PART 17. July 1, 2019. A federal judge has ordered a mediator to move swiftly to improve health and sanitation (FOR MIGRANT CHILDREN) at Border Patrol facilities in Texas

ASSIGNMENT: You are the head of the Department of Public Health Sciences, The University of Texas at El Paso and have been “volunteered” to develop a Rapid Response “shadow” licensing program for the new Carrizo Springs, Texas “emergency” shelter which will house as many as 1,600 teens.

“What are the basic rules that determine how immigrant children are treated in U.S. immigration detention?”..

In the 1980s, the Reagan administration aggressively used detention of Central Americans as a device to deter migration from that region, where violent civil wars had caused tens of thousands to flee…

One suit was filed by the American Civil Liberties Union in 1985 on behalf of Jenny Lisette Flores, a 15-year-old from El Salvador. She had fled violence in her home country to live with an aunt who was in the U.S.

But Flores was detained by federal authorities at the U.S. border for not having proper documentation permitting her to stay in the U.S…

But the primary legacy of the case was the subsequent settlement, to which both the Clinton administration and the plaintiffs agreed in 1997.

The Flores settlement established basic standards for the treatment of unaccompanied minors who were in the custody of federal authorities for violating immigration laws.

It requires the federal government to place children with a close relative or family friend “without unnecessary delay,” rather than detaining them; and to keep immigrant children who are in custody in the “least restrictive conditions” possible. Generally speaking, this has meant migrant children can be kept in federal immigrant detention for only 20 days…”  (A)

“Bleak scenes of tearful, malnourished children reeking of filth and jammed into frigid, overcrowded quarters have emerged in new accounts from immigrant rights lawyers, who conducted dozens of interviews with children inside Border Patrol stations across Texas…

Immigrant rights lawyers, just hours after the tour, petitioned a federal judge to order additional oversight of Border Patrol holding facilities across Texas, where migrant children are being held.

The filing asked the court to require immediate inspections of the facilities by public health experts and accused the federal government of violating standards for detained migrant care established in a court settlement. The advocates also sought to have detained children released to parents or other relatives living in the U.S…

On Friday, U.S. District Judge Dolly Gee ordered the court monitor overseeing the settlement to bring the migrant lawyers and the federal government together for mediation. She said the monitor may appoint “an independent public health expert” to address conditions in facilities, if she deems that is necessary. Both parties are to file status reports by July 12.” (B)

“Citing the Flores Settlement Agreement, which requires the U.S. government to ensure “safe and sanitary” conditions for migrant children in federal custody, attorneys…. “the children need immediate access to emergency care and improved living conditions to prevent more illness and even death.”..

In an interview with The Washington Post, Peter Schey, who has been litigating the ongoing case since its initial filing in 1985, said Wednesday’s filing represented the first time attorneys have felt the need to seek emergency relief from a judge.” (C)

“Lawyers are particularly concerned about the spread of illness inside Border Patrol facilities, which can sometimes turn fatal. Five children have died in Border Patrol custody since December, some of whom were initially diagnosed with a common cold or the flu. The processing center in McAllen, known as Ursula, recently quarantined three dozen migrants who were sick after a 16-year-old died of the flu at the same facility…

Dr. Julie Linton, the co-chair of the American Academy of Pediatrics, previously told HuffPost that children can’t recover from illnesses in Border Patrol facilities. These centers are described as “hieleras” ― Spanish for iceboxes ― because of their freezing temperatures, and migrants describe sleeping on floors under bright lights that shine 24/7, with nothing but Mylar blankets to keep warm…” (D)

“More than 200 migrant children detained in a remote Border Patrol station in southwest Texas without adequate food, water and sanitation have been moved after news of the conditions became public last week…

A law professor who recently visited the facility, Warren Binford of Willamette University, described the conditions for children in an interview with NPR’s Lulu Garcia Navarro.

“Many of them are sleeping on concrete floors, including infants, toddlers, preschoolers. They are being given nothing but instant meals, Kool-Aid and cookies — many of them are sick. We are hearing that many of them are not sleeping. Almost all of them are incredibly sad and being traumatized. Many of them have not been given a shower for weeks. Many of them are not being allowed to brush their teeth except for maybe once every 10 days. They have no access to soap. It’s incredibly unsanitary conditions, and we’re very worried about the children’s health.””  (E)

“U.S. government officials say they’ve moved more than 100 kids back to a remote border facility where lawyers reported detained children were caring for each other and had inadequate food, water, and sanitation.

An official from U.S. Customs and Border Protection said Tuesday that the “majority” of the roughly 300 children detained at Clint, Texas, last week have been placed in facilities operated by the Office of Refugee Resettlement.

The official, who briefed reporters on the condition of anonymity, wouldn’t say exactly how many children are currently detained there. But the official says Clint is better equipped than some of the Border Patrol’s tents to hold children…”  (F)

“About half of the roughly 2,300 children confined in a privately run Florida facility intended as a temporary shelter for migrant teenagers have been there for more than 20 days and many of them for months, despite legal standards that require children who cross the border to be speedily released or sent to state-licensed shelters that are equipped to offer longer-term care.

The Homestead center near Miami, the only one in the government’s large network of shelters run by a private, for-profit corporation, is intended to keep children for only a few days, but has been holding them for much longer as a result of the unusually large number of unaccompanied children arriving in recent months along the southwest border…

Children living at Homestead have complained that it is extremely crowded and noisy, and that they enjoy no privacy, according to reports filed with a federal court. They report feeling increasingly despondent because they have no idea when they will be released, lawyers said. Rules prohibit them from listening to music or writing in a journal. Some reported having suicidal thoughts.

