The American Public Health Association (APHA) is committed to the global defense of health and human rights and to reaffirming its record of opposing anti-immigrant statutes in the nation, as well as its position on the public health impact of border policies.1–3 Moreover, the United States has an affirmative responsibility to enforce policies to enhance security at its borders, as well as an affirmative responsibility to create and implement policies that do not harm the health and human rights of documented and undocumented people.4 The challenge of reconciling competing claims in this area is considerable. Historically, immigration policies emerge from competing factors, including economics, security, human rights, and humanitarian responses, affecting the lives of those within and outside US borders. Consistent with its mission, APHA has demonstrated its concern in earlier resolutions with ensuring that security enforcement does not violate fundamental health and human rights of migrants, their families on both sides of the border, the communities locally and globally that bear witness to the rising death toll on the US–Mexico border, and the health workers and advocates who take action to protect the health and human rights of border crossers.1,2
Since 1993, policies and strategies to control immigration, such as the Violent Crime Control and Law Enforcement Act of 1994, “Operation Hold the Line” and “Operation Rio Grande” in Texas, “Operation Gatekeeper” in California, “Operation Safeguard” in Arizona, and the 2004 National Border Patrol Strategy have intensified the ongoing militarization of the US–Mexico border.4,5 The Border Patrol’s policy of “prevention through deterrence” has resulted in the purposeful displacement and diversion of migrants into more treacherous and dangerous zones to cross, such as deserts, rivers, canals, and rugged terrain. In the last fifteen years, estimates of the death toll along the US-Mexico border range from over 3800 to 5600 deaths, essentially representing over a 100% increase in the number of deaths of border crossers since the enactment of immigration control measures in 1994.3,5–10
More than three fourths of the rise in migrant border-crossing deaths along the southwest border can be attributed to an increase in deaths in the Tucson, Arizona, sector between 1990 and 2003.6 These statistics are merely the number of known deaths, and do not include those border crossers who have never been found or were reported missing, thereby underestimating the actual number of migrants who have died attempting to cross the border.11,12
Collectively, these border deterrence operations serve to prevent migrants from crossing in well-established urban corridors where they historically have relied on familiar networks for assistance and instead deflect migrants to more remote rural areas where they are exposed to greater dangers and the risk of death, especially in the harsher environments of deserts and mountains. The logic behind this policy is to move unauthorized migration to rural terrain where the Border Patrol believes it has the tactical advantage. During the early stages of the Border Patrol’s policy of “prevention through deterrence,” US enforcement officials believed that the increased costs to migrants in terms of personal safety and higher fees to coyotes—the guides leading migrants across the border would inhibit many people from crossing.5,13,14
In their quest to evade US enforcement operations in well-established urban crossing areas, migrants are squeezed into remote areas where they are exposed to the extreme elements of deserts and mountains and suffer dehydration, hyperthermia, hypothermia, and drowning. From 1993 and 2008, migrant deaths caused by exposure, especially heat-related exposure, increased substantially, whereas deaths from traffic fatalities and homicide declined, representing a major shift in the causes of migrant border-crossing deaths. The increase in deaths from heat exposure over the last 15 years is consistent with government reports that found evidence of a migrant traffic shift from urban areas like San Diego and El Paso into rural desert areas after the implementation of the Southwest Border Strategy in 1994 and the 2004 Border Patrol National Strategy.5,6,8,14–17
Despite a Border Patrol funding increase of 867% and an increase in agent staffing levels by 354% between 1993 and 2008, there has been no decrease in attempted migrant border crossings and no increase in apprehensions of border crossers.11,18–20 Border enforcement activities have not deterred undocumented migration, but instead have resulted in 3 to 4 times as many undocumented people remaining in the United States permanently or staying for longer periods of time. Previous studies, in fact, suggest that decreasing border apprehensions are not a result of these massive increases in Border Patrol enforcement but rather more accurately reflect fluctuations in the US economy. For example, the only 2 periods when the undocumented immigrant population did not increase correspond directly to the 2001–2002 and the 2007–2008 recessions. The most recent border-crossing data might also be a reflection of the current economic crisis in the United States.3,5 Rather than curtailing undocumented migration, increased border enforcement has pushed flows into more remote areas and has raised the personal and financial cost of crossing for migrants. Ironically, burgeoning enforcement has transformed a temporary and circular labor supply into a permanent settled population.5,8,14,17,19,20
Moreover, despite a nearly 50% drop in Border Patrol apprehensions, the recent economic downturn, and a decrease in border crossings, migrant deaths along the border continue to increase. Through August 31, 2009, the Border Patrol reported 519,394 apprehensions for this year, the lowest number since the early 1970s. Through August 2009, US Customs and Border Protection reported 416 deaths compared with 390 deaths in 2008 and 398 deaths in 2007.2,21
