For Dr. Teresa Chen, the scene was “apocalyptic.”
She worked at Valley, an outdoor waiting area in San Diego's rural Mountain Empire, to provide volunteer medical care to asylum seekers who breached the U.S.-Mexico border wall and are awaiting arrest by U.S. authorities. I was there for Of the Moon.
In the crowds gathered here and elsewhere, she found children with deep lacerations, broken bones, fevers, diarrhea, vomiting and even seizures. Some she hid in trash cans and overflowing entry toilets. The asthmatic boy, who doesn't have an inhaler, gasped in the acrid smoke from bush and garbage fires lit to keep warm.
With capacity at migrant processing centers stretched, migrants, including unaccompanied children, are forced to wait for hours or even days in outdoor holding areas. There, lack of shelter, food and sanitation infrastructure poses a series of public health concerns for the greatest number of people. Vulnerable.
“From a public health perspective, there are communicable diseases and outdoor exposures that can affect anyone, not to mention medically vulnerable populations,” Zuckerberg San Francisco General Hospital and Trauma Center Emergency Department said Dr. Chen, the treatment room physician.
A federal district judge in California could rule as early as Friday on whether the government is legally required to protect and feed waiting children.
Attorneys for the Justice Department argue in court filings that because the children are not yet officially in U.S. Customs and Border Protection custody, there is no obligation to provide such services.
“Minors in these areas near the California-Mexico border are not apprehended or apprehended by CBP, nor are they in CBP's lawful custody,” the attorneys wrote.
“CBP has been apprehending minors and rapidly transporting them to safe and sanitary U.S. Border Patrol facilities. However, until that happens, Plaintiff will not be in DHS custody,” they wrote, referring to the Department of Homeland Security. I wrote it.
When asylum seekers enter the United States during official ports of entry, they often present themselves to Border Patrol agents near the wall with the intention of being arrested. They are taken to a processing facility where they undergo medical examinations, background checks and basic provisions to begin the legal claims process.
But unlike these immigration detention facilities, the outdoor sites lack shelter, food, and government-affiliated medical staff. Erica Pinheiro, executive director of Al Otro Lado, a legal and humanitarian nonprofit that works in the camp, said some areas lacked toilets, forcing people to defecate in the open. With limited diapers, wipes and cream provided by volunteers, infants are forced to wear dirty diapers for long periods of time, causing severe diaper rash, according to court documents.
A senior Customs and Border Protection official acknowledged in an interview that people sometimes had to wait days before being processed, but vulnerable populations like children have always been prioritized, and in recent months He said waiting times have decreased significantly. He said officials have more than tripled the capacity of a processing center in San Diego and increased the number of transit buses and personnel to try to alleviate concerns.
Still, he said the system was not built for migrant encounters on the current scale, and as the border has moved to more remote areas, vehicles and personnel have been diverted between encampments and Border Patrol agents. He said the process ended up consuming more resources because it had to travel further. station. He said a significant increase in federal funding would be needed to fully address the problem.
At least seven migrant detention centers have opened at various points along the California border. One is a large patch of dirt in the desert beside a highway. The other is a mountainous wilderness plateau. The other is a narrow gap between two parallel border walls built just meters from the Mexican city of Tijuana.
None of the detention areas have been officially established by immigration authorities, but they are a mainstay of their operations. This is a makeshift camp where asylum seekers are told to wait in line for counting, untie their shoes, and remove only one layer of clothing.
Adriana Jasso, who runs a volunteer aid station on behalf of the nonprofit American Friends Service Committee against the steel plates of the border wall in San Ysidro, Calif., uses food provided by the government, He said there was a shortage of water and powdered milk. of particular concern. “There is no logic when the most powerful country in human history, the most concentrated nation of wealth, cannot meet the basic needs of its children,” she said.
Immigrant advocacy groups have filed multiple complaints with the Department of Homeland Security's Office of Civil Rights and Civil Liberties, and a group of lawyers represents children in immigration detention as part of a 1997 federal court agreement known as the Flores Settlement. went to court over the conditions.
The Flores settlement agreement established standards for the treatment of migrant children in government custody. Among other things, it calls for children in immigration custody to be given access to toilets, food, drinking water, and emergency medical care, and to be “released from detention without unnecessary delay to appropriate assignees, such as parents or relatives.” ing. ”
Plaintiff lawyers in the settlement, including the Oakland-based nonprofit National Youth Law Center, have filed a new motion to enforce Flores conditions on young immigrants waiting to be processed outdoors. . They argue that children waiting against the border wall should be given the same safe and sanitary housing as children already in official custody. This is because they are prohibited from leaving the camp and have no means of returning.
It is difficult to measure the burden of medical problems on children in detention areas. Volunteers are only allowed on-site at the discretion of border patrol agents, and the patchwork of aid groups does not keep collective records of wound treatment or electrolyte administration.
In a December 2023 email to federal officials, lawyers said infants in the holding area were beginning to vomit due to severe dehydration, and some children were being given one granola bar a day for nutrition. I wrote that it was given. Pedro Rios, director of the American Friends Service Committee's U.S.-Mexico Border Program, said he had seen migrants who had gone five days without food and were eating leaves, and mothers who had stopped producing breast milk due to illness. He said he encountered it. Traumatic stress and infants without formula to replace it.
Since last summer, hundreds of children have been brought to the site each month, and Dr. Chen, who is also a professor of emergency medicine at the University of California, San Francisco, said he evaluated and treated 100 children in one week alone. I'm guessing. . She encountered a 5-year-old and a 12-year-old who had spent three nights outdoors. She was an 8 or 9 year old kid who had her face stitched up outdoors. The 13-year-old boy suffered trauma and was bleeding from his ears and nose.
Children are not the only immigrants with serious health problems. In remote areas of eastern San Diego County, people who turn themselves in to border authorities endure difficult journeys through rugged mountain and desert terrain, often arriving at detention centers in poor health. Doctors encountered a man who had undergone a kidney transplant and was running out of immunosuppressants, a woman who had a traumatic stroke and couldn't reach her own shoelaces, and an immigrant who had become hypoxic after traveling with an oxygen concentrator. He said he did. He eventually died.
Doctors are particularly concerned about cases of hypothermia in children because many children have lower body fat than adults and may become malnourished during travel. Migrants spend the entire night at the waiting area exposed to heavy rain, which can cause them to get drenched and their body temperature to drop rapidly. Last month, two minors were hospitalized with hypothermia.
Karen Parker, a former social worker from Brevard, Calif., who volunteers medical triage at the Eastern camp, said she has seen unaccompanied minors with broken legs, sprained ankles and panic attacks. He said he encounters this on a daily basis. “They are becoming physically ill from stress, fatigue and trauma,” she says. “I look at it thinking it's finally here, but my eyes are blank.”
Since last summer, the number of people and waiting times have fluctuated. In recent weeks, Mexican military activity has pushed migrants westward into urban areas between Tijuana and San Ysidro, California, with asylum-seekers who breached the primary border wall being forced into the secondary border wall. Federal agents must wait in an 80-foot space behind them. Fewer gaps in the main border wall means more children are dragged over it or smuggled under it, despite the