Intended for healthcare professionals

Feature Health of Migratory Populations

Care and the caravan: the unmet needs of migrants heading for the US

BMJ 2018; 363 doi: (Published 19 December 2018) Cite this as: BMJ 2018;363:k5315
  1. Angelika Albaladejo, independent journalist
  1. Los Angeles, USA
  1. angelikaalbaladejo{at}

People fleeing violence and poverty in countries such as Honduras rely on volunteers for what limited healthcare they can access on their way through Mexico, and many who arrive in the United States cannot access the care they need, reports Angelika Albaladejo

Thousands of Central American migrants travel north through Mexico to the southern US border every year. In the run-up to recent midterm elections, US president Donald Trump referred to these refugees as an “invasion.” The “caravan” has received widespread media attention, sparked backlash, and inspired more asylum seekers to band together for safety.

But the exodus from this part of the world is far from new. Consistently, in recent years, more than 500 000 migrants are estimated to enter Mexico clandestinely at its southern border each year.1 Most are leaving the “northern triangle” countries of El Salvador, Guatemala, and Honduras, with their sights set on the US.

Throughout the tough and dangerous journey, access to healthcare is limited.2 Shelters, physicians, and rights advocates are responding to this humanitarian crisis, offering very limited health services along the route while urging regional governments to collaborate on policies to protect this vulnerable population.3

Crime, corruption, and climate change

Endemic violence and corruption and lack of economic opportunity in their home countries are among the “perfect storm of factors fuelling migration,” said Daniella Burgi-Palomino, senior associate at the Latin America Working Group, an advocacy organisation based in Washington, DC.

Violence committed by gangs, security forces, vigilantes, and in the home is widespread. The northern triangle countries have among the highest homicide rates in the world outside of war zones and some of the highest rates of sexual and gender based violence.456

Hundreds of thousands of people are forcibly displaced from their homes and often cannot access health services while in hiding.7 …

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