Amy Cohen, a psychiatrist who has visited the facility, said the noise level was extremely high, especially in a tent with no soundproofing where “children are crammed” and teachers must use microphones to be heard above the noise…

Immigrant advocates have gone to court to argue that Homestead should be required to meet the rigorous standards established for detaining migrant children — though government officials argue that the facility, operated as a temporary “influx” shelter, not a detention center, is not legally required to do so.

Under those standards, established under a 1997 consent decree, children must generally be released within about 20 days, or transferred to a licensed shelter that has comfortable living accommodations and a full education program.

Costing over $1 million a day to operate, Homestead opened in February… “ (G)

“Maintenance reportedly eats up most of the $775 daily cost per child for the tent camps, since it’s difficult to keep temporary structures suitable for humans in a desert. In permanent facilities run by Health and Human Services, the cost is $256 per person per night, and NBC News estimates that even keeping children with their parents and guardians in Immigration and Customs Enforcement facilities would only cost $298 per night…

“…Southwest Key Programs, a nonprofit that set up a boys’ shelter in the husk of an old Walmart, reportedly netted $955 million in federal contracts between 2015 and 2018, according to The New York Times. A network of nonprofit groups, BCFS, reportedly received $179 million in the same time period. BCFS is the same contractor that held migrant kids in parked vans for 39 hours earlier this year, as ICE slowly did the paperwork to reunite the children with their families”  (H)

“Hundreds of migrant children being transferred from squalid, overcrowded Border Patrol detention centers are heading into the custody of a federal refugee agency that’s already struggling to feed and care for tens of thousands of minors…

The refugee office’s shelters have taken in more than 52,000 children since October — a 60 percent jump from the previous year, driven by a record influx of migrants and complicated by the Trump administration’s aggressive border policies. Its parent agency, the Department of Health and Human Services, is pursuing strategies to cope with the surge, which include freezing money for anti-trafficking efforts and services for survivors of torture, and possibly furloughing employees.

The crunch is also slowing HHS’s oversight of shelters, efforts to expand the number of beds and attempts to unite migrant children with sponsors in the United States…

“This historical influx is challenging the capacity of the federal government to shelter UAC [unaccompanied alien children] and presents child welfare concerns beyond the treacherous journey that these minor children take across the southern border,” said an HHS spokesperson in an emailed statement…

“It’s a very difficult time,” an HHS official told POLITICO. “The program grew faster than we were ready.” (I)

“A federal judge has ordered a mediator to move swiftly to improve health and sanitation at Border Patrol facilities in Texas, where observers reported migrant children were subject to filthy conditions that imperiled their health.

Judge Dolly M. Gee of the Central District of California asked late on Friday that an independent monitor, whom she appointed last year, ensure that conditions in detention centers are promptly addressed. She set a deadline of July 12 for the government to report on what it has accomplished “post haste” to remedy them…

The new order stopped short of directly ordering the government to take action but referred the issue to the monitor to take action for the “prompt remediation” of conditions at the facilities, included the retention of an independent public health expert…

In her order, Judge Gee said that the court had detailed previous violations by the government of a 1997 consent decree, called the Flores settlement agreement, which established standards for the care of migrant children in its custody. A monitor had been appointed last year over the government’s objections after plaintiffs in the Flores case successfully argued that there had been egregious violations of the agreement…

The “emergent” nature of the recent reports “demands immediate action,” the judge added…

The motion for a temporary restraining order asked the court to mandate immediate inspection of facilities in McAllen, Clint and Weslaco, all in Texas, by a public health expert. It also requested that medical professionals obtain access to those facilities and that the government speed up the release of children detained at the facility to sponsors — mainly parents or relatives in the United States.”  (J)

“A federal judge has ordered U.S. Customs and Border Protection (CBP) to allow medical professionals into detention facilities holding migrant children, CNN reported Sunday.

U.S. District Judge Dolly Gee ordered that health professionals be allowed in the facilities to ensure the conditions are “safe and sanitary” for children being detained there and to assess the children’s medical needs.

The order pertains to all of CBP’s facilities in the El Paso and Rio Grande Valley sectors in Texas, CNN reported. The centers are the subject of a lawsuit regarding the 1997 Flores Settlement Agreement and reports of unsafe and unsanitary conditions at detention centers.” (K)

“By the time Dr. Roberto “Bert” Johansson saw the toddler in the emergency room, she was vomiting, feverish, dehydrated and desperately ill with acute gastroenteritis.

The girl had been in Border Patrol custody for two days before agents rushed her to El Paso Children’s Hospital. Johansson told CNN he admitted her and put her on an IV line, fluids and other treatment.

“She lived, but her illness had been missed,” he said of that day three months ago. “We need to get to these kids earlier.”..

But Johansson, a pediatrician who specializes in emergency medicine and intensive care, says there’s another pressing problem: The medical screening the Border Patrol gives to undocumented children is “absolutely, unequivocally inadequate.”” (L)

BREAKING NEWS. “Health officials at the University of New Mexico are designing a program to help treat sick migrants – many of them seeking asylum – being detained in crowded government facilities near the border.

Dr. Sanjeev Arora, director of Project ECHO – Extension for Community Healthcare Outcomes – at the University of New Mexico Health Sciences Center, said that an ECHO program to help treat migrants in facilities near the Mexican border is being developed and should be up and running in the coming weeks.

“There are children and people (at the border) who are housed in government facilities who need health care, and there isn’t enough expertise there,” Arora said. “We are going to bring our existing resources to bear and start an ECHO for them.”..

ECHO programs, which now total in the hundreds and reach worldwide, are essentially video teleconferences where specialized experts of a topic share knowledge with health care providers in areas where health officials don’t have the same expertise, especially rural areas.

