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The Health Protection of Irregular Migrants at the Borders: The Case of the Darién Gap

By Andrea Jaramillo Contreras | Issue #22

Figure 1. Photo taken by Andrea Jaramillo in July 2022.
Figure 1. Photo taken by Andrea Jaramillo in July 2022.

Between 2021 and 2022, more than 350,000 migrants from 53 different countries crossed one of the world's most dangerous migration routes between Panama and Colombia, called the Darién Gap, with the aim of reaching the United States. Between 1,200 and 1,300 irregular migrants cross this border every day, and some 300 are stranded on the Colombian side of the border, in Necoclí, waiting for economic support or migration alternatives.

The Darién Gap is sixty miles of dense rainforest, steep mountains, and extensive swamps. During 5 to 11 days, migrants have to cross inhospitable routes, rivers and long stretches of land that require a high level of physical strength. According to reports by ACNUR, R4V and Médecins Sans Frontières (MSF), human trafficking, assaults, sexual violence, killings, disappearances and deaths are some of the risks that migrants face along this route. After crossing the Darién Gap, migrants continue their journey by road, passing through Panama, Costa Rica, Nicaragua, Guatemala, and Mexico until they reach the United States. This route can last weeks, months or even years, depending on the origin of the migrants, the restrictions at the borders and their economic resources. During their journey, they face lack of access to health care, food supplies, potable water and housing. On top of that, the control of smugglers, traffickers and criminal groups at these borders put the migrants in a situation of extreme vulnerability. From 2016, 221 irregular migrants have died trying to cross this border.

The protection of the right to health without distinguishing people’s legal status, origin or social condition follows the United Nations principle of “Leave No One Behind” of the 2030 Agenda for Sustainable Development, claims for equity and non-discrimination to the most disadvantaged and poor in the world. The recognition of the special vulnerability of migrants in terms of social exclusion and discrimination along their migratory route put them as priority actors in accessing a competent health service adaptable to their needs. However, at the borders of Colombia and Panama, the lack of regulations that protect migrants in transit, the financial and local capacities at the borders, the restrictive policies at the borders, and the misunderstanding of what the right to health means for migrants in transit are one of the main aspects that influence the access to health of irregular migrants in the Darién Gap.

Figure 2. Photo taken by Andrea Jaramillo in July 2022.
Figure 2. Photo taken by Andrea Jaramillo in July 2022.

  1. Lack of regulations that protect the right to health of irregular migrants in transit: A legal instrument in Colombia that protects the right to health of migrants in transit is absent. According to the “health sector response plan to the migratory phenomenon”, irregular migrants only have the right to access the initial medical emergency, which does not respond to the multiple needs that migrants in transit face on their journey. In Colombia, the right to health is tied to the legal status of migrants and their desire to remain in the territory, but not to the essence of their human condition, disregarding the universality and inalienability of this human right. It seems that Colombia is not responding to the commitments in international conventions such as the Global Compact for Safe, Orderly and Regular Migration, the New York Declaration for Migrants and Refugees and the Declaration of the Sixty-first World Health Assembly .

  2. Financial resources and local capacities at the borders: The migration crisis together with the poverty levels in the region of Necoclí which exceed 50% , the levels of conflict, and the lack of technical and financial resources of this region have exceeded the capacities of this municipal government to deal with the needs of migrants in transit. So far, the central government has not played a leading role in the protection of these migrants, leaving this responsibility in the hands of international organisations. According to the migration office in Colombia, these people are migrants in transit and therefore it is not their responsibility to protect them.

  3. International border order and restrictive migration policies: The significant lack of cooperation with neighbouring countries and the limited institutional capacity of the authorities in Latin American countries have produced the intensification of vulnerabilities at the borders. Despite the different meetings held between the governments of Colombia, Panama, and the United States to give solutions to the increase of migration flow of irregular migrants at this border, there is not yet a solution that puts the human dignity of these migrants over border restrictions and securitization. Most of the agreements respond to US intentions to exert control over drug and human trafficking networks, rather than to address the needs and vulnerabilities of migrants in transit.

  4. The misunderstanding of the right to health: Migrants in transit are not only exposed to emergency care during their journey, but to multiple socio-economic and structural dimensions that intersect with the social determinants of health, such as housing, water, food, security, among others. The right to health demands a holistic perspective that requires an articulated work between different sectors of society such as governments, international organisations and civil society, in which migrants can be beneficiaries of healthy living conditions throughout their migratory journey and not only humanitarian attention at the borders.

The case of irregular migrants in transit through the Darién Gap shows the absence of national and transnational policies that protect their right to health. It seems that the connotation of “transit” reinforces principles of inequality and discrimination, violating the universality and inalienability of human rights. Additionally, the creation of border security policies by governments further complicates the situation of migrants, placing them in a continuous level of uncertainty and vulnerability that profoundly affects their health condition, especially at borders where legal restrictions interact with the lack of responsibility of governments towards these migrants.

Andrea Jaramillo Contreras has a PhD in Sociology from Philipps-University of Marburg, Germany and currently works as a research assistant at Institute of the History, Theory, Ethics of Medicine at Justus-Liebig University of Giessen (Germany). She was part of the project “Migrant Health at the Borders in Times of COVID-19: Assessing Gaps, Needs and Priorities in the Implementation of Human Rights-based Health Policies and Programs in the Andean Region of Latin America” funded by the DFG/German Research Foundation (Deutsche Forschungsgemeinschaft). In the field of migration, she is particularly interested in the temporality and border dynamics of migrants on the move and the impact of international cooperation on the right to health and wellbeing of migrants. Connect with her on LinkedIn.


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