Philippe Stoesslé

Durant leur exil vers les États-Unis, les populations centraméricaines en situation irrégulière sont particulièrement exposées à des risques de santé en même temps qu'elles souffrent d'un accès compliqué au système sanitaire mexicain. Pour leur part, les institutions de santé ont beaucoup de mal à atteindre ces populations par définition mobiles. Les traditionnelles interventions de santé publique ne tiennent que rarement compte de la complexité des déterminants sous-jacents de leur santé et n'ont que peu d'effets sur elles. En réalité, la santé des migrants est essentiellement déterminée par des facteurs situés en dehors du secteur de la santé institutionnelle. Leurs conditions de voyage, de travail, de logement et de vie renferment d'importants risques pour leur bien-être physique et psychique; qui est également conditionné par leur accès aux services sociaux et de santé, leur irrégularité administrative, les conséquences des politiques restrictives d'immigration et les sentiments anti-migrants répandus qu'ils affrontent quotidiennement. Aussi, face à leurs souffrances, le Mexique alterne des postures opposées en apparence, proclamant l'accès universel au système de santé comme droit fondamental inhérent à la dignité humaine, mais qui se heurte aux priorités de « sécurité nationale » des politiques migratoires. Les politiques de santé s'inscrivent alors dans un continuum avec celles de contention migratoire. Basé sur un travail de terrain effectué entre 2016 et 2019 dans des centres de santé et des hôpitaux de l'État du Nuevo León (Nord-Est du Mexique, frontalier avec le Texas), nous avons identifié et analysé les conditions d'accès aux soins des sans-papiers centraméricains en fonction de leurs trajectoires migratoires et de vie, ainsi que des logiques institutionnelles d'accès aux soins. Nous avons interrogé les aspects, presque jamais traités, liés à la stigmatisation et aux discriminations. Le système de santé mexicain produit une discrimination systémique dans son rapport à autrui, particulièrement envers les populations centraméricaines, que les fournisseurs de soin tendent à « essentialiser » dans une catégorie stéréotypée et ethnicisée du « migrant sans-papiers centraméricain ». Face à cette situation, ces derniers élaborent des stratégies de résistance au gré de leurs ressources et de leurs trajectoires personnelles. Apparaît alors une dissension entre le droit fondamental à la santé et la situation juridique irrégulière. Le biologique se confond avec le politique, provoquant une tension permanente entre protection et menace à la santé des migrants. La frontière entre médecine et droit, entre soins et répression, devenue floue, ne peut qu'approfondir la crainte et la méfiance des migrants envers les hôpitaux et renforcer leur mise à l'écart.

This article explores the social construction of international migrants as a threat to public health and public safety in Mexico, specifically in the case of the Metropolitan Area of Monterrey, since relations within this new sense of “otherness” in this city cause issues for public health and citizen security as traditionally conceived. An in‐depth review of the secondary literature on citizen security and health security related to migration and of the Mexican legal framework was conducted, and public information requests were made to Mexican public agencies. If citizen and health security are complementary paradigms, migrants seem excluded from their application. Far from being considered holders of rights, they are primarily restricted in their exercise of rights because they are not “citizens.” These “newcomers” are perceived as “pathogenic agents” and “criminal illegal immigrants” rather than as deserving of these rights by the authorities, the media, and the majority population of Monterrey. These dynamics are likely to keep them not only on the fringes of “the city” but also in a very vulnerable position to fall victim to of all kinds of exploitation, resulting in a form of “management” of human mobility based on exclusion.

This article deals with cultural stereotypes toward Central American migrants in the Mexican healthcare system, which lead to the naturalization of the supposed cultural characteristics of these new users. Based on 21 interviews of health and administrative staff in the state of Nuevo Leon (northeastern Mexico), it shows the first recourse to culturalist explanations to describe any phenomenon related to migrants' health. According to this perspective, the health of migrants, their relation to illness, and their patterns of seeking healthcare would be mainly determined by characteristic cultural traits, which justify their penurious attendance at health centers, and their low adherence to treatments. The culturalist explanation of migrants' health behaviors may influence the care they receive, as well as their adherence to treatment, which ultimately reinforces the health inequalities initially highlighted. This culturalist excess is partly explained by the incorrect understanding of the directives of health authorities in favor of the integration of an intercultural perspective in healthcare. Despite some ongoing training in this area, it does not seem sufficient to correct this situation effectively.

How do advocacy organizations from the San Diego—Tijuana area contest and resist Trump’s immigration policies? What resources and tactics do they use to externalize their demands at the local and international levels? Based on semi-structured interviews with eight advocacy organizations—with a local, binational, and international presence—that have mobilized to externalize their demands on different local and international arenas, this research aims to answer these questions by applying the transnational advocacy networks literature to the mentioned case study. Our main findings show that transnational relations between advocacy organizations represent a counterbalance to Trump’s immigration policies. Some organizations have adapted to react to a set of new policies implemented by the administration, and, at the same time, they have diffused information, values, and ideas as part of their resistance tactics. Through transnational advocacy networks, local organizations have accomplished international relevance, turning into key players of advocacy in the region. These networks demonstrate that, despite Trump’s restricting immigration policies, transnational channels between these actors remain open for collective action.

Le Mexique est un point de passage obligé pour les migrants centraméricains en situation irrégulière qui tentent d’atteindre les États-Unis. En intégrant des contributions de la psychologie sociale et de la sociologie, notre étude exploratoire se concentre sur un sous-groupe extrêmement vulnérable de cette population. Nous avons mené dix entretiens en profondeur avec des migrants qui ont vécu le deuil d’un être cher du premier cercle familial pendant leur transit au Mexique. Après avoir analysé leurs stratégies d’adaptation au deuil et l’importance des réseaux de soutien social, nous avons observé une association entre le capital social des migrants et leur capacité de résilience. Ce travail fournit des informations qui peuvent servir de base pour de plus amples recherches liées au thème de la mort en contexte de mobilité.

This study identified risk factors for health and access to healthcare services of migrants during their journey across Mexico to the United States. Data were collected in shelters located in Monterrey, the largest city of northeastern Mexico, through a basic clinical examination and a survey completed by 75 migrants; 92% of them were undocumented Central Americans. During their transit, they are at a high risk of contracting, developing, and transmitting diseases. The need of working to survive affects health-seeking behavior and a constant fear of being traced keeps migrants away from public health services, which delays diagnosis and treatment of diseases. Negligent lifestyles, such as smoking, drinking (31.8% of men and 11.1% of women), and drug abuse (13% of men and 11% of women), were found. Regarding tuberculosis (TB), undocumented migrants are usually not screened, even though they come from countries with a high TB burden. Besides, they might be overexposed to TB because of their living conditions in overcrowded places with deficient hygiene, protection, and malnutrition (54.7% of the sample). Possible comorbidities like acquired immune deficiency syndrome (AIDS; 4%) and diabetes (2.7%, but probably under-diagnosed) were referred. Migrants have little TB knowledge, which is independent of their level of education or a previous experience of deportation. About one-third of the migrants were totally unfamiliar with TB-related symptoms, while 36% had correct knowledge of basic TB symptoms. We conclude that a shortage of information on the highly vulnerable migratory population combined with a lack of social support and health education among migrants may play a significant role in the spread of communicable diseases. We recommend that health authorities address this urgent, binational, public health concern, in order to prevent outbreaks of emerging infections.