COMMENTARY

What Deportation Centers Are Like for Kids: AAP Takes a Look

Hansa Bhargava, MD; Fernando Stein, MD

Disclosures

May 08, 2017

Hansa Bhargava, MD: Hi. I am Dr Hansa Bhargava, a practicing pediatrician, senior medical correspondent for Medscape, and senior medical officer for WebMD. I have the pleasure of having Dr Fernando Stein, president of the American Academy of Pediatrics (AAP), here to discuss some very important issues. Dr Stein, thank you for being here, and welcome.

Fernando Stein, MD: Thank you.

Executive Orders Relating to Refugees and Immigration

Dr Bhargava: In his first week in office, President Donald Trump signed immigration and refugee-related executive orders that were opposed by the Academy because of concern about harm to children. The executive orders expand [the categories of] immigrant children and families who would be prioritized for deportation and seek to take enforcement action against cities that provide safe harbor for undocumented immigrants. Dr Stein, you have been very personally involved in visiting border detention facilities to observe children and the effects of these types of detention. Can you describe your main observations and concerns?

Dr Stein: Yes. There has been a drastic rise and fall in the numbers of detentions over the past 6 months. When I visited for the first time in August 2016, the Immigration and Customs Enforcement (ICE) officials were capturing about 100 children and families a day. In December, that number was approaching 1000 a day. When I visited 3 weeks ago, ICE officials were capturing dozens—it was down to a trickle.

Part of the explanation is known as the "Trump Effect." People think that the policies of the President of the United States, announcing that there would be a separation of children from their parents, if captured, had a chilling effect on the people crossing the border. The interesting question is, where are these children coming from? They are leaving Guatemala, El Salvador, and Honduras to flee from bullets and famine.

But the reason is not that children are not continuing to flee these countries; it is that they are staying in Mexico. I was at a meeting of several of the Mexican pediatric organizations, along with representatives from UNICEF and the Pan American Health Organization 6 weeks ago. Mexico is having a very difficult time because it is ill-prepared to deal with the onslaught of immigrant children and their families.

Dr Bhargava: Have there been more crime and assaults in these circumstances because people are afraid of being caught? We have heard some reports of that happening in the United States with the increased activity of ICE.

Dr Stein: Recently, I heard an interview with the chief of police in Houston[1] in which he said that there had been a drop of up to 40% in violent crime reported in the Latino community in his city. We know that decrease in crime has not happened. We know that [the decrease in reports] is because they are being underreported.

What Children Experience in Detention Centers

Dr Bhargava: There are effects on children, on families, and on crime.The AAP issued a recent policy statement[2] opposing family detention. What are the main points in that statement and what does the AAP propose as an alternative?

Dr Stein: The AAP thinks that children should absolutely not be held in detention. These children are not criminals, and we think that they can and should be embedded in the community as soon as they arrive because they are children.

I can briefly describe how they are held, which would tell you how inappropriate detention is. I visited a center [in Texas] called Ursula. The walls are 25 to 40 feet tall. It is a concrete building akin to a megastore like Costco or Walmart, with a dividing wall created by very thick prison-grade chicken wire. Children are separated by age and by gender. There is an image I would like to erase from my mind: a child with his name and telephone number written in tar paint on his white T-shirt.

Children get stripped from their clothes and their possessions—their teddy bear, their security blanket. These are put in a plastic bag. Then they are given the uniforms of the center and a Mylar blanket. There were 1000 children in there. If you put 1000 children anywhere else, they are going to be running and laughing and chasing each other. The most compelling vision and experience of that moment was that these children were quiet. There was absolute silence. They were not being ordered to be quiet. They were laying down but not sleeping.

I should say that the guards are not mean to them at all. Many of the guards are immigrants themselves, but they are police officers (or whatever you would call that type of activity) with a job to do. These children are put in detention and often they do not know what is going to happen next. They get processed and eventually they get interrogated. They are asked, "Where are you going?" The majority of them have a phone number. The [detention center] calls the relative and says that they have their nephew or niece and asks whether they will accept them and present them to court within 30 days. The relative says yes, and these children are given a bus ticket and shown the street.

At that point, their possessions are returned. The communities of Harlingen, Del Rio, and McAllen have gathered together to help these children. They pick them up in a bus and take them to a church hall or some other kind of facility, and re-interview them. They say, "Your uncle is in Milwaukee. Well, that is a 3-day bus ride. You are going to need a backpack with 12 bottles of water and nonperishable foods. Here is your backpack." The way this plays out shows both the best and a little bit of the worst that we have in the American soul.

Dr Bhargava: That is a very sad depiction. Are the children allowed to see their mother or father after they are put in these facilities?

Dr Stein: When I visited there, they had not implemented the [policy of] separation [of children and parents] that was announced, to our knowledge.

Doctors: A New Class of Criminal?

Dr Stein: Let's discuss another aspect, which is their medical care. Recent drafts of policies that we have become aware of talk about criminalizing anyone who helps or renders medical care to these children. That has the potential of making criminals out of doctors who see these patients. And also nurses and families—uncles and aunts—that receive these children in their houses. If that were to be implemented, it would create a new class of criminal.

Dr Bhargava: The AAP has come out strongly in the past few years about the issue of toxic stress. We have seen studies that demonstrate that toxic stress actually affects humans down to their very DNA. Would you consider this [situation to be one that causes] toxic stress?

Dr Stein: Yes, and not only for immigrant children but also for providers. Physicians are being subjected to toxic stress, such as the 10-minute limit to see a patient. Imagine making a criminal out of one of our colleagues because he or she committed the crime of seeing patients who needed to be seen who were in the United States illegally.

Dr Bhargava: Do you have any advice for individual clinicians who would like to support the AAP's efforts in this area?

Dr Stein: Get involved. Speak up. We have a legislative conference soon and will have over 220 pediatricians who are going to Washington to advocate for children.

Dr Bhargava: Thank you, Dr Stein. I am Dr Hansa Bhargava from Medscape. Thank you for joining us today.

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