The “homeless, tempest-tost” “masses” that Emma Lazarus invoked in her seminal poem, “The New Colossus”: Send these to me.
The privilege of caring for our world’s vulnerable populations drives my work as an infectious disease/tropical medicine physician. Moreover, as a founding member of the New York City Refugee and Asylee Health Coalition (NYCRAHC), it is my basic duty to speak out against the extreme vetting that refugees and asylee-seekers endure when resettling in the United States.
While medicine allows me to treat the newly arrived with the dignity and compassion they deserve, I know it is not enough to protect them against the xenophobic attacks of the current Trump administration. As a resident of this country, I know that we are failing them, and in doing so we harm our core American identity. In other words, we merely hurt ourselves. A virulent and nationalistic impulse threatens both our new neighbors and the health of our democracy, and it is time we take prescriptive action in support of refugees.
Under the current regime, cultural pride is acceptable only when it tips its red-brimmed allegiance to “America First.” But signs of hostility—particularly toward migrants fleeing war-torn conditions—haven’t just suddenly appeared. According to the Pew Research Center, the U.S. public has shown a consistent distaste for refugees and asylees since the 1950s.
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So why do we continue to parade such inflammatory contradictions of welcoming cultural pluralism while masking xenophobia? Digesting these contradictions leads to a sociopolitical ulcer, which, I’m convinced, is caused by a basic misunderstanding of what a refugee actually is.
Refugees have been forced to flee their country because of a well-founded fear of persecution, war, and violence due to reasons related to race, religion, nationality, political opinion, or membership in a particular social group. International organizations, including the United Nations High Commission on Refugees (UNHCR) and the International Organization for Migration (IOM), use this legal definition to determine who can be moved to places of safe refuge. Asylees follow a different path; their trauma is (at first) self-recognized and they must present their claims upon arrival in the receiving countries.
Refugees are the most vetted migrants of any group traveling into the United States, and the vetting process can sometimes take a decade. It begins with the IOM declaring certain conflicts (national, tribal, or otherwise) improper for repatriation of certain groups and thereby assigning the protected “refugee” definition to members of this group. They then undergo a number of screenings (taking approximately 18-24 months) before the U.S. State Department begins its own extensive screening process (including a health screening that is performed by the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine). As a result, they pose absolutely no security or infectious risk.
Yet despite refugees being among the most heavily screened and “benign” migrants to enter our country, many U.S. residents perceive them as a threat to our safety and way of life. Right-wing media such as Fox News label them as “narcotraffickers,” “communists,” or “Islamic fundamentalists.” These stereotypes are only amplified by social media that prefers propaganda to news and presidential tweets that spread misinformation. In one prime example, President Trump has famously claimed that the country has resettled more Muslims than Christians—a fact that’s easily refuted by statistics that show the United States has resettled far more Christians since the 2002 fiscal year.
So why do we remain so disdainful of folks seeking protection from a world that has eviscerated their lives and identities? Many are coming from nations where they may never have seen a physician. Up to 30 percent of them have experienced some form of post-traumatic stress disorder (PTSD), and even more are experiencing a form of depression. They need help, and we have the bandwidth to provide assistance. To refuse or delay such help adversely impacts their health and violates our humanitarian imperative. However, the provision of care for our newly arrived guests is often met with hostility, even if the usual (conservative) suspects are not included.
One case comes to mind. I recall treating an Afghan family in my South Bronx community infectious disease clinic. Their appointment ran slightly over the allotted time, but this commonly happens in community health medicine. In response, a U.S.-born patient began hurling vile, racially-charged accusations at the family for “stealing” her time. The female patient had almost certainly experienced multiple dimensions of stigma during her life, yet she reserved one privilege: her U.S. birth.
Somehow, aggregate trauma did not amount to empathy but instead fed into an aggressive form of antipathy. So how do we exorcise these nationalist demons? What course of action do we follow to respect cultural pluralism—to truly open our arms and our conscience to the suffering and dispossessed?
As a doctor, I urge U.S. residents to better understand unfamiliar populations before they begin blaming them for their troubles and cause vulnerable people more possible harm.
Together, we must reconnect with the spirit and voice of Emma Lazarus. “Making America Great Again” means that we must look beyond our world view, constructed by our immediate community and influences, and assess the facts to understand how our decisions and actions affect people in need. Abdicating our duty to protect the homeless, the “tempest-tost,” and the marginalized does anything but make this nation great. It is cowardly. Cruel. Inhumane. And it’s certainly not the America I know or hope to treat.