MSF: World Refugee Day: Fear Is Also a Border

North the migrant walks, their goal still in sight, but once they cross the line, they learn with dread That fear is still with them, breathing down their neck.

It starts the day it becomes unbearable to stay one more night in your home. When you pack a bag not knowing if you’ll ever return—or even survive. Fear cuts through the migrant experience. First, instinct. But eventually, it can become an illness.

Throughout the migratory route, Médecins Sans Frontières/ Doctors Without Borders (MSF) witnesses how physical, verbal, or psychological suffering turns into fear that paralyzes those who feel it but serves those who use it—whether political actors, criminal groups, or a society lacking empathy.

In migration, fear quickly stops being just an emotion. It becomes currency—a price paid in dollars, pesos, or euros. Sometimes it even comes before money: fear is the first true cost of a journey that hasn’t yet begun—and one that keeps collecting long after a person has crossed any border.

In Tapachula, at Mexico’s southern border, Viridiana says the terror began at home. “My children witnessed everything,” she told MSF social workers at a local shelter. “I left my country… I never thought I’d end up here. I didn’t even know where I was going. I just knew I had to leave, because my son’s father was threatening to kill me if he ever saw me with someone else.”

“I have a cut on my face,” Viridiana says. “Two stab wounds on my legs, a blow to the head with a revolver, another to the nose with a glass plate. There are so many things you can see that I just can’t erase… and the ones in my heart, only God can heal.”

Across the route, MSF’s mental health teams work with people who have suffered violence or sexual violence—whether in their home countries or during the journey. In cities like Esquipulas (Guatemala), Tapachula, Mexico City, Reynosa and Matamoros, stories like Viridiana’s are painfully common, part of a systemic crisis, not an accident.

“From a mental health perspective, we see fear reflected in clinical histories, yes,” says Alejandro Alvarado, MSF’s Mental Health Activity Manager in Reynosa and Matamoros, “but it goes far beyond anything that can be recorded as a symptom.”

“There are two ways to understand fear. The first is a natural emotional response to a threat: if I see a snake, I might flee or freeze. Both are normal, adaptive responses. That’s useful fear.”

But when fear is used to control or manipulate migrant populations, it crosses through pathology. “When fear is prolonged,” Alvarado explains, “it stops being a healthy reaction. It becomes chronic and constant. And that’s when it starts to affect how we function day-to-day. It becomes pathological. Just like prolonged sadness can turn into depression, sustained fear can become disabling. It’s no longer just an emotion—it starts to affect our ability to live or survive in our environment.”

Fear blocking us

In Esquipulas, a town near the Guatemalan-Honduran border, Paula says she chose not to continue her journey rather than face more violence. “We already made it to Mexico, we were in Tapachula. But we didn’t go any further because we were too afraid,” she said outside one of MSF’s mobile clinics. “They said if migration police didn’t catch you, the cartel would.”

She’s a survivor of sexual violence in the Darién Gap. Armed men also threatened her four-year-old son. “In the jungle, they put a gun to his head. Thank God he’s still too innocent to understand most things, but yes, they put a gun to his head—to threaten his father.”

Paula’s family attempted to apply for asylum legally through CBP One, an web app made by the Biden administration aimed for an orderly asylum application to the U.S. available in many cities in Mexico. But when the current U.S. administration canceled the program on it’s first day in office, her plans collapsed. “I’ve kind of come to terms with it now,” she said months later. “But it hurt a lot knowing I was going to have to make the same journey again… only this time, with nothing.”

And the threat still lingers. “I’m okay now,” she says, “but there are moments when I feel like someone is following me. Like there’s an enemy behind me.”

Paula’s experience illustrates exactly what Alvarado describes. “Fear doesn’t necessarily respond to a visible threat,” he adds from his base on the Mexico–United States border, “but rather to past traumatic experiences or the context in which people are living. It’s a constant, anticipatory fear—not because of what already happened, but because of what could happen at any moment.”

Holistic support for invisible wounds

In cases like these, fear stops being a temporary emotion and becomes a disabling condition. While it is not the only factor, it is a recurring feature in the majority of mental health cases MSF supports,

and it causes not only deep suffering but also numerous complications throughout the therapeutic process as patients and therapists work to regain mental stability.

As part of the comprehensive care MSF provides, an important tool is the mhGAP program, a WHO initiative that trains medical and psychology staff to deliver psychiatric-level support in contexts where there are no psychiatrists, no specialized services, and no access to medication. This protocol is activated when therapeutic interventions alone are not sufficient and allows for the integration of medical evaluation, psychological care, and, when needed, pharmacological treatment.

“What we aim to do is expand treatment options for people,” explains Alvarado, “offering a comprehensive approach, with the person’s consent, and adapted to their reality.” Between October 2024 and May 2025, MSF’s mental health teams in Guatemala, Reynosa and Matamoros, Mexico City, and Tapachula carried out more than 2,200 individual consultations, and over 240 mhGAP cases were started and followed up. But beyond the numbers, the biggest challenge is continuity: many of the people we treat are still on the move or living in unstable conditions, which makes it hard to follow through on therapeutic processes that require time.

That is why, in addition to mhGAP, MSF also works under a broader Mental Health and Psychosocial Support (MHPSS) approach, which seeks to respond at the community level—before suffering turns into pathology.

Not all wounds are visible. But when fear threatens to become permanent, humanitarian care must find pathways to recovery where borders have been closed by prejudice and xenophobia.

MSF teams provide support to people in transit along the Latin American migration corridor, offering care in mental health, social work, health promotion, and primary medical attention. We call on authorities, humanitarian organizations, and civil society actors to stop deepening the mental health crisis of people on the move, and to take an active role in building safe environments that foster their physical, psychological, and emotional well-being.