Instead of one doctor being able to treat one patient through videoconference, the sharing of knowledge allows the number of patients helped to grow exponentially, Arora said.” (M)

PART 16.  June 21, 2019. “The federal government is opening a new MASS FACILITY TO HOLD MIGRANT CHILDREN, a temporary emergency shelter that will not be subject to state child welfare licensing requirements.”

“Are you arguing seriously that you do not read the [Flores] agreement as requiring you to do anything other than what I just described: cold all night long, lights on all night long, sleeping on concrete and you’ve got an aluminum foil blanket?”

HHS..”instructed officials to cut programs “not directly necessary for the protection of life and safety,” a spokesperson for the HHS said, according to the Washington Post. These services include English classes, recreational programs like soccer, and legal aid,…”

Statement from the American Public Health Association and Trust for America’s Health

“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.

“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.

“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.” (T)

 “Migrant children are increasingly resorting to sleeping outside of border patrol stations because the agency charged with sheltering them, the Department of Health and Human Services, has been overwhelmed by the influx of asylum-seekers, NBC News reported Tuesday.

HHS, which is reportedly operating at 97 percent capacity, is responsible for caring for the record number of migrant children that are arriving at the border each day until they can be placed with a sponsor. As reports of a humanitarian crisis at the border continue to mount, HHS officials have urged Congress to provide more resources for the provision of medical care and shelter.

As of May 31, 1,448 unaccompanied migrant children have remained in border patrol custody for at least 72 hours, the maximum time allotted by law, while waiting to be transferred to HHS, according to NBC News.

In total, 1,402 unaccompanied migrant children have been processed by border patrol and are now waiting to be transferred to a HHS facility, where are they supposed to receive a bed and support from a social worker.

The children often resort to sleeping on concrete slabs or outside the border patrol stations while they await transfer to an HHS facility that corresponds to their gender and age. The influx of women and children arriving at the border in recent months has delayed this process as HHS lacks adequate housing to accommodate a population that is no longer comprised mostly of single adult males as it once was.” (A)

“The federal government is opening a new mass facility to hold migrant children in Texas and considering detaining hundreds more youths on three military bases around the country, adding up to 3,000 new beds to the already overtaxed system.

The new emergency facility in Carrizo Springs, Texas, will hold as many as 1,600 teens in a complex that once housed oil field workers on government-leased land near the border, said Mark Weber, a spokesman for Office of Refugee Resettlement.

The agency is also weighing using Army and Air Force bases in Georgia, Montana and Oklahoma to house an additional 1,400 kids in the coming weeks, amid the influx of children traveling to the U.S. alone. Most of the children crossed the border without their parents, escaping violence and corruption in Central America, and are held in government custody while authorities determine if they can be released to relatives or family friends.

All the new facilities will be considered temporary emergency shelters, so they won’t be subject to state child welfare licensing requirements, Weber said. In January, the government shut down an unlicensed detention camp in the Texas desert under political pressure, and another unlicensed facility called Homestead remains in operation in the Miami suburbs.” (B)

“The Trump administration is scaling back services for unaccompanied minors who cross the US-Mexico border, citing budget constraints after a surge in crossings not seen in over a decade.

The Trump administration is struggling to deal with the number of migrants entering the US, and has placed much of the blame for insufficient services and even several recent deaths of migrant children onto migrants themselves.

According to new data released by Customs and Border Protection, 109,144 people were taken into custody last month, nearly 9,000 of them unaccompanied children.

The Trump administration is slashing support and services for unaccompanied minors who cross the US-Mexico border, citing budget constraints after a surge in crossings not seen in for more than a decade.

The Office of Refugee Resettlement (ORR), which is part of the Department of Health and Human Services (HHS) and provides housing and resources for migrant children, has instructed providers to suspend funding for certain programs.

It instructed officials to cut programs “not directly necessary for the protection of life and safety,” a spokesperson for the HHS said, according to the Washington Post. These services include English classes, recreational programs like soccer, and legal aid, the Post said.” (C)

“The government’s plans were swiftly rebuked by civil rights lawyers representing unaccompanied children, who have been crossing the border in ever-larger numbers this year to flee poverty and violence in their home countries, mainly in Central America. And the chief of at least one large shelter operator said he would continue to offer education and sports at his network’s facilities.

Some 13,200 migrant children, including adolescents who crossed the border alone and young children who were separated from their parents, are currently housed in more than 100 shelters across the country. They receive English instruction, as well as math, civics and other classes. Most facilities have a sports field and allow children to go outside, often to play soccer, at least once a day…

Civil rights and child welfare advocates said that any move by the government to eliminate education and recreation would constitute a violation of the Flores settlement, which in 1997 established the standards for treating migrant children held in government facilities, and would prompt them to sue for reinstatement of the activities.

“If this administration goes forward with denying education, recreation and other unspecified so-called nonessential services, it would be in flagrant violation of the Flores settlement and will face immediate legal action,” said Neha Desai, co-counsel on the settlement decree, who visits government shelters to ensure compliance. She is also the immigration director at the National Center for Youth Law in Oakland, Calif.

“To those of us whose job it is to promote the health and safety of children, this is a shocking directive,” said Amy Cohen, a psychiatrist who consults for the Flores team and regularly interviews children at shelters. “It violates every tenet of basic child welfare practice and will further harm the medical and psychological health of children fleeing extraordinarily dangerous circumstances in their home countries.”…

 “We have not and we are not going to curtail recreation and education. We just can’t do that,” said Kevin Dinnin, president of BCFS, the second-largest shelter network, which houses about 1,000 children in facilities in Texas. “We will have to use reserve funds until the government figures out what they are going to do.” (D)

“For the past year and a half, Dr. Eric Russell has been traveling from Houston to McAllen, Texas, every three months or so to volunteer at the Catholic Charities Humanitarian Respite Center, a first stop for many asylum-seeking migrants who’ve been released by U.S. Customs and Border Protection in the Rio Grande Valley.

