Cycle of Instability: U.S. Supreme Court Ruling and Unhoused Migrants

On June 28, 2024, the U.S. Supreme Court ruled in City of Grants Pass v. Johnson that cities have the authority to arrest, cite, and fine those who sleep in outdoor public spaces, disproportionately targeting the nation’s unhoused people.

Within this population lies a growing number of migrants from Central and South America, as recent data by the Joint Center for Housing Studies at Harvard University reveals. The report notes that although immigration status is not collected in homelessness data, Hispanic ethnicity can be used as an approximate measure of unhoused migrants, given the large proportion of migrants entering the United States from Central and South America.

From 2022 to 2023, the number of unhoused Hispanic people grew by 28% relative to 7% for their non-Hispanic counterparts. This pattern is prominent in areas facing a pronounced influx of migrants, such as Chicago, which has received more than 50,000 migrants from Texas since August 2022. During a single night in January 2024, more than 18,800 Chicagoans experienced homelessness—a threefold increase over the last year, with asylum-seekers making up nearly 75% of this population.

How the Ruling Has Taken Effect

Since the City of Grants Pass v. Johnson Supreme Court ruling, several cities across the country have started taking action to clear homeless encampments. California—the state with the greatest number of migrants from Central and South America and the largest unhoused population—is a prime example. Under Governor Gavin Newsom’s executive order, city officials are required to give residents of encampments only 72 hours’ notice before a sweep, after which any remaining belongings may be confiscated and destroyed.

Los Angeles County is one of the few to push back on Newsom’s order and is currently seeking alternative solutions to the crisis. For many immigrants, however, the threat still looms large. Manuela—a migrant from Venezuela living with her two children in a tent in Los Angeles’ Skid Row—asks in Spanish,”Where are we supposed to go then? They haven’t told us to leave here yet, thank God, but we worry every day. I’ve heard the stories. You never know.”

28%

From 2022 to 2023, the number of unhoused Hispanic people grew by 28% relative to 7% for their non-Hispanic counterparts

Many shelters require ID or proof of residency, and fear of rumored immigration raids often discourages people from seeking assistance. Further, many shelters are not equipped to house families together, deterring those who do not wish to be separated.

Cities including New York have allowed undocumented migrants to stay in facilities under the “right to shelter” law; however, recent policy changes have introduced limits to those stays. Migrants categorized as “new arrivals” can now only stay in New York City shelters for 30 days and families with children for 60 days, leading to the concern of many ending up back on the streets, trapped within cycles of instability.

A Cycle of Instability and Poor Health Outcomes

One of the main concerns with the forced clearing of encampments is that it results in the immediate loss of vital medications, sterile injection equipment, and essential medical devices, including walkers and wheelchairs. Forced clearings disrupt medication regimens, adding difficulties for unhoused people to manage chronic conditions. This not only presents an immediate health crisis for affected individuals, but it also catalyzes a cascade of long-term public health repercussions.

“I’m pregnant,” Manuela explained, “I try to keep all of my medicine in one place so I know where they are in case we need to go quickly. I just want to make sure my baby is healthy.’

Migrants stand at a processing center as they wait for a bus to Chicago, in downtown Brownsville, Texas, U.S., October 24, 2023. The Republican-led state of Texas said it has spent at least $100 million since April 2022 to bus tens of thousands of migrants who recently crossed the U.S.-Mexico border to Chicago, New York, Denver, and other Democratic-led cities. — Migrants stand at a processing center, as they wait for a bus to Chicago, in downtown Brownsville, Texas, on October 24, 2023. REUTERS/Carlos Barria

The loss of mobility aids such as walkers and wheelchairs prevents access to essential services. Interruptions in essential medications for infectious diseases, including HIV and tuberculosis, not only exacerbate the individual’s health but also amplify a greater public health risk. Further, chronic conditions such as hypertension and diabetes become more severe in the absence of regular medical care, medications, and proper nutrition. For pregnant individuals like Manuela, unstable living conditions jeopardize the lives of both the mother and the child. The challenges unhoused migrants face, however, are compounded by obstacles that citizens do not deal with.

Language barriers, fear of deportation, and limited eligibility for health and social services make accessing health care more difficult. Housing assistance programs, such as Section 8, often require specific immigration documentation such as a Green Card, I-94, or I-688B. This often disqualifies many migrants, particularly those crossing the border from Central and South America, who may not have these documents. Unhoused migrants thus become more susceptible to the negative effects of encampment clearings. They may also be forced to leave trusted health-care providers who speak their language and provide care but do not present a risk of deportation. That loss can be particularly life threatening for those managing chronic illnesses.

Further, the trauma of navigating relocation in a language that is not one’s own after an already harrowing journey to the United States increases the risk of mental health and substance use disorders. This cycle is self-perpetuating. Just as instability leads to poor health outcomes, poor health outcomes deepen instability—which is aggravated by the inability to find and maintain employment when ill, in turn reducing the chances of securing stable housing. This feedback loop is difficult to break without sustainable interventions.

Encampment Sweeps Disrupt Progress

Street medicine is expanding across the United States as a way of providing health care to people experiencing homelessness, particularly in California.

Newsom launched CalAIM in 2022, an experimental Medicaid initiative backed by the Joe Biden administration. The initiative dedicates $12 billion from state and federal funding over five years to outreach programs that include street medicine teams. Street medicine services are essential to unhoused migrants because they provide care without requiring insurance or immigration status. Those services use multidisciplinary teams of health care and social workers to provide bilingual services to unhoused migrants, helping establish trust and link them to specialized health-care providers.

Just as instability leads to poor health outcomes, poor health outcomes deepen instability

But street medicine providers say that new orders to clear encampments following the recent Supreme Court ruling are thwarting their progress, undermining previous funding efforts.

“It makes our work much more difficult,” says Erica Robinson, president of Health Matters Clinic, a nonprofit providing street medicine services and pop-up clinics for vulnerable populations in Los Angeles. “We lose contact with people who are already hard to reach, and it prolongs their path to housing when critical documents like identification are lost in the process.”

Street medicine teams are many migrants’ only way of seeking medical services. “I can’t remember the last time I went to the doctor’s office,” Manuela said, “but I see them [doctors] when they come around on the streets. I know them.”

The teams become familiar faces, figures of trust within encampment communities. But, during encampment cleanings, as Robinson adds, “migrants are caught in a cycle where the ability to build lasting connections for housing and support becomes disrupted.”

For many city officials, homeless encampments symbolize disorder, something to be “cleaned up.” Governor Newsom’s response to the ruling reflects this perspective, emphasizing the need to sweep encampments to “protect the safety and well-being of our communities.”

It’s evident, however, that the health of unhoused migrants is overlooked in those efforts, raising questions about whose safety and well-being are being valued.