Swift mental health response for migrants and asylum seekers crossing the US-Mexico border

For many people traveling through the Americas in search of safety, crossing the southern border into the United States marks the end of a dangerous and uncertain journey—but the start of another that brings its own challenges.

In August, Doctors Without Borders/Médecins Sans Frontières (MSF) resumed collaboration with local humanitarian organizations in Arizona that assist people crossing the southern US border from Mexico, delivering essentials like hygiene products, food, water, and psychological first aid.

Many migrants describe a flood of emotions and relief for having arrived, but also sadness and anger over the difficulties they have experienced and homesickness for what and who they left behind.

Below, Athena Viscusi, a clinical social worker in MSF’s psychosocial care unit working in Arizona, answers questions about our work with people crossing the border, their needs, and what they tell her about their experiences before arriving in the United States.

What are some of the needs that asylum seekers have right after they cross the border into the United States?

We talk about post-traumatic stress in people on the move. But for those who are just crossing the border, it’s not post-traumatic. They are still in a kind of traumatic reaction, which is a physical and a mental state. And they should be. They are hyper alert, and ready to run at any moment after what many of them have gone through.

At this point, it's important to restore that sense of control and agency. They've been completely disempowered and at the mercy of other people. Some have been brutalized repeatedly. And if not themselves, they have witnessed other people being brutalized. Some have been under a constant threat of violence for days, weeks, or months.

There is also physical exhaustion. Some of them have been sleeping outside or not sleeping at all, traveling on the floor of a car, or just walking for miles. They really have such overwhelming physical needs that need to be fulfilled: food, water, and rest.

How can aid organizations help meet these needs?

The most relevant psychosocial intervention for most arrivals is psychological first aid—that includes meeting their immediate physical needs for food and rest, listening to them, and connecting them with necessary information. The presence of a trained mental health professional permits more targeted interventions and helps people in distress get relief and develop skills.

Some are from extremely deprived circumstances, have little education or possessions, or are from marginalized or oppressed groups in their countries of origin. Often their family units have been disrupted and they may have lost travel companions along the way.

The length of stay in volunteer-run makeshift camps, size of the group, languages spoken, and the severity of needs affect the quantity and quality of psychosocial services that can be provided.

What material items provide the greatest immediate comfort to those arriving?

Often, there is no cell phone connection along the border wall and for many stretches of desert in the Mexico and US sides of the border, so provision of internet is a key psychosocial intervention; it allows migrants to contact their families.

For volunteers who are helping migrants and asylum seekers on the US side, an internet connection facilitates access to websites and phone calls to get information to reassure and orient them—for example, how to locate someone in detention, where to find medical services in the city of destination, educational materials in various languages, and of course, translation apps.

Providing simple recreational activities for children, such as bubbles, balloons, and small toys, is also a useful psychosocial approach. Trained mental health professionals can also address parents’ concerns about their children and provide information about the immigration process ahead.

What are some of the stories you heard from migrants and asylum seekers and how you were able to help?

We spoke with a Chinese woman who had been forcibly implanted with an intrauterine device (IUD) due to China’s “one child policy” and religious discrimination. She was crying hysterically, and her partner specifically requested psychological help for her.

A Honduran woman fleeing domestic violence with her six-year-old son had visible scars from what looked like machete cuts. We helped her calm down, understand the asylum process, and refocus on the needs of her son.

An unaccompanied minor from Guinee was separated from the group of unrelated adults he had traveled with. He received an explanation of the system for unaccompanied minors and was prepared psychologically for what was ahead. He had been robbed of all his belongings in Mexico and did not have any family or friends to contact in the US.

A young man from Sudan had been wounded during the shelling of his home outside Khartoum, during which his two brothers died in front of his eyes. He still carried shrapnel embedded in his collarbone. He was tearful and spoke of constantly having the image of his dead brothers in his head. This story had a hopeful ending: One of the volunteers was able to connect him with a relative who is a surgeon in nearby Phoenix, who agreed to operate on him pro bono.

What mental health challenges do volunteers experience at the border?

Burnout is a significant factor for volunteers doing this hard, and sometimes unrewarding work. Volunteers witness tremendous suffering and injustice. They travel long distances over terrible roads to provide assistance in very remote areas, work long hours in the hot sun with no shade, and go long periods without any means of communication. They receive calls about migrants lost in the desert and find wounded people and dead bodies, while lacking resources such as reliable cars or funds for food and other supplies to meet the needs of migrants. Some have been doing this work since the 1980s.

The most significant factor contributing to volunteer resilience is the social support that comes from a community of like-minded people. Some are members of religious communities and are even members of the clergy. Maintaining social bonds is a key psychological need for both volunteers and migrants.

Since early 2024, MSF has worked alongside volunteers from Humane Borders, Samaritans, No More Deaths, and other Arizona-based groups helping asylum seekers and migrants crossing the US-Mexico border in the Sonora desert. Initially, a small team evaluated medical needs in the region, and suggested ways to develop capacity and increase services and collaboration. In August 2024, MSF resumed its support to local groups. MSF will consider additional support based on the needs that might arise from a surge in numbers of people crossing the border.