On the Greek island of Leros, newly arriving families from Syria, Somalia, Afghanistan, Pakistan, and beyond are routinely received at the landing dock and escorted into barbed wire–lined refugee camps. Many ask if they are being taken to prison. Inside these barrack-like camps, residents are assigned an Isobox, or converted shipping container, in which to live. Although these metal units are certainly sturdier and safer than tents or huts made from tarpaulin and bamboo, they are far from anything that resembles a home. However, because most refugees are held in these camps (or “registration centers”) for months to years while their asylum papers are processed, these containers become obligatory homes of sorts. As several camp staff explained to me, many prefer to call them “caravans,” recognizing the inappropriateness of housing any human in something called a container.

Nearly 40% of those living in such containers are children, with >2200 arriving unaccompanied each year according to recent statistics from the Greek Council for Refugees.1 These children do not attend school. They must line up in long queues to see the doctor and in longer queues to receive daily rations. Many of their parents, if they are alive, are emotionally absent. Child abuse, gender-based violence, and suicide are rampant. Although a life of containers and queues would be difficult for any human, the impact on young humans is immeasurable.

All the children in these camps landed there because they had been forced to flee from their homes. Whether because of famine, war, or persecution, they risked their fragile lives to seas, deserts, and smugglers to seek a safer home. Between January and September of 2017, it is recorded that 161 087 such children claimed asylum in Europe, with an additional estimated 56 717 in the remainder of 2017. Almost 60% of children were <5 years of age.2 These thousands of children, and many more across the globe, face daily adversities that impact their well-being for life.3 However, rather than providing safe homes for them, many countries across the European Union and the world are closing their doors (tightening their refugee policies and granting fewer applicants protection status).4 That is, as the number of displaced children increases worldwide, the number of new homes for them is reflexively decreasing.

As a result, refugee camps, such as the one on Leros, are becoming overcrowded and indefinite holding centers. Greece, for example, passed a containment policy that prohibits migrants from leaving the islands until they are granted asylum in a designated country, a process that is often prolonged and unpredictable. While awaiting their resettlement assignment, camp residents live out this uncertainty in conditions that magnify and multiply their store of traumas.

These prisonlike holding places positioned along the paths of fleeing families resemble the many detention centers and shelters along the US border. Here, “caravans” refer to large groups of migrants from El Salvador, Honduras, Guatemala, and elsewhere in Central America who are similarly fleeing trauma-ridden pasts. Once they reach the border, however, they are stopped and held in processing centers with notoriously atrocious living conditions under the charge of US Customs and Border Protection. Moreover, the US Department of Homeland Security has reserved the right to separate children from their families and place them in shelters or foster care, undoubtedly adding a new layer of adversity.5 Similar to the children who are held on Leros in caravans of a different sort, these children must now shoulder an even heavier load of traumas: those resulting from separation and isolation are now heaped together with those gathered along their asylum-seeking journey, not to mention those accumulated from their lost homes.

Extensive evidence reveals that adverse childhood experiences leave negative and long-lasting imprints on child development.6 Yet, the adversities faced by migrant children globally continue to persist and proliferate. Frustrated with a sense of powerlessness in this situation, I traveled to Leros last month on behalf of the Syrian American Medical Society. Our clinic, which was housed in 1 of the infamous containers, was frequented by children with malnutrition and recurrent diarrhea, old artillery wounds and unabating pain, uncontrolled seizure disorders, undiagnosed thalassemias, mothers who were suicidal, and burns that could not be caused by anything but abuse. Exhausted caregivers brought us their toddlers who refused their daily rations and lived on milk alone, and teenagers hobbled in with sprained ankles after trying to escape over the camp’s 15-ft fence. Regardless of their chief complaint, most seemed to come seeking some remedy for their sense of humanity.

What our modest organization was able to accomplish on Leros was limited. And yet, the benefit of seeing what we saw was immeasurable. Beyond treating the assortment of childhood conditions common to camp settings was the value of bearing witness to the refugee crisis in full color. We were forced to watch how politics in practice wreaked havoc on the lives of so many of our patients. Bearing witness to the lives of these asylum-seeking children who dwelled in containers and feeling the thready pulse of their predicament revealed not only our clinical limitations in this context but also our collective responsibility in this crisis. These children needed not only our stethoscopes and syringes but also our privileged, unconfined voices to advocate for a true place of refuge for them and their families. Beyond our paracetamol and antiparasitics, they needed us to act against the root cause of their adversities.

Each child I saw there on Leros, and each child who is detained at the US border, represents pure resilience and survival, an audacity to carry on against all odds. However, they should not be left to struggle alone. It is our collective responsibility to speak out against the unjust policies that continue to pull them down. The call to action is not only to raise awareness of the adversities that are thrown on children who are seeking asylum but also to urge our legislators to change the policies that perpetuate these adversities. As specialists of child health and well-being, we must partner with our politicians to prevent further harms, such as by relaxing the restrictions placed on refugees who are seeking asylum in countries like the United States and in Europe and stopping the separation of children from their families at our border. We must proactively engage policies such as these that have enduring repercussions for a growing number of children in the world, whether they are from the Middle East and stuck in Greece or from Central America and being held in Texas.

This generation of children lives constantly on the move, yet they are stuck in camps and containers that stifle their natural ability to cope, develop, and thrive. These children, transient yet immobilized as they are, deserve a life of freedom, security, and care just as any other child. No human, young or old, should be living in something called a container. Calling it a caravan makes it no less prisonlike. Confinement, family separation, and the deprivation common to camp settings all add to a young migrant’s store of traumas, which follows them for life. It is our collective duty to look beyond rhetoric and act on behalf of these children who need protection and our voices as unconfined advocates of child health. Speak now against the immigration policies that keep these children on the move but inevitably immobilized.

Dr Esmaili conceptualized the manuscript, drafted the initial and final versions of the manuscript, approved the final manuscript as submitted, and agrees to be accountable for all aspects of the work.

FUNDING: No external funding.

Thank you to Dr David Hill for his review of the article and to the Syrian American Medical Society for their humanitarian work with refugees around the globe.

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. Statistics: Greece. 2018. Available at: www.asylumineurope.org/reports/country/greece/statistics. Accessed April 26, 2018
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. Latest statistics and graphics on refugee and migrant children. 2018. Available at: https://www.unicef.org/eca/what-we-do/emergencies/latest-statistics-and-graphics-refugee-and-migrant-children. Accessed April 26, 2018
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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.