Population Movements

Central American Refugee Health Profile

Drivers of Immigration

Historically, the primary drivers of immigration from El Salvador, Guatemala, and Honduras to the United States have been family reunification and the economy; however, civil war throughout the region in the 1980s also prompted immigration. Recently, extreme poverty and increasing violence have spurred a new wave of immigration1.

Increased instability and growing gang violence have been particularly unsettling for families and have pushed many children, often unaccompanied by an adult, to flee to the United States. The numbers of unaccompanied minors who arrived in the U.S. from El Salvador, Guatemala, and Honduras significantly increased from 2009 to 2014 (Figure 2). While the number of unaccompanied minors arriving in the United States decreased from 2014 to 2015, more than 23,000 children arrived in 2015 from El Salvador, Guatemala, and Honduras, with an additional 11,000 from Mexico9. The Department of Homeland Security (DHS) reports that unaccompanied minors presenting at border stations have health issues, often associated with the difficult journey or crowded, unsanitary, and environmental conditions experienced prior to arrival in the United States. The majority of health conditions reported include scabies, lice, rash illness, diarrhea, and respiratory infections10.

Figure 2: Unaccompanied Minors Encountered at U.S. Border, 2009-2015

The Central American Minors Refugee/Parole Program

Because of the large number of minors crossing the southwestern border, U.S. Citizenship and Immigration Services (USCIS) in the Department of Homeland Security initiated the Central American Minors (CAM) Refugee/Parole Program in December 2014. The CAM program allows for refugee and parolee processing in El Salvador, Honduras, and Guatemala, and provides qualifying minors with safe and legal means of entering the United States11.

To be eligible for refugee status under the CAM program, minors and their parents must meet strict requirements. The child must meet the following criteria:

  • The child (biological, stepchild, or legally adopted) of the qualifying parent
  • Unmarried
  • Under 21 years old
  • A Guatemalan, Honduran, or Salvadoran national living in his or her country of nationality

Additional information regarding the CAM program, including detailed steps outlining the refugee application process, can be found at the USCIS websiteExternal and the Department of Homeland Security websiteExternal. Additional information on how minors may qualify for humanitarian parole through the CAM program is also available at these sites.

Refugee and Parole Status

The 1951 Convention Relating to the Status of Refugees defined a refugee as a person who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country”12. Additional information on international refugee status can be found hereExternal. For the U.S. legal definition of a refugee please refer to Section 101(a)(42) Cdc-pdf[PDF – 1 page]External of the Immigration and Nationality Act. In contrast, parole status allows an individual, who may otherwise be inadmissible or ineligible for admission to the United States, to enter the U.S. legally for a specified period of time13. For additional information on parole status, please refer to the USCIS websiteExternal. If granted refugee status through the CAM program, individuals have access to federal benefits, including health insurance coverage through Refugee Medical Assistance (RMA) or Medicaid. Those granted parolee status are not eligible to receive the same benefits.

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