Cándido Álvarez has made it his policy never to go to the doctor.
“Not when I’m sick, not even when it’s serious,” he said. “I prefer not to go.”
So when, amid one of Houston’s increasingly sweltering summers recently, he said his body temperature reached a whopping 120F during his construction job at an unventilated bodega – and when blood in his urine indicated that such extreme heat exposure was likely damaging his kidneys – he acknowledged it was an alarm bell. But not enough of one to get him to the emergency room.
He remembers how just four hours at the hospital when he had Covid-19 landed him with a $7,500 bill.
“I’m going to die not so much from the illness but from thinking about how I’m going to pay the rent,” he said.
Originally from Honduras, Álvarez, 47, is an undocumented immigrant who has lived in the US since 2015 and in Houston for almost as long. Unlike his wife and three kids, he doesn’t have health insurance, despite constantly facing risks on the job such as contact with mold and insulation debris, threats made worse by bosses who don’t provide basic safety equipment such as masks and eye protection.
He has often worked remodeling houses inundated by Houston’s notorious floods or cleaning up waste that people have thrown into the streets after major storms sweep through. Then, at home, he is surrounded by other potential contaminants, including one of Houston’s two major airports right down the street and many of its chemical plants within a few miles. He says the city’s environmental agency insists the air is fine, but he has his doubts.
“How is it going to be possible that this doesn’t affect the environment?” Álvarez asked. “It has to affect it, because 24 hours a day they’re expending smoke from those plants.”
Álvarez and his family are just one example of how the climate crisis, industrial pollution and environmental disasters already combine to hit lower-income immigrant communities harder than most others in Houston, one of the most diverse metropolitan areas in the country. Public health is affected, and then, on top of that, the second Trump administration has been choking off access to healthcare for these marginalized communities because of rising costs and the hardline mass deportation agenda making people afraid to seek treatment, even in emergencies.
Where Álvarez’s family lives is where much of Houston’s pollution ends up, tied to a 21-year life expectancy gap between the lower-income, primarily Black and brown residents on Houston’s east side and their wealthier, whiter neighbors on the west side of the city.
This phenomenon is illustrated partly by something known as “the arrow” because of the shape relevant data make when displaying key indicators of wellbeing on a map of the city. If the arrow represents affluence, it points from the wealthy western neighborhoods to the east, where prosperity is lacking.
Inside the arrow’s lines, if superimposed on a map, sit luxury stores, green spaces and the richest suburb in Texas, with the point of the arrow abruptly ending where it hits the downtown area. And just outside the arrow’s margins, to its south and east, where many of the city’s blue-collar immigrants live, poverty rates, childhood asthma rates, and the number of solid waste sites and facilities that use harmful chemicals are all higher, while markers of prosperity such as median home value and college degree attainment are lower.
“Almost every indicator you look at, this arrow emerges,” said Nadia Valliani, director of community impact at the Greater Houston Community Foundation.
Now, with Houston’s outsized vulnerability to extreme weather – cyclones, severe thunderstorms, winter storms, hurricanes, floods and heat have all pummeled the south-east Texas city in recent years – and the local county’s moniker as “the epicenter of North America’s petrochemical industry”, immigrants exposed to the worst consequences of poor environmental planning disproportionately struggle with health and safety.
“I think we just haven’t stopped living in survival mode for a very long time,” said Norma Gonzalez, a community advocate at the Houston-based immigrant-serving organization Woori Juntos.
Gonzalez said that homes in their neighborhood that have been flooded up to their windows during past deluges remain in the same precarious condition, with no added infrastructure to prevent future floods. And amid disaster after disaster, staff at Woori Juntos have noticed people becoming more isolated, not wanting to ask for help.
Roughly 30% of the residents of Houston – the fourth-largest city in the US, with a population of about 2.4 million people – are foreign-born.
Nearly a third of immigrants in the area do not have legal immigration status, while 64% are either green card holders or naturalized citizens, according to the Migration Policy Institute. Although Mexicans constitute the largest immigrant group based on nationality and a majority of local immigrants identify as Latino, Houston is extremely diverse. Vietnamese, Urdu, Tagalog, Arabic and other languages all coexist with Spanish and English on the streets and in homes.
