A Nation of Immigrants — Without Access to Affordable Health Care

Many refugees and migrants undertake perilous journeys that threaten their health. Aylan Kurdi’s death is emblematic of these dangers: the image of the Syrian toddler, washed up on a Turkish shore after the boat carrying him to asylum capsized, is seared into our collective consciousness. The International Organization for Migration estimates Aylan was one of more than 47,000 people who died on migration journeys worldwide between 2014 and 2021.

It should be no surprise that refugees and migrants also have poorer health outcomes than citizens of their host countries. Travel restrictions and border closures during the COVID-19 pandemic only exacerbated their health challenges. A recent report from the World Health Organization highlights opportunities and challenges for governments to address the health problems of refugees and migrants.

How Does Displacement Impact Health?

Displacement and migration can disrupt access to health care. In the United States, people who migrate through regular pathways face administrative and cultural barriers to obtaining health insurance, while undocumented immigrants are shut out from getting health services altogether. By some estimates, immigrants are three to five times more likely to be uninsured than citizens, making it difficult for them to obtain even basic preventive care.

For asylum seekers relegated to U.S. border facilities,?health concerns prevalent in congregate settings, like gastrointestinal issues, respiratory illnesses, and skin diseases, abound. The consequences can be horrific. In 2018, seven-year-old Jakelin Caal Maquin and eight-year-old Felipe Gomez Alonzo?died about two weeks apart in Border Patrol custody?from infections that could have been prevented with timely access to care. The year 2020 saw the?highest number of deaths in U.S. Immigration and Customs Enforcement custody?in a decade and a half.

The WHO report presents stark examples of the impacts of displacement. During the pandemic’s early months in Kuwait, COVID-19 ran rampant among migrant workers, who tend to live in crowded accommodations with few resources. Data from Singapore show that migrant workers living in dormitories accounted for 93 percent of the country’s total confirmed cases. And while some nations, like Australia and Egypt, offered free testing for migrants, others, including South Africa, largely excluded noncitizens from their pandemic response. Meanwhile, many Latino adults in the U.S. feared getting tested and vaccinated because doing so required providing personal information and documentation — a likely contributor to their worse COVID outcomes.

Securing Better Health Outcomes for Refugees and Migrants in the U.S.

U.S. policymakers have an opportunity to heed the WHO’s call for all nations to provide health coverage to migrants and refugees, as well as access to primary care and disease prevention. But to ensure better health outcomes, refugees and migrants also need a role in health care decision-making — for example, through participation in the health care workforce and in the design and implementation of services. These inclusive health policies can be bolstered by programs that minimize risk factors for illness, such as financial and housing insecurity, labor and employer exploitation, and lack of a social safety net.

The U.S. also can do a better job of ensuring refugees and migrants are able to access the services they’re eligible to receive. One barrier to access is confusion around the Trump administration’s public charge rule, which made it difficult for immigrants using public services to receive a green card. Although the Biden administration reversed the rule two years ago, persistent fear over it continues to undermine access to care. For Afghan refugees in the U.S., who are eligible for federal public health benefits like food assistance and Medicaid, language barriers and the long enrollment process present significant obstacles to accessing health care.

The United States has the resources to be a global leader in refugee and migrant health. The WHO’s recommendations offer a pathway to safeguard the health needs and rights of all people on the move.

The author thanks Shanoor Seervai, Munira Gunja, and Evan Gumas for their contributions.