The "controlled flow" migration strategy and regimes of humanitarian care for people "in transit" through Darién, Panama.

Since 2021, over one million people have traveled on foot across the Darién border region separating Panama and Colombia en route to the U.S.-Mexico border. Extreme physical conditions of the route, crossing rivers and mountains through the Darién Forest, present lethal vulnerabilities to violence and impacts on migrant health. As migration across Darién has increased and diversified, complex medical emergencies, including migrant death, sexual violence, and injury, present critical areas for social service response. Since 2016, the Panamanian State has implemented the "controlled flow" migration strategy and, in recent years, non-governmental organizations provide basic services through a system of migrant reception centers. Our research, based on ethnographic methods including participant observation, health surveys, and semi-structured interviews (n = 39) with migrant-serving officials examines the everyday conditions and limitations to the provision of care based on a medicalized response to violence after people traverse the treacherous terrain across the Darién Forest. We trace how migration policies in Panama construct violence and shape the possibilities for humanitarian care for migrant people "in transit" through Panama. This paper advances understanding of the impacts of border externalization on shaping mobility, migrant protection, and regimes of care in transit corridors along the route to the U.S. By analyzing the public health impact of a regional border regime, we deepen research on the nexus of migrant care and control that frames the humanitarian response to increased migration across Darién Province for people traveling to the U.S. southern border.