Call It a Crisis: Confronting Public Health Risks on the U.S.-Mexico Border – Rachel Stonecipher & Sarah Willen
Rachel Stonecipher (SMU) & Sarah S. Willen (University of Connecticut)
You wouldn’t know it from the U.S. national media, but a multi-dimensional public health crisis is unfolding on the U.S.-Mexico border that few seem ready to acknowledge.
The complexity of this crisis – about which we know little since the affected group is a moving target, and a controversial one at that – came to light during a recent study tour to Tucson, Arizona, sponsored by the Embrey Human Rights Program at Southern Methodist University (SMU) in winter 2011 in which one of us [RS, an SMU undergraduate] had the privilege of taking part. The group spent two weeks meeting with leaders and officials in local law enforcement, the U.S. Border Patrol, the Pima County Office of the Medical Examiner, and various humanitarian organizations active on the U.S. and Mexican sides of the border. These encounters revealed reports of violence and neglect throughout the migration process that signal a complex, cross-border health crisis far too vast for activists to address alone.
What health risks do migrants face, and why should Americans living near the border – or, for that matter, the rest of us – care? Below we consider health risks at three stages of migration – border-crossing, “interception,” and deportation – and identify a number of disturbing policy gaps as well as some ripe opportunities for intervention.
Without doubt, clandestine efforts to cross the desert border are perilous. Dehydration and heat-related illness claim hundreds of lives annually, and many of these deaths go unrecorded. The map included above, produced by the faith-based NGO Humane Borders, identifies 1,755 known deaths between 1999 and 2007. In 2009 alone, the U.S. Border Patrol recovered remains of 417 people, including 213 in its dry, mountainous Tucson Sector. Notably, these figures refer only to deaths recorded on the U.S. side of the border.
Some local activists have tried to minimize the gravest health risks of desert crossing by creating water stations in the desert – which activists of a different stripe see fit to destroy (see image). According to Robin Hoover, founder of Humane Borders, 80 percent of Tucson residents support the stations, but most prefer to “leave the water stations out of the [political] conversation,” while every other form of assistance is up for public debate. In fact, many have told Hoover that the stations are acceptable – just “don’t do anything else.” In other words, most Arizonans accept water stations as a charity project but are reluctant to acknowledge their importance as a public health intervention.
Through water stations, humanitarian aid camps, and desert patrols, a handful of NGOs nonetheless provide assistance to migrants in need. The Tucson Samaritans, for instance, have amassed a sizeable base of volunteers who conduct three-person daily desert patrols that administer first aid, offer food and water, and call for medical evacuations when necessary.
The fact that NGOs wield the heavy burden of providing aid and responding to rights violations is a symptom of the governmental “unruliness” that often reigns in border regions. More than 6,000 people have died along the U.S.-Mexico border since Operation Gatekeeper began in 1994, yet no uniform system exists to count or repatriate remains. The Border Patrol does not search for the dead; its agents only count the bodies they find. Also, migrant deaths are counted only in counties that touch the border, which creates a jagged, arbitrary line of accountability. And medical examiners’ offices often fail to communicate effectively, especially between states.
According to Robin Reineke, a University of Arizona graduate student who works with the Pima County Medical Examiner’s office (and an occasional AccessDenied contributor), collaboration on these issues is challenging. In Pima County, for instance, the Office of the Medical Examiner works with the organization Derechos Humanos in an effort to keep a local death count, with some success. Reineke explains that NGOs sometimes receive missing persons reports from families but fail to forward that information to the Office of the Medical Examiner. With limited information and no available DNA-matching technology, medical examiners struggle to establish links between deceased individuals and anxious families by hand-matching descriptions to remains, and some remains are still unidentified after five years or longer. We can only imagine the impact of these missed opportunities for identification on family members searching for their loved ones.
Arrest and Detention
For migrants who do reach their destination but face subsequent arrest, “interception” itself can involve serious health risks, both physical and mental. What happens to migrants after they are arrested and detained often remains shrouded from both the public eye and, to a great extent, the eyes of the human rights community. This is a particularly grave concern when arrested individuals already are sick or injured. Once local law enforcement, Border Patrol, and Immigration and Customs Enforcement take over, NGOs find themselves essentially powerless to intervene.
Detainees are also at risk of abuse – physical and mental – at the hands of police and Border Patrol officers. Despite official denials, No More Deaths, the Border Action Network, and other NGOs have collected and responded to numerous reports of abuse. In 2008, for instance, No More Deaths released a report documenting 400 instances of abuse at the hands of Border Patrol officials within a two-year period. Although federal law and agency memos set standards for humane treatment of apprehended individuals, Danielle Alvarado of No More Deaths reports that oversight mechanisms are “woefully inadequate.”
Many current problems with enforcement and oversight stem from the Border Patrol’s “expedited removal” procedures. Officially, Border Patrol holding centers are termed “processing centers” rather than detention facilities, which clouds the agency’s responsibilities toward those in custody. The Border Patrol assures the public that detainees generally are held in such centers for six to twelve hours—and at maximum, 72 hours. This variable period of incarceration, when combined with agent shift changes, leaves no shift accountable for providing food, medical care, or access to an attorney in the first crucial hours after migrants are found in the desert. Additionally, no formal reporting mechanism exists whereby migrants who have faced physical or mental harm during arrest, detention, hospitalization, or deportation might file a report with Customs and Border Protection.
