On 20 March 2020, the Trump administration announced that it would be limiting nonessential travel across US land borders [1]. Citing the threat of covid-19, the processing of asylum seekers or those who enter the US without appropriate documentation or authorization would, without delay or legal process, be deported [2]. These policy changes, and subsequent others, have created an acute-on-chronic health crisis amongst asylum seekers and migrants on Mexico’s northern border [3]. 

Consistent with previously unsubstantiated claims that asylum seekers pose a public health threat to the US, the United States government purported that these policies were needed to safeguard Americans from covid-19 [4,5]. Yet at the time of the announcement, there were over 17,000 confirmed cases of covid-19 in the US, compared to only 164 cases in Mexico, and 37 cases reported in Guatemala, El Salvador, and Honduras combined [6,7]. 

In reality, it is the US that poses a public health threat to other countries. As cases surge nationally, scores of migrants being held in US detention centres are being deported to Mexico and elsewhere without comprehensive guidelines on testing [8]. Over 2,700 individuals in ICE detention centres have tested positive [9] and there is an ongoing investigation into claims that migrants deported by the US to Guatemala are responsible for up 20% of the country’s covid-19 cases [10,11].

Asylum seekers and migrants are now waiting indefinitely in—and being sent to—cities along the northern Mexico border that are ill equipped to meet their basic needs and protect them from covid-19. Overcrowded housing, a lack of basic sanitation, and inadequate access to healthcare are just a few markers of the dire conditions faced by migrants [12,13].

Before the pandemic, those on the border were already vulnerable to poor health outcomes. Untreated chronic health conditions are pervasive, and infectious disease outbreaks occur in shelters and tent encampments due to the unsanitary living conditions [14]. Post Traumatic Stress Disorder, depression, and other mental health problems cause tremendous suffering among asylum seekers; the trauma experienced prior to reaching the US-Mexico border is further exacerbated by exposure to violence and criminal activities once they arrive [15,16].

These conditions mean that covid-19 can spread quickly, and that those infected are more likely to have severe disease. Already, outbreaks of covid-19 have been reported in multiple communities and shelters where asylum seekers and migrants live. In the city of Juárez, one of the largest hubs for asylum seekers, over 1,900 cases and 420 deaths have been reported [17]. Given weak disease surveillance systems, this is likely just the tip of the iceberg. 

There is little that asylum seekers and migrants can do to protect themselves from covid-19. The basic tenets of infection prevention and control measures—social distancing, hand washing and self-isolation—are near impossible. Worse so, access to healthcare is severely limited. Many of the NGOs and charities who were once the backbone of healthcare provision have reallocated resources and scaled back care as they respond to the pandemic in their home communities. The limited essential services that were once granted by the Government of Mexico have also been halted [18].

The resources required to treat covid-19—hospital capacity, human resources, ventilators, and personal protective equipment for health workers—simply don’t meet the need, and there is no indication that this will change in the near term [19]. What does this mean for the thousands of people who are waiting in limbo on the border, with nowhere to go?  They are sitting ducks as the virus closes in. 

As cases surge in Mexico and in states along the US southern border [20, 21], both governments have a responsibility to act immediately to protect this vulnerable population. Policies and practices that put asylum seekers and migrants at risk of poor health outcomes need to be reversed. In the United States, sending asylum seekers to Mexico under Migrant Protection Protocols and mass deportations should immediately cease and the processes for claiming asylum should resume. Alternative approaches to deportations, such as releasing detained migrants on humanitarian grounds, should be implemented [22].

In Mexico, key steps are underway to reduce covid-19 spread in housing. Quarantine hotels are receiving newly arrived migrants, and shelters are drastically reducing capacity [23]. Yet in order to have widespread impact, efforts need to be scaled and high-risk populations prioritized. Mitigation strategies need to be proactively developed to address the repercussions of reducing housing capacity, such as exacerbating homelessness and vulnerability to crime. For those who remain in shelters, sanitation and ventilation, as well as routine screening and containment protocols, need to be improved. 

The rise in covid-19 cases highlights the urgent need for increased access to care and information sharing. Telehealth, for example, has shown enormous potential in resource constrained environments throughout the pandemic. It has the ability to circumvent common barriers to care seeking, including restricted mobility; fear of violence and insufficient health resources [24, 25]. Additionally, more locally relevant educational material is needed on how the disease spreads, and how people can protect themselves. As trusted members of the community, civil society organizations are crucial allies for identifying and implementing practical solutions. 

The health crisis at the northern border of Mexico is quickly escalating. While it is clear that the situation will not be resolved until the underlying policies that threaten asylum seekers and migrants are addressed, there are still interventions that could save lives if immediately implemented. As outbreaks hasten, the fact that many people along the border could have been protected from covid-19 through humane and proactive policies, will make the losses all the more devastating. 

Megan B. Diamond, Assistant Director, Programs & Innovation, Harvard Global Health Institute Twitter: @megan_b_diamond

Carissa Novak, Program Manager, Harvard Global Health Institute Twitter: @carissa_novak

Luke Testa, Program Assistant, Harvard Global Health Institute Twitter: @testa_luke

Alejandro Olayo-Méndez, Assistant Professor, Boston College School of Social Work

Competing interests: None declared