During his most recent visit to the clinic in April, when he saw more than 150 migrants, he noted a troubling new trend: a number of people reported that their medication had been taken from them by U.S. border officials.

“I had a few adults that came who had high blood pressure, who had their blood pressure medications taken from them and, not surprisingly, their blood pressure was elevated,” Russell told Yahoo News. “There was a couple of adults that had diabetes that had their diabetes medicines taken from them, and wanted to come in because they were worried about their blood sugar. And, not surprisingly, their blood sugar was elevated.”

For Russell, a pediatric emergency medicine physician, the patient who stood out the most during that visit was a boy of 8 or 9 with a history of seizures. According to his mother, the child had been on a long-term seizure medicine in their home country, but the medication had been taken from him upon entering the Border Patrol custody in McAllen and never returned…

 “My concern is, what’s going to happen if you put a 9-year-old child who has a history of seizures, without any seizure medicine on a bus for 3 days … is that he’s going to have a seizure,” Russell said.

Russell added that he can understand the need for a policy regarding the use of outside medication by detainees. However, he said, “At the end of the day, as a medical provider, as a physician, we take an oath to first do no harm. And taking somebody’s medications seems like it’s causing harm.”…

In light of these deaths, the American Academy of Pediatrics, along with other child health and welfare experts, have offered a number of recommendations for how CBP can improve the care of migrant children in its custody, which include ensuring access to screenings and treatment by medical professionals who know how to recognize and respond to the subtle yet often rapidly worsening signs of illness in children.

“The AAP has been in discussions for months with [CBP] about increasing the number of pediatric-trained providers that are at these large processing centers,” said Griffin. However, information provided by CBP officials suggests the agency has yet to heed the AAP’s advice as it expands contracted medical services across the southwest border.”  (E)

“The government agency that takes custody over all unaccompanied minors who arrive on the border has been unable to answer questions about the number of children who have died in its custody in the years since President Donald Trump took office.

When children who are traveling by themselves either ask for asylum at ports of entry or are apprehended by Border Patrol, they are eventually transferred into the custody of the Office of Refugee Resettlement. ORR—an agency within the Department of Health and Human Services (HHS)—maintains a series of shelters for the unaccompanied minors, many of which are run by independent contractors…

On May 23rd, Pacific Standard sent an email to HHS asking if, since 2016, any other children had died in ORR custody that the public had not been made aware of. A media contact in the HHS’s Administration for Children and Families office confirmed that the email had been received, and said: “[The] inquiry is with the program office for response—we’ll get the information back to you just as soon as we have it.”

HHS never got back to Pacific Standard’s inquiry, nor to two subsequent inquiries sent the next day and again on June 5th…

Jennifer Podkul, the senior director of policy and advocacy for Kids in Need of Defense—an advocacy organization for immigrant children—says it’s plausible that there are more children who have died than the public is aware of.

“It’s certainly possible,” Podkul says. “I don’t have any specific information about specific cases [that have’t been reported], but there are a few reasons why I say it’s plausible: One is that there’s no mandatory reporting requirement for ORR, unlike ICE. And the other reason, that’s really important, is that ORR doesn’t have any sort of public monitoring system.”

According to Podkul, though ORR and HHS completes reviews of the facilities they run for children—both those run by the government and those run by contractors—those sorts of audits aren’t released to the public.” (F)

“A 16-year-old from Guatemala died of complications of the flu while in U.S. Border Patrol custody, according to preliminary autopsy findings, alarming doctors who questioned whether immigration authorities missed warning signs or chances to save his life.

Carlos Hernandez Vasquez contracted bacterial infections in addition to the flu, as well as sepsis, which can lead to tissue damage and organ failure, according to a report released by Hidalgo County authorities this week. He died May 20. A full autopsy is pending.

Carlos is the sixth child in the last year to die after U.S. border agents detained him, and the second known to have died of the flu, after 8-year-old Felipe Gómez Alonzo died on Christmas Eve…

 “By the time you’re 16 years old, you have great immunity, and you shouldn’t be dying so quickly,” said Dr. Nizam Peerwani, the Tarrant County medical examiner in Fort Worth, Texas, and an adviser for the advocacy group Physicians for Human Rights.

Peerwani said Carlos’ rapid deterioration raised questions about whether he may have had potential symptoms including a fever, body aches, or breathing trouble before the Border Patrol says he reported being sick.

He should have been taken to a medical facility or clinic instead of remaining in detention, Peerwani said.

Dr. Julie Linton, co-chair of the American Academy of Pediatrics’ immigrant health special interest group, also said the prescription of Tamiflu may not have been enough treatment, especially since the medicine works best in the first two to three days of illness. While Carlos’ illness was discovered the day before his death, he may have sick well before then, she said. “We cannot treat Tamiflu as a substitute for the other care that is required,” Linton said.

Doctors who treat the flu rely on a patient telling them how long they’ve had symptoms. Linton pointed out that the processing center where Carlos was detained has the lights on 24 hours a day, which may have made it difficult for him to know how long he had been sick.”  (G)

“County health officials announced Thursday that the influenza outbreak at a local migrant shelter continues to worsen with 22 new cases of flu or flu-like symptoms.

