“I Need to Keep Me and My Mother Safe”: The Asylum Crisis at the US-Mexico Border

Thank you for your publication of “I Need to Keep Me and My Mother Safe: The Asylum Crisis at the US-Mexico Border” by Dr. Elena Hill. As her former Program Director at Boston Medical Center, I was thrilled to read her important perspectives and the narratives that she shared -- ones that shine light on the deep and important hard truths that endure at our national borders.
As a family medicine physician working on the front lines of an urban safety net hospital, I was also struck by how Dr. Hill’s stories of refugees ring true for many of the structural barriers that patients have within our national borders. In particular, the author’s stunning narratives of people who have suffered discrimination in their home countries, having to take a number and lining up without any clear sense of where they are in the line, when they may be called (“from months to years”) or whether in fact they will ever be called, parallels many of the narratives I hear from patients daily as they struggle to find safe and stable housing.
The term “housing instability” is broad and includes moving frequently,staying with friends or relatives, or spending the bulk of a household income on housing (1,2). Black and Latinx households are two times more likely to experience housing instability (3), as are Blacks who have spent time in prison (4). In fact, 5 years after release from prison, Black individuals who have spent time in prison were more likely to experience housing instability than White individuals who have spent time in prison, even after controlling for earnings (4).
I have seen, and studies support, that housing instability not only negatively impacts health but also makes it more difficult for my patients to prioritize and access care (1,5,6).
The rates of housing instability, though somewhat abated by rent moratoriums during the pandemic, continued to skyrocket as a result of job loss and insecurity during COVID-19 - further exacerbating health inequities experienced by Black and Latinx populations, And safe and stable housing remains an elusive numbers games. Individuals and families take numbers and “wait in line” for public housing, without any clear idea of how long the wait will be and what they can do to protect themselves in the intervening months and years. Communication is often elusive and confusing, especially for individuals who may not speak English as a first language or have a low level of educational attainment.
How long will we keep people waiting, both within and at our national borders, to be let into a “home”? A place where they can feel safe to tell their stories, access true health, and begin their lives again?

Sincerely,

Katherine Gergen Barnett, MD,
Vice Chair of Primary Care Innovation and Transformation, Boston Medical Center
Clinical Associate Professor of Family Medicine, Boston University Medical School

References
1. Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006;21(1):71-7. doi: 10.1111/j.1525-1497.2005.00278.x.
2. Frederick TJ, Chwalek M, Hughes J, Karabanow J, Kidd S. How stable is stable? Defining and measuring housing stability. J Community Psychol. 2014;42(8):964-79.
3. Joint Center for Housing Studies. The state of the nation’s housing 2014 [Internet]. Boston: Harvard University; 2014 Jun 26 [cited 2017 Nov 27].
4. Geller A, Curtis MA. A sort of homecoming: Incarceration and the housing security of urban men. Soc Sci Res. 2011;40(4):1196-213.
5 Cutts DB, Meyers AF, Black MM, Casey PH, Chilton M, Cook JT, et al. US housing insecurity and the health of very young children. Am J Public Health. 2011;101(8):1508-14. doi: 10.2105/AJPH.2011.300139.
6 Meltzer R, Schwartz A. Housing affordability and health: Evidence from New York City. Hous Policy Debate. 2016;26(1):80-104.