On the banks of the Rio Grande, on the Mexican side of the border between the American state of Texas and the Mexican state of Tamaulipas, is a situation that by any account was a COVID-19 nightmare waiting to happen. In tents crowded along the river near the town of Matamoros, around 1,500 migrants await their chance to have a hearing that will allow them to enter the United States as asylum-seekers. You might worry, as I did, that the close quarters of the camp would make these already vulnerable people even more vulnerable to the coronavirus. But so far, case numbers have been limited, and people have stayed healthy. How have they done it?
The migrants at Matamoros are fleeing political situations and violence that in many other cases would make them refugees, but they are not refugees due to the complicated ramifications of the United States’ governments Migrant Protection Protocols and decisions made by the Mexican government. That means they do not have access to the complex international system that supports refugees. But they do have people in their corner. Medical care in the camp is run by a relatively tiny American NGO, Global Response Management, which was founded in 2017 by Pete Reed, a U.S. Marine Corps combat veteran, and Alex Potter, a seasoned nurse and photojournalist, who had been in Iraq and saw the need for a humanitarian organization willing to work in areas of war and conflict. After time spent working in Bangladesh and Yemen, the organization acquired a reputation for going in where few others would. When GRM executive director Helen Perry first went to Matamoros, she found hundreds of people camped along the Rio Grande, within sight of the U.S. border, with no access to water, toilets, or medical care. Because the state of Tamaulipas is controlled by drug cartels, not many other organizations had been willing to take on the risk of working there, Perry told me, but that is exactly the kind of situation GRM exists to ameliorate.
So, in September, they opened a clinic, found volunteers to staff it, and, given the dire situation, involved themselves in providing water and sanitation. Six months later, they were faced with the prospect of managing a pandemic in a low-resource situation—the town of Matamoros, with a population of 500,000, has only eight ventilators. Isolating people and maintaining social distancing is virtually impossible in a tent camp. And would they have enough volunteers to keep the clinic staffed? (I had been scheduled to volunteer there in May, but like many others, my employer’s travel restrictions precluded me from going.) Fearing the worst and knowing they had a vulnerable, malnourished population to care for, the GRM team prepared extensively for COVID-19.
Knowing there would be no guarantee of an available ventilator at the hospital in Matamoros if they did have to transport someone, they began preparations in March that would enable them to care for patients on site, said Andrea Leiner, GRM’s director of strategic management plans. They built a field hospital. They acquired items that would allow them to care for COVID-19 patients in a low-resource setting: oxygen concentrators to give oxygen extracted from the air to patients, monitors to help them keep a close eye on critically ill patients, and a transport ventilator in case they were in a situation where they had to send a patient to a local hospital. Borrowing from Ebola preparation and knowing they might run out of personal protective equipment, they stocked reusable Tyvek suits. They set up an isolation area. Because they wouldn’t have easy access to the gold standard of COVID-19 testing in the form of PCR tests, they ordered antibody tests. The camp had been short of the recommended number of toilets for the population, so another important preparation came from doubling the number to 120 and implementing a sanitizing protocol after each use. They handed out cloth masks to the camp’s occupants, along with vitamin D and multivitamins, and they simultaneously focused on educating the various microcommunities within the camp about what was going on. (The migrants from each country have a leader, and GRM worked with those people to educate the camp and counteract misinformation about the virus.)
They made it to June before the first COVID-19 cases were identified in the camp population. At first, they tried isolation. However, many of the 20 patients they attempted to isolate were asymptomatic, and because the isolation area was outside the camp, people were reluctant to go to it, understandable for a population that has been displaced over and over throughout their lives. Realizing that isolating patients was eroding their trust, GRM began recommending self-isolation in their tents but not enforcing it, and offering testing to those who came to the clinic but not requiring that either. They continued to focus on aggressive prevention measures. So far, only about 50 people have tested positive, many have been asymptomatic, and almost none have been sick. Only one patient, requiring oxygen, was transported to the nearby field hospital, set up to aid Mexicans with COVID-19. GRM’s field hospital, with oxygen concentrators and a single transport ventilator, remains unused, even while the town of Matamoros has had more than 3,000 cases of its own.
There are a variety of possible reasons for the relatively low impact of COVID-19 on the camp’s population, according to Perry. Although the rate of malnutrition is high, the average age is fairly young. People who were sick at baseline or had severe underlying conditions probably did not survive the arduous journeys that got most people to the camp. Besides sleeping in tents, they are mostly outdoors in hot, humid conditions that the virus doesn’t like. And many are wearing masks. So even if they do get infected, they are likely getting a smaller viral load, now widely believed to be protective against severe infection. No staff at the clinic have become sick either, likely as a result of ensuring sufficient PPE supplies.
Like the migrant workers in my own ER who are told they have COVID-19, the reaction of many in the camp when they test positive is resignation, but the reaction of some, especially those who are asymptomatic, is disbelief. Like many all over the world, some migrants believe the virus is a hoax. And not surprisingly for people who have been abused and lied to by their own governments, and ours, many see it as a way to control them. “COVID isn’t the worst thing in the world to them,” Sam Bishop, GRM’s project manager in Matamoros, told me. And COVID-19 hasn’t deterred new migrants from fleeing violence and persecution—they are still arriving in the camp.
Even if COVID infections haven’t ravaged the camp, the pandemic is still affecting migrants’ lives. Because of COVID-19, asylum court dates are postponed and hearings aren’t happening. For example, one asylum-seeker’s hearing was pushed from June 23 to Aug. 1, and then pushed back again to October. Each time the hearing is moved, the migrant must walk to the U.S. border and be given a slip for their next date from a box of appointment slips. Needless to say, this constant postponement of court dates has further eroded their trust in the authorities and the process, and migrants are boarding buses to other places on the border where things are supposedly better. (Also, in the name of COVID-19, the U.S. government gets what it wants, which is to keep these migrants out.)
Initially, COVID-19 affected the availability of volunteers, as hospitals like mine restricted their employees’ travel, but lately that’s changed, and the clinic has been able to maintain adequate staffing. Additionally, the clinic utilizes asylum-seekers from Cuba and Nicaragua with medical training to provide care—doctors, nurses, and a pharmacist. As fellow migrants, they are able to gain trust with patients in a way that American volunteers cannot.
There are other disasters besides COVID-19 to content with. Hurricane Hanna brought flooding to the camp, and the clinic had to move to the sidewalk outside the camp. The field hospital had to be taken down. Tents had to be moved, and things became even more crowded. Some migrants had to move to shelters in the city. Many others were terrified of evacuating, worried about what would happen if they left the small ground they had claim to. Trust in information is so severely eroded, and they fear that each additional disaster presents an opportunity for others to control them (which it does) and an excuse to relocate them against their will.
The situation in the Matamoros camp could be a lot worse. Still, the situation as it stands highlights the fact that for the world’s desperate, it is not necessarily COVID-19 itself that is most frightening, but the downstream effects of COVID-19 on the reality they were living in already.