Pandemia en la Frontera II: The Psychosocial Consequences of COVID-19 on Refugees in Tijuana
When our lives went through the sudden, shocking, and possibly painful changes after the COVID-19 spread, we naturally used different coping mechanisms to self-sooth, because dealing with unexpected and restrictive changes can be destabilizing and hurtful. I recently came across a new documentary showcasing how ten different people in Los Angeles made their favorite comfort foods from their home countries to cope with being in lockdown, a beautiful way that ethnic and cultural socialization helped make those folks resilient. Comfort, food, and home may seem like basic needs to us, but for forcibly displaced refugees across the world these items are much more of a luxury. Many cannot remember the last time they experienced comfort, ate food, or felt at peace with the concept of home. While it is impossible to grasp the depth of this population’s pain and resilience, it is imperative to explore the inequities in which the current pandemic impacts their psychosocial health.
Not far from Los Angeles, thousands of people exposed to unspeakable levels of traumatic adversities make their way to the US/Mexico border in Tijuana to seek asylum in the US. The overwhelming majority of this migrant population is trying to accomplish one common goal: escape persecution and preserve life, constituting them as refugees per UN conventions. While every one of these refugees has a unique and rich life history, an often shared experience is the extreme fear of imminent violent threats directed at them by gangs in their communities, coupled with poverty and lack of political infrastructures. While out of the scope of this piece, let’s recognize that the sociopolitical instability and poverty giving rise to these violent groups is closely tied with US historic and contemporary foreign policies in Central America.
Before refugees arrive in Tijuana, they have often already faced multiple forms of adversities in their home communities and throughout their journey. Ana (name changed for safety reasons), is among hundreds of families seeking refuge in a remote shelter outside of Tijuana, where incessant raining has literally crumbled the earth beneath their feet. I met Ana when I visited the shelter as a mental health provider with the Refugee Health Alliance, a leading organization providing medical and mental health services to refugees in the city. She had to escape her home town in Honduras because her boyfriend had tried to leave the local gang and was almost killed for doing so. They first hid in a tiny shed for a week without food before leaving their town, struggling to keep their 1-month old baby quiet throughout the journey. Ana struggled with PTSD, and she was growing despondent about the prospect of ever feeling safe again. The risk of exposure to major adversities continues to be extremely high for refugees throughout their search for safety. As they travel between cities and countries, they often experience injuries, malnutrition, sexual assault, persecution by local officials, and theft of their very minimal belongings.
Once at the border, exposure to these extreme challenges continues, from lack of access to basic necessities such as food and shelter to confronting the threat of trafficking, discrimination, and disappearance. Victoria (name changed) is another young woman residing at a shelter specifically for unaccompanied minors. She did not like to talk about the scars on her body, but we heard about how often she had been approached by traffickers to leave the shelter. When we asked about the adolescents’ most pressing needs, they requested underwear, socks, and sanitary pads.
The compilation of experiences prior to arrival in Tijuana and in the city risks the onset — or exacerbation — of complex trauma, the pernicious implications of exposure to cumulative experiences of traumatic adversities throughout the course of development. This, coupled with the chronic uncertainty of whether they will find refuge in the US, creates a starkly different experience with the COVID-19 pandemic, especially in relation to the refugees’ psychosocial health.
Three contextual factors can help elucidate the depth of how this pandemic has impacted this population’s psychosocial health. First, refugee populations in Tijuana — and beyond — have already been heavily burdened with adverse life events that have taxed their capacity to cope with new environmental challenges. Prevalent rates of trauma, anxiety, and depression-related mental health challenges stemming from their unimaginable life experiences often severely stresses their internal systems for navigating new problems, like the ones brought about due to the pandemic. This is true in the case of most forcibly displaced populations across the world, but it is especially salient for refugees who are in transition and lack any sense of stability, as in the case of those in Tijuana.
