Every chair in the waiting room was filled with dozens of newly arrived immigrants waiting to be seen by a Cook County health worker at a Chicago clinic. Julio Figuera, 43, was among them.
He didn’t want to talk much about his journey to Chicago from Venezuela, where a social, political and economic crisis has plunged millions into poverty and driven 7 million people to flee, including Figuera and three of his children.
But somewhere along the way, he’d come down with pneumonia.
Living with hundreds of other asylum seekers at O’Hare International Airport while waiting for more permanent housing, Figuera returned to the county clinic for follow-up care. The persistent cough returned, and so did he. The staff checked his vitals, listened to his chest and gave him a hepatitis vaccine.
“I rarely get sick,” he said. “It was the journey that made me sick.”
Tens of thousands of migrants who’ve come to the United States are navigating a patchwork system to find treatment for new or chronic health problems.
Doctors across the country say it’s rare for migrants to receive medical screenings or anything beyond emergency care when they arrive at the US-Mexico border, and there’s no overarching national system to track care. After that, migrants’ options shrink or expand – depending on where they end up – with some cities funneling new arrivals into robust public health systems and others relying on emergency rooms or volunteer doctors to treat otherwise preventable health problems.
“You have these little islands of care. You have these little islands of protection,” said Deliana Garcia of the non-profit Migrant Clinicians Network, which served more than 1,000 migrants in need of medical care in the first 10 months of this year. “But how do you know what’s going on from east to west or north to south?”
More than 2 million people crossed the border illegally between October 2022 and September 2023, according to Border Patrol data. For the most part, doctors told the Associated Press, the migrants are healthy; they have to be to make the arduous journey. It’s the journey that can turn manageable health problems into emergencies.
That’s why public health leaders across the country – from New York to Los Angeles, Boston to Denver – say the demand for care is high. And providing it is central to their organisations’ missions.
“It’s so central to what we do that I don’t feel like anyone has really hesitated that this is the right thing for the organisation to do,” said Craig Williams, chief administrative officer of Cook County’s health system. “I don’t feel like we’ve really stepped back from anything else in the last year because of this initiative.”
The cost of care
The work comes at a price: About 14,500 migrants have visited the Cook County clinic this year, with as many as 100 being picked up from the shelters in vans each day for emergency care, vaccinations and a foothold in the public health system. The county spends about $2.2 million a month – or nearly $30 million since the clinic opened about a year ago.
New York City Health and Hospitals recorded 29,000 migrant patient visits in the last fiscal year, which ended in mid-June. There, health workers have administered more than 40,000 vaccines and provided medical screenings for all new arrivals.
Other cities are trying to cope as best they can, such as Denver, where nearly 26,000 migrants arrived last year. Dr Steve Federico, a director at Denver Health, said the city’s process was inadequate.
Migrants are asked by shelter staff if they need immediate medical attention. If they say yes, they’re either sent to an emergency room or connected to a nurse by phone through Denver Health, a public hospital and health care organisation.
There are no basic health screenings, Federico said, which can increase the risk of infectious disease outbreaks among shelter residents. In Chicago, there was a small outbreak of chickenpox in a shelter.
Without early detection and treatment, Federico said, “now everybody has it. And if someone’s at higher risk, they’re going to get sicker.
Federico and city spokesman Jon Ewing both said Denver is already stretched for resources – given the need to house and feed migrants. Ewing said Denver is looking to improve its medical screening process, but added that it’s not clear how much that will cost or whether there are enough resources to do it.
The challenges of care
Migrants in the US face a lack of access to consistent medical care, as well as healthy food and stable housing. This can mean that someone with a chronic condition, such as diabetes or hypertension, can end up in hospital simply because they have lost, run out of, or had their medication confiscated during their travels. Doctors say they’ve also seen migrant children with asthma who need new inhalers.
“You have essentially healthy people who are put in really remarkable circumstances where they are not able to survive thoroughly, and then they come across (the border) in a really compromised state,” said Garcia, of the Migrant Clinicians Network.
Some women arrive late in their pregnancies and have never had prenatal care.
“We just gave the first prenatal visit to a woman who was nine months pregnant two weeks ago,” said Dr Ted Long, senior vice president of New York City Health and Hospitals, where more than 300 healthy babies have been born to migrant mothers.
Even when care is available, it can be difficult for migrants to access it. Some avoid seeking help altogether for fear of a large bill or because of long-standing mistrust of the medical system.
Dr Stephanie Lee is the medical director of refugee resettlement and coordinator of the Unaccompanied Youth Program at Penn State Health’s Family Practice Pediatrics Clinic. She said she sees a lot of patients who don’t have health insurance or don’t know how to get it.
One mother who had been waiting for more than a year to apply for asylum told Lee she was paying out of pocket because her family didn’t have insurance.
“The process is so broken you can’t even do anything,” Lee said. “They came to see me and I was just paying out of pocket because the child needed a physical and needed to be checked before he could go to school.”
The Migrant Clinicians Network, which has been connecting patients with health care providers for 30 years, just received a $5 million grant from the National Institutes of Health. Its caseworkers keep in touch with migrants, doing things like setting up medical appointments, helping fill out social service applications, taking people to appointments, and figuring out payment options.
They even keep in touch with a trusted family member in the migrant’s home country, in case they fall off the radar.
“We have a lot of babies named after the people who work on our team,” says Garcia, who oversees the programme.
But that’s the best-case scenario.
The shelter system in Massachusetts is so full that the governor called in the National Guard in August to help. Dr Fiona Danaher and her colleagues often can’t find migrants when they need to follow up with them because they don’t have a US phone number.
“We see situations, even with migrants who are just moving between shelters in the Boston area, where they get completely lost to follow up,” said Danaher, a primary care paediatrician at Mass General Brigham Health System. “And then the wheel gets reinvented and the same tests get done.”
She encourages her colleagues to give patients a physical copy of everything done during their visit: vaccines administered, medication prescribed, benefits applied for. That way, they can just hand it to the next person they see – like a critical game of telephone.
There’s “a lot of low-hanging fruit” when it comes to caring for migrant patients, she said, and a “very old-school level of note-taking” is “an important investment to make”.
