Cándido Álvarez has a simple healthcare policy: never go to the doctor. Not when he's sick, not when it's serious, and definitely not when his body temperature hits 120°F during a construction job in an unventilated bodega. Even blood in his urine - a likely sign of kidney damage from extreme heat - wasn't enough to get him to an emergency room. Why? A four-hour hospital visit for COVID-19 left 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," said Álvarez, a 47-year-old undocumented immigrant from Honduras who has lived in Houston since 2015. Unlike his wife and three kids, he has no health insurance, despite daily exposure to mold, insulation debris, and bosses who consider masks and eye protection optional accessories. He's often remodeling flood-damaged homes or cleaning up storm debris, all while living within spitting distance of an airport and multiple chemical plants. The city insists the air is fine. Álvarez has doubts.
Álvarez's story is a case study in how the climate crisis, industrial pollution, and environmental disasters conspire to clobber lower-income immigrant communities harder than others in Houston, one of America's most diverse metro areas. Add a second Trump administration's mass deportation agenda and rising healthcare costs, and you've got a recipe where seeking medical treatment feels like a luxury few can afford.
Where Álvarez's family lives is where much of Houston's pollution ends up - a fact reflected in a 21-year life expectancy gap between the lower-income, predominantly Black and brown east side and the wealthier, whiter west side. This gap is neatly illustrated by something locals call "the arrow": a shape that emerges when you map prosperity indicators across the city. Inside the arrow lie luxury stores, green spaces, and Texas's richest suburb. Outside it, to the south and east where many blue-collar immigrants live, poverty rates, childhood asthma rates, and the number of hazardous waste sites all spike.
"Almost every indicator you look at, this arrow emerges," said Nadia Valliani, director of community impact at the Greater Houston Community Foundation.
Houston's vulnerability to extreme weather - cyclones, severe thunderstorms, winter storms, hurricanes, floods, and heat have all pummeled the city in recent years - pairs disastrously with its status as "the epicenter of North America's petrochemical industry." Roughly 30% of Houston's 2.4 million residents are foreign-born, and nearly a third of them lack legal status. They're the ones bearing the brunt of poor environmental planning.
"I think we just haven't stopped living in survival mode for a very long time," said Norma Gonzalez, a community advocate at Woori Juntos. Homes flooded up to their windows in past deluges remain in the same precarious condition, with zero added infrastructure to prevent future floods. And amid disaster after disaster, people are becoming more isolated, reluctant to ask for help.
Hurricane Harvey in 2017 dumped up to 60 inches of rain - a downpour made 15-38% worse by the climate crisis, according to estimates. It killed 89 people and caused $158.8 billion in damages. Since then, Houston has weathered the COVID-19 pandemic, the 2021 winter storm, a May 2024 derecho that left 900,000 without power, and Hurricane Beryl two months later, which plunged 3 million homes and businesses into darkness. And those are just the natural disasters.
Harris County processes 2.6 million barrels of crude oil daily. Its east side hosts a 52-mile shipping channel that human rights advocates call a "racial sacrifice zone," with more than 400 petrochemical facilities. Before big storms, refineries hastily burn off fuel and chemicals; those same plants flood easily, contaminating floodwater that then pollutes streets and waterways. During Harvey, a trillion gallons of rain mixed with sewage and 340 tons of air pollution from plant malfunctions. At one facility, 461,000 gallons of gasoline spilled half a mile from a predominantly Latino neighborhood.
Nearly a quarter of participants in a study of Houston's Vietnamese community reported injuries or illness from Harvey. Those with damaged homes were far more likely to suffer poor mental health. In a 2017 survey of Texas Gulf Coast counties, nearly a quarter of immigrants said they needed more medical care; over half had no health insurance, and more than 40% had no regular doctor.
Since January 2025, 48% of likely undocumented immigrants, 14% of lawfully present immigrants, and 8% of naturalized citizens across the country have skipped medical care due to immigration-related fears, according to KFF research. The mass deportation campaign adds stress to patients already struggling with chronic disease or mental health issues.
Melissa Villarreal, who studied Harvey's impact on Mexican-origin women, recalled how even under the first Trump administration, lack of access to FEMA assistance or affordable loans left families in unsafe conditions. Undocumented immigrants face challenges opening bank accounts and building credit. Families blocked off whole rooms due to mold and holes in the roof, or used only one bathroom because they couldn't afford to fix the other.
"Because they didn't have the money, they never recovered," Villarreal said. "But then what happens the next time there's a disaster?"
Experts call the ensuing mental health effects the "recovery from the recovery," as people of color face FEMA denials and are expected to treat unsafe living conditions as their new normal. Villarreal suggests fixes: accepting more types of documentation, better call center training, and hiring more multilingual staff.
Meanwhile, local organizations and grassroots activists are devising better-targeted disaster aid and advocating for proactive prevention. Hilda, an undocumented immigrant and environmental advocate in northeast Houston's Settegast neighborhood, hopes to mitigate soil contamination and flood risks by planting more vegetation. It's a small green step in a city that keeps getting hit by everything but the kitchen sink - and sometimes, apparently, that too.