Every chair in the waiting room was occupied by dozens of newly arrived migrants waiting to be seen by a Cook County health worker at a clinic in Chicago. Julio Figueroa, 43, was among them.
He didn’t want to talk much about the trip to Chicago from Venezuela, where a social, political and economic crisis has pushed millions into poverty and caused 7 million to fleeFigueroa and three of his children included.
But somewhere along the way, he contracted pneumonia.
The figure who lived with hundreds of other asylum seekers at O’Hare International Airport while awaiting more permanent shelter, returned for follow-up care at the county clinic. The persistent cough is back, so is he. Staff checked his vitals, listened to his chest and gave him a hepatitis shot.
“I rarely get sick,” he said. “It was the trip that made me sick.”
Tens of thousands of migrants who have come to the United States navigate a mosaic system to find treatment for new or chronic health problems.
Doctors across the country say it’s rare for migrants to receive medical exams or anything other than emergency medical care when they arrive at the U.S.-Mexico border, and there’s also no comprehensive national system to track care. Migrants’ options dwindle or expand afterward—depending on where they end up—with some cities directing newcomers to 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 shelter,” said Deliana Garcia of the nonprofit Migrant Clinicians Network, which supported more than 1,000 migrants in need of medical care in the first 10 months of this year. “But how does anyone 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 data from the Border Patrol. For the most part, doctors told The Associated Press that the migrants are healthy; they must be to make the difficult journey. Travel is what can turn manageable health issues into emergencies.
Because of that, public health leaders across the country — from New York to Los Angeles, Boston to Denver — say there’s a high demand for care. And providing it is central to their organizations’ missions.
“It’s so important to what we do that I don’t feel like anybody’s really wavering about whether it’s the right thing for the organization to do,” said Craig Williams, chief administrative officer of the Cook County Health System. “I don’t feel like we’ve backed away from anything else over the last year because of this initiative.”
The cost of care
The work doesn’t come without a price: An estimated 14,500 migrants have visited the Cook County clinic this year, with about 100 being brought in by vans from shelters each day for immediate care, vaccinations and support in the public health system. The county has been spending about $2.2 million a month — or nearly $30 million since it opened the clinic about a year ago.
New York City Health and Hospitals recorded 29,000 visits by migrant patients in the most recent fiscal year, which ended in mid-June. There, health workers administered more than 40,000 vaccines and provided medical examinations for all new arrivals.
Other cities are trying to cope as best they can, like Denver, where nearly 26,000 migrants have arrived in the past year. Dr. Steve Federico, director of Denver Health, said the city’s process is inadequate.
Shelter staff ask migrants if they need immediate medical attention. If they say yes, they are either sent to an emergency room or connected by phone to a nurse through Denver Health, a community hospital and health organization.
There are no basic health screenings, Federico said, which can increase the risk of infectious disease outbreaks among shelter residents. In Chicago, a shelter saw a small outbreak of chicken pox.
Without catching and treating the diseases in time, Federico said, “Now everyone has it. And then if someone is at increased risk, they will get sicker.
Federico and city spokesman John Ewing said Denver is already stretched for resources — given the need to shelter and feed migrants. Ewing said Denver is looking to improve its medical screening process, but added it’s unclear how much it will cost or whether it has enough resources to accomplish it.
The challenges of caregiving
Migrants face a lack of access to consistent medical care in the US, as well as healthy food and stable housing. This could mean that someone with a chronic condition, such as diabetes or hypertension, could end up in hospital simply because they lost or ran out of medication or had it confiscated during the trip. Doctors said they also saw migrant children with asthma who needed new inhalers.
“You have essentially healthy people put in really remarkable circumstances where they’re not able to fully survive and then they come across (the border) in a really compromised state,” said Garcia of the Migrant Clinicians Network.
Some women arrive far along in their pregnancy and have never had prenatal care.
“We did the first prenatal visit to a woman who was nine months pregnant just two weeks ago,” said Dr. Ted Long, senior vice president at New York City Health and Hospitals, where more than 300 healthy babies have been born to migrant mothers.
Even when care is available, migrants have a hard time getting it. Some avoid seeking help entirely due to fear of a large bill or a long-standing distrust 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 Pediatric Clinic. She said she sees many patients who don’t have health insurance or don’t know how to get it.
One mother, who had been waiting for asylum for more than a year, told Lee she was paying out of pocket because her family had no insurance.
“The process is so broken that you can’t even do anything,” Lee said. “They came to see me just paying out of pocket because the kid needed a physical and needed to be seen before he went to school.”
The Migrant Clinician 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 staff liaise with migrants by doing things like arranging medical examinations, helping them fill out applications for social services, taking people to meetings 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 that are named after people who work on our team,” said Garcia, who runs the program.
But that’s the best case scenario.
The shelter system in Massachusetts, it’s 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 she needs to track them down because they don’t have a U.S. phone number.
“We’re seeing situations even with migrants who are just moving between shelter locations in the greater Boston area where they’re completely lost to being tracked,” said Danaher, a primary care pediatrician at Massachusetts General Brigham Health System. “And then the wheel is reinvented and the same tests are done.”
She encourages her colleagues to give patients a physical copy of everything that was done during their visit: shots given, medications prescribed, benefit programs applied for. That way, they can just pass it on to whoever sees them next – like a critical game on the phone.
There is “a lot of low-hanging fruit” when it comes to caring for migrant patients, she said, and the “very old level of note passing” is “an important investment to make”.
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Associated Press writers Sophia Tareen in Chicago and Jesse Bedine in Denver contributed to this report. Shastri reported from Milwaukee.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. AP is solely responsible for all content.