“The city beats [to] the pulse of immigrants,” said Ginny Goldman, director of the climate recovery group Organizing Resilience, adding that it “could not be more run, and developed, and shaped by immigrants”.
However, Texas is already a disaster-prone state and Harris county, the largest and most central county in the Houston metropolitan area, encompassing much of the city’s east and west sides, is more vulnerable to disasters’ negative impacts than 72% of other US counties, according to the Greater Houston Community Foundation. Summers bring excruciating heat, with the number of days above 95F increasing substantially in recent years, while storms and other weather-related emergencies, often exacerbated by the climate crisis, cause property damage and loss of life.
When Hurricane Harvey hit in 2017, the area was engulfed in up to 60in of rain, a downpour that estimates indicate was made 15-38% worse by the climate crisis.
Considered a one-in-1,000-year flood event, Harvey set a record in the contiguous US for the maximum amount of rainfall from a tropical storm or hurricane. It killed 89 people and left $158.8bn in estimated damages in its wake.
This was followed by a series of other massive storms and the Covid-19 pandemic, compounding Houstonians’ adversities.
More than half of Harris county’s residents who responded to a survey by local university researchers said they endured blackouts during Harvey and the 2021 winter storm. About 900,000 Houston-area residents lost power for days during the May 2024 derecho wind storm, and when Hurricane Beryl hit two months later, 3m homes and businesses were plunged into darkness.
Meanwhile, natural hazards have not mixed well with the petrochemical industry’s human-made ones in Harris county, where 2.6m barrels of crude oil are processed daily.
Even under normal circumstances, Houston’s east side must contend with a 52-mile shipping channel that human rights advocates have labeled a “racial sacrifice zone”, as residents report significant respiratory issues after living alongside more than 400 petrochemical facilities.
Then, ahead of big storms, the city’s oil refineries and chemical plants tend to hastily burn off fuel and chemicals. Those same refineries and plants are easily flooded, contaminating flood water that then pollutes streets and local waterways. Chemicals release into the soil, water and air after combining with flood waters.
During Harvey, a trillion gallons of rain formed flood waters and mixed with surface water that reportedly contained thousands of gallons of sewage, while 340 tons of air pollution came from plants shutting down, restarting and malfunctioning. After powerful flood waters hit two tanks at an energy pipeline operator facility, 461,000 gallons of gasoline spilled half a mile from a neighborhood that is predominantly Latino.
Inevitably, the more vulnerable immigrants were harmed at high rates by Hurricane Harvey. Nearly a quarter of participants in a study focused on Houston’s Vietnamese community said they suffered injuries or illness, while those with damaged homes were far more likely to endure poor mental health.
Years later, after the derecho and Beryl, immigrant communities similarly grappled with their health because of mold and debris where they resided, Gonzalez said.
“It is a hassle for folks to have to continue to try to go on with their regular lives when things in their home are literally falling apart,” they said.
In a 2017 survey of Texas gulf coast counties, nearly a quarter of immigrants said they could use more help getting the medical care they and their families needed. Over half did not have health insurance, and more than four in 10 didn’t have a doctor’s office to visit when sick, unless they went to the emergency room.
Such barriers to healthcare access have only deepened with the second Trump administration’s immigration crackdown, which has hit Houston’s communities hard. Advocates have likened the ramped-up enforcement – and the fear it has engendered – to a disaster in itself.
Since January 2025, 48% of likely undocumented immigrants, 14% of lawfully present immigrants and 8% of naturalized citizens across the country say they or their families have skipped out on medical care because of immigration-related fears, according to research by the KFF non-profit organization (formerly the Kaiser Family Foundation). The mass deportation campaign also has inherent health implications, putting additional stress on patients who are already struggling with chronic disease or mental health concerns.
Melissa Villarreal, who researched Harvey’s impact on Mexican-origin women for her PhD dissertation, recalled how even under the first Trump administration, the lack of access to Fema assistance or loans with an affordable interest rate through a reliable lender left many families in unsafe conditions – immigrants who are undocumented or in liminal statuses face challenges opening bank accounts and accruing credit. Families blocked off whole rooms in their homes because of mold and holes in the roof, she said, or they used only one bathroom in a two-bathroom home because they couldn’t afford to fix the other one.
“Because they didn’t have the money, they never recovered,” she said. “But then what happens the next time there’s a disaster?”
