McALLEN, Texas -- On Nov. 9, 2016, a group of pediatricians entered a large warehouse here, the size of a Walmart. Seven hundred children lay on mats on the floor of the “processing center,†with Mylar blankets on them. It was completely quiet, except for the rustling of the blankets. The children were lying on the blankets but they were not asleep.
Chain link pods divided apprehended families by sex — sons separated from their mothers, daughters from their fathers. “You can smell the fear,†said one of the doctors.
“As pediatricians, we’ve never seen that large a number of children not playing, not picking on each other, not crying, not doing anything — just totally quiet,†said Marsha Griffin, MD, a pediatrician who practices in this border town.
This was the day after the 2016 election, and the pediatricians were visiting the Customs and Border Protection processing center in McAllen. Griffin, co-chair of the American Academy of Pediatrics (AAP) Immigrant Health Special Interest Group, served as their guide.
Griffin had worked with two fellow AAP members on a policy statement for the academy calling on the government to stop separating families who've been apprehended after crossing the border and, moreover, to stop detaining children altogether. In preparation for the release of that statement, Griffin had urged the AAP's leadership to come witness what these families are experiencing.
The contingent included the AAP's then-sitting president, Benard Dreyer, MD, and incoming president, Fernando Stein, MD, and several members of the special interest group, as well as leaders of the Texas Pediatric Society. The doctors had traveled down three months earlier intending to tour the processing center, but at the last minute were denied access.
"It was quite shocking to have the most prestigious pediatricians in the country told they could not enter" this facility where children were being held," Griffin said. After some negotiation, a return trip was agreed upon.
Punishing Trek
Griffin is a Texan by birth. As a young mother living in Harlingen, she became an advocate for people coming to the U.S from Mexico and Central America; she visited detention centers and refugee sanctuaries. Over the following decades, she completed graduate studies in the theology of social justice, founded a nonprofit that produced documentaries examining issues encountered by adolescents and was a director for a trust that develops housing and services in inner-city Minneapolis.
At 50, Griffin entered medical school, earning her degree in 2003 from the University of Texas Health Science Center at San Antonio.
Now practicing in the Rio Grande Valley, "I became a megaphone," she said, "going, 'What the hell, what the hell, what the hell?'" Children arriving from the south were being traumatized, and she urged her colleagues to take notice and action.
Many of these children are, as Fernando Stein said at the time of the release of the AAP policy statement, "victims of unspeakable violence, persecution and abject poverty" in their home countries, who then endure a punishing, often terrifying trek north.
In December of last year, 4,842 families were apprehended at the border in the Rio Grande Valley Border Patrol Sector. Children are held in processing centers for up to 72 hours. Those with a parent or legal guardian are then either repatriated to their home countries, placed in Immigration and Customs Enforcement family residential centers or released into the community to await a hearing.
Griffin's co-authors of the policy statement, titled and released in March of last year, were Julie Linton, MD, a pediatrician in Winston-Salem, North Carolina and Griffin's co-chair of the Immigrant Health Special Interest Group, and Alan Shapiro, MD, who runs a program for minors who arrive in New York City unaccompanied.
Through interviews with detainees and the Department of Homeland Security Office of Inspector General, the authors gathered accounts of "egregious conditions" in many of the processing centers, including extreme cold, a lack of bedding, open toilets, no bathing facilities, constant light exposure, confiscation of belongings, insufficient food and water, and no access to legal counsel.
The authors summarized the determinations of an , which stated that "DHS's immigration enforcement practices should operationalize the presumption that detention is generally neither appropriate nor necessary for families -- and that detention or the separation of families for purposes of immigration enforcement or management are never in the best interest of children."
The AAP authors concurred and urged longitudinal evaluation of the health consequences of detention of immigrant children.
Plea to Colleagues
The AAP statement affirmed that studies of detained unaccompanied immigrant children have found high rates of post-traumatic stress disorder, anxiety, depression, suicidal ideation, and other behavioral problems, and that expert consensus has determined that even brief detention of a child can cause psychological trauma and induce long-term mental health risks.
Further, the CDC's reports a significant link between childhood trauma and chronic conditions later in life, including cardiac disease, hypertension, lung cancer and diabetes.
Griffin and her co-authors petitioned their colleagues: "Pediatricians who care for previously detained immigrant children in communities throughout the United States should be aware of the traumatic events these children have invariably experienced to better understand and address their complex medical, mental health, and legal needs. Pediatricians also have an opportunity to advocate for the health and well-being of vulnerable immigrant children."
At about the same time that their statement was released, the Women's Refugee Commission published a report titled and, soon after, the affirming a "commitment to patients' health and well-being, irrespective of their immigration status."
Urgent
On the morning of that November 2016 tour of the McAllen processing center, Marsha Griffin was not alone in her despondence over the election of Donald Trump. The president-elect had made clear his intentions regarding immigrants from the south. A wall, Griffin knew, wouldn't keep people out. "Nothing is going to do that," she asserted. "It's life or death. It's not, 'Should we go to Disney World this year or next?' They're leaving because they have to. It's desperation."
The tour that morning, Griffin said, was a "harrowing experience" for the pediatricians, "seeing that level of suffering" among children.
The subsequent policy statement has been well received, not only within the pediatric community, Griffin stressed, but with other child advocates, including attorneys with whom pediatricians are increasingly forging alliances.
"I have a lot of hope that doctors are rallying together across the country to provide declarations and reviews of medical charts with immigration attorneys," she said, addressing "what is truly a human rights violation."
"Hopelessness," Griffin added, "isn't an option."