Physicians Caring for Migrants Are 'Screaming Into the Void'

Usha Lee McFarling, MA

December 02, 2019

Detention Centers Attract Scrutiny

It was the reported deaths of three detained migrant children from influenza that most upset Sara (Sally) Goza, MD, a pediatrician from Fayetteville, Georgia. She decided that she wanted to see firsthand how children at the border were being treated. It took half a year, but Goza finally got permission in May to visit "Ursula," the retrofitted warehouse in McAllen, Texas, that serves as the largest detention center for US Customs and Border Protection (CBP).

As Goza entered, she was overpowered by the smell of sweat, urine, and feces. Worse, she said, was the silence, even in rooms packed with children and teens. "Not a single boy was saying a word. Their faces were flat," Goza said. The only sound was the fluttery crinkling of Mylar blankets that the children clutched for warmth.

What we're doing to these children," she said, "will cause ramifications for years to come.

The veteran physician remains haunted by what she saw: 3- and 5-year-old sisters clutching hands so tightly that their knuckles turned white; a young boy terrified because he'd lost a scrap of paper with his aunt's phone number that his father had warned him not to lose when they were separated. "He was devastated," Goza said. "He didn't know if he'd ever see his father again. He didn't know his aunt's phone number."

Children told Goza that they were given food that was still frozen. They were cold. They slept in rooms where lights were never turned off. Other physicians who toured facilities reported seeing mothers wearing shirts stained with breast milk and vomit; children with filthy, matted hair; and crowded conditions that were vectors for disease.

Julia Graves, MD, a California dermatologist who traveled to Texas this summer to help care for migrants as a volunteer, called the refusal to provide influenza vaccine to detainees in crowded conditions "cruelly stupid." Physicians far from the southern border, in Boston and Chicago, have treated children who were so sick once they reached their post-detention destinations that they required emergency care. (CBP officials have called the situation a humanitarian crisis and said they were providing the best medical care possible with their limited resources.)

Goza, who will become president of the American Academy of Pediatrics (AAP) on January 1, plans to use her post to speak against the detention of children and separation of families. Border enforcement agents, she said, are not trained to take care of children and should not be asked to do so.

Goza is deeply worried about what could become an epidemic of toxic stress, as the tens of thousands of detained children continue to react to the trauma they've suffered. "What we're doing to these children," she said, "will cause ramifications for years to come."

In November, a federal judge ruled that the US government must provide mental health services to thousands of migrants who experienced psychological harm as a result of the Trump Administration practice of separating parents from children when they enter the country.