In addition to human rights concerns because of targeted border strategies, independent organizations have documented that the Immigration and Customs Enforcement (ICE; formerly the Immigration and Naturalization Service) and Border Patrol have engaged in violations of health and human rights. For example, the findings of a recent audit by the investigative arm of the Department of Homeland Security, Office of Inspector General, included several instances of mistreatment and neglect among immigrant detainees, including issues of inadequate health care, lack of timely access to medical facilities, environmental health and safety concerns, and noncompliance with detention confinement guidelines. Moreover, the report noted that the ICE Detention Standard on Detainee Grievance Procedures does not provide a process for detainees to report abuse or civil rights violations.14,22,23
Border enforcement activities also do not address the root causes of migration, which include the growing socioeconomic disparities in sending countries, coupled by the demand for low-skilled, low-wage workers in the United States. Although some unauthorized migrants enter the United States to seek asylum, most enter for economic reasons. Per capita incomes in the United States are 5 to 7 times higher than those of Mexico and most Central and South American countries.24,25 Various studies also suggest that the implementation of the North American Free Trade Agreement (NAFTA) and the related intensified liberalization of the Mexican economy resulted in strengthening migratory pressures.26–28 Combined with the resulting intensifying social and infrastructural links between the 2 countries, the research suggests that the rural exodus leads to an increase in migration from Mexico to the United States, a development of which the Clinton Administration was very much aware.28 In terms of farm labor, for example, a NAFTA-related trade deficit (in favor of the United States) contributed significantly to the loss of an estimated 1.3 million jobs in Mexico’s agricultural sector between 1994 and 2002.28,29 Because opportunities for legal entry into the United States to seek employment are limited, people resort to unauthorized attempts to gain entry. Deaths among unauthorized migrants are emerging as a major public health issue that is intertwined with social, economic, and political factors.5,25
US Border enforcement activities and immigration policies are the first step in a legal process of subordination that fosters an exploitable workforce more vulnerable to rights violations. Fear of deportation, and ultimately the high costs and considerable risks to re-enter the United States, has created a workforce that is less likely to report workplace safety and wage violations, less likely to have access to training and protective equipment, and less likely to facilitate worker willingness to seek medical attention.5,30–38. This situation is particularly problematic because many foreign-born workers seek jobs in high-risk occupations such as agriculture and construction. The fatality rate of foreign-born Hispanic workers is 44% higher than the national rate.39
Border enforcement activities along the US–Mexico border have not stopped people’s need to migrate, but rather have resulted in jeopardizing the lives and health of undocumented migrants who continue to be motivated to cross the border to find work or join family. The lack of information on the public health consequences of these activities is aggravated by the fact that it has not been previously recognized as a public health problem. In fact, ICE itself has responded to the increased number of deaths along the border by instituting the Border Safety Initiative (BSI) in 1998 to increase safety along the US–Mexico Border. A 2007 study evaluating the impact of the BSI program suggests, however, that there were no overall reductions in the rate of migrant deaths as a result.40 Although some BSI programs, such as the Border Patrol Search, Trauma, and Rescue initiative, were found to be positively associated with the prevention of some migrant deaths, it is difficult to identify Border Patrol efforts as the sole cause for any lives saved, because several others groups have been active in life-saving campaigns along the border.40
Many groups concerned with conditions along the border have also carried out rescue operations through the work of volunteers and have provided medical treatment, distributed water and food, and even conducted medical evacuations to those in need. Such groups include No More Deaths, the Border Action Network, Border Links, Derechos Humanos, Humane Borders, Healing Our Borders, and numerous religious organizations among others. However, the Border Patrol has been oppositional to those groups providing humanitarian assistance to migrants in distress. Some have even been prosecuted for federal immigration crimes.40,41
- Border crossing deaths are a public health crisis. US policies and strategies undertaken since 1993 to control unauthorized immigration along the US–Mexico border have led to significant direct and indirect morbidity and mortality among vulnerable populations at the border and at the same time have not deterred undocumented migration. Therefore, policy efforts to balance the complex human health and security needs related to unauthorized immigration should ensure that the prevention of border crossing deaths is prioritized and accounted for as a public health crisis.
- There is a need to address the economic, social, and other related root causes of border crossing deaths and to highlight the essential role of all public health practitioners in the construction of humane immigration policy that emphasizes the protection of public health.
- Border-crossing deaths are symptomatic of haphazard and ineffective border and immigration policies that do not address the root causes of migration. Therefore, efforts to prevent border crossing deaths should target the social and economic underpinnings of migration and the need for effective and just immigration policies and the protection of humanitarian aid efforts.