The total number of confirmed flu and “influenza-like illness” since May 19 among asylum-seeking migrants at a shelter in Bankers Hill operated by Jewish Family Service of San Diego now stands at 81. Officials with the county’s Health and Human Services Agency confirmed 12 new cases on both Tuesday and Wednesday.

In addition, the county has quarantined 63 asylum seekers at various local hotels to try to contain the outbreak. Two asylum seekers at the shelter have been transported to the hospital due to their flu symptoms, according to the county. Health officials have screened roughly 450 asylum-seeking migrants at the shelter for symptoms since May 19.

The county defines an outbreak as one person contracted an illness and a second person contracting it and showing symptoms within 72 hours. The county first declared the outbreak May 23…

Cases of flu and chicken pox have afflicted immigrant detention facilities for months, with some detained infants and children showing fevers of up to 105 degrees. CBP agents temporarily closed processing functions at the McAllen facility last week amid a flu outbreak, during which it quarantined more than 30 detainees, according to the Washington Post.

The flu has also caused multiple deaths among detainees at the border in the last six months. Immigration officials confirmed the flu-related death of a 16-year-old Guatemalan boy at the McAllen facility last week, the fifth Guatemalan child to die in federal custody since December and at least the second to die from flu complications.

The county said it plans to continue monitoring the situation and providing updates on new flu cases at the shelter. County health officials are also treating outwardly healthy people at the shelter to prevent the flu from spreading any further.” (H)

“The recent death of a Guatemalan child after a flu outbreak at the Customs and Border Protection Centralized Processing Center in McAllen is unsurprising, according to the American Academy of Pediatrics.

Dr. Julie Linton is the co-chair of the American Academy of Pediatrics Immigrant Health Special Interest Group. She said processing facilities and detention centers are no place for children.

Linton said the Ursula Central Processing Center, which is the largest in the nation, is the type of facility that is a haven for infectious diseases like flu or tuberculosis and infestations like scabies.

“When you enclose people in close quarters and large spaces, it’s much more difficult to control the spread of illness,” Linton said. “I think what we also know, however, is that we have children who are presenting and asking for medical attention — we have families who are asking for medical evaluations for their children — and they’re being evaluated, and then after evaluation they’re being sent back to processing centers.”

Linton said a sick child is not going to do well in those conditions.

“I’m a pediatrician, and I care for sick children all the time, and I would never suggest, in healing, a child return to a cold concrete floor, covered by a silver, mylar blanket which is really more of a sheet, to heal from their illness, and certainly not in a setting where they’re exposed to constant stress,” Linton said…

The AAP has created a toolkit to help those who come into contact with immigrant children to help them get and stay healthy.

The McAllen processing center temporarily closed last week after medical staff identified 32 other migrants who were experiencing symptoms of the flu.” (I)

“The deaths of migrant children in U.S. custody raise grave humanitarian concerns and set off alarms. Medical experts, human rights groups and children’s advocates long have decried unsanitary and crowded conditions at the facilities where children and families are detained for days before they are transferred to shelters or released with notices to appear before a judge. These experts have warned that the living conditions, coupled with the physical and traumatic effects of migrants’ grueling journeys here, exact a punishing toll that endangers the children’s lives.

Castro and other members of Congress have called for a federal investigation. According to Castro, prior to the deaths over the past eight months, U.S. Customs and Border Protection had gone more than a decade without a child dying in its custody.

Federal scrutiny of the immigration detention facilities holding children and families is urgently needed. Americans deserve a full accounting of the deaths and a plan for averting more tragedies. The U.S. must guard its borders, but it must do so responsibly, ensuring the welfare of the children it holds in its custody. Detaining 10-year-olds in fenced-in pens who are not a threat to this country and who, with their families, are merely seeking protection is punitive and not what America stands for. If the administration cannot adequately care for the children in its custody, it must re-examine its detention policy.

No investigation can be complete without a thorough vetting of the administration’s hard-line border enforcement policies, which once separated thousands of children from their families, literally tearing some from their parents’ arms, a policy since discarded amid an international outcry. It may take up to two years for authorities to identify the children, the federal government said in April. It is no wonder that such a dereliction of duty leads some to question if children are merely considered collateral damage in the administration’s crackdown on immigration…

The Border Patrol needs help, agreed Marsha Griffin, a pediatrician on the South Texas border and a spokesperson for the American Academy of Pediatrics. “We need to provide them with more and better medical (staff), especially when it pertains to children,” Griffin told us.

Along with other facets of its border enforcement crackdowns, the federal government is trying to send a message to deter migrants from coming, Gilman said.”  (J)

“As the Trump administration works to address what it describes as a growing “crisis” at the U.S.-Mexico border, officials said in a court filing that it may take two years for the government to identify thousands of migrant children who were separated from their families.

The filing Friday outlined the government’s plan to use data analysis and manual reviews to sift through the cases of about 47,000 children who were apprehended by U.S. immigration officials from July 1, 2017, to June 25, 2018, to identify which children might have been taken from family members. It estimated the process “would take at least 12 months, and possibly up to 24 months.”

Last month, U.S. District Judge Dana Sabraw expanded the number of migrant families that the government may be forced to reunite under his previous order after an inspector general report revealed that the administration had an undisclosed family separation pilot program in place starting in July of 2017. The ruling was made as part of a lawsuit led by the American Civil Liberties Union.

“The administration refuses to treat the family separation crisis it created with urgency, ” the ACLU said in a statement Saturday. “We strongly oppose any plan that gives the government up to two years to find kids. The government swiftly gathered resources to tear families apart. It must do the same to fix the damage.” (K)

“Rom Rahimian, a medical student working at Banner-University Medical Center Tucson, was trying to help a 20-year-old Guatemalan woman who had been found late last year in the desert — dehydrated, pregnant and already in labor months before her due date. But the Border Patrol agents lingering in the room were making him uncomfortable.

