Migration and health in Latin America during the COVID-19 pandemic and beyond

COVID-19 has created a syndemic scenario that is deepening pre-existing structural inequalities for migrants in Latin American countries (LACs).1, 2 LACs have been severely affected by COVID-19, and migrants are among the populations most impacted by the heightened humanitarian crisis across the region. Socioeconomic inequalities between migrants and local people have widened, and there are fears that progress towards the Sustainable Development Goals (SDGs) will be reversed.

During the COVID-19 pandemic, food insecurity, unemployment, and reduced socioeconomic agency have led to considerable insecurity and anxiety for migrants living in LACs.3, 4 The region faces one of the largest mass migrations worldwide; more than 5·5 million refugees and migrants have left Venezuela, 4·6 million of whom now live in the Latin American region.5, 6 In central America, a combination of criminal and political violence, poverty, and the increasing impact of droughts on farmers forced thousands to move northwards, where many people have become trapped due to restrictive migration policies.⁷ For decades, migration fuelled the economic and cultural development in the region. Today, migration has increasingly become an issue of risk and precarity.

Together with the social and structural disparities that make Latin America a region with one of the highest levels of inequalities in the world,8, 9 the worsening environment for migrants during the pandemic means their basic needs are unmet¹⁰ and their social, economic, and cultural capabilities are not realised. In LACs, migrants face barriers in accessing regular health services due to inadequate information, the absence of culturally appropriate care, or insufficient legal provisions. Additionally, there have been challenges in the prevention of COVID-19 among migrant populations as a result of poor public health communication, reduced access to public health prevention measures, and living or working in conditions where it is difficult to isolate.¹¹ The deteriorating determinants of migrants' health and wellbeing, revealed and increased by COVID-19, strain health systems in LACs, and governmental, regional, and international organisations' efforts to advance inclusive health policies.¹²

COVID-19 has reduced human mobility within and across borders. Border closures and changes to migration policy across Latin America interrupted migrants' movement, leaving thousands stranded across the region. Others were forced to return to the same danger, social exclusion, inadequate health care, and poverty they had fled. Migrants who were trapped in transit, or who were living with undocumented or irregular status, became even more vulnerable to family separation, trafficking, or exploitation.¹³ In the pandemic migrants have had reduced access to asylum processes and resettlement schemes have been suspended,¹⁴ with many asylum seekers and refugees subsequently facing a protection crisis.

This diverse region has proven its capacity to cooperate and exchange knowledge and practice in public health,15, 16 and has a strong tradition of social medicine and community health, which is evident in the multiple community-based initiatives that have emerged to combat COVID-19.17, 18 However, the detrimental impacts of COVID-19 on migrants and failure of inclusive health policies and systems have revealed the vulnerability of migrants to the consequences of politics designed without considering migration and human mobility in government agendas. These failures underline the importance of compliance with international standards, such as the Global Compact for Safe, Orderly and Regular Migration¹⁹ and the WHO global action plan to promote the health of refugees and migrants.²⁰

Explicit commitment from governments to include migrants in all phases of the evolving public health response to COVID-19 is needed. This response must include ensuring access to vaccination and social protection programmes without discrimination and addressing the broader socioeconomic inequalities that affect migrants' health.²¹ The forthcoming Ibero-American Summit on April 21, 2021, presents an opportunity for heads of states and governments across the region to make explicit commitment to ensure all migrants, refugees, and asylum seekers, irrespective of age, gender, or migration status, have universal and equitable access to health care and pandemic prevention and response. Sustainable and inclusive approaches to migrant health should go beyond humanitarian response and meet the needs of local and mobile populations alike, in line with the SDG agenda. Yet the regions, countries, and municipalities most affected by COVID-19 also need solidarity and global support in responding to the current global public health crisis and future global health challenges.

© 2021 Mads Nissen/Politiken/Panos pictures

This online publication has been corrected. The corrected version first appeared at thelancet.com on April 15, 2021