Therefore, APHA urges the following:
- Federal, state, and local governments; public health agencies; healthcare organizations and professionals; and colleges and graduate programs in public health should recognize the militarization of the US–Mexico border as a public health crisis.
- Federal, state, and local governments and public health agencies need to ensure health and social services, support research, conduct surveillance, and support other efforts to protect the health and human rights of undocumented migrants.
- ICE and the Border Patrol should comply with international standards of health and human rights by adopting policies and strategies that do not endanger the lives and health of migrants.
- The Border Patrol must comply with the recommendations of the Government Accounting Office to improve its method for collecting data to accurately record border crossing deaths.6
- Healthcare organizations and professionals should provide needed acute health care services to undocumented border crossers and take appropriate steps to ensure adequate continuity of care to those currently within the detention center system.
- Schools, colleges, and graduate programs in public health should promote research documenting this public health crisis, develop education activities, and support advocacy to increase knowledge and awareness of this public health crisis.
- American Public Health Association. APHA policy statement 95-01: Opposition to anti-immigrant statutes. Washington, DC: American Public Health Association; 1995. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=96. Accessed December 19, 2009.
- American Public Health Association. APHA policy statement 99-24: Health and human rights violations at the US–Mexico border. Washington, DC: American Public Health Association; 1999. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=195. Accessed December 19, 2009.
- Jimenez M. Humanitarian crisis: migrant deaths at the US–Mexico Border. New York, NY: American Civil Liberties Union of San Diego and Imperial Counties and Mexico’s National Commission of Human Rights; 2009. Available at: www.aclu.org/files/pdfs/immigrants/humanitariancrisisreport.pdf. Accessed December 19, 2009.
- Dunn TJ. The Militarization of the US–Mexico Border, 1978–1992. Austin: University of Texas Press; 1996.
- Dunn TJ. Blockading the Border and Human Rights: The El Paso Operation that Remade Immigration Enforcement. Austin: University of Texas Press; 2009.
- US Government Accountability Office. Illegal Immigration: Immigration Border-Crossing: Deaths Have Doubled Since 1995; Border Patrol’s Efforts to Prevent Deaths Have Not Been Fully Evaluated. GAO-06-770. Washington, DC: US Government Accountability Office; 2006. Available at: www.gao.gov/new.items/d06770.pdf. Accessed on February 11, 2009.
- Bailey S, Eschbach K, Hagan J, Rodriguez N. The human costs of border enforcement: migrant deaths at the Texas-Mexico Border. Migr World Mag. 1996;24:16–20.
- Rubio-Goldsmith R, McCormick MM, Martinez D, Inez MD. The “Funnel Effect” & Recovered Bodies of Unauthorized Immigrants Processed by the Pima County Office of the Medical Examiner, 1990–2005. Tucson: Mexican American Studies & Research Center at the University of Arizona, 2006. Report Submitted to the Pima County Board of Supervisors. Available at: www.borderhealth.org/files/res_763.pdf. Accessed December 19, 2009.
- Eschbach K, Hagan J, Rodriguez N, Hemindez-Leon R, Bailey S. Death at the border. Int Migr Rev. 1999;33:430–454.
- US Department of Homeland Security. Securing America’s Borders—CBP 2008 Fiscal Year in Review. Washington, DC: US Customs and Border Protection, 2008. Available at: www.cbp.gov/xp/cgov/newsroom/highlights/08year_review.xml. Accessed February 7, 2009.
- Cornelius WA, Salehyan I. Does border enforcement deter unauthorized immigration? The case of Mexican migration to the United States of America. Regulation and Governance. 2007;1:39–153.
- Martinez D. Unauthorized border crosser death along the Arizona/Sonora border. Arizona Department of Health Services Border Health Newsletter; 2007. Available at: www.azdhs.gov/phs/borderhealth/pdf/newsletter2_3.pdf. Accessed June 15, 2009.
- Andreas P. Border Games: Policing the U.S.– Mexico Divide. Ithaca, NY: Cornell University Press; 2000.
- Hagan J, Phillips S. Border blunders: the unanticipated human and economic costs of the US approach to immigration control, 1986–2007. Criminol Public Policy. 2008,7:83–94.
- Cornelius WA. Death at the border: efficacy and unintended consequences of US immigration control policy. Popul Dev Rev. 2001;4:661–685.
- Eschbach K, Hagan J, Rodriguez N. Causes and Trends in Migrant Deaths Along the U.S.–Mexico Border 1985–1998. Research Working Paper #01-4. Houston, Texas: Center for Immigration Research, University of Houston; 2001.
- Massey DS. Backfire at the Border: Why Enforcement Without Legalization Cannot Stop Illegal Immigration. Washington, DC: Center for Trade Policy Studies, Cato Institute; 2005.