Fema’s bureaucratic hurdles in turn exacerbated people’s stress and disaffection amid an already fragile situation.
“You think, ‘Well, Harvey’s a once-in-a-lifetime storm.’ And then suddenly they’re realizing now, ‘Oh, that’s not the case. This is going to happen again,’” said Villarreal.
Experts have called the ensuing mental health effects the “recovery from the recovery”, as many people of color who deal with Fema denials and other frustrations after the storm feel as though they’re simply expected to live in unsafe situations as their new normal.
Villarreal suggested fixes that Fema could implement with relative ease: accepting more types of documentation, training its call center operators better and hiring more multilingual staff.
Meanwhile, some local organizations and grassroots activists are devising better-targeted aid after disasters and advocating for more proactive prevention beforehand.
Sitting in a park in north-east Houston’s Settegast neighborhood, Hilda – an undocumented immigrant, environmental advocate and three-decade-long Houstonian who asked to only use her first name for fear of immigration enforcement – said she hopes to mitigate future local soil contamination and flood risks through communities planting more vegetation to address contaminants and absorb water. More plants and fewer impermeable surfaces such as concrete or cement, she argues, could help combat some of the devastation that the homes around her suffered during Harvey. She remembers how people abandoned or sold their properties to investors for cheap, some of them after nightmarish experiences of being inundated during the floods.
“They were afraid that their children would be taken by the current,” Hilda said. “Better to sell that house, because they don’t want to go through that again.”
After Harvey, the city’s official plans for flood reduction in wealthy, whiter west Houston far eclipsed those for north-east Houston.
And when Hurricane Beryl hit in 2024, which scientists say was intensified by the climate crisis, Hilda got very sick after running out of her diabetes medication.
Hilda lives between Settegast and a neighboring community called Trinity Gardens, in a historically Black area where she moved because of the lower cost. Other immigrants did the same, she said, because without being able to secure loans – without credit or a social security number – it’s better for them to buy cheaper houses that they can pay off quickly. That way, the argument goes, even if they’re detained or deported, they at least retain the US-based asset they’ve worked hard for, and can rent it out.
Originally from Mexico, Hilda has always lived in regions affected by hurricanes, and in Houston, she said, extreme weather is nothing new. But she has noticed an increase in the volatility around her in recent years – how dry it is usually, and then how much rain falls when the water finally comes.
“That’s what has changed,” she said.
Then there is industrial waste. Hilda pointed out one of Houston’s infamous “mountains” nearby – an unusual rise in the city’s low-lying, flat topography that usually means a grassed-over dump, despite looking natural to the untrained eye.
Her local site is part of Houston’s long history of placing waste disposal and other polluting facilities in communities of color. An academic study published in 2023 found 40 out of 46 soil samples in north-east Houston showed chemical levels that suggested a potential risk for cancer, and lead levels in some of the samples were well above what is safe for children.
In the city’s south-west, which is also outside the more affluent periphery of universities, world-renowned hospitals and other prime real estate – and where another large concentration of lower-income immigrants lives – the infrastructure is similarly poor, said Alain Cisneros, campaign coordinator at the immigrant-led organization Fiel.
In Harvey’s aftermath, Cisneros took a truck filled with donations to the area, where he recalls lines of people waiting for dry clothes. His organization went door to door to understand how people were living and found newborn babies in first-floor apartments inundated with water, he said.
“Everything combines from something bad to worse,” Cisneros said. “[And] if there isn’t enough income for a family, they’re going to continue renting, in deplorable situations, but they can’t move.”
For immigrants stuck in dangerous conditions, one invaluable local source of medical care is the Ibn Sina Foundation’s network of community clinics. Staff from there have waded through flood waters to bring basic medical supplies and other necessities to people.
Mariela Soberanis, a clinic manager, said that many Houstonians struggle with healthcare after a major storm, related to both physical and mental health.
And in more normal times, her staff provide a low-cost one-stop shop, especially for the uninsured, with specialists, ultrasound exams, bloodwork, dentists, pediatric specialists, facilities for minor procedures and an on-site pharmacy.
Yet in recent months, the clinic’s waiting room has been noticeably emptier as immigration enforcement officers prowl the streets.
“People don’t want to come out,” Soberanis said. “Unless they really, really, really have to.”
