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Health concerns increase for migrant children in outdoor detention sites

For Dr. Theresa Cheng, the scene was “apocalyptic.”

She had come to Valley of the Moon, an open-air detention site in San Diego’s Mountain Empire countryside, to provide volunteer medical care to asylum seekers who had crossed the U.S.-Mexico border wall and were waiting to be apprehended by American authorities.

Among the crowds at this and other sites, she found children suffering from deep lacerations, broken bones, fever, diarrhea, vomiting and even seizures. Some hid in overflowing dumpsters and porticos. An asthmatic boy without an inhaler breathed in the acrid smoke of brush and trash fires, set for warmth.

With capacity at immigration processing centers limited, migrants, including unaccompanied children, wait for hours or even days in outdoor waiting areas, where lack of shelter, food and he health infrastructure has triggered a series of public health problems for most. vulnerable.

“From a public health perspective, there are communicable diseases and outdoor exposures that would strike anyone, much less this medically vulnerable population,” said Dr. Cheng, an emergency physician at the hospital. San Francisco General and Zuckerberg Trauma Center.

A federal district court judge in California could rule as early as Friday on whether the government is legally required to house and feed the children while they wait.

In a court filing, Justice Department lawyers argue that because the children have not yet been formally taken into custody by U.S. Customs and Border Protection, they are not required to provide such a service.

“Minors in these areas – near the California-Mexico border – have not been arrested or apprehended by CBP and are not in CBP’s lawful custody,” the attorneys wrote.

“CBP quickly apprehended and transported minors to safe and sanitary U.S. Border Patrol facilities. But until that happens, plaintiffs are not in the custody of DHS,” they wrote, referring to the Department of Homeland Security.

When asylum seekers enter the United States between official ports of entry, they often present themselves to Border Patrol agents near the wall with the intention of being apprehended. They are taken to a processing center, where they undergo a medical exam, background check and basic arrangements as they begin the legal claims process.

But unlike these immigration processing centers, the open-air sites do not have shelters, meals or government-affiliated medical personnel. Some sites do not have toilets, forcing people to defecate outside in the open, according to Erika Pinheiro, executive director of the nonprofit legal and humanitarian organization Al Otro Lado, which has provided help in the camps. With a limited number of diapers, wipes and creams provided by volunteers, babies were kept in dirty diapers for long periods of time, according to court exhibits, causing severe diaper rash.

A senior Customs and Border Protection official acknowledged in an interview that people had sometimes waited days for processing, but said vulnerable groups like children were still prioritized and wait times had declined considerably in recent months. He said the agency has more than tripled the capacity of San Diego’s processing centers and increased the number of buses and transportation personnel to speed up arrests.

Nonetheless, he added, the system was not designed for migrant encounters on the current scale, and moving crossings to more remote areas has made the process even more resource-intensive, since vehicles and personnel must travel further between encampments and Border Patrol. stations. He said a significant increase in federal funding would be needed to fully address the problem.

At least seven migrant detention zones have been created in different locations along the California border. One is a large expanse of land in the desert, next to a highway; another is a plateau in a wild and mountainous nature; another is the narrow space between two parallel border walls that were erected just steps from the Mexican city of Tijuana.

None of the holding areas have been officially established by immigration officials, but they have become a mainstay of their operations: makeshift camps where they ask asylum seekers to queue for counting, to take off their shoelaces, undress and wait.

Adriana Jasso, who runs a volunteer aid station against the steel slats of the border wall in San Ysidro, Calif., on behalf of the American Friends Service Committee, a nonprofit organization, said the lack of food , water and formula provided by the government had been of particular concern. “There is no logic if the most powerful country in human history, the country with the highest concentration of wealth, is not able to provide for the basic needs of children,” he said. she declared.

Migrant advocacy groups have filed several complaints with the Department of Homeland Security’s Office for Civil Rights and Civil Liberties, and a group of attorneys who represent children in immigration custody in connection with A 1997 federal court agreement known as the Flores settlement took the courts to task over the terms.

