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‘Brewing humanitarian crisis:’ AAP leaders, members visit Texas border to assess needs of immigrant children :

January 6, 2017

The number of immigrant children and families fleeing Central America has surged in the last year, with about 700 to 1,000 people a day being apprehended at the U.S. border.

“This is a brewing humanitarian crisis that is boiling up quietly until it bubbles over,” said AAP President Fernando Stein, M.D., FAAP, who visited the Texas border on Nov 10.

Dr. Stein was accompanied by AAP Past President Benard P. Dreyer, M.D., FAAP, Texas Chapter President Kim Avila Edwards, M.D., FAAP, AAP members and staff. The group visited a Customs and Border Protection processing center called Ursula that houses unaccompanied children and families in McAllen, Texas.

Information gathered at the visit will inform the impending AAP policy on detention of families and unaccompanied immigrant children. The Academy also contributed to a report published last fall that advises the director of the U.S. Department of Homeland Security on the needs of children and families detained at family residential centers. The report, available at, states that family residential centers are not necessary and suggests that families be released with orders to appear in court at the time of their hearing.

After surviving the trek from Central America, children at the Texas processing center are on U.S. soil, but their journey is far from over. Conditions are not welcoming inside Ursula, which has a second nickname: la perrera (the kennel), because of the chain link fences that divide the warehouse into quadrants.

Dr. Stein recounted how heartbroken he felt for the detained children.

“They are temporarily deprived of all their possessions — that may include a security blanket or teddy bear.”

The children are grouped by gender and age, sometimes separated from other family members for the next 36 to 72 hours, he added. Children have a mat to sleep on and a Mylar blanket. For safety, the lights are never turned off. In the processing center, the children have no way to know the time of day.

Outside of Ursula, community resources are stretched to their limits. Churches struggle to provide medical assistance, clothing and meals before the children and families continue on to their sponsor or to a long-term dormitory, Dr. Stein said.

The latest surge could be linked to the deportation of gang members from the U.S. to Central America. “This has been covered in Latin American press,” he said. “They are creating very violent conditions that are forcing families and children to flee back to the United States.”

Dr. Stein advised pediatricians who see children after they are released into the community to ask about adverse events they experienced or witnessed before, while in transit to and after arriving in the United States.

“The possibility of any of these children having some sort of traumatic event that can trigger very conflicting post-traumatic stress disorder is high, so the first thing a pediatrician needs to do is an assessment for psychological trauma,” he said. “In interviews I have conducted prior to this visit, many of them have had to sell their bodies to people along the way to pay for favors, to not be killed, all kinds of really horrible experiences.”

Many children have been traumatized after witnessing the murders of their family members, he added.

Families also fear deportation once here and may not know their rights.

Pediatricians can offer guidance on children’s legal pathways in seeking asylum and letting them know that they have a right to a free education, said Dr. Stein. “They need legal representation because they or their family members do an inadequate job in representing them and their unique condition.” (See resources.)

Changes to U.S. immigration policies have been discussed in the media, but he advised against planning for the unknown. “When you are flying an airplane, you don’t worry about the sky above or the sky below. You keep flying.”

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