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People on the Move: Global Migration as a Context for what We Need to Do as Health Care Providers

Wednesday, February 10, 2016   (0 Comments)
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Tina Castañares, MD, Hood River, Oregon

Editor's Note: Dr. Castañares will be presenting on migration at the Western Forum for Migrant and Community Health February 24-26 in Portland, OR 


Never before in history have so many people, from so many places, been on the move -- fleeing or  leaving behind their own towns, countries, even continents and hemispheres. 


In the field of migrant and community health, we’ve long regarded migration and immigration largely as a matter of seeking work and “making a better life” for one’s family.  We’ve always known there are important geopolitical reasons that conditions in the “sending countries” (Mexico, the Caribbean nations, others) “push” many of their citizens northward.  But we’ve usually focused our attention on official US immigration policy, and even more on the conditions of life in this country once people have arrived.  Generally we’ve not considered the “migrant streams” in a broader context of global income inequities, injustices, climate change, and other forces creating such movement.    


Today we must broaden our field of vision.  Racism, nativism and exclusionism have emerged more strongly than ever, both here and around the world, as migrants and refugees from developing or impoverished countries try to find new homes in wealthier nations.    


Many (“the internally displaced”) cannot successfully escape their homelands, or are forcibly returned to them …..homelands with governments which cannot or will not protect their citizens.  Of those who apply for refugee status to the United Nations, only about 1% are successful.  People ‘lucky’ enough to be sheltered and served in refugee camps nowadays typically spend over 10 years there before relocation or resettlement.  Migrants who get into another country, like the unaccompanied minors from Central America arriving within our southern borders, rarely succeed in being given asylum status – despite the circumstances they are fleeing.  Millions now are trying to escape war and the devastation of natural and human-caused disasters but are increasingly facing closed doors, fear, a lack of resources, even a violent reception wherever they go.


What’s going on?  What is the relevant history, and what can we predict for the decades to come?  It’s time to discuss global forced migration -- why most people leaving their homelands today have no choice, as a result of war, gang violence, trafficking, extortion, religious persecution, tribal and ethnic ‘cleansing,’ coercion, climate change, and sudden catastrophes.  At the same time we must acknowledge the central roles our own country has played in creating these drivers of migration.  Only by better understanding this larger context can we address, together, the questions of “who is my neighbor?  who is my family? ” and rise to our moral obligations as global citizens. 


I’ve followed trends in world migration for some 20 years, looking through a lens of ethics.  Migrants reaching the US in the past 5+ years who become farmworkers are likely to be different – and will be treated differently – than those of 10 years ago.  “Guestworker” programs in agriculture and other industries will probably be revived or utilized even more than they are now, but possibly with less (not more) protection for workers due to the xenophobia characterizing this heated election year.  Immigrants from Asia, Africa, and the Middle East may well experience more suspicion and enmity today, and they will require differently planned services, support, and programs.  Many of them will be survivors of significant trauma and deprivation.


Anti-immigrant rhetoric has heated up again in our nation.  Health and human services professionals and advocates like ourselves are greatly needed as informed advocates, educators, and humanistic providers who recognize the extreme vulnerability – but also the remarkable richness and value --  of international migrants in our society.


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