The agents remained in the obstetrics ward night and day as physicians worked to halt her labor. They were present during her medical examinations, listened in on conversations with doctors and watched her ultrasounds, Mr. Rahimian said. They kept the television on loud, interfering with her sleep. When agents began pressing the medical staff to discharge the woman to an immigration detention facility, the doctors took action.

“It was a race against the clock to see if we can get her into any other situation,” Mr. Rahimian said. He called a lawyer and asked, “What can we do? What are her rights?”

As apprehensions of migrants climb at the southwest border, and dozens a day are taken to community hospitals, medical providers are challenging practices — by both government agencies and their own hospitals — that they say are endangering patients and undermining recent pledges to improve health care for migrants.

The problems range from shackling patients to beds and not permitting them to use restrooms to pressuring doctors to discharge patients quickly and certify that they can be held in crowded detention facilities that immigration officials themselves say are unsafe. Physicians say that needed follow-up care for long-term detainees is often neglected, and that they have been prevented from informing family members about the status of critically ill patients. Agency vehicles parked conspicuously near hospital entrances, health providers say, are also stoking fear and interfering with broader immigrant care.

Doctors typically do not know what rights they might have to challenge these practices. At Banner and several other hospital systems across the country, they have called on administrators to oppose and change security measures that they view as endangering health..

Health systems, too, maintain policies that doctors say are problematic. Banner Health, like some others, has a policy that applies equally to immigration detainees and prisoners. It disallows bathroom privileges, requires at least two limbs to be secured to beds unless medically inadvisable, gives agents discretion over whether mothers may visit newborns and obliges law enforcement officers to remain with patients.” (L)

“A premature newborn baby girl and her 17-year-old migrant mother were almost entirely ignored and neglected for an entire week while held by Border Patrol near the Texas border.

Lawyers who visited the immigration processing station in McAllen, TX, told HuffPost that the one-month-old infant was wrapped in a dirty towel and wore soiled clothing. The mother was severely underslept, wheelchair-bound, and unable to walk or lie down due to pain from an emergency C-section.

The baby was born in Mexico after the mother left Guatemala for the U.S. while eight months pregnant. Neither mother nor child has been publicly identified.

According to immigration and human rights attorney Hope Frye, the mother was taken to a hospital at least once for pain medication, but the baby had not received any medical care since being placed in Border Patrol custody.” (M)

“The Trump administration has made its position on immigration clear as day. But the executive branch’s crackdown on immigration — legal and otherwise — has come with a cost. A new NBC News analysis found that 24 immigrants died in ICE custody since President Trump took office, and that figure notably doesn’t include migrants who died while they were detained by other government agencies.

“What we’re seeing is a reckless and unprecedented expansion of a system that is punitive, harmful and costly,” Katharina Obser, a senior policy adviser at the Women’s Refugee Commission, told the news outlet. The government has filed to provide immigrants in its custody with medical and mental health care, she added.

The NBC News report comes as the number of migrant children who die after crossing the U.S.-Mexico border continues to rise. The report also indicates that the number of immigrants in U.S. custody has recently reached an all-time high, with about 52,500 immigrants currently in ICE custody per day.

In a statement provided to NBC News, ICE said that “it takes very seriously the health, safety and welfare of those in our care,” and that “any death that happens in ICE custody is a cause for concern.”

So far, at least five migrant children have died after being apprehended at or near the U.S.-Mexico border since December. A 10-year-old girl from El Salvador also died in September, although the public did not learn about her death until  May of this year, per the BBC. The five children who have died since December were all from Guatemala.” (N)

“The Texas Tribune reports more than 5,800 unaccompanied migrant children are living in 35 shelters across the state as of last month.

The U.S. government has also reported more than 144,000 migrants were apprehended or denied entry last month, which is a 13-year high.

They say more than half of the families detained had children. And 8 percent of these migrants are considered to be unaccompanied minors…

Right now, Texas has 35 state-licensed shelters. The Texas Health and Human Services Commission says combined, the 35 shelters can accommodate up to 6,423 children, meaning the state shelters are at about 90 percent capacity.

These migrant children living in federal shelters no longer have access to English classes, recreational programs, like soccer, and legal aid, after the Trump Administration decided to cancel these activities due to budget pressures earlier this month.

The Texas Tribune reported that the director of Hope Border Institute, Dylan Corbett, told them this decision was.. “a demonstration of their willingness to use children as pawns in a politically motivated plan to inflict as much pain as possible.” (O)

“……the administration is taking new steps to deprive the children it is holding in custody of basic necessities. Last week, the administration cut funding for education, recreation and legal aid for migrant children and youth in federal shelters. An estimated 13,200 minors are currently being held in shelters contracted by the Office of Refugee Resettlement (ORR). The Children’s Defense Fund recently joined more than 100 other organizations signing on to a letter to the Secretary of HHS and other federal leaders condemning the decision.

As the letter explains, “It is widely recognized in international, federal, and state law that children are unique from adults and should be afforded special protections that support their developmental needs.” That’s why the Flores settlement, the existing agreement that limits the length of time and conditions under which federal officials can detain immigrant children, requires the government to place children in the least restrictive setting that is in the best interest of the child.

It’s also why the services the administration is taking away from these children — including English, math, science and reading classes and outdoor activities such as soccer and basketball — are essential to their development…

Immigrant children are still children. They are our children. It doesn’t matter how a child came to be in our country — once they are here, in the wealthiest and most powerful nation on earth, it is our duty and our obligation to care for them, support them and give them the opportunity to grow up and thrive. Instead, we are cruelly stripping away their chance to learn, to play and to connect. And in the worst and most unforgivable cases, we are letting them die on our watch.

