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Health at the Edge: Central American Migrants’ Healthcare While Moving Through Mexico

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?

A poster hanging in a government building serving migrants in southern Mexico in 2014. It reads: “I have the right: to be cared for when I feel bad or sick (the right to health); to be able to eat when I’m hungry (the right to to have food); to learn new things (the right to education).”

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.

A mural in a migrant shelter in northern Mexico in 2019.

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.

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“El Mara”: The Stereotyping of Central Americans in Mexico and the United States

In the Summer of 2015, I headed to Tijuana to do some field work for my dissertation. I took a taxi from the hotel where I was staying to the first migrant shelter I would be visiting there.  That shelter served all types of migrants who were arriving in Tijuana. Chatting with the taxi driver on the way, I told the taxi driver about my research on Central American migrants. His response: “Esos no tienen solución.” (“Those [Central Americans] can’t be fixed.”) He then set into a discourse about Central Americans’ irresolvable (and, as he saw them) natural tendencies toward crime. 

I have found this discourse about the violence of Central Americans more or less intact wherever I go in Mexico. From grocery store clerks, to business owners, to restaurant workers, I have heard Mexicans from many different backgrounds voice their concerns that Central American migrants are violent and bad for their communities. When I ask these people how they know that Central Americans are violent, they tell me second-hand stories about Central Americans murdering people or robbing houses. Some liken all Central Americans to the “Maras,” the extremely violent Central American gang. Others describe Central Americans as poor people with different accents who are often begging at traffic lights and seeing what they can get from you (“a ver que te pueden sacar”). While many Mexicans are aware of the struggle that Central Americans face while crossing Mexico, and various individuals and organizations proffer them aid, I have found the amount of negative sentiment aimed at Central Americans in Mexico to be astonishing.

So, how do those sentiments affect the day-to-day lives of Central American migrants?  My research suggests that they certainly feel the prejudice. Many migrants tell stories of discrimination. They describe knocking on doors along their journeys and asking for water, only to be denied water once a would-be benefactor discovers they are Central American.  Others describe being treated as dangerous or threatening.   

One adult migrant from Honduras, “Josue,” recalls working construction in central Mexico. He was trying to make enough money to live while he and his son waited for their Mexican asylum applications to be processed.  His co-workers called him “El Mara,” even though Josue left Honduras fleeing the Maras.

“Desde el Primer día [de trabajo] me pusieron el Mara, por ser centroamericano.  Está bien por que es broma, pero también me enoja, por que me traje a mi hijo de Honduras por que las Maras lo querían reclutar, nunca pense que a mi me llamarían Marero.” (“Since my first day [at work], they called me ‘el Mara,’ because I’m Central American.  Which is fine, because they’re joking, but it also makes me mad, because I brought my son [here] from Honduras because the Maras wanted to recruit him.  I never thought I’d be called a Mara.”)

Josue described being the target of many jokes while in Mexico—about being a gang member, a murderer, a kidnapper, or a drug addict, all very far from his true past as a plumber from a small town. 

While Josue was picked on mostly in jest, stereotyping is a real problem for Central American migrants both in Mexico and in the U.S. For example, in 2017, Republican Jack Martins ran for County Executive in Nassau County, New York. In the midst of Donald Trump’s anti-Central American migrant rhetoric, Martins released a campaign poster showing three shirtless men covered face-to-waist in tattoos, standing in front of graffiti. The poster associates the men with the MS-13, a Mara group. The top of the poster read: “Meet your new neighbors!” To the side, the poster states that his opponent’s campaign is supported by “special interst groups” that “want to make Nassau County a sanctuary county for illegal immigrants and protect those convicted of violent crimes from deportation.” Similar to Josue’s treatment in Mexico, this poster closely links Central American migrants and violent gangs, when, in reality, many migrants are fleeing from the havoc wreaked by those gangs. Martins eventually lost to his opponent, but the sentiment reflected in his campaign ads continues to pervade anti-migrant politics.

Related image

Both, Josue’s experience in Mexico and Martins’ local campaign ad in New York demonstrate how Central American migrants are stereotyped in both Mexico and the U.S.  Those stereotypes affect Central Americans as individuals; they also have the dangerous ability to wrongly influence public opinion more widely.     

Not all migrants are “bad,” and not all migrants are “good.” But migration is a social issue, and a person’s migrant status says nothing inherent about them. Generalizations about migrants’ behaviors, physical appearances, or capacities is little more than badly-masked discrimination.


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Visibility & Protection​: Understanding Central American Migrant Caravans

Angel A. Escamilla Garcia
January 27, 2019

The week, news broke of another migrant caravan departing from Honduras with the intention of reaching the Mexican-American border. News outlets estimate that this caravan contains at least seven thousand people, with some reporting up to ten thousand, and it includes a substantial number of families and minors. This, after three caravans, made the same trek in 2018. Such numbers make us wonder–why the caravan, and why now?

A look at the origins of the Central American migrant caravan is illuminating. In 2010, migrant shelters in Southern Mexico began conducting a yearly migrant Via Crucis (the Way of the Cross) to raise awareness about the plight Central American migrants on their way to the United States through Mexico. The Via Crucis was a march by migrants and activists, from a shelter to a nearby place symbolic for migrants, such as a roadblock or a train station. The name Via Crucis recalls the walk of Jesus carrying his cross before his crucifixion and seeks to reflect the tortuous route migrants take northward. Often, the participants of the Via Crucis themselves carried a cross. (See image below)

In March 2015, following the 2014 implementation of the “Southern Border Plan” along the Mexico-Guatemala border, the Via Crucis grew. The United States pushed for and partially funded increased immigration enforcement on and near that border. Pursuant to the plan, Mexico detained and deported more than 120,000 migrants in 2014.

