Beyond Title 42

Humane policies at the United States border should replace harsh new asylum restrictions.

A woman hugs her child in Mexico after migrating from Honduras.

2023 © Yesika Ocampo/MSF

Alert is a quarterly magazine published by Doctors Without Borders/Médecins Sans Frontières (MSF-USA) that features ground reporting from our work around the world. This article appears in the Summer 2023 issue (Vol. 24, no. 2), Lives Uprooted.

US border policies can have dire consequences for the health and well- being of asylum seekers and other migrants. As Title 42 expires and new restrictions take its place, Doctors Without Borders/Médecins Sans Frontières (MSF) continues to respond every step of the way. 

The expiration in May of the Title 42 policy should have been a good thing. For the past three years, successive US administrations had used this public health order to effectively shut down access to asylum at the southern border. This left many people seeking safety stranded in Mexico while those who had crossed into the US were subjected to rapid expulsions without due process. The Title 42 policy may have ended, but newly announced policies threaten to worsen conditions migrants are already facing. As new harms replace the old, MSF teams in the region are bracing for the fallout. Here’s what to know about what has—and hasn’t—changed.

A migrant holds his arm out for treatment by an MSF staff member in Matamoros, Mexico.
MSF teams provide medical and mental health care to migrants in shelters and a makeshift camp in Matamoros, Mexico.
2023 © MSF

Title 42 is a public health order that was exploited to limit access to asylum.

Title 42 was originally enacted in 1944 as part of the Public Health Service Act and did not apply to the asylum system until March 2020, when the Trump administration used the pandemic as pretext to curtail immigration at the southern border. But for many asylum seekers, returning to the very dangers they fled in their home country is not an option. Instead, they have been stranded along Mexico's border region without adequate care and shelter, compounding the crisis.

New asylum restrictions will make it even more difficult to seek safety in the US.

Just as Title 42 expired in May, President Biden announced sweeping new restrictions that create more barriers to asylum. The new rules disqualify most asylum seekers who pass through another country en route to the US southern border if they enter the US without authorization. All asylum seekers are now required to secure an appointment with border officials using CBP One, a mobile app that is inaccessible to people with literacy or language barriers and those without access to a smartphone. Asylum seekers must also demonstrate "exceptionally compelling circumstances by a preponderance of evidence" for protection in the US. Like Title 42, these policy changes are designed to deter asylum seekers, but they only further endanger the lives of people seeking safety.

For many asylum seekers, returning to the very dangers they fled in their home country is not an option. 

These policies have dire consequences for migrants’ health.

The journey through the Americas to the US border is long and dangerous, with limited or no access to food, shelter, or protection from targeted attacks and sexual violence. Many migrants may fall ill due to freezing temperatures or crowded conditions that allow diseases to proliferate rapidly, while access to medical care is severely limited or nonexistent. By creating a bottleneck at the border, the new asylum restrictions will prolong migrants’ exposure to harmful conditions while further straining the capacity of local care providers.

Two people whose faces we cannot see sit on black plastic chairs, facing each other. One is wearing a blue T-shirt the other is in an MSF vest.

Maynor meets with an MSF mental health professional to discuss his experience.

2023 © Yesika Ocampo/MSF

White MSF vehicles in the desert at the US-Mexico border.

MSF teams provide physical and mental health care to migrants at different points along the Central American migration route.

2023 © Yesika Ocampo/MSF

The journey through the Americas to the US border is long and dangerous, with limited or no access to food, shelter, or protection from targeted attacks and sexual violence.

A migrant family including mother, father, and child stand together at a shelter in Mexico.
Cinthia Yolani Matute Cruz, her husband, and their son sleep in a tent in the desert. They registered for an interview at the US-Mexico border, but when they showed up, they were turned away because their record didn’t appear in the system.
2023 © Yesika Ocampo/MSF

MSF teams are stationed directly on migration routes throughout Central America and Mexico.

MSF teams are strategically positioning operations along common migration routes to reach the most people in need of medical and mental health care. Last year, MSF provided more than 108,510 medical and 10,183 mental health consultations to migrants and asylum seekers. Services included care for children and adolescents, treatment for survivors of sexual violence, and health promotion. But much more support is needed to meet growing needs.

Ending Title 42 is not enough. We must rebuild a safe and humane asylum system.

Harsh deterrence policies don’t work; they only force people into more danger. The US must not turn its back on asylum seekers. All migrants—no matter where they are from or what their circumstances—should be treated with dignity and compassion. People seeking safety should not be thrown back into harm’s way.

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