Thousands of migrants have been living for months on the US-Mexico border in makeshift encampments, where they rely on volunteers for basic necessities and are targeted by criminal gangs while they wait for a chance to apply for asylum in the US.

For these already vulnerable migrants, the implications of a potential coronavirus outbreak could be devastating.

For now, only seven cases have been identified across all of Mexico, and no cases have been identified in cities with high concentrations of migrants, such as Matamoros, Juárez, and Tijuana.

But as new cases are reported daily worldwide, aid workers believe it could only be a matter of time before it hits these border cities, where thousands of migrants have been living in makeshift tent encampments that have little means to deal with a major public health crisis.

Since February 2016, the Trump administration’s policies at the border have forced migrants to wait in Mexico for months at a time. US Customs and Border Protection officials have been limiting the number of asylum seekers they process at ports of entry each day, making migrants wait for their turn in Mexico, where migrant shelters are at capacity. Across Tijuana, Nogales, and San Luis Rio Colorado — the three largest ports of entry on the southern border — nearly 12,000 asylum seekers were on the waitlist to be processed as of November, the most recent month for which data available in court filings.

Even after migrants are processed, they are quickly sent back to Mexico under the Trump administration’s “Remain in Mexico” policy, officially known as the Migrant Protection Protocols (MPP). More than 60,000 migrants have been sent back to await decisions on their US asylum applications.

Only some of them have been lucky to find housing in shelters, hotels, or rooms for rent. For thousands of others, only colorful tents and tarps stand between them and the elements.

In Matamoros, a city of about 500,000 people across the border from Brownsville, Texas, about 2,000 migrants have moved into tent encampments along the Rio Grande — so close to the US border that they can show up at the port for processing whenever their names are called. These migrants are already at risk for extortion, kidnapping, and rape at the hands of cartels and other criminal actors; they are dependent on American volunteers for even the most basic necessities.

Now they are vulnerable to another threat: the novel coronavirus. A group of NGOs offering basic services to migrants in the camps is already working with the Mexican government to prepare for the possibility of a coronavirus outbreak.

“We know that this is something that could severely impact the encampment,” said Andrea Rudnick, cofounder of the nonprofit Team Brownsville, one of the organizations on the ground in Matamoros. “On a daily basis, we’re hearing of more cases. It won’t be long now before we have a case in Brownsville.”

An outbreak of coronavirus along the border would likely spur a crackdown from the Trump administration, which has already floated (and walked back) the idea of closing the border.

It would also be a humanitarian crisis for the migrants themselves — who seem to be the most at risk of catching it not on their journeys to the US but from American volunteers trying to help them.

How volunteers are preparing

The UN High Commissioner for Refugees (UNCHR) runs refugee camps in other parts of the world, including major camps for Syrian refugees in Jordan and for Rohingya refugees in Bangladesh. But UNHCR has nothing to do with these makeshift encampments along the US-Mexico border. Migrants themselves are in charge, with some oversight from the Mexican government and international NGOs.

The infrastructure is therefore lacking. Some tents were erected on land that has been contaminated with feces because there were no public toilets, raising concerns about E. coli infections. Running water is in short supply. Volunteers preside over several “tiendas” — Spanish for stores — that dole out basic supplies, free of charge. And Global Response Management, a health care nonprofit, has set up a mobile health care unit in the middle of the encampment.

It would be difficult to contain the spread of the coronavirus in the camps with thousands of people living in such close quarters. But aid workers on the ground are working on coming up with a protocol to quarantine anyone who is infected.

Helen Perry, the executive director of Global Response Management, said that the organization is planning to set up separate tents that are somewhat removed from the rest of the encampment, creating “cold,” “warm” and “hot” zones of isolation. They would have to get permits to do so, and isolation would need to be voluntary. On March 2, aid workers also met with Mexican immigration authorities, who are working on their own plan to quarantine people.

