Carlos Martinez

In recent years, the US government has implemented several bureaucratic changes aimed at stalling the influx of asylum seekers. From the "metering" system initiated under the Obama administration to the Migrant Protection Protocols (MPP) implemented by the Trump administration, these measures have erected a bureaucratic wall against asylum seekers that has kept them captive in Mexican border cities. Drawing on ethnographic fieldwork conducted in Tijuana, Mexico, I examine how these policies have produced deadly conditions for asylum seekers by calibrating time and space in such a way that increases their exposure and vulnerability to highly precarious environments and predatory bureaucracies.

Drawing on ethnographic fieldwork among homeless deportees living in the Tijuana River canal, I examine how the 'rehabilitation' of toxic terrains can have corporeal and social consequences for those inhabiting such spaces. For decades, the Tijuana River basin traversing the U.S.-Mexico border has been perceived by officials from both countries as an unruly body of water. Prone to persistent flooding, the canal also experiences flows of toxic sewage from Tijuana's maquiladora industry. In recent years, the riverbed in Tijuana has been inhabited by homeless and drug using communities, many of whom have been deported from the U.S. In response, rehabilitation of the canal and forced drug rehabilitation have been conjoined and promoted by the state as solutions for managing this unruly terrain and its residents. I take the deployment of the term 'rehabilitation' targeting both homeless deportees and the canal as an opportunity to consider how the concurrent disciplining of landscapes and human populations has been a central and evolving feature of the Anthropocene. I examine how my homeless interlocutors have experienced 'rehabilitation' as a violent process of abjection, dispossession, and captivity, which has converted this transborder landscape structure into a carceral zone under the guise of urban sanitation and health promotion.

Amidst ongoing efforts to address racial injustice, U.S. medical institutions are grappling with the structural roots of anti-Black racism. The REPAIR (REParations and Anti-Institutional Racism) Project is a 3-year strategic initiative at the University of California, San Francisco aiming to address anti-Black racism and augment the presence and voices of people of color in science, medicine, and health care. It offers a framework for thinking and acting to achieve repair in relation to racial injustice and is anchored by 3 concepts-reparations, abolition, and decolonization-which have been deployed as annual themes in academic years 2020-2021, 2021-2022, and 2022-2023, respectively. In this article, the authors describe the REPAIR Project, preliminary outcomes from its first year, and potential future lines of inquiry for medical educators and health sciences researchers. The authors argue that the full damage from slavery and its legacies cannot be undone, but everyone can work in new ways that reduce or eliminate harm.

THE PURPOSE OF THIS CHAPTER is to share the lived experience of undocumented Latino migrant day laborers (LMDLs) in the San Fran- cisco Bay Area who left their homes in Mexico and Central America to pursue work in the United States in order to compensate for the lack of employment back home needed to support their families and liveli- hoods. More specifically, the consequences of being undocumented, as expressed and described by 51 LMDLs orjornaleros who participated in semistructured in-depth qualitative interviews, are shared and induc- tively discussed and analyzed in this chapter.

Overdose incidence and death rates among Latino/x communities in California have increased dramatically in recent years. In 2019, San Francisco County was among the three counties in California with the highest opioid- related death rates among Latino/xs. Recognizing these trends, the San Francisco AIDS Foundation (SFAF) and the National Harm Reduction Coalition (NHRC) petitioned the San Francisco Department of Public Health (SFDPH) in 2021 to make funds available for conducting a needs assessment aimed at examining the conditions, challenges, and barriers impacting Latino/x people who use drugs (PWUD). This project is the first study of its kind in California using a harm reduction framework to prioritize the challenges faced by Latino/x substance users in accessing needed services. This report aims to fill existing gaps in knowledge about Latino/x PWUD in San Francisco and how best to serve them. Our needs assessment reveals that Latino/x PWUD in San Francisco face multiple barriers to accessing critical harm reduction services and a significant portion of them lack knowledge regarding life-saving tools, such as naloxone. Moreover, our assessment indicates that Latino/x PWUD experience various social inequalities— including a lack of housing and employment, inadequate access to mental health services, and undocumented or precarious legal status—that make them more vulnerable to overdose and may alienate them from existing services. At the end of this report, we provide a series of immediate, medium-term, and broader policy and program interventions aimed at overcoming existing knowledge gaps and service barriers. California has the largest Latino/x population in the United States, making it an important site for innovating and implementing harm reduction practices targeting this community. Thus, the results and proposals put forward by this project are relevant not only for stemming the tide of overdose among Latino/x PWUD in San Francisco, but also for protecting Latino/xs across the country.

