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AAP continues advocating for humane treatment of children at border

May 9, 2023

“Hello! Where are you going?” I asked a 9-year-old boy in my broken Spanish during an AAP visit last year to the Humanitarian Respite Center of the Rio Grande Valley in Texas. He and his family had just gone through untold challenges to escape the dangers in their home country and seek asylum in the U.S. After crossing the border, they went through U.S. Customs and Border Protection (CBP) processing and now were on their way to their family’s sponsor.

When I told the boy (again in broken Spanish) that I was a doctor, he looked at me a little suspiciously and wanted to know if I was going to stick anything up his nose (the medical staff had just tested him for COVID). I laughed and said no, and welcomed him to our country with a high five, which he happily returned.

The Humanitarian Respite Center run by Catholic Charities was full of hundreds of people, including many infants, children and adolescents. While waiting for a bus or flight to sponsor destinations across the country, they received food, clothing and basic legal and medical support. They finally know they are safer than where they came from.

We also visited the Donna Processing Facility in the Rio Grande Valley run by the Department of Homeland Security (DHS) CBP. Unaccompanied children and families who have been apprehended in that region are brought here first before families are released to places like the respite center. (Unaccompanied children are those who have no lawful immigration status in the U.S., are younger than 18 and do not have a parent or legal guardian immediately present and able to care for them when they enter the U.S.)

The treatment of children in these CBP facilities has been scrutinized over the last several years guided by AAP policy and advocacy. With pediatrician leadership at DHS, there has been movement in the right direction, but the care of families and unaccompanied children still needs to be improved. Chain-link fencing, comparable to cages, has been replaced by clear, plastic walls. However, we observed jail-like holding cells packed with men and women, including pregnant women.

Every day, thousands of women and children arrive exhausted and in need of care.

In the facility holding rooms, they must sleep on mats on the floor, covered in Mylar blankets pulled over their heads to block out the bright lights. There is little that is child-friendly, including the presence of armed law enforcement personnel when children and families arrive. While they receive basic necessities, including food, water, clothes and baby supplies, there are not enough caregivers for the large numbers of children in the facility on any given day.

It still is a human processing center, and it feels like one. The walls are stark white, the lights are bright, the lines are long and the furnishings are reminiscent of a disaster relief facility. It’s hard not to think of herding when watching how people are being moved from one station to the next. The balance of reducing trauma to children and adolescents and the need to process thousands of people daily is an obvious struggle.

Ideally, no child — especially an unaccompanied child — would be subjected to these facilities, and a humanitarian process staffed by clinicians, social workers and other child welfare specialists in child-friendly spaces would replace them.

While systemic separation of parents from children no longer is in place, the separation of children from other trusted adults, such as aunts, uncles and grandparents, continues. CBP is required to transfer unaccompanied children to the Department of Health and Human Services’ Office of Refugee Resettlement (ORR) within 72 hours. Upon transfer to ORR, unaccompanied children usually are placed in congregate care environments or, in more limited cases, foster care placements.

As of early 2023, ORR operated approximately 300 programs in 27 states that provide housing, food, clothing, health care, education, recreation, case management and access to legal services. The average length of stay for an unaccompanied child in an ORR placement was about one month in 2022. During this time, ORR works to find and vet a sponsor for child, typically a parent, other relative or family friend with whom the child will live while pursuing immigration relief. It can take years for unaccompanied children to have their immigration case heard, which will determine whether they can remain legally in the U.S. or must repatriate to their home country.

For many years, the AAP has advocated strongly for improvements in the care and treatment of immigrant children. Most recently, the AAP, along with the Migration Policy Institute, released a report titled A Path to Meeting the Medical and Mental Health Needs of Unaccompanied Children in U.S. Communities (see related story). It includes numerous recommendations for government, including ORR, health systems, schools and communities.

News that DHS once again is considering family detention led the AAP, along with nearly a dozen medical and mental health organizations, to urge it to abandon the harmful practice of detaining families. The AAP also recently provided detailed comments on a Biden administration proposal that, if implemented, would severely restrict families’ lawful right to seek asylum in the U.S.

As pediatricians, we know that all children need access to age-appropriate, trauma-informed, evidence-based health care. Regardless of how children arrive in our country, they should be treated humanely and afforded the protections that all children deserve.

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