Thus, following the implementation of the Southern Border Plan, the Via Crucis organizers announced their intention to march all the way from the southern state of Oaxaca (and later from Tabasco) to Mexico City. The leaders sought to meet with government officials and to make visible the harsh conditions that Central American migrants faced after the implementation of the Plan. The 2015 migrant caravan had less than three hundred participants and was stopped and harassed multiple times by federal and local authorities before eventually reaching Mexico City in mid-April. There, members of the migrant Via Crucis met with Secretary of the Interior Miguel Ángel Osorio Chong, and members of the National Commission of Human Rights, and they visited the Basilica of Guadalupe to thank the Saint for their safe arrival.

A member of the 2015 Via Crucis carrying a cross with the words “Enough with Migrant’s Blood” inscribed.
Picture from Cuarto Obscuro by ARTURO PÉREZ ALFONSO /CUARTOSCURO.COM Source: https://www.animalpolitico.com/2015/04/solalinde-tramita-amparo-para-el-viacrucis-migrante-aun-asi-no-confiamos-advierte/

Despite these 2015 meetings, and continued annual migrant Via Crucis, little has changed for the undocumented migrants who walk, train hop, and hitch-hike through Mexico year-round on their way to the U.S. These individuals face daunting journeys. Through my research, I have witnessed migrants who have walked for days through deserts, forests, and swamps, all in order to avoid detention and deportation by Mexican authorities. In the process, dehydration, fungus, blisters, wounds, bug bites, sickness, and hunger become their routine. In addition to these physical realities, their undocumented status in Mexico turns the space they cross into a hunting ground for predators. At the hands of criminal groups, individuals, and officials, extortion, brutal beatings, rape, kidnapping, and death all are possibilities for migrants moving through Mexico undocumented.

Facing such great dangers, and inspired by the migrant Via Crucis, migrants in the last few years have thus begun to form their own large groups for migration. Their moving together creates a certain safety in numbers. By grouping together, they make themselves visible to everyone, including to authorities, to people that want to harm them, to the general public, to the news media, which helps prevent them from being clandestinely targeted by criminal groups and corrupt officials. These are the caravans that now dominate the news.

This grouping aspect of Central American migration is not exclusive to the caravan. During my time in the field, it was common to meet all types of informal groups of people migrating together. When I would ask groups how they knew each other, the most common answer was that they had grouped together looking for protection or guidance. This includes youth that join up with unknown adults seeking some protection and women that find partners along the journey hoping to avoid potential sexual abuse.

Thus, though migrant caravans now make politically-charged headline news, they are neither new, nor do they represent a new “threat.” Instead, they are coherent social responses by vulnerable individuals who seek to reclaim some of the humanity that has been taken from them.


Speedy Gonzalez and Sylvester: The Resilience ​of Migrants and the Marginal Effect of Physical Barriers

Angel A. Escamilla García
January 8, 2019

The Tijuana-San Diego border wall, taken from Tijuana (2015).

I am a graduate student who researches the movement of migrants through Mexico. During my time along the migration route in Mexico, I have had the opportunity to meet many Central Americans moving northward toward the U.S. Among those migrants are some who have already crossed the U.S.’ southern border multiple times. Their knowledge of the border crossing was impressive, as were their stories about being lost in the desert, being towed under by currents in the Rio Grande River, and being kidnapped by drug cartels.

But, what most caught my attention about this sub-group of migrants was their resilience to make the trip to the United States yet again, despite the obstacles lying between them and the U.S. One question I liked to ask them was how they found the strength to try again, especially after seeing and experiencing extreme hunger during their migrations, violence, and possible deportation. In 2015, I asked this question to “Luis,” a Male from El Salvador on his way back to the United States :

“I have three little girls and a wife waiting for me in South Carolina. I had a good life there, but I was stopped for speeding and was deported back to El Salvador. That was a year and a half ago, and since then I have been deported four times, three times from Mexico [back to El Salvador], and once while crossing the border wall in California.”

When I asked Luis if he was afraid of the increasing levels of policing on the American border, he told me:

“I am not afraid of crossing. My life is there. I am like Speedy Gonzales, have you watched it?”

“Yes,” I said, “but, what do you mean?”

He explained: “Speedy Gonzalez was little but fast, and Sylvester the Cat always wanted to catch him. Despite all his effort, the mouse always got away. I am the Speedy Gonzalez, and no matter how much they try to catch me, I will get away with it. My family is there.”

Speedy and Sylvester. Source: https://www.imdb.com/title/tt0055298/mediaviewer/rm1424766208

Like Luis, many of the migrants I have met have similar reasons to keep trying to cross into the U.S.; for them, there is no other option but keep trying.

My research suggests that migrants’ motivations for coming to the U.S. are too complex for us to believe that a physical wall will deter them. Love, hope, families, promises, lives––all are inspirations for migrants to keep trying to overcome a physical barrier. Especially when they have already endured a long and difficult 2000-mile journey across Mexico. One more twelve-foot barrier is little more than a nuisance.