All the chairs in the waiting room were filled by dozens of newly arrived migrants waiting to be seen by a Cook County health worker at a clinic in Chicago. Julio Figuera, 43, was among them.

Figuera, along with his three children, did not want to discuss traveling from Venezuela to Chicago. The country is currently facing a severe crisis, causing millions to struggle with poverty and forcing 7 million people to flee.

However, at some point in time, he had developed pneumonia.

Figuera, along with many other asylum-seekers, resided at O’Hare International Airport while awaiting more permanent housing. He came back to the county clinic for a check-up after experiencing a persistent cough. The healthcare team assessed his vital signs, listened to his chest, and administered a hepatitis vaccine.

He said, “I hardly ever get ill. It was the trip that caused me to become sick.”

Many migrants in the United States are facing challenges in accessing healthcare for both new and ongoing health issues due to the complex system in place.

According to doctors nationwide, it is uncommon for migrants arriving at the U.S.-Mexico border to undergo medical screenings or receive any care beyond treatment for urgent medical needs. Additionally, there is no unified national system in place to monitor the care provided to migrants. Once they reach their destination, migrants’ access to healthcare varies depending on the location. Some cities have established comprehensive public health systems to assist new arrivals, while others rely on emergency departments or volunteer physicians to address preventable health concerns.

Deliana Garcia, from the nonprofit organization Migrant Clinicians Network, stated that there are small areas where care and shelter can be found for migrants. The organization has already assisted over 1,000 migrants in receiving medical treatment within the first 10 months of this year. However, it is difficult to keep track of the situation across different directions.

According to data from the Border Patrol, over 2 million individuals crossed the border without authorization from October 2022 to September 2023. Doctors interviewed by The Associated Press stated that the majority of these migrants are in good health, as they need to be in order to complete the challenging journey. However, the act of traveling can exacerbate minor health problems and potentially lead to urgent situations.

As a result, health officials nationwide – from New York to Los Angeles, Boston to Denver – report a significant need for healthcare services. Meeting this demand is a crucial aspect of their organizations’ goals.

Craig Williams, the chief administrative officer of Cook County’s health system, stated that this initiative is an essential aspect of our work and he does not sense any hesitation from anyone regarding its importance for the organization. He also believes that over the past year, the organization has not prioritized any other initiatives over this one.

Operating the clinic has come at a cost: Approximately 14,500 migrants have utilized the services of the Cook County clinic in the current year. Up to 100 individuals are transported by vans from shelters daily to receive urgent medical attention, including vaccinations, and to gain access to the public healthcare system. Since its establishment a year ago, the county has allocated approximately $2.2 million each month, totaling to almost $30 million, for the clinic’s operations.

Last fiscal year, New York City Health and Hospitals recorded 29,000 visits from migrant patients, with over 40,000 vaccinations given and medical screenings offered to all new arrivals by health workers.

Other cities are trying to manage as best they can, like Denver, where nearly 26,000 migrants have arrived within the last year. Dr. Steve Federico, a director at Denver Health, said the city’s process is inadequate.

Shelter staff inquire with migrants about their immediate medical needs. If they indicate a need for urgent care, they will either be directed to an emergency room or connected with a nurse at Denver Health, a public hospital and health organization, via telephone.

Federico mentioned that there are no fundamental health evaluations being conducted, which could heighten the likelihood of infectious diseases spreading among shelter residents. In Chicago, a single shelter experienced a minor outbreak of chickenpox.

According to Federico, if illnesses are not detected and addressed promptly, they will affect everyone. This poses a greater risk for those who are more vulnerable, leading to more severe symptoms.

Both Federico and Jon Ewing, spokesperson for the city, expressed that Denver is currently facing resource limitations, particularly in regards to providing shelter and food for migrants. Ewing mentioned that the city is exploring options to improve their medical screening process, but the exact cost and availability of resources is uncertain.

Migrants in the U.S. often struggle to obtain consistent healthcare, as well as nutritious food and secure housing. This can have serious consequences for individuals with chronic conditions such as diabetes or hypertension, who may end up hospitalized due to losing or running out of their necessary medications, or having them taken away during their journey. Healthcare professionals have also observed migrant children with asthma requiring replacement inhalers.

According to Garcia, a member of the Migrant Clinicians Network, individuals who were previously in good health are placed in extremely challenging situations where they are unable to fully survive. As a result, they often arrive at the border in a compromised condition.

There are pregnant women who have not received prenatal care and are in the later stages of their pregnancy.

Dr. Ted Long, senior vice president at New York City Health and Hospitals, reported that a woman who was nine months pregnant received her first prenatal visit two weeks ago. Over 300 healthy babies have been delivered to migrant mothers at this hospital.

Migrants may face difficulties in accessing healthcare, even when it is available. Some may choose to forgo seeking assistance due to concerns over high costs or a lack of trust in the healthcare system.

Dr. Stephanie Lee is the medical director of refugee resettlement and coordinator of the unaccompanied youth program at Penn State Health’s Family Practice Pediatrics Clinic. She said she sees many patients who don’t have health insurance or don’t know how to get it.

A mother who had been waiting for over a year for her asylum request told Lee that she was covering the costs herself as her family did not have insurance.

“The system is severely flawed, making it impossible to take any action,” Lee stated. “They had to personally cover the costs because their child required a physical and examination prior to starting school.”

The Migrant Clinicians Network, established for three decades, was recently awarded a $5 million grant from the National Institutes of Health. Through their case workers, the organization maintains communication with migrants by assisting with medical appointments, facilitating social service applications, providing transportation to appointments, and resolving payment arrangements.

They also maintain communication with a reliable relative in the migrant’s country of origin, in case they become untraceable.

Garcia, who manages the program, mentioned that many babies are named after team members.

However, that is the most ideal situation.

The governor of Massachusetts called upon the National Guard in August to help with the overcrowded shelter system. Dr. Fiona Danaher and her colleagues face difficulties in locating migrants for follow-up due to lack of a U.S. phone number.

According to Danaher, a primary care pediatrician in the Mass General Brigham health system, even migrants who are simply moving between shelter locations in the greater Boston area can become lost in terms of follow-up. This often leads to repeating the same tests and reinventing the wheel.

She urges her coworkers to provide patients with a printed record of everything that occurred during their appointment, including administered vaccines, prescribed medications, and applied benefit programs. This allows patients to easily pass the information along to their next healthcare provider, akin to a crucial game of telephone.

She stated that there are many simple ways to care for migrant patients, and that “traditional note passing” is a crucial investment to make.

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This report was contributed to by Associated Press journalists Sophia Tareen in Chicago and Jesse Bedayn in Denver. Milwaukee was reported on by Shastri.

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The Robert Wood Johnson Foundation provides support to the Associated Press Health and Science Department. The AP is solely responsible for all of its content.