Migration Series | Precarity along the Colombia–Panama border: How providing healthcare services to transit migrants can foster new logics of inclusion and exclusion

Transit migrants journeying the Americas to North America often pass through Necoclí, a seaside town close to the Colombia–Panama border and the Darien Gap. Upon their arrival, they frequently require medical attention but can only access emergency medical services. In this article, Carolina Aristizabal shows how a limited healthcare provisioning system designed for immobile populations has been reworked by humanitarian organizations to help transit migrants receive the care they need. She argues that new logics of inclusion and exclusion emerge as a result of such reconfigurations — a development that may lead in some cases to xenophobia in local communities.

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Traversing the Americas

On their way to Mexico, the United States, and Canada, irregular migrants coming from as near as Venezuela, Haiti, and Ecuador and as far as India and Senegal arrive at Necoclí, a seaside town located near to the Colombia–Panama border. Here, after crossing the Gulf of Urabá, they enter the Darien Gap, a geographic region in the Isthmus of Panama that connects South America with Central America. From there they travel further north. In 2022, around 250,000 migrants arrived in Panama through the Darien Gap; this year, by July 2023, around 252,000 people have already undertaken this journey.[1]


Health care provisioning: for whom?

When in Necoclí, transit migrants often require assistance, especially in the form of healthcare services. However, even though they may stay in the town for weeks on end, transit migrants are frequently seen as outsiders of ‘immobile’ social provisioning systems usually underpinned by citizenship. As a result, they have access only to limited medical services, which adds to the precarity they already face. Several humanitarian organizations have stepped in to fill the gap left by a lack of government healthcare services for this group of people. Yet, the local implications of this workaround remain underexplored.

For this reason, I decided to conduct research on the topic in the framework of the research paper for my Master’s degree in Development Studies. I observed and conducted interviews with healthcare providers and inhabitants of Necoclí last year because I wanted to understand the different ways in which the Colombian government and non-governmental actors organize and legitimize the provisioning of healthcare services to these transit migrants, especially in a context in which local communities are living under precarious conditions with unsatisfied basic needs. Some of my findings about precarity, categorization, and humanitarian action are highlighted below.


Continued precarity while waiting

When migrants arrive in Necoclí, a lack of reception facilities in the town add to the already existing, often precarious traveling conditions they face when making their way there. For example, while some of them can stay at hotels once they’ve arrived in the town, others have to sleep in tents and hammocks on the beach, close to the two municipal docks.

Staying close to the sea allows them to wash their clothes and bathe in its waters. However, they do not have a roof over their heads or access to running water or sanitary facilities, and they are less safe in public spaces. The border zone between Colombia and Panama is characterized by a weak governmental presence and the dominance of armed groups, especially the Gulf Clan (El Clan del Golfo), which controls drug and arms trafficking routes along this Colombian border (Garzón et al., 2018) as well as the migration dynamics in the territory to a large extent.[2]

Moreover, while some migrants are immediately able to buy boat tickets from a company offering transportation through the Urabá Gulf once they arrive, others must stay in Necoclí as long as needed to gather the necessary money to buy these tickets. This means that hundreds if not thousands of migrants may be stuck in the town for days or weeks on end before being able to travel further.


A lack of adequate healthcare services

Transit migrants typically undergo long and arduous journeys and upon their arrival in Necoclí may require medical attention to treat amongst others mental health issues, HIV infections, Covid-19 infections, rabies, and food or water poisoning. Pregnant women also need prenatal care. In 2022, Necoclí had one public hospital where migrants could receive emergency services for free, as well as some ‘low-complexity’ services such as vaccinations and laboratory tests for prioritized populations.

However, many of their health issues remain untreated partly because the government’s Principle of Universality does not apply to non-citizens. According to the Healthcare Law (Law 100 of 1993), under this principle everyone in Colombia has the right to access healthcare services at any moment of their lives, without any type of discrimination. Colombian nationals and migrants with resident permits can access any available public healthcare service. However, given the citizen requirement, migrants in transit can only access emergency services — highlighting the boundaries to the ‘Principle of Universality’.