- Ewing W. Border insecurity: US Border–Enforcement Policies and National Security. Special Report. Washington, DC: Immigration Policy Center, American Immigration Law Foundation, 2006. Available at: http://immigration.server263.com/images/File/specialreport/border_insecurity_spring06.pdf. Accessed February 7, 2009.
- Massey DS. Beyond the border buildup: towards a new approach to Mexico–US migration. Immigration Daily; 2006. Available at www.ilw.com/articles/2006,0109-massey.shtm. Accessed February 7, 2009.
- Massey DS. When less is more: Border enforcement and undocumented migration. Testimony (written statement) before Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law Committee on the Judiciary, House of Representatives, US Congress; April 20, 2007. Available at: http://cmd.princeton.edu/papers/house%20testimony%2004%2020%2007.pdf. Accessed December 19, 2009.
- Hsu SS. Border deaths are increasing. Washington Post. September 30, 2009. Available at: www.washingtonpost.com/wp-dyn/content/article/2009/09/29/AR2009092903212.html. Accessed December 19, 2009.
- US Department of Homeland Security. Treatment of Immigration Detainees Housed at ICE Facilities. Washington, DC: US Department of Homeland Security, Office of Inspector General; 2006.
- Phillips S, Hagan J, Rodriguez N. Brutal borders? Examining the treatment of deportees during arrest and detention. Soc Forces. 2006;85:93–109.
- World Bank. World Development Report 2005: A Better Investment Climate for Everyone. Washington, DC: World Bank; 2005.
- Sapkota S, Kohl III HW, Gilchrist J, et al. Unauthorized border crossings and migrant deaths: Arizona, New Mexico, and El Paso, Texas, 2002–2003. Am J Public Health. 2006;96:1282–1287.
- Andreas P. The escalation of US immigration control in the post-NAFTA era. Polit Sci Q. 1999;113:591–615.
- Massey DS, Espinosa KE. What’s driving Mexico–US migration? A theoretical, empirical, and policy analysis. Am J Sociol. 1997;102:939–999.
- Nevins J. Dying for a cup of coffee? Migrant deaths in the US–Mexico border region in a Neoliberal Age. Geopolitics. 2007;12:228–247.
- Polaski S. Jobs, wages, and household income. In: JJ Audley, DG Papademetriou, S Polaski, S Vaughan, eds. NAFTA’s Promise and Reality: Lessons From Mexico for the Hemisphere. Washington, DC: Carnegie Endowment for International Peace; 2003:17–19. Available at www.carnegieendowment.org/files/nafta1.pdf. Accessed May 31, 2009.
- American Public Health Association. APHA policy statement 2005–4: Occupational health and safety protections for immigrant workers. Washington, DC: American Public Health Association; 2005. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1318. Accessed February 17, 2009.
- Striffler S. Inside a poultry processing plant: an ethnographic portrait. Labor Hist. 2002;43:305–313.
- Saucedo LM. The employer preference for the subservient worker and the making of the brown collar workplace. Ohio State Law J. 2006;67:961–1022.
- Walter N, Bourgois P, Loinaz HM. Masculinity and undocumented labor migration: Injured Latino day laborers in San Francisco. Soc Sci Med. 2004;59:1159–1168.
- Marín AJ, Grzywacz JG, Arcury TA, et al. Evidence of organizational injustice in poultry processing plants: possible effects on occupational health and safety among Latino workers in North Carolina. Am J Ind Med. 2009;52:37–48.
- Moure-Eraso R, Friedman-Jimenez G. Occupational health among Latino workers: a needs assessment and recommended interventions. New Solut. 2004;14:319–347.
- Quandt SA, Grzywacz JG, Marín AJ, et al. Illnesses and injuries reported by Latino poultry workers in Western North Carolina. Am J Ind Med. 2006;49:343–351.
- Azaroff LS, Lax MB, Levenstein C, Wegman DH. Wounding the messenger: the new economy makes occupational health indicators too good to be true. Int J Health Serv. 2004;34:271–303.
- Sakala C. Migrant and seasonal farmworkers in the United States: a review of the health hazards, status, and policy. Int Migr Rev. 1987;21:659–687.
- Richardson SA. Fatal work injuries among foreign-born Hispanic workers. Mon Labor Rev. 2005;128:63–67. Available at: www.bls.gov/opub/mlr/2005/10/ressum.pdf. Accessed February 2, 2009.
- Guerette RT. Immigration policy, border security, and migrant deaths: An impact evaluation of life saving efforts under the Border Safety Initiative. Criminology and Public Policy. 2007;6:245–266.
- Becker, A. Volunteers reach out to save migrants. The Dallas Morning News. August 5, 2005. Available at: www.nomasmuertes.org/dallasnews.pdf. Accessed December 19, 2009.
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