Migrants and Refugees Face an Invisible Trauma We Can’t Ignore

In the wake of multiple legal challenges, the Biden Administration late last month aimed to fortify the Deferred Action for Childhood Arrivals (DACA) program with a new rule that would shield more than 600,000 undocumented people brought to the U.S. by their parents. While proponents of the program welcomed the move and heralded it an “effort to bulletproof the DACA program,” our response in this moment overlooks a fundamental problem: each challenge on immigration—whether the Muslim Ban, family separation, or challenging DACA—takes a toll on refugee and migrants through vicarious trauma and weathering, regardless of the outcome.

While we debate annual refugee caps, if Title 42 should be repealed and whether to welcome Haitian and Afghan refugees, each day migrants experience the trauma of instability. This additional trauma—often ignored because of other acute, pressing issues—has lasting physical and psychological health effects that we document in our refugee and migrant patients for decades. Understanding this often-invisible trauma is a vital component of recovery and rehabilitation.

Shock experiments conducted in the 1980s in rats showed that when rats can control when they are subjected to pain, they develop tolerance to it. On the other hand, rats that have no control over when they are shocked become depressed, dejected, develop ulcers, lose weight and have compromised immune systems that make them more susceptible to disease.

Similarly, humans experience a crippling response when faced with persistent uncertainty. Consider the simple routines and patterns in our lives that allow us to function. For example, the uncertainty of in-person school for children during the COVID-19 pandemic debilitated many American families, which led to record rates of women quitting their jobs, sent many families to move to the suburbs where schools were more likely to have in-person classes and put substantial stress and strain on families and marriages.

DACA recipients and refugees and migrants in Afghanistan, Greece or at the U.S.-Mexico border experience weeks, months or years of instability. The impact of uncertainty extends beyond a single affected individual or family: it permeates entire communities through vicarious trauma, or trauma transmitted second-hand through bearing witness to stories of other people who have experienced pain and suffering. Imagine struggling to drive after taking care of a friend who had a bad car accident or being crippled by the decision of whether or not to send your children to school after a school shooting close to home. Vicarious trauma produces its own psychological weight and burden.

Read more: The Invisible Tragedy Facing Refugees Like Me

As director of the Human Rights Impact Lab and as a forensic medical evaluator of torture and trauma, I document in my refugee and asylum seeking patients significant trauma from instability: the inability to sleep at night after hearing the story of a friend who was deported in an immigration raid; flashbacks after hearing about a child who was separated from her parent and placed in a shelter; extreme stress as a result of persistent challenges to evacuating vulnerable Afghan allies; debilitating fear after reading news articles about the cartel-sponsored kidnapping and trafficking of young girls who were forced to remain in Mexico while waiting for their immigration hearings.

These stories leave notable and prominent physical and psychological imprints on my patients. As a result of the instability and vicarious trauma, immigrants of all legal statuses experience weathering, a term used in medicine to describe the physiological wear and tear of stress that can result in advanced aging, elevated blood pressure and heart attacks. Like the shock experiments with rats, uncertainty and instability can be as harmful as the outcomes themselves.

Weathering may have a multi-generational effect. Traumatic experiences have the power to change our gene function through multiple mechanisms such as methylation marks, which attach to our DNA and act as on-off switches. These methylation marks can be triggered by cues in the external environment, such as symptoms of starvation, stress or violence. The damage from trauma can extend for generations, potentially through non-genetic mechanisms that regulate our DNA function.

Vicarious trauma has typically been described as an individual phenomenon—a social worker who is devastated by hearing again and again about the abuse of children; a physician who is overwhelmed by seeing pain and suffering of dying ICU patients; a firefighter who is traumatized by seeing a child die in flames—but vicarious trauma can also be collective. We experienced vicarious trauma in seeing the World Trade Center towers fall on Sept. 11, 2001. We experienced vicarious trauma in witnessing George Floyd’s murder on video. We experienced vicarious trauma in watching police officers mowed down during the siege of the Capitol on Jan. 6.

The vicarious trauma of anti-immigrant policies is now directly affecting our American collective. When the Trump administration, for example, embraced a “zero tolerance” policy at the U.S.-Mexico border resulting in family separation, vicarious trauma affected the immigration officers who were responsible for tearing children from their parents or keeping watch over toddlers wrapped in foil blankets on the floor. The same was true at the Kabul airport in Afghanistan, where young military officers within arm’s reach of desperate families with young children had to enforce a security zone and block them from coming in. Vicarious trauma may soak into the DNA of those Americans as well and permeate the communities in which they reside.

Read more: Too Many Leaders Are Failing To Uphold Their Promise To Protect Refugees

My first step as a physician when treating a hemorrhaging patient in the operating room is to step back and assess the full scale of the trauma. Only then can I recognize the source of the bleed and resuscitate the patient.

For advocates of migrant rights, recognizing the sources of trauma is a critical first step. Studies have demonstrated that trauma, and perhaps even DNA methylation, may be reversed if we can identify the cause and treat it. This includes, at minimum, a trauma-informed assessment of physical and psychological health, and targeted therapies where appropriate. For example, after torture we might diagnose and treat nerve injuries and chronic pain with medications or physical therapy; we might also diagnose and treat post-traumatic stress or anxiety disorder from the events.

Acknowledging vicarious trauma and weathering in refugees and migrants from instability itself is important. So too is understanding the damage that we are precipitating in our own communities, and their multigenerational effects. Once we step back and assess these impacts, we can begin to explore, address and account for the trauma that we have caused in refugee and migrant communities, and in our own.