According to Jaime Farrant, formerly of the Border Action Network, NGO efforts in this area are crucial, in part because the testimonies they collect belie public denials by police and Border Patrol that any such abuse takes place. Efforts to gather evidence, however, are thwarted when abused detainees are deported. Across the border in Mexico, a few humanitarian organizations (including No More Deaths) hold “abuse clinics” in which deportees can learn about their rights and report past rights violations, but without any formal reporting mechanism, individuals who have suffered abuse have little recourse.
Deportation itself can have negative health consequences as well. Although largely invisible on the U.S. side of the border, these consequences are evident to Mexican and cross-border organizations like the Kino Border Initiative. One especially serious concern involves the deportation of injured individuals who have not yet been medically stabilized. According to Juan Francisco Loureiro, who operates the Casa de San Juan Bosco Shelter on the Mexican side of the border in Nogales, Sonora, deportation before stabilization is actually a common phenomenon. Since care on the Mexican side of the border is limited and deportees – especially those from southern Mexico and Central America – are far from home, the deportation of sick or injured individuals can involve serious risk to life and limb. At present, we are not aware of any group that keeps formal, public records on such incidents.
* * *
Although NGOs can minimize some health risks for some migrants by establishing water stations and conducting medical patrols, grassroots activists clearly cannot provide either a complete portrait of or comprehensive response to the myriad, complex public health challenges of transnational migration along the U.S.-Mexico border. Both human rights principles and contemporary realities demand that we hold countries with porous borders – including but not only the U.S. – accountable. Not only must such countries recognize migration as an enduring global phenomenon with complex causes and share accountability for both lives and deaths, but they must also engage in transnational public health efforts to develop the kind of multi-layered interventions needed to protect human life in border regions.
Humanitarian groups have valuable insights to offer government agencies – in this case, to U.S. Homeland Security personnel – and neither professional nor political commitments can legitimately stand as obstacles to such conversations. To leverage their power most effectively, humanitarian groups will need to consolidate their efforts and insights and speak as a coordinated force. The Southern Border Communities Coalition on the U.S.-Mexico border, which was just established in March 2011, offers one such model.
Population mobility may be a permanent feature of globalization, but the health risks of migration are neither inherent nor inevitable. Like the humanitarian organizations that work along the border, we all must insist on an expansive understanding of “public health” that recognizes people in transit as members of a common moral community: as people who are connected to us, and whose lives matter. Whether or not we understand or agree with the choice to migrate, activists along the U.S.-Mexico border remind us that border crossers are human beings who – like all other members of our moral community – are deserving of health-related attention, investment, and care.
Rachel Stonecipher is a third-year honors student at Southern Methodist University, where she is also a member of the Hyer Society. A double-major in anthropology and cinema-television, she spent the summer of 2011 conducting ethnographic research on the social structure of im/migrant rights activism in Tucson, Arizona, with support from a Richter Fellowship.
Sarah S. Willen, PhD, MPH is Assistant Professor of Anthropology at the University of Connecticut and a founding member of the AccessDenied blog team.
Stonecipher, Rachel and Sarah S. Willen. 2011. “Call It a Crisis: Confronting Public Health Risks on the U.S.-Mexico Border.” AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed [date] at http://accessdeniedblog.wordpress.com/2011/08/26/call-it-a-crisis-confronting-public-health-risks-on-the-u-s-mexico-border-%E2%80%93-rachel-stonecipher-sarah-willen/.
 A new policy forum on Migration and Health in the open-access journal PLoS Medicine divides the transnational migration process into five stages: “pre-departure, travel, destination, interception, and return.” We concur with the editors of the PLoS forum, who contend that research and public health work must consider two key factors: first, the cumulative nature of risk, and second, the fact that opportunities for intervention exist across these stages. See Zimmerman C., L. Kiss, and M. Hossain. 2011. “Migration and Health: A Framework for 21st Century Policy-Making.” PLoS Medicine 8(5): e1001034.
 For the first time in nine years, the Tucson Samaritans were inactive for an entire week this past July, suggesting their volunteer base may be shrinking. The group was unable to find enough volunteers to fill any daily patrols.
 Willen, S. 2010. “Darfur through a Shoah Lens: Sudanese Asylum Seekers, Unruly Biopolitical Dramas, and the Politics of Humanitarian Compassion in Israel.” In A Reader in Medical Anthropology: Theoretical Trajectories, Emergent Realities. B. Good, M. Fischer, S. Willen, M. DelVecchio Good, eds. Malden, MA: Wiley-Blackwell.
 No More Deaths is slated to release a second report on border abuse this fall.
 See Fassin, D. (2009) “Illegal Immigrants as the Last Frontier of Welfare.” AccessDenied: A Conversation on Un/authorized Im/migration and Health; Willen, S., J. Mulligan, and H. Castaneda. (2011). “Take A Stand Commentary: How Can Medical Anthropologists Contribute to Contemporary Conversations on ‘Illegal’ Im/migration and Health?” Medical Anthropology Quarterly 45(3): 331–356; and Willen, S. (in press). “How is Health-Related ‘Deservingness’ Reckoned? Perspectives from Unauthorized Im/migrants in Tel Aviv.” Social Science & Medicine.
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