A dual role for humanitarian actors

In 2022, to make up for the gap in the provisioning of healthcare services to transit migrants, non-governmental actors such as the Colombian Red Cross, the Colombian Institute of Tropical Medicine with the International Organization for Migration (IOM), Mercy Corps, UNICEF, and HIAS started providing healthcare services that extend beyond emergency care. These services included 1) psychological assistance, 2) sexual and reproductive health services, 3) children’s growth and development programmes, and 4) dentistry — services that are considered ‘non-essential’ and were therefore not provided to transit migrants by the government.

In this way, humanitarian actors assumed two different roles: on the one hand, they supported the state in its responsibility to provide emergency services, and on the other hand, they complemented this service based on a more dynamic reading of the needs of transit migrants and of the types of health provisioning necessary.

For humanitarian actors, these services were provided based on the Principle of Humanity, which refers to the aim of saving lives “in a manner that respects and restores personal dignity”[3] for any person, as well as the IOM’s mission to promote “humane and orderly migration that benefits migrants and societies”.[4] Moreover, non-governmental actors also made use of the resident/migrant binarity to define their criteria of eligibility, since some of them provide healthcare services just for transit migrants, while others also provide medical attention to permanent residents under particular circumstances.

As an example from my fieldwork, a Colombian child living in Necoclí could not be part of the Red Cross growth and development programme, even though she or he had been insufficiently attended to by the Colombian health system due to a lack of resources. On the other hand, both a Colombian woman living in Necoclí and a transit migrant had access to Mercy Corps’s programme on sexual and reproductive health.


The need to maintain a delicate balance

The dynamics of transit migration changed the healthcare system in Necoclí since governmental and non-governmental responses to the needs of transit migrants are based on their principles and their capacities. They made use of the resident/transit migrant duality as an eligibility criterion to define medical attention. The importance of this research lies in the possibility to understand how governmental and non-governmental actors, as well as Necoclí residents, reconfigure and problematize the criterion that is used to define the accessibility of transit migrants to the healthcare provisioning system.

In a context in which inhabitants face big challenges to access basic healthcare services, the use of this criterion requires maintaining a delicate balance between responding to the needs of transit migrants and the needs of residents. The provisioning of medical attention for transit migrants arriving to Necoclí allows us to understand not only how an immobile social system responds to the needs of a mobile population but also to analyze how the precarious conditions of migrants and residents shape and legitimize the eligibility criterion to this system. When non-governmental actors exclude residents from their services, this can lead to perceptions of unfair treatment and acts of xenophobia by residents, which could deteriorate even more the precarious conditions of transit migrants.

In the framework of migration governance, the eligibility criterion that is used by governmental and non-governmental actors to provide healthcare services should go beyond their principles to also consider the imaginaries and relationships that they reinforce in local communities and that end up (de)legitimizing health provisioning for transit migrants.

[1] https://www.migracion.gob.pa/inicio/estadisticas

[2] https://voragine.co/las-victimas-de-la-selva-asi-trafican-con-migrantes-en-necocli/

[3] United Nations High Commissioner for Refugees, 2022

[4] International Organization for Migration, 2022

This is part of and concludes the Migration Series. Read the previous topics on the migration series:

How does a place become (less) hostile? Looking at everyday encounters between migrants and non-migrants as acts and processes of bordering.

From caminantes to community builders: how migrants in Ecuador support each other in their journeys.

From branding to bottom-up ‘sheltering’: How CSOs are helping to address migration governance gaps in the shelter city of Granada

“Us Aymara have no borders”: Differentiated mobilities in the Chilean borderlands

Opinions expressed in Bliss posts reflect solely the views of the author of the post in question.

About the author:

Carolina Aristizabal is a Colombian political scientist and holds an master’s degree in Development Studies from the ISS. She has worked with non-governmental organizations and the local government in the city of Medellín, her hometown.

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