Pediatrics and Adolescent Medicine
THE MIGRANT CHILDREN CRISIS IS NOT OVER
Heyman Oo, MD, MPH
On April 6, 2018, Attorney General Jeff Sessions announced a “zero-tolerance” policy regarding the immigration crisis at the U.S. southern border, but it was not until May 7, 2018, that he delivered remarks in San Diego that would spark an eight-week national outcry.¹ In an attempt to deter illegal border crossings, the U.S. Department of Justice and U.S. Customs and Border Patrol (CBP) took what was formerly a quiet, obscure, case-bycase procedural decision—i.e., the separation of family units in CBP custody—and universally expanded the policy to separate all asylum-seeking parents from their children. In less than two months, almost 3,000 children were separated from their caregivers at border processing facilities, sometimes under false pretenses of “taking them for a bath.”² These children, including over 100 children under the “tender” age of five, were transported without their caregivers’ permission or knowledge to detention centers and shelters all over the country. We have all seen the photos of children in cages. We have heard the stories of toddlers as young as three years old representing themselves in immigration court hearings without their parent present.³ Many of us physicians felt particular outrage at the reports of children being forcibly given psychotropic medications without consent in order to “calm them”⁴ after they were exhibiting clear behavior changes related to their governmentinflicted trauma. As healers and as health experts, we knew how this trauma would have long-lasting detrimental effects on the health of these children for months and possible years to come. So we showed up and we spoke out—pediatricians, psychiatrists, family medicine providers, and many others. We attended rallies, wrote letters, contacted Congress, went on local and national television demanding not only compassion for these families for compassion’s sake, but also educating the public about the science of trauma in childhood and its persistent, negative effects on health. Finally, and perhaps in part because of our collective efforts, on July 22, a U.S. District judge in San Diego signed an injunction on the family separation policy⁵ and required the government to reunite all separated children with their caregivers within one month. It was a solid victory. Now, many months later, after hundreds of news articles, journal pieces and opinion blogs, what more is there to say? To start, as of mid-September, over 500 children still have not been reunited with their caregivers for reasons not entirely clear or transparent. These children are scattered all over this country, some perhaps placed with distant family members or family friends; some may be in shelters for unaccompanied minors (a false designation given when our government forcibly separated them from their parents making them newly unaccompanied) and some, no doubt, placed with strangers in 14
our already-overburdened foster care system. The American Civil Liberties Union and other organizations continue to work tirelessly to obtain the names and locations of these children in reunification efforts. However, this humanitarian mess of our government’s creation is far from over. On the contrary, the Department of Homeland Security (DHS) is proposing to Congress ways to hold minors in detention for longer periods of time, maybe even indefinitely. They aim to overrule or circumvent the Flores settlement of 1997, which requires the government to hold minor migrants in the “least restrictive setting possible” and usually for less than a month.⁶ Recent reports show that the number of immigrant children currently in government detention has already reached historically high numbers,⁷ and these numbers will only continue to rise if the Flores settlement is completely overturned. We know that there is no “safe” detention environment, no dose or set period of time that is without consequence for detained children. Moreover, government-funded detention facilities and shelters have a long history of widespread physical, sexual and medical abuses. Most recently, these abuses were documented in 30,000 pages of evidence submitted for a lawsuit filed by the ACLU⁸ and in a whistleblower report filed by two physicians serving as health experts for the DHS Office of Civil Rights and Civil Liberties.⁹ As medical providers, we serve as advocates for our patients and their families. When it comes to children, who are by definition disenfranchised and more vulnerable, our responsibility as pediatricians is that much greater. Until every one of these remaining children is reunited with their families, we as physician advocates need to keep writing, keep calling and keep speaking out. We need to urge our public officials to uphold the Flores settlement and require that the government honor and recognize
SAN FRANCISCO MARIN MEDICINE NOVEMBER 2018 WWW.SFMMS.ORG