P3B082: A Home Fit for Habitation: Haitian Migrant Families Experiencing Homelessness in Boston

Introduction: Boston has been a sanctuary city for migrants seeking safety and asylum; however, many Haitian migrants face substantial challenges accessing stable housing upon arrival and thus present to the emergency department (ED) for homelessness. This case aims to 1) discuss the geopolitical context driving Haitian migration and resettlement and 2) examine challenges faced by new migrants in accessing housing.

Case Description: A mother and toddler presented to a Boston safety-net hospital ED for homelessness after being evicted from a residence where they were required to pay rent in advance without an official lease. They were originally from Haiti and recently arrived in the United States (US) after journeying through South and Central America. Due to lack of safe alternative shelter, the family boarded overnight in the ED, where they received assistance with accessing temporary shelter in a hotel.

Discussion: Due to devastating earthquakes, colonization, and sociopolitical complexities, emigration from Haiti to South America increased in 2010. The search for economic and political stability catalyzed further Haitian migration within South and Central America, with many migrants ultimately seeking asylum in the US. Greater Boston is one of the top three US destinations for Haitian migrants. Since April 2022, our Boston safety-net hospital has experienced a notable spike in Haitian migrant families presenting to the pediatric ED in search of housing. Despite Boston’s growing Haitian diaspora, many migrants have minimal social support and have difficulty finding and paying for housing due to work authorization restrictions tied to their immigration status. Lacking other safe options, migrant families often present to the ED for homelessness. Massachusetts is a right-to-shelter state that mandates state-funded emergency assistance (EA) shelter for families experiencing homelessness. This includes newly arrived migrants, though many still face challenges in providing required documentation (e.g. personal identification or child custody paperwork), which may have been lost, stolen, or damaged during their travels. Other required documents, such as proof of Massachusetts residence, may also be difficult or confusing to obtain. Families who do meet EA criteria may also struggle to navigate the shelter application process in a new language, and must confront long lines, limited shelter intake hours, and transportation barriers.

Conclusion: Many Haitian migrants face considerable adversity while seeking safe and affordable housing after arrival in the US, leading to increased presentations to the ED for homelessness. To be more effective advocates, pediatric clinicians must be aware of the sociopolitical context that drives migrant families to healthcare settings in search of housing. In addition to providing real-time support, frontline clinicians are uniquely positioned to advocate for comprehensive policy-level solutions, such as eliminating work restrictions that limit income for those seeking asylum and simplifying the EA shelter application process.