Public Health as the Antidote for, not a Weapon Against, the Refugee Crisis

The allure of an elusive “American dream” beckons many who face perilous conditions at home to embark on the arduous journey to seek refuge in the United States—a nation that touts itself as a bastion for human rights on both domestic and international fronts. Yet, the US federal government has a shameful track record of violating refugees’ rights to seek asylum by prematurely or categorically banning their entrance altogether. The COVID-19 pandemic, and public health more broadly, represent the latest justification for cruel, anti-immigrant policies. Not only should the federal government outlaw these policies, but public health measures should be used to inform new policies to replace them.

Public health has long been wielded as a weapon against asylum-seekers entering the US to justify discriminatory policies, such as the prohibition of immigrants living with HIV/AIDS in 1987 and the xenophobic Chinese travel bans that reinforce anti-Asian rhetoric surrounding COVID-19. We witnessed this phenomenon yet again in September of 2021 when the Biden administration invoked Title 42 to legitimize the forced removal of thousands of Haitian refugees. This policy forced approximately 15,000 Haitians attempting to cross the Southern border back to Haiti–a home country now fraught with political turmoil following post-hurricane destruction, the assassination of president Jovenel Moïse, and subsequent gang violence. Title 42 authorizes the federal government to take “emergency action,” however that might be interpreted, to prevent the spread of communicable diseases. It originated as a clause of the antiquated Public Health Services Law of 1944 and was re-invoked by the Trump administration to justify the refugee expulsion under the guise of public health. With Title 42 in place, asylum-seekers entering the US will continue to face high-risk conditions that facilitate COVID-19 transmission, which is just the thing the federal government claims the policy intends to prevent.

Implementing Title 42 was never actually about promoting public health, but rather about furthering a political promise of “solving the border crisis.” Unsurprisingly, a harsh removal policy that violates human rights is neither a sustainable solution nor does it align with the objective of improving public health. The federal government and policy-makers must employ an approach to immigration that is informed by evidence-based measures to promote health and prevent the spread of COVID-19, such as physical distancing, mask provision, increased COVID-19 surveillance, access to vaccinations and primary healthcare services, and safer quarantine alternatives to crowded detention centers.

A recent study found that 92 percent of 607 asylum-seekers attempting to enter the U.S. had family or close friends here. These findings challenge the assumption that refugees must be housed in the high-transmission detention centers that the CDC classifies as high-risk, congregate settings. Instead, they can be screened, connected to health services, and freed to the homes of relatives or friends to quarantine safely in a low-density setting. Quarantine accommodations for those without connections in the US include shelters and vacant hotels, which many states have already implemented for houseless individuals as part of their COVID-19 responses.

Basic access to services that promote health and safety should be a right to anyone regardless of whether they qualify under refugee status or not. There is not only a moral imperative but also a public health imperative. Public health measures reduce the spread of COVID-19 and ensure that chronic illnesses do not go untreated. They effectively protect both native and foreign-born populations from communicable diseases during the migration process and reduce the well-documented burden of disease upon the healthcare system.

Supporters of Title 42 might argue that refugees are often traveling from countries with high community transmission, which poses a greater risk of spreading COVID-19. Contrary to this misconception, studies show that refugees tend to remain static, often settling into their adopted countries permanently. In contrast, business travelers and tourists deemed essential to the US economy often have the means to travel back and forth, which increases the risk of COVID-19 transmission at higher rates. The portrayal of foreign migrants as vectors of disease is a racialized trope that serves to further the agenda of anti-immigration advocates through the baseless invocation of public health.

Though it is impossible to reverse the harm that has already been caused to thousands of refugees from Haiti and other countries, it is imperative that the federal government and policymakers implement a solution that starts with putting an end to Title 42 and ensuring safe conditions for refugees at the border. As long as the U.S. continues to politically destabilize developing nations, wars continue to rage, and extreme weather events and global pandemics continue to erupt, there will be mass migration to the U.S. for asylum. Thus, it is the federal government’s duty to immediately adopt an evidence-based public health approach that includes healthcare, safe processing, and accommodations for refugees as an essential part of the solution.

Gabby Khawly is an MPH student in the Department of Epidemiology.