite tent clinic to overcome this restricted access. | Positive | HP05: “Since camp visits are restricted from COVID, all the asylum seekers living outside the camp cannot access the medical team in the camp. That's a huge barrier for many migratory asylum seekers. So we took an alternative approach to set up a medical post outside the camp to take care of everyone. We've looked for solutions to overcome these barriers and had great results while caring for everyone.” -Nurse and asylum seeker, Cuba |
| Suspended community health activities | Suspended community health workshops and other large community gatherings to reduce transmission risk. Although this was disappointing, residents understood the need for this policy. | Indifferent | HP06: “If we want to do dental health or preventive health education, we can't do it in large groups. We have to do it tent to tent or in small groups with little kids. In terms of daily rounds, I still see the families in their tents whenever.” -Physician, the United States |
| Masking when in the food reception line | Asylum seekers were required to wear masks and practice social distancing to reduce disease transmission when forming lines to collect food and other supplies. | Indifferent | Asylum seekers understood the importance of this policy and were generally willing to comply with mask wearing when they gathered to receive food and other supplies. However, many reported that social distancing in these settings was infeasible. |
| Fence construction and restriction of camp entry | The INM constructed a fence around the camp perimeter to control camp migration to reduce disease spread from unknown people. | Negative | Asylum seekers perceived the construction of a fence around the camp perimeter as a threat to personal safety, as they lacked escape options in emergency situations. Many preferred increased restrictions on camp entry to constructing a permanent barrier. |
| Temperature checks | Temperature checks with infrared guns were performed when entering or exiting the camp, before a medical consultation, or randomly during tent wellness check-ups, to identify residents with fever and potential COVID-19 cases. | Negative | AS07: “When you leave, they take your temperature and that's why we don't leave anymore. Every time they took my temperature, I had a really bad headache. Doing it always hurts me and we heard it can ruin your brain. So I don't leave the camp anymore because I don't want them checking my temperature.” -Asylum seeker, Mexico |
| Required COVID-19 antibody testing | Patients presenting to clinic and those with symptoms were tested to identify COVID-19 antibody cases. Health care professionals were unsure why they had COVID-19 antibody tests, but no viral PCR testing capabilities. | Indifferent | HP02: “It did create confusion when we were testing people. At one point we were testing everyone to get the data set, but a lot of people didn't want to come back after that. So we stopped obligatory testing. But if people want the test, we will offer it to them.” -Emergency services project manager, the United States |
| Field hospital construction | Constructed a 12-bed, secure health care facility to isolate and care for COVID-19 patients, provide quality care in a controlled setting and reduce disease transmission to uninfected residents. | Negative | AS08: “We understand that the organizations get a lot of money from us. They made a hospital and said that COVID is worse than it was so they could put people with any symptoms into isolation. We heard rumors that they were getting money to take care of the sick when in reality no one was infected.” -Asylum seeker, Mexico |
| Compulsory quarantine | Isolated patients who tested positively for COVID-19 antibodies, independent of symptoms, to reduce potential disease transmission to uninfected community members. | Negative | AS09: “The doctors only think about COVID. That's why they believe anyone with a cough has COVID, and they sent everyone to be isolated for prevention. They quarantined one guy away from his kids, and just left them alone for days. I said there's no way I'm going to the clinic, because they can't separate me from my little girls because they are my life.” -Asylum seeker, Honduras |
| Outsource food procurement | Organizations providing food shifted services from daily delivery by U.S. volunteers to procurement at local Matamoros restaurants, to reduce border travel and potential transmission by volunteer groups. | Negative | AS10: “The food is terrible, and I try not to give it to my daughters. It makes us sick. Before, the Americans would bring us food, which was clean and homemade, but now they cannot because of COVID. It is made in local restaurants, but we are seeing videos of unsanitary conditions. It was common to find a cockroach or fly in your food.” -Asylum seeker, Mexico |
| Suspension, reduction of activities by non-health care organization activities | Non-medical organizations shifted their service delivery model to work remotely, or suspended activities to lessen frequency of border crossings to reduce transmission. | Negative | AS16: “Since COVID we have felt a little forgotten because less volunteers are visiting. It's different from before when they would come, share and interact with us. So suddenly we feel a bit abandoned, but we know this is due to the pandemic and that spiritually they are with us.” -Asylum seeker, Honduras |
This table describes the policies implemented to prepare for and in response to the COVID-19 pandemic in the Matamoros, Mexico asylum seeker camp, as well as asylum seekers participants' sentiments toward these policies. Quotes and explanations from health care professionals and asylum seeker participants are included in the rightmost column to demonstrate qualitative perceptions and explain nuances toward these policies.
INM, Instituto Nacional de Migración; NGO, nongovernmental organization; WASH, water, sanitation and hygiene.