Challenges and Effects of the COVID-19 Pandemic on Asylum Seeker Health at the U.S.-Mexico Border

Abstract

The coronavirus disease 2019 (COVID-19) pandemic presents health care challenges to asylum seekers living in congregate encampments, including those along the U.S.-Mexico border. It is necessary to understand the impact of the pandemic among this population to address health care needs, reduce transmission, and diminish COVID-19-related morbidity. Methods: Thirty interviews were conducted with asylum seekers and health care professionals in a temporary camp in Matamoros, Mexico to determine challenges, perceptions, and effects of the COVID-19 pandemic. Interviews were coded in NVivo12 by using a team-based approach. Results: The pandemic caused significant mental health burdens but no perceived adverse physical effects, with the U.S. border closure and health care access barriers as more pressing concerns. Participants reported access to information about COVID-19 but had varied levels of knowledge and adherence to disease reduction strategies due to camp conditions. Most participants believed that they had special protection from COVID-19, including strong immune systems or from God. The nongovernmental organizations providing health care and sanitation faced multiple challenges to implement new policies to manage COVID-19. The institution of required temperature checks and quarantine of COVID-19 positive patients led to distrust, decreased seeking of health care services among asylum seekers, and possible underreporting of COVID-19 cases. Conclusion: Our findings among asylum seekers in a Matamoros camp highlight the challenges to implementing disease reduction policies in low-resource congregate camps. Policies to address disease outbreaks focusing on the social determinants of health, health care access barriers, and community engagement may be more acceptable to asylum seekers, suggesting the need for effective strategies to provide prevention information that complements such measures.

“Lived the Pandemic Twice”: A Scoping Review of the Unequal Impact of the COVID-19 Pandemic on Asylum Seekers and Undocumented Migrants

“…Several studies documented low levels of knowledge about transmission and symptoms of COVID-19 [ 37 , 39 , 54 ] and poor understanding of infection control measures [ 49 ] compared to the host population. Several factors contributed to differential effectiveness of information and communication interventions.…”

“…Lastly and crucially, lack of trust in government and authorities is a pervasive problem that impacts the effectiveness of control measures [ 55 ]. Asylum seekers and undocumented people’s experience of this distrust is unique given they are at the coalface of states’ securitised border control, and past or current institutional violence [ 24 , 34 , 49 ]. As such, most participants in a U.K. study expressed suspicion towards the government’s COVID-19 response measures: “I don’t know to what extent it is true.…”

“…A similar phenomenon was observed among undocumented migrants in Saudi Arabia [ 24 ] where most undocumented people did not trust nor intend to make use of the government’s amnesty granting them access to medical services. Asylum seekers at the U.S.–Mexico border also showed distrust for official institutions and non-governmental organizations (NGOs) and therefore did not come forward for healthcare or testing during the pandemic [ 49 ].…”

“…A study six weeks into the Swiss lockdown showed that anxiety and depression were more prevalent among undocumented people compared to recently regularised people (71.4% vs. 66.7%) [ 7 ]. The deterioration in mental health associated with pandemic control measures was also worse for asylum seekers and undocumented migrants in Jordan ( p < 0.05) [ 23 ], Mexico [ 49 ], and Lebanon [ 38 ] compared to other groups. Qualitative evidence paints an equally dire picture of complex mental health issues in very varied settings, with some COVID-specific fears among undocumented migrants in precarious jobs and housing [ 47 ].…”

“…Qualitative evidence paints an equally dire picture of complex mental health issues in very varied settings, with some COVID-specific fears among undocumented migrants in precarious jobs and housing [ 47 ]. However, there was also widespread tension, anxiety, and uncertainty brought on by the pandemic and restrictions for asylum seekers and undocumented migrants [ 29 , 33 , 40 , 44 , 47 , 49 , 50 ] on top of existing instability: “We are heading towards an unknown path, we cannot turn back and we will die in both cases either from the virus or from hunger, if the lockdown continues” [ 29 ]. There are also some studies that showed the direct impact of lockdown on rising depression and anxiety by comparing before and after lockdown rates.…”