Introduction: The US deports more Mexicans to Tijuana than any other borderland city. Returning involuntarily as members of a stigmatized underclass, many find themselves homeless and de-facto stateless. Subject to routinized police victimization, many take refuge in the Tijuana River Canal (El Bordo). Previous reports suggest Tijuana River water may be contaminated but prior studies have not accessed the health effects or contamination of the water closest to the river residents.

Methods: A binational, transdisciplinary team undertook a socio-environmental, mixed methods assessment to simultaneously characterize Tijuana River water quality with chemical testing, assess the frequency of El Bordo residents’ water-related diseases, and trace water contacts with epidemiological survey methods (n = 85 adults, 18+) in 2019, and ethnographic methods in 2019–2021. Our analysis brings the structural violence framework into conversation with an environmental injustice perspective to documented how social forces drive poor health outcomes enacted through the environment.

Results: The Tijuana River water most proximate to its human inhabitants fails numerous water-quality stan- dards, posing acute health risks. Escherichia coli values were ~40,000 times the Mexican regulatory standard for directly contacted water. Skin infections (47%), dehydration (40%) and diarrhea (28%) were commonly reported among El Bordo residents. Residents are aware the water is contaminated and strive to minimize harm to their

Migrants along the US-Mexico border have been subjected to transnational violence created by international policy, militaristic intervention, and multinational organizational administration of border operations. The COVID-19 pandemic compounded migrants’ vulnerabilities and provoked several logistical and ethical problems for US-based clinicians and organizations. This commentary examines how the concept of transnational solidarity facilitates analysis of clinicians’ and migrants’ shared historical and structural vulnerabilities. This commentary also suggests how actions implemented by one organization in Tijuana, Mexico, could be scaled more broadly for care of migrants and asylum seekers in other transnational health care settings.

In a Case Study in Social Medicine, a man presents to a mobile clinic in Maine with pain in his right wrist. Recognizing that he has a repetitive motion injury from raking blueberries, a physician ventures out into the field to analyze the causes and collaborate in finding solutions.

"Captive States: Migration and Expulsion on the Carceral Frontier" examines how the amalgamation of U.S. immigration policies, the global drug war, and violent bureaucracies have transformed the U.S.-Mexico borderland region into a zone of captivity for Central American migrants and Mexican deportees. Based on eighteen months of ethnographic fieldwork, this project examines the everyday lives and survival strategies of these communities in Tijuana, Mexico. Moving between migrant and homeless encampments, governmental and private shelters, drug rehabilitation centers, and activist clinics, my dissertation analyzes the lives of those subjected to intersecting forms of confinement and dispossession at the U.S.-Mexico border.
For several years, Tijuana has consistently received the highest portion of deported Mexicans from the United States in the country. Simultaneously, the U.S. government has implemented several policies aimed at stalling the influx of asylum seekers into the country. From the “metering” system initiated under the Obama administration to the Migrant Protection Protocols and Title 42 policies implemented by the Trump administration, these measures have erected an arcane bureaucratic wall against asylum seekers. Though deportees and asylum seekers arrive to the border region through different routes, my project demonstrates how a transnational assemblage that I refer to as the carceral frontier seeks to confine the movements of both communities while exploiting their vulnerabilities.