In the meantime, they’re also taking measures to prevent coronavirus from spreading to the camps in the first place. “Where the camp is located is fairly isolated, and we can say relatively [confidently] that the majority of people in the camp have not recently traveled to Europe or Asia, so that reduces their risk,” Perry said. (The vast majority of asylum seekers arriving at the border come from Central American countries, but some migrants hail from other countries, notably Cameroon.)

The biggest risk could come from American volunteers, who could be carrying the virus unknowingly during the two-week incubation period and inadvertently infect people in the camps.

Volunteers have been instructed not to come to the camps if they have been exposed to coronavirus, if they have traveled within the past 30 days to Europe or Asia (where there are a high number of active infections), or if they have a fever, cough, or flu-like symptoms. These kinds of restrictions, however, might become less effective as community spread continues in the US.

Everyone from the World Health Organization to the US Centers for Disease Control and Prevention recommends regular hand-washing as one of the top ways to prevent the spread of the virus. But there’s limited access to running water in the camps, which makes that hard.

It’s not the first time that volunteers have wrestled with how to prevent sickness from sweeping through the camps. Cases of infectious diarrhea have been a major concern, as has seasonal flu, which poses a danger to children and pregnant women in particular. Rudnick said that volunteers have tried to administer as many flu vaccines as possible, but they’ve been limited by how many they’ve been able to obtain in Mexico since they can’t import the vaccines from the US.

Other than preventing the virus from reaching the camps, Rudnick said a big concern is how asylum seekers will access food and other supplies if American volunteers can no longer come across the border because they have to quarantine themselves or if travel is restricted — either by the US or Mexican governments.

They are now creating a two-week stockpile of nonperishable food, including rice, beans, and canned vegetables and meats, that asylum seekers can access themselves. But like many medical providers across the US, they’re having difficulty sourcing medical masks and other equipment due to shortages.

The group of NGOs is also creating a contingency plan in the event that American medical volunteers can’t come to the camps. Global Response Management, which relies on US-based staff, can administer basic health care to migrants, but it is not equipped with the kind of specialized medical equipment that an outbreak might demand — for example, a ventilator to help someone breathe. For that, they would rely on the local hospital, which is already stretched thin.

“Health care infrastructure in that area is already stressed,” Perry said. “There’s no guarantee that we would be able to get hospitalization if they needed that.”

But with no reported cases of coronavirus in the area yet, Rudnick said volunteers are also cautious not to alarm asylum seekers, many of whom have fled life-or-death situations in their home countries and are already experiencing trauma.

“Right now, we’re trying to not panic anybody,” she said.

Trump’s policies are putting asylum seekers in danger

If it weren’t for the Trump administration’s policies, the migrants who have been forced to wait in these encampments would already be in the US. Migrants arriving at the border were previously processed in much greater volumes and allowed to enter the US quickly, where they were released by immigration agents if they didn’t pose a public safety risk or were found likely to flee, or else sent to immigration detention.

It isn’t a question of CBP’s capacity: In October 2016, US Customs and Border Protection officials processed more than 20,000 people at ports of entry across the border. By contrast, they processed fewer than 10,000 people in October 2019 although the agency’s budget had increased by about 19 percent over the preceding three years.

The policies Trump has enacted on the border are designed to keep migrants out. The administration has credited MPP for the recent 75 percent drop in arrests at the southern border as well as for helping to all but end the practice of detaining families — since most have instead been sent back to Mexico under the program.

Meanwhile, the US hasn’t administered on-the-ground support to migrants stranded in Mexico. Congress approved a funding bill last year that included aid for additional resources, including medical care and basic necessities, inside the ports of entry but not on Mexican soil. The US has continued to send aid to Mexico — $139 million in 2018 — but otherwise, advocates haven’t seen any evidence of a US presence on the Mexican side of the border administering aid to migrants.

The humanitarian crisis is happening in plain sight, and as the threat of a coronavirus pandemic looms, the Trump administration’s policies have made them even more vulnerable to an outbreak than they would be in the US.