As the COVID-19 pandemic continues to rage across the country and around the world, its disparate impact on marginalized populations has become increasingly apparent. Two particularly vulnerable groups that are suffering the harms of inadequate protection from the dangers of COVID-19 are migrants currently held in immigration detention facilities and immigrants living in the United States. At a time when many public health scholars have the ear of the nation, it is incumbent upon all of us to advocate for marginalized and excluded non-citizens held in detention at our borders, living in our communities, and working in essential jobs across the nation. The harms being perpetrated by the Trump administration in the name of public health will echo through generations if we do not, as a profession, reject these measures and stand for justice.

While the CDC has instructed residents of the United States to wash their hands, wear masks, and practice social distancing, migrants in detention facilities run by Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) have no control over their ability to engage in any of these practices. As a result, cases of COVID-19 have skyrocketed in immigration detention, with ICE’s own numbers indicating that over 1700 migrants have tested positive for COVID-19, and at least two migrants and four guards have died from the disease. The public health community has for years decried the unsanitary and unsafe conditions in detention facilities in the United States and the inhumane treatment of migrants, particularly women and children, seeking to enter the U.S., but in the midst of a nationwide communicable disease outbreak, the plight of migrants is at risk of being overlooked.

Consider the parallel between immigration detention and the U.S. prison system. At the urging of public health experts and advocates, some prisons and correctional facilities across the country have begun releasing inmates accused of nonviolent crimes in order to reduce the chances of widespread outbreaks. Despite this small step towards progress in the wider carceral system, immigration detention facilities are still holding thousands of migrants and asylum seekers, the overwhelming majority of whom did not commit violent crimes. According to the non-partisan Center for Migration Studies, ICE still held over 4,000 asylum seekers determined to have a “credible fear” of persecution or violence in their home countries, even several months into the pandemic. Meanwhile, COVID-19 cases continue to rise as ICE shuffles detained migrants between facilities.

In addition to continuing to detain some migrants and asylum seekers in unsafe conditions, the Trump administration is also using COVID-19 as an excuse to ramp up immigration enforcement and deterrence strategies. Border Patrol agents have been instructed to expel people apprehended at the border without following legal requirements to determine if a migrant has a valid asylum claim. In the name of public health, hundreds of minors have been sent to Mexico, where they face the dangerous conditions experienced by people subject to the Migrant Protection Protocols (MPP, also known as “Remain in Mexico”), including rampant kidnapping, sexual assault, and murder.

The COVID-19 crisis does not only affect asylum-seekers and migrants in detention. Immigrants who live in the United States, with or without legal status, are also disproportionately harmed by the fatal intersection of anti-immigrant policy and inadequate public health measures. When the Trump administration changed the public charge rule in 2019 to discourage legally residing immigrants from using social services like Medicaid and SNAP, tens of thousands of commenters wrote to oppose the changes. Some who wrote in opposition argued that the policy would be bad for the health of immigrants and American citizens alike, citing the communicability of disease outbreaks and the dangers of discouraging vulnerable people from seeking health care. They could not have known how prescient those concerns were, as we can now see the effect the public charge rule has had on immigrants’ willingness to seek care for COVID-19. 

In addition to the damaging public charge rule, the U.S. government has doubled down on the harm to undocumented immigrants by excluding them from the 2 trillion dollar Coronavirus Aid, Relief, and Economic Security (CARES) Act. Although many undocumented immigrants are essential workers, they are not entitled to relief under the CARES Act, and even the U.S. citizen children of undocumented immigrants are unable to access the benefits of the program. Most undocumented immigrant adults are ineligible for publicly funded insurance, and their children are only eligible if they are citizens or reside in one of the few states that provide coverage to undocumented children. These exclusions from social safety-net programs, while clearly unjust even during non-pandemic times, seem downright cruel and counter-productive to the goals of public health in the midst of a dangerous pandemic disease outbreak.

The injustice of this moment, directed against some of the most marginalized members of society, presents a unique challenge to public health scholars and practitioners. As COVID-19 continues to ravage communities of color and tear through immigration detention facilities, it is incumbent upon all of us, as members of the public health community, to use our collective voice, power, and privilege to call for immediate and long-term change. This crisis has demonstrated the moral and practical dangers of excluding some populations from the benefits of publicly funded health care and denying the humanity of non-citizens seeking to make a better life for themselves and their families. We must meet this moment with persistent advocacy for justice in all of the systems that perpetuate health disparities, including a reimagining of both our health care and immigration systems. If we truly believe that the “public” in public health includes all of us, there is no other alternative. 

Rachel Fabi, PhD