Migrant families in a sports facility near the border in Tijuana. Courtesy Tijuana mayor’s office

She was hunched, wrinkled as a raisin, and supported herself on her cane as she took a seat across from me at the intake table. I looked into her weary eyes through the dim light of the church auditorium and it occurred to me, that in seven months of translating for doctors in Tijuana, I had never seriously considered the unique plight of the older refugee.

I’m not alone — for most people, this is a subpopulation that is out of sight and out of mind. To date, I have never heard any doctor, community leader, or relief organization member discuss targeted efforts to protect older refugees or directly acknowledge their unique needs and contributions. The vast majority of social support programs for asylum-seekers benefit young children or working-age adults — people with a future and economic potential. Refugees are among the world’s most marginalized people, making older refugees quite possibly the most neglected demographic on earth.

I looked back up at the frail woman and began her medical history intake form by asking for her name and year of birth. Claudia, I call her, was born in 1965. Claudia was younger than my mother, but she looked more like my grandmother. She was fleeing persecution, and the exposure to violence in Guatemala and her journey North had aged her prematurely. Those who count as “older adults” vary significantly among individuals, especially those of different cultural and socioeconomic backgrounds. The aging process is influenced by many factors, including exposure to pollution, lack of health care, difficult physical labor, inadequate access to contraceptives, chronic stress, and much more.

Claudia squinted at me as she complained of back pain, headaches, chills. These ailments were not unique. As I moved from camp to camp that day, I noticed a pattern: almost every older adult I met suffered from an aching back. Towards the end of the mobile clinic visitations, I finally asked a patient why he thought back pain was so common. His answer was simple: the concrete.

Many refugees in Tijuana avoid living on the streets by moving into crowded shelters on the outskirts of town. Families sleep in tents on hard concrete floors, surrounded by up to 200 strangers. The elders of the family are less physically resilient than their younger counterparts, yet they’re often the first to sacrifice bedding and insulation to allow their children and grandchildren to sleep more comfortably.

These refugee families have traveled for hundreds of miles — from Central America, southern Mexico, Haiti, and Cameroon — to reach the U.S.-Mexico border just to remain in Mexico until their asylum case is heard. Phil Cañete, the lead clinic coordinator of the Refugee Health Alliance, emphasized that “the majority of asylum seekers are young. The journey to Tijuana is fraught with danger through every step of travel. It is incredibly physically demanding and so, naturally, most asylum seekers are young and healthy. However, the older asylum seekers that arrive risked the journey out of desperation.”

I also spoke with Jose Maria Garcia, director of the Movimiento Juventud 2000, or “youth movement,” shelter about the unique challenges older adults in the shelter must face. He responded that the lack of alternatives, the danger outside the shelter walls, and the risk of being torn from loved ones forces many older adults to adapt to the shelters available to them. He estimates that 90% of the asylum-seekers in his shelter wait at least  six months before the backlogged U.S. immigration system agrees to hear their case, which doesn’t necessarily guarantee entry or a chance to restart their lives.

The vulnerability of older refugees stems from the fact that they often suffer from chronic health conditions or impaired mobility, which reduces their capacity to provide for themselves or their families. Given that refugees are fleeing violence, persecution, or natural disasters, most arrive in Tijuana impoverished, malnourished, and psychologically traumatized. Cañete summarized the biggest gaps in care for older refugees as medications, food, and housing. He elaborated that Seguro Popular, the public health insurance in Mexico, “previously allowed anyone, regardless of immigration status, to receive subsidized medications for at least three months. This benefit ended in January 2020 due to pressure to curb immigration and to push back against the growing population of Central American asylum seekers.”

Food insecurity among elders is rampant because the few soup kitchens that exist in Tijuana cater to those who can arrive by foot. Beyond the ambulatory limitations that come with age, the COVID-19 pandemic has trapped shelter occupants inside with no possibility of leaving to seek additional nutrition. Furthermore, there are simply not enough beds in Tijuana’s shelters to accommodate the city’s substantial homeless population and growing base of older asylum seekers.

Cañete explained that, “for older asylees in this time of crisis, isolation will be critical in preserving the health of those who are most vulnerable. Right now, the Xolos stadium in Tijuana is being converted into a venue to isolate individuals. This will be beneficial to some, but there are not enough beds. The Mexican government must take steps to increase capacity for isolation and steps to address food insecurity and housing.”

Isolation is crucial because the refugee shelters in Tijuana are hotbeds for infectious diseases: overcrowded, poorly-ventilated spaces with insufficient food, beds, and personal hygiene products. We can help by promoting organizations such as the Refugee Health Alliance or the Al Otro Lado legal group, which are collaborating to identify at-risk migrants, such as older refugees, and isolate them in hotel rooms for the remainder of quarantine.

The reality is that older refugees are both vulnerable and valuable. Older refugees, like Claudia, are important members of both their families and communities. People like her maintain cultural traditions, pass on folklore, care for grandchildren, and can act as stabilizing forces for families in transition. To take advantage of these powerful reservoirs of knowledge, humanitarian organizers must seek the input of older refugees in the development and implementation of relief programs. Educational and vocational training must include older refugees to facilitate their adaptation to their new circumstances.

Finally, the asylum seekers in Tijuana who are able to reach the U.S. need American advocates. Constituents must pressure elected officials to extend the COVID-19 relief stimulus package to care for asylees. Cañete believes that’s critical because “asylees are arriving to the States solely with the items they can physically carry. They are under-resourced and need help to adequately isolate and provide for themselves and their families in this time of crisis.”

Now, more than ever, we must stop ignoring the plight of older refugees, like Claudia, and acknowledge that the only difference between elders languishing in Tijuana and our own parents or grandparents is a trick of fate in birth and circumstance.

Alexandra Reep is a 4th-year undergraduate student at UC San Diego who volunteers at the refugee shelters in Tijuana.

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