The response of health systems to the needs of migrants and refugees in the COVID-19 pandemic: a comparative case study between Mexico, Colombia and Peru.

Background: Protecting the health of migrants and refugees during the pandemic was a significant challenge in the Latin American region. We aimed to describe and contrast the response of the health systems of Mexico, Colombia and Perú to migrants' and refugees' health needs during the COVID-19 pandemic, and to situate the response in the context of the migration and health policies of each country. Methods: We conducted case studies of the three countries. The data collected for each case included: 1) policy documents; 2) peer-reviewed and grey literature; 3) qualitative interviews with key informants. Findings: The three countries issued policies to detect COVID-19 cases among migrants and refugees, and granted them access to COVID-19 care regardless of their migration status or facilitated regularization as a way to improve access to care. However, other health care needs were not considered, some groups of migrants remained invisible in the policies, and policies rarely considered the increased social and economic vulnerability of migrants and refugees during this period. Pre-existing barriers to care were made worse during the pandemic. All three countries' response to migrants was reliant on non-governmental organizations, with international cooperation being especially active in Colombia, and local civil society organizations in Mexico. Interpretation: The response of each country was a continuation of their previous approach to migration and health. Developing plans for pandemic response that consider migrants and refugees' particular needs will be important to improve response capacities in the future. Funding: Funding was provided by USA for the International Organization for Migration (IOM) under an agreement with the Johns Hopkins Center for Humanitarian Health.