Heidi de Marco, Kaiser Health News

Asylum seekers from Mexico, Central America, Africa and the Caribbean camp at El Chaparral Plaza in Tijuana, Mexico, as they wait for their immigration cases to be heard in the U.S.

TIJUANA, Mexico — El Chaparral Plaza once teemed with tourists, street vendors and idling taxis. But the plaza, just outside the San Ysidro port of entry on the Mexican side of the border, now serves as a sprawling refugee camp where migrants from Mexico, Central America and Haiti wait in limbo while they seek asylum in the U.S.

Dr. Hannah Janeway, an emergency medicine physician who works in a Los Angeles hospital but volunteers at the border, estimates at least 2,000 people are jammed into tents and repurposed tarps here, living without running water and electricity.

Survival is the pressing concern, not covid.

“The encampment just keeps growing day by day,” Janeway said.

A record number of migrants are making the often long and perilous journey to the border. U.S. Customs and Border Protection apprehended 180,034 people at the southern border in May, a 78% increase since February. By comparison, border agents apprehended about 144,000 people in May 2019.

New guidelines issued in February by the Biden administration require migrants seeking asylum to register online or via phone from their home countries, get tested for the coronavirus in Mexico and then come to a U.S. port of entry on a specific day for their asylum interviews. The goal is to reduce the number of people making the dangerous trek and alleviate the waiting in border towns like Tijuana — but people continue to show up without going through the process.

“As I was driving here, I just saw two buses drop off a group of migrants,” Janeway said. “Where are they going to go?”

Because migrant shelters were already at capacity before this year’s influx of migrants, many end up at the El Chaparral camp, where food and medical care are scarce and there is little access to sanitation facilities — other than hand-washing stations and portable toilets.

Janeway, who co-directs the Refugee Health Alliance, a nonprofit organization that provides medical care to migrants at the U.S.-Mexico border in Tijuana, visits the camp two to three times a month to tend to patients and spread the word about the nearby clinic she opened in 2018, located a few blocks from the plaza.

Migrants and a few Tijuana locals wait to be seen at the Resistencia en Salud clinic. (Heidi de Marco/KHN)

The clinic, Resistencia en Salud, provides free care and depends on donations and a mostly volunteer staff to keep the doors open.

“I believe that the people that I’m serving deserve to have health care and a reduction to their suffering,” Janeway said.

The clinic is small and basic, with two exam rooms. Staffers coordinate with Mexico’s public health system to handle patients who need more specialized care, such as surgery or chemotherapy.

On a recent Thursday, Janeway made her way along the edge of the camp — lined with tents, tarps fashioned into makeshift shelters and mounds of trash — to check on the water tank supply her organization provides. She said the Mexican government is not providing much in the way of health care or essential provisions, like water.

The office of Baja California’s secretary of health (Secretaría de Salud de Baja California) did not respond to multiple requests for comment.

“It’s the government’s responsibility, but I don’t want to play a game of chicken with them about water,” she said. “It’s critical. There are all these kids here with [gastrointestinal] illnesses.”

At the clinic, Janeway and her staff “see it all,” she said: heart problems, back pain, cancer, assault injuries. In addition to medical treatment, Resistencia en Salud provides mental health services and support to the LGBTQ community.

By the time doors opened at 10:30 a.m., a line of people were waiting to sign up. Some were turned away because the clinic hit capacity. Octavio Alfaro and his 12-year-old son, whose knees had been hurting, were among the hopefuls.

The 53-year-old from Villanueva, Cortés, in Honduras, had been waiting for asylum for 2½ years.

“My story is cruel,” he said.

Dr. Hannah Janeway consults with one of more than a dozen patients she treated on a recent Thursday. (Heidi de Marco/KHN)

Alfaro left Honduras with his three children, fleeing gang violence. “In Honduras, you cannot risk starting a business because if you don’t pay what the gangs charge you, they will put you in the ground,” he said. “They wanted to take my son and were ready to kidnap my daughter to do what they do to young girls.”

Stories like his are common in the encampment, he said. “That’s why we come. For a better life for these kids.”

Alfaro met Janeway at the El Chaparral encampment in late May. She quickly wrote an advocacy letter in support of his 14-year-old daughter Brenda’s asylum claim. Brenda has a cardiac murmur that requires immediate surgery in the U.S. “She needs to be seen by a specialist,” Janeway said. “She can’t get that type of care here.”

Janeway said many patients like Alfaro and his family are just trying to survive in Tijuana’s encampments and overcrowded shelters, where they fear being assaulted or robbed. Navigating the pandemic is secondary.

The clinic has seen only a handful of covid patients, Janeway said, and, as far as she knows, no one is vaccinating migrants.

Nurse Luz Elena Esquivel said she tries to educate patients about maintaining distance and wearing masks, “but sometimes it seems impossible,” she said. “It’s not their priority. Their priority is crossing.”

On this day, a dozen clinic staff members saw 55 people in about six hours. They moved in synchrony from patient to patient, attempting to treat as many as possible, including a 3-year-old child from Honduras who was so small he appeared 6 months old, a Mexican transgender woman in need of hormone therapy and a Haitian man complaining of chest pain. In the middle of it all, they rushed to treat a man who collapsed in the waiting area.

The latest wave of migrants has put a strain on the clinic, which needs more money, more volunteers and another doctor. “The working conditions aren’t that good. And the salaries we can offer aren’t either,” Janeway said. “But the people who are here are here because they are very dedicated to helping this population. It’s a mission.”

Dr. Christian Armenta, a family physician at the clinic, was born and raised in Tijuana. He started working at the clinic in the midst of the pandemic. “It was very scary in the beginning, but I adapted quickly,” he said. “As a doctor and a Tijuanense, I have to generate some sort of impact to better my city.”

About 95% of the patients are migrants, he said. The rest are people from Tijuana who live on the streets or in shelters. “The environment in which they are living creates the perfect storm to generate health problems,” he said.

Alfaro, a construction worker by trade, was robbed more than once. “I’ve been mistreated here,” he said. “My tools have been stolen twice.”

The clinic relies on donated medical supplies. (Heidi de Marco/KHN)

Even so, Alfaro said he feels like a child of Tijuana. “The people I have met here are like my family.”

In the middle of her shift, Janeway stepped out of the clinic to deliver some good news to Alfaro.

“I just talked to the lawyers and they told me that you have a date to cross on June 8,” she said.

“Glory to God,” Alfaro said. “I’m so happy. If I’ve learned one thing here, it’s to have patience.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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