Second, for the refugees who are able to secure living accommodations at shelters, the inevitable realities of communal living circumstances can be highly detrimental to most types of protection from the virus. Shelter conditions are often already dilapidated, with limited access to adequate hygiene, nutrition, and personal space. While this was already a major nuisance for the families, the setup is especially dangerous for the spread of COVID-19, especially as refugees have minimal autonomy and power in protecting themselves if anyone at the shelter contracts the virus. Many shelters have placed extreme restrictions on mobility in and out of their premises as a means of reducing the risk of a spread. While a potentially effective form of COVID-19 prevention, the implications of this reduced mobility has been incredibly grave for a group who is already financially and psychosocially vulnerable. The very limited source of income that folks depended on through their work as day laborers is cut off, and an already ostracized group is further pushed to the margins. Little is known about the experiences of those who have opted to leave the shelters as they are scattered across the city, often in highly remote areas. As a whole, however, we know that access to medical and mental health services for an already underserved group is further reduced because providers can no longer travel to the shelters, and refugees are unlikely to physically seek care in public spaces for fear of persecutions by those from whom they have escaped. The few refugees who have been able to make contact through visits to volunteer medical clinics report that food is running out in some shelters, and children are growing malnourished.
Finally, the prospect of an unpredictable future, while a common current concern of humanity as a whole, can be especially painful and detrimental for this group. Refugees in Tijuana are often either seeking to be put on a list of people who are considered for admission to the US, or they are awaiting their turn from that list. Even when they are permitted to present themselves at the ports of entry (POE) from the list, the “Remain in Mexico” policy necessitates that they be returned to Tijuana to await the processing of their asylum case. This creates a chronic state of uncertainty, confusion, and psychosocial destabilization because individuals can never feel secure about what their next day may entail. When engaging young children in bibliotherapy at a makeshift shelter in the heart of the city, I often witnessed children’s confusion about their surroundings. Some thought they were taking a break before continuing on their journey, others were well aware that Americans did not want them in their country. One young boy from El Salvador missed his goat, and all he cared about was to be reunited with it regardless of where he ended up. This chronic state of unpredictability, together with the imminent risk of exposure to violence and persecution, can lead to a highly stressed internal context for dealing with all the uncertainties of COVID-19. The current POEs are no longer accepting new asylum claims — per reports of refugees on the ground — until further notice, all the more destabilizing the small beacons of hope the families hold on to for their survival.
Stability, predictability, social cohesion, and hope are all underpinnings of psychosocial well-being that are shared among humanity as a whole, regardless of past exposure to adversities and legal status. However, refugee populations worldwide, including those in Tijuana who are likely not far from those who are reading this piece, are at an increasingly higher risk and vulnerability for the deleterious consequences of this worldwide pandemic. Similar to the folks making their comfort food, members of this group have certainly adapted to find self-soothing mechanisms, just as they have been resilient in the past. Food ingredients are at a minimal, electricity is often a luxury, and a walk around the neighborhood is not an option, but friendships are built, stories are told, and respect is shared. As a mental health clinician, the opportunity to witness the resilience and strength of these individuals across multiple contexts in Tijuana has always been awe-inspiring as they hold space for each other’s pains and foster hope in one another.
The Refugee Health Alliance is currently working to establish a line of tele-health between clinicians and refugees because access to care has been severely disrupted in the wake of the pandemic. This tele-health service will bridge the gap in the refugees’ access to medical and mental health services. You can learn more about the process and contribute to the endeavor here: https://www.gofundme.com/f/telemedicineforrefugees
You can read more about the Remain in Mexico policy here: https://www.lawg.org/all-about-the-remain-in-mexico-policy/
Zainab Hosseini is a Ph.D. candidate in Developmental and Psychological Sciences at the Graduate School of Education, Stanford University, and an associate clinical social worker. Her research focuses on building culturally relevant and trauma informed social emotional learning programs for children impacted by emergencies, specifically refugees. She currently collaborates with community partners across multiple refugee contexts in Greece, Lebanon, and Iran to explore how refugee caregivers define adaptive social and emotional skills and resilience in their children. Zainab is also a mental health clinician and often volunteers to provide psychosocial support to individuals within emergencies, most recently through her collaboration with the Refugee Health Alliance in Tijuana.
