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Health Concerns Rising for Migrant Children at Outdoor Waiting Sites

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

He had arrived at Valley of the Moon, an open-air holding site in rural San Diego’s Mountain Empire, to provide voluntary medical care to asylum seekers who had breached the U.S.-Mexico border wall and were awaiting detention. by US authorities.

Among the crowds at this and other sites, he found children with deep lacerations, broken bones, fever, diarrhea, vomiting and even seizures. Some were hiding in trash cans and overflowing port-a-potties. An asthmatic boy without an inhaler gasped in the acrid smoke from brush and garbage fires, which had been lit for warmth.

With the capacity of immigration processing centers stretched to the limit, migrants, including unaccompanied children, wait for hours (sometimes days) in open-air waiting areas, where a lack of shelter, food and health infrastructure has triggered a number of public health concerns for the majority. vulnerable.

“From a public health standpoint, there are communicable diseases and outdoor exposures that would affect anyone, let alone this medically vulnerable population,” said Dr. Cheng, an emergency room physician at General Hospital and Zuckerberg Trauma Center of San Francisco.

A U.S. District Court judge in California could decide Friday whether the government is legally obligated to house and feed the children while they wait.

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

“Minors in these areas, close to the California-Mexico border, have not been arrested or apprehended by CBP and are not in legal custody of CBP,” the attorneys wrote.

“CBP has been detaining and transporting minors to safe and sanitary U.S. Border Patrol facilities expeditiously. But until that happens, plaintiffs will not be in DHS custody,” 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 detained. They are taken to a processing facility, where they receive a medical exam, background check and basic supplies while they begin the legal claims process.

But unlike those immigration processing facilities, the open-air sites have no shelter, meals or government-affiliated medical staff. Some sites have no toilets, causing people to defecate in the open, according to Erika Pinheiro, executive director of the nonprofit legal and humanitarian organization Al Otro Lado, who has provided aid in the camps. With a limited supply of diapers, wipes and creams from volunteers, babies have been kept in dirty diapers for long periods, according to court evidence, causing severe diaper rash.

A senior Customs and Border Protection official acknowledged in an interview that people had sometimes waited days to enter processing, but said vulnerable groups like children were always prioritized and that wait times had decreased significantly in recent months. . He said the agency had more than tripled capacity at processing centers in San Diego and had increased the number of transportation buses and staff to speed up arrests.

Still, he said, the system was not created for migrant encounters on the current scale, and the shift of crossings to more remote regions has made the process even more resource-intensive, as vehicles and staff must travel further. between the camps and the Border Patrol. seasons. He said a significant increase in federal funding would be necessary to fully address the problem.

At least seven migrant detention areas have sprung up at various points along the California border. One is a large tract of land in the desert next to a road; another is a plateau in a mountainous desert; another is the narrow gap between two parallel border walls that have been erected just meters from the Mexican city of Tijuana.

None of the detention areas were formally established by immigration officials, but they have become a mainstay of their operations: makeshift camps where they instruct asylum seekers to line up for counting, remove their shoelaces, Take off a single layer of clothing and wait.

Adriana Jasso, who runs a volunteer aid station against the steel slats of the border wall in San Ysidro, California, on behalf of the nonprofit American Friends Service Committee, said the lack of food, water and baby formula provided by the government has been particularly worrying. “There is no logic if the most powerful country in the history of humanity, the country with the greatest concentration of wealth, is not able to meet the basic needs of children,” she said.

Immigrant advocacy groups have filed multiple complaints with the Department of Homeland Security’s Office of Civil Rights and Liberties, and a group of attorneys representing children in immigrant custody as part of a 1997 federal court settlement known as the Flores agreement has been adopted by the courts on the conditions.

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

Plaintiff attorneys in the settlement, including the National Center for Juvenile Law, an Oakland-based nonprofit, have filed a new motion to enforce Flores’ terms for immigrant youth still waiting to be prosecuted. outdoors. They argue that the children waiting by the border wall deserve the same safe and sanitary housing as those already in official custody, since they are prohibited from leaving the camps and have no way to return.

The burden of medical problems among children in detention areas is difficult to measure, since volunteers can only enter the sites at the discretion of border agents, and a hodgepodge of aid groups do not collectively keep track of the wounds treated or electrolytes dispensed.

In a December 2023 email to federal officials, an attorney wrote that babies in detention areas had begun vomiting due to severe dehydration and that some children had been given one granola bar for sustenance per day. Pedro Ríos, director of the US-Mexico border program for the American Friends Service Committee, said he had encountered migrants who had been eating leaves because they had been there for five days without food, as well as mothers who had stopped producing breast milk due to traumatic stress and babies without formula to replace it.

Hundreds of children have gathered at these sites each 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 alone. one week. . She encountered a boy aged 5 and 12 who had spent three nights outdoors; an 8 or 9 year old boy who she gave stitches in the face outdoors; a 13-year-old boy with a traumatic injury, blood coming from his ears and nose.

Children are not the only immigrants with serious health problems. In remote areas of eastern San Diego County, those who turn themselves in to border authorities have often endured arduous journeys through rugged mountain terrain and desert lands, arriving at detention areas in declining health. Doctors said they found a man with a kidney transplant who was running out of immunosuppressants, a woman with a traumatic stroke who couldn’t reach her own shoelaces and a migrant who had traveled with an oxygen concentrator and became He had become hypoxic. He finally died.

Doctors are particularly concerned about cases of hypothermia among children, since many have less body fat than adults and may be malnourished due to their travels. Migrants have been left soaked overnight in waiting areas by heavy rain, which can cause a drop in body temperature. Two minors were hospitalized for hypothermia last month.

Karen Parker, a retired social worker from Boulevard, California, who conducts voluntary medical testing at the eastern camps, said that in addition to broken feet and sprained ankles, she routinely encounters unaccompanied minors suffering from panic attacks. “The stress, exhaustion and trauma make 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, into a more urban region between Tijuana and California’s San Ysidro, where asylum seekers breaching the main border wall must wait for federal agents in space. 280 feet behind a second wall. Fewer breaches in the main border wall mean more children are dragged over or smuggled under, concertina wire notwithstanding. Aid workers have documented an increase in deep cuts to the head and local neurosurgeons have reported an increase in traumatic injuries.

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

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

Local emergency medical teams were inundated with calls from the sites, and aid workers said federal agents had often denied their requests to dial 911, suggesting migrants were faking injuries. Those who suffered serious injuries often called volunteer medical staff for advice over the phone.

When Dr. Cheng received one such call on a recent morning and arrived at the scene to find a 13-year-old boy with a weak pulse and blood coming from his ears and nose, two border agents were nearby but had taken no action. steps to help, he said in court papers.

Dr. Cheng performed CPR, but it took an hour for emergency services to arrive, he said. The child died.