Even for an administration already known for its cruel treatment of immigrant children this is another heartless and disgraceful step too far. We are better than this.” (P)

“A 2-year-old boy locked in detention wants to be held all the time. A few girls, ages 10 to 15, say they’ve been doing their best to feed and soothe the clingy toddler who was handed to them by a guard days ago. Lawyers warn that kids are taking care of kids, and there’s inadequate food, water and sanitation for the 250 infants, children and teens at the Border Patrol station.

The bleak portrait emerged Thursday after a legal team interviewed 60 children at the facility near El Paso that has become the latest place where attorneys say young migrants are describing neglect and mistreatment at the hands of the U.S. government.

Data obtained by The Associated Press showed that on Wednesday there were three infants in the station, all with their teen mothers, along with a 1-year-old, two 2-year-olds and a 3-year-old. There are dozens more under 12. Fifteen have the flu, and 10 more are quarantined.

Three girls told attorneys they were trying to take care of the 2-year-old boy, who had wet his pants and had no diaper and was wearing a mucus-smeared shirt when the legal team encountered him…

The lawyers inspected the facilities because they are involved in the Flores settlement, a Clinton-era legal agreement that governs detention conditions for migrant children and families. The lawyers negotiated access to the facility with officials, and say Border Patrol knew the dates of their visit three weeks in advance.

Many children interviewed had arrived alone at the U.S.-Mexico border, but some had been separated from their parents or other adult caregivers including aunts and uncles, the attorneys said.

Government rules call for the children to be held by the Border Patrol for no longer than 72 hours before they are transferred to the custody of Health and Human Services, which houses migrant youth in facilities around the country.” (Q)

“Although the conditions in which migrant children are being detained has prompted widespread outrage, the Trump administration defended its detention centers in court on Thursday, Newsweek reports. At the 9th Circuit Court in San Francisco, a Justice Department lawyer said that denying migrant children soap and toothbrushes, and requiring them to sleep on concrete floors in cold and crowded rooms, still qualifies as “safe and sanitary” treatment. This prompted incredulity from several judges at the hearing, according to Newsweek.

“Are you arguing seriously that you do not read the [Flores] agreement as requiring you to do anything other than what I just described: cold all night long, lights on all night long, sleeping on concrete and you’ve got an aluminum foil blanket?” U.S. Circuit Judge William Fletcher asked. “I find that inconceivable that the government would say that that is safe and sanitary.”” (R)

“Fellow Judge A Wallace Tashima remarked: “It’s within everybody’s common understanding that if you don’t have a toothbrush, you don’t have soap, you don’t have a blanket, those are not safe and sanitary conditions” (S)

  1. A. Migrant Children Sleep Outside Due to Lack of HHS Resources, by JACK CROWE, https://www.nationalreview.com/news/migrant-children-sleep-outside-due-to-lack-of-hhs-resources/
  2. B. US Opens New Mass Facility in Texas for Migrant Children. The facility in Carrizo Springs, Texas, will hold as many as 1,600 teens in a complex that once housed oil field workers by ASSOCIATED PRESS, https://www.snopes.com/ap/2019/06/07/us-opens-new-mass-facility-in-texas-for-migrant-children/
  3. C. Trump administration cancels legal aid and English classes for unaccompanied minors in further crackdown on migration, by Rosie Perper, https://www.businessinsider.com/us-cancels-legal-aid-english-classes-for-unaccompanied-migrant-minors-2019-6
  4. D. Migrant Children May Lose School, Sports and Legal Aid as Shelters Swell, by Miriam Jordan, https://www.nytimes.com/2019/06/05/us/migrant-children-services.html?smid=nytcore-ios-share
  5. E. Border Patrol is confiscating migrant kids’ medicine, U.S. doctors say, byCaitlin Dickson, https://news.yahoo.com/border-patrol-is-confiscating-migrant-kids-medicine-us-doctors-say-225354608.html
  6. F. ARE THERE MORE MIGRANT MINORS WHO HAVE DIED IN GOVERNMENT CUSTODY?, by JACK HERRERA, https://psmag.com/social-justice/are-there-more-migrant-minors-who-have-died-in-government-custody
  7. G. Doctors Alarmed That Flu Killed Migrant Teen Detained In Texas, by NOMAAN MERCHANT, https://www.houstonpublicmedia.org/articles/news/2019/06/07/336037/doctors-alarmed-that-flu-killed-migrant-teen-detained-in-texas/
  8. H. Flu cases at San Diego migrant shelter reach 81, County confirms 22 new cases, https://www.kusi.com/flu-cases-at-san-diego-migrant-shelter-reach-81-county-confirms-22-new-cases/
  9. I. Why Children Keep Getting Sick At Detention, Processing Centers, by BONNIE PETRIE, https://www.tpr.org/post/why-children-keep-getting-sick-detention-processing-centers
  10. J. Editorial: Migrant kids are dying in U.S. custody. We can’t let this stand, https://www.statesman.com/opinion/20190525/editorial-migrant-kids-are-dying-in-us-custody-we-cant-let-this-stand
  11. K. It may take 2 years to identify thousands of migrant children separated from families, by William Cummings, https://www.usatoday.com/story/news/politics/2019/04/07/immigration-family-separations-may-take-2-years-identify-children/3393536002/
  12. L. Migrants in Custody at Hospitals Are Treated Like Felons, Doctors Say, by Sheri Fink, https://www.nytimes.com/2019/06/10/us/border-migrants-medical-health-doctors.html?smid=nytcore-ios-share
  13. M. Teen Mother & Her Premature Newborn Neglected For A Week In Border Patrol Custody, by ALEJANDRA SALAZAR, https://www.refinery29.com/en-us/2019/06/235508/teen-mother-newborn-baby-neglect-border-patrol-texas-immigration
  14. N. The Number Of Immigrants Who Died In ICE Custody Is Only Part Of The Picture, by MONICA BUSCH, https://www.bustle.com/p/the-number-of-immigrants-who-died-in-ice-custody-is-only-part-of-the-picture-17988861
  15. O. Data shows more than 5,800 migrant children are living in Texas shelters, by Salina Madrid, https://cbs4local.com/news/local/data-shows-more-than-5800-migrant-children-are-living-in-texas-shelters
  16. P. MARIAN WRIGHT EDELMAN: Immigrant Children are Still Children, by Marian Wright Edelman, https://washingtoninformer.com/marian-wright-edelman-immigrant-children-are-still-children/
  17. Q. Attorneys: Texas Border Facility Is Neglecting Migrant Kids, by The Associated Press, https://www.usnews.com/news/us/articles/2019-06-20/lawyers-claim-dangerous-situation-at-border-detention-site
  18. R. “Inhumane” Conditions At Texas Border Site, Lawyers Say, by SETH MILLSTEIN, https://www.bustle.com/p/migrant-children-are-detained-in-inhumane-conditions-at-texas-border-site-lawyers-say-18134453
  19. S. Are US child migrant detainees entitled to soap and beds?, https://www.bbc.com/news/world-us-canada-48710432
  20. Separating parents and children at US border is inhumane and sets the stage for a public health crisis, https://www.apha.org/news-and-media/news-releases/apha-news-releases/2018/parent-child-separation

