Over the past two years, buses have transported hundreds of thousands of migrant children and adults from southern states to sanctuary cities. The migrants arrive with nowhere to live — and in need of health care.
“They had no community, they had no families and then the cities were not ready to accept them in a way that would keep them safe,” said Alan J. Shapiro, M.D., FAAP, senior medical director of the Montefiore Bronx Health Collective in New York City.
New York saw an influx of more than 200,000 migrants in the last two years, with about 58,000 asylum-seekers living in city-funded shelters as of Nov. 10, 2024.
Terra Firma, an organization co-founded by Dr. Shapiro, conducted immunization drives, provided mobile medical care to children and parents, connected families to assistance with asylum applications and held social services workshops. Pediatricians around the country are involved in similar efforts to connect migrant children with care.
“The work is very similar to disaster relief,” Dr. Shapiro said. “You want to direct your care to the most immediate needs, stabilizing children and families.”
Buses also were sent to Washington, D.C., Chicago, Denver, Los Angeles and Philadelphia. The dispersals began in April 2022 as a response from the Texas, Arizona and Florida governors to the Biden administration’s intentions to end border restrictions put in place during the worst days of the COVID-19 pandemic.
More than 47,000 have come to Chicago, where many bused migrants were camping outside police stations until the city moved them into shelters or other sites in December 2023. Medical students at the University of Illinois Chicago created the Mobile Migrant Health Team. Their unit visited those at police stations and collected health histories and concerns, provided over-the-counter medications and connected those in need to emergency or primary care.
In Washington, D.C, which has seen an influx of more than 13,000 migrants, mobile units from Children’s National Hospital and other federally qualified health centers began servicing shelter sites in September 2022 with onsite vaccination, triage and acute care. That expanded to well-child care and sick visits in June 2023.
How pediatricians can get involved
Large-scale relief efforts like these can begin with pediatricians who want to bolster the Academy’s position — outlined in the policy statement Providing Care for Immigrant, Migrant, and Border Children — that “it is in the national interest that we work to ensure that all children within the United States, including immigrant, border, and migrant children, grow up physically and developmentally healthy.”
“You can provide referrals and have information on immigration attorneys,” said Minal Giri, M.D., FAAP, co-founder and chair of the AAP Illinois Chapter’s Refugee and Immigrant Child Health Initiative. “You can write letters of support on behalf of parents who are being deported or who are involved in legal proceedings” and whose children would face medical hardship because of displacement.
Dr. Giri started working with unaccompanied migrant children more than a decade ago when she began evaluating detainees seeking special immigrant juvenile status due to abuse, abandonment or other reasons.
“I was doing the evaluations and quickly realized there were not a lot of people in Chicago performing these — there was just a handful of us, maybe four people — especially not pediatricians,” she said.
The lack of a formalized referral system led her to co-found the Midwest Human Rights Consortium, which advocates for equitable access to legal immigration.
Dr. Giri, who is a member of AAP Council on Immigrant Child and Family Health (COICFH) Executive Committee, said all pediatricians can do simple things such as stocking “Know Your Rights” pamphlets in their clinics and using signage with information pertaining to immigrant families.
Dr. Shapiro suggested joining COICFH.
“You’re going to meet a lot of like-minded pediatricians who have already been doing the work, have a lot of expertise in the area and have been dealing with the problems that you as a new pediatrician who (is) interested in this population might want to start solving yourself,” he said.
He also recommended reaching out to local organizations working with the immigrant population such as the AAP chapter, primary care association or other nonmedical community groups.
“Perhaps the best lesson I learned in working with migrants and immigrants is to work in a multisector way,” Dr. Shapiro said. “Look for the folks in your community that are doing nonprofit legal services. They would be a great source of information, but also of possible patient referrals, and a good way to start bridging a medical-legal partnership.”
Terra Firma is one of those partnerships. A collaboration of Montefiore Bronx Health Collective and the New York Legal Assistance Group, the organization pursued a “clinic that would not only see these children and give them comprehensive care and mental health services, but also be willing to … evaluate children and write affidavits that could be used as evidence to support their immigration cases,” Dr. Shapiro said.
Preparing for the future
The new Trump administration has pledged to change the country’s immigration landscape, and pediatricians can help prepare patients and families for whatever lies ahead.
“You can be a trusted source of information,” Dr. Giri said. “Be able to have a conversation with families to allay their fears and possibly make mental health recommendations.”
Dr. Giri suggested pediatricians familiarize themselves with local social services so they can connect families with legal services, volunteer attorneys, guardianship options and other resources.
“I think the antidote to fear is planning,” Dr. Giri said. “That is the antidote to uncertainty.”
