GD04 Skin, scars and sovereignty: the dermatological toll of the Darién Gap migration

Abstract

The Darién Gap, a 95-km jungle corridor between Colombia and Panama, has become one of the most perilous migration routes and a critical passageway for migrants travelling towards the USA. In 2023, over 500 000 migrants crossed the Darién Gap (the majority originating from South America and the Caribbean), with hundreds of deaths reported annually due to violence, drowning, trauma and disease. While the political and humanitarian dimensions are well documented, the dermatological burden remains under-recognized. This study explores the ‘biological price’ of migration and the implications for health systems as tropical pathologies reach nonendemic clinical settings in the USA. We synthesized contemporary epidemiological data from humanitarian nongovernmental organizations and clinical reports from frontline transit clinics along the Darién Gap and subsequent migration corridors. Dermatological conditions were mapped to geographical stages of the journey to assess the impact of environmental exposure, prolonged moisture, mechanical friction and the collapse of hygiene infrastructure on skin disease patterns. The skin acts as a cumulative record of migratory hardship. Sustained humidity, occlusion and repeated river crossings precipitate immersion syndromes: trench foot and severe intertriginous dermatoses. Intertrigo frequently progresses to candidal and dermatophyte infections and Gram-negative toe-web infections, and secondarily infected eczematous dermatitis, reflecting chronic maceration and limited access to antifungal or antiseptic care. In the jungle interior, vector-borne disease predominates. Cutaneous leishmaniasis represents the most significant long-term morbidity, producing chronic ulcerations often untreated until migrants reach the USA. Overcrowded encampments further facilitate outbreaks of scabies and pediculosis, perpetuating cycles of reinfestation along the migration route. Dermatological morbidity in the Darién Gap is a predictable consequence of a specific migratory pathway. These findings underscore the need for ‘migratory medicine’ literacy. Addressing these conditions is vital for individual healing and for mitigating the public health impact of neglected tropical diseases in an increasingly interconnected and mobile world.