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PREQUELS

PART 1. June 18, 2018 “The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.”

“The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.” (C)

PART 2. June 19, 2018. “…Trump’s (family separation) policy amounts to “government-sanctioned child abuse.””,

“…Trump’s (family separation) policy amounts to “government-sanctioned child abuse.””

PART 3. June 20, 2018. “If it could happen to them…why can’t it happen to us?”…separating children from their parents,

“If it could happen to them…why can’t it happen to us?”…separating children from their parents

PART 4. June 21, 2018. “The business of housing, transporting and watching over migrant children detained along the southwest border is not a multimillion-dollar business. It’s a billion-dollar one…

“The business of housing, transporting and watching over migrant children detained along the southwest border is not a multimillion-dollar business. It’s a billion-dollar one…

PART 5. June 22, 2018. “The idea of pulling a child out of a parent’s arms, or identifying a parent but still keeping them separate-it isn’t right.”

“The idea of pulling a child out of a parent’s arms, or identifying a parent but still keeping them separate—it isn’t right.”

PART 6. June 23, 2018. Tender-Age Immigrant Children. “They need bilingual workers. Some kids speak indigenous languages, so that’s an issue as well. https://doctordidyouwashyourhands.com/2018/06/tender-age-immigrant-children-they-need-bilingual-workers-some-kids-speak-indigenous-languages-so-thats-an-issue-as-well/

PART 7. June 25, 2018. Trump’s policy “could be creating thousands of immigrant orphans in the U.S.”, https://doctordidyouwashyourhands.com/2018/06/trumps-policy-could-be-creating-thousands-of-immigrant-orphans-in-the-u-s/

PART 8. June 26, 2018. White House Press Secretary Sarah Huckabee Sanders said the government was starting to “run out of space” to house people apprehended crossing the border

White House Press Secretary Sarah Huckabee Sanders said the government was starting to “run out of space” to house people apprehended crossing the border

PART 9. June 27, 2018. “…the only way parents can quickly be reunited with their children is to drop their claims for asylum… and agree to be deported.”

“…the only way parents can quickly be reunited with their children is to drop their claims for asylum… and agree to be deported.”

PART 10. June 28, 2018. “In 6 Days, Trump Admin Reunited Only 6 Immigrant Children With Their Families”, https://doctordidyouwashyourhands.com/2018/06/in-6-days-trump-admin-reunited-only-6-immigrant-children-with-their-families/

PART 11. June 19, 2018. “Only a dead heart is unstirred by the intentional infliction of suffering on children and babies as a weapon of deterrence.”

“Only a dead heart is unstirred by the intentional infliction of suffering on children and babies as a weapon of deterrence.”

PART 12. July 4, 2018. “President Trump has moved on from caring about the migrant children in cages

“President Trump has moved on from caring about the migrant children in cages

PART 13. July 5, 2018. “Most immigrants facing deportation wouldn’t climb onto a table during their court hearings. But then again, most 3-year-olds don’t go to court without parents or lawyers.

“Most immigrants facing deportation wouldn’t climb onto a table during their court hearings. But then again, most 3-year-olds don’t go to court without parents or lawyers.

PART 14. July 7, 2018. ..The HHS needs to review thousands of case files by hand for clues to which children were taken from their parents…

..The HHS needs to review thousands of case files by hand for clues to which children were taken from their parents…

PART 15. December 4, 2018. PUBLIC HEALTH administrators can transform monumental unique challenges to “rapid response” opportunities. Think: Hurricanes Florence and Michael, the California wildfires, the mysterious polio-like illness, the opioid epidemic, mass shootings, and immigrant family separation.

PUBLIC HEALTH administrators can transform monumental unique challenges to “rapid response” opportunities. Think: Hurricanes Florence and Michael, the California wildfires, the mysterious polio-like illness, the opioid epidemic, mass shootings, and immigrant family separation.