The Flores settlement agreement established the standards of treatment for immigrant children in government custody. Among other things, it requires that children in immigration custody have access to toilets, food, drinking water and emergency medical care, and that they be released from detention in of an appropriate sponsor, such as a parent or relative, “without unnecessary delay”. »

Lawyers for the plaintiffs in the settlement, including the National Center for Youth Law, an Oakland-based nonprofit, filed a new motion to enforce Flores’ terms on young migrants still awaiting processing in outdoors. They say children waiting at the border wall deserve the same safe and sanitary housing as those already in official detention, since they are barred from leaving the camps and have no way to return. .

The burden of medical problems among children in waiting areas is difficult to measure, because volunteers are only allowed on sites at the discretion of border agents, and a mix of humanitarian groups do not keep collective records of wounds treated or electrolytes distributed.

In a December 2023 email to federal officials, an attorney wrote that infants in waiting areas began vomiting due to severe dehydration and that some children were given a granola bar a day to Eat. Pedro Rios, director of the American Friends Service Committee’s U.S.-Mexico border program, said he has encountered migrants who were eating leaves because they had been there for five days without food, as well as mothers who had stopped of producing breast milk due to traumatic stress and infants without formula to replace it.

Hundreds of children have been gathered at the sites every month since last summer, and Dr. Cheng, who is also a professor of emergency medicine at the University of California, San Francisco, estimated that she had evaluated or treated 100 children in a single week. . She met a child aged 5 and 12 who had spent three nights outside; an 8 or 9 year old child whose face she gave stitches in the open air; a 13-year-old boy suffering from a traumatic injury, with blood flowing from his ears and nose.

Children are not the only migrants to suffer serious health problems. In remote areas of eastern San Diego County, those surrendering to border officials have often endured arduous journeys through steep mountainous terrain and desert lands, arriving at holding areas in poor condition. deteriorated. Doctors said they encountered a man with a kidney transplant who lacked immunosuppressants, a woman with a traumatic stroke who couldn’t reach her own shoelaces, and a migrant who traveled with an oxygen concentrator and had become hypoxic. He finally died.

Doctors are particularly concerned about cases of hypothermia in children because many of them have lower body fat than adults and may become malnourished from their travels. Migrants were drenched by heavy rain in waiting areas overnight, which can cause body temperatures to plummet. Two minors were hospitalized for hypothermia last month.

Karen Parker, a retired social worker from Boulevard, Calif., who volunteers to do medical triage in Eastern camps, said that in addition to broken feet and twisted ankles, she regularly encounters unaccompanied minors suffering from panic attacks. “The stress, the exhaustion, the trauma makes them physically ill,” she said. “I look at them, thinking they’re finally here, but their eyes are so empty.”

The number of people and the length of wait times have fluctuated since last summer. In recent weeks, Mexican military activity has pushed migrants westward, to a more urban region between Tijuana and San Ysidro in California, where asylum seekers who cross the first border wall must wait for federal agents in a space 280 feet behind a second. There are fewer holes in the main border wall, meaning more children are being transported over it or smuggled under it, despite the concertina wire. Aid workers have documented an increase in deep head cuts, and local neurosurgeons have reported an increase in traumatic injuries.

In recent weeks, a 3-year-old and a 1-year-old both fell from the border wall into their parents’ arms.

“When you hear the babies crying and crying, right on the other side of that wall, that’s the worst,” said Clint Carney, director of government affairs for the nonprofit Survivors of Torture, International, which provides assistance through the slats in the border wall.

Local emergency medical services teams were inundated with calls from the sites, and aid workers said federal agents often refused their requests to dial 911, suggesting the migrants were faking injuries. Those who were seriously injured often called volunteer medical staff to notify them by telephone.

When Dr. Cheng received one such call one recent morning and arrived on scene to find a 13-year-old boy with a weak pulse and blood pouring from his ears and nose, two border agents were standing nearby but had not made any contact. steps to help, she said in court documents.

Dr. Cheng performed CPR, but it took an hour for emergency services to arrive, she said. The boy is dead.

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