Since 2014, Mexico has provided undocumented Central American migrants with free basic healthcare in its public hospitals. However, a 2015 study conducted by the Mexican research institution CIESAS showed that less than 2% of migrants that needed healthcare services were using them. Why? And how do Central American migrants—especially those making long, unguided trips across the country—manage their health while moving through Mexico?
Juan Carlos is a 46-year-old from El Salvador. When I first met him in a city just a few hours south of the Texas-Tamaulipas border, he seemed to be just like any other middle-aged migrant headed North. But, he was carrying a small red thermos with him all the time. When I asked him about the thermos, he answered, “My life goes in that thermos.” Juan Carlos opened the thermos and showed me two small plastic bags inside, one containing a single needle, and the other containing a glass bottle of insulin.
Juan Carlos is diabetic and needs specific doses of insulin to regulate his blood sugar. His small bottle was almost empty, however, and he had just one dose left. When we met, he had been traveling for a week without an insulin injection, saving his last dose for an emergency.
He had been to a hospital in Mexico once before. He explained that he had been told many times since entering Mexico that he would have access to healthcare, but he was hesitant to go to the hospital because he was afraid of being detained and deported. Still, as his insulin supply waned earlier in his journey, he had gone to a public hospital to ask for help. There, Juan Carlos was told that he would only be provided with insulin if it was an emergency; he would have to officially register and check-in at the hospital to receive any further care. “But,” he explained, “I had been assaulted a few days before and I had no documents to present to be able to register.” He also reiterated his fear of deportation: “I can’t stay for too long in one place, I have no place to stay, and I am afraid I will be detained and deported if I stay near the hospital while waiting to be approved for medication.”
Thus, instead of relying on the public hospital system, Juan Carlos had spent the past several weeks before we met traveling from NGO migrant shelter to migrant shelter, employing the minimal health services that some shelters offer. “Without these shelters, I would be probably dead,” he says.
During my field work, I have found this to be typical—migrants seem to avoid using the healthcare system in Mexico, despite knowing that it is free. They are often afraid that instead of being aided, they will be deported. They also report suffering constant discrimination in the healthcare system and finding the system unnavigable (such as being asked for extensive documents, being directed from one location to another, etc.). Instead, migrants typically rely on self-medication for illness and wounds. This allows them to keep progressing northward and avoiding additional deportation risk.
Not until they are on the brink of grave illness, infection, or insuperable pain do they tend to reach out to migrant shelters in search of help, saving any recourse for the formal healthcare system as a truly last resort. As a result, migrant shelters often end up receiving and serving many migrants with serious medical conditions, open wounds, and severe skin problems. They are also faced with migrants, like Juan Carlos, who have dangerously run out of medication. Many shelters offer basic health care services, like stocking basic medicine, and a few have volunteer doctors or nurses for a few hours a week. Still, they cannot provide services that would equate to those of a medical clinic or a hospital, and they have to prioritize their already-scarce resources, saving them for the worst of cases. In response, shelters have also attempted to fight for and defend migrants’ rights in the formal healthcare system. For many migrants, shelters can thus become shields against persecution.
Juan Carlos was only at the shelter where we met for a couple of days. When he realized they had no insulin, he left early the next morning to continue heading North. Rather than waiting an uncertain amount of time for medical attention and risking deportation so close to the border, he decided to keep moving.
While Mexico’s formal provision of healthcare for Central American migrants is praiseworthy, the country’s criminalization and persecution of migrants makes the healthcare system, in practice, nearly impossible to access. This provokes a situation in which migrants dangerously postpone addressing health issues, and it pushes the burden of their healthcare to less-equipped and under-resourced civil and religious organizations. And for what purpose? Why force migrants to choose between potential deportation or blindness, amputation, or death? NGOs, civil, and religious groups in Mexico use their limited resources to fight for healthcare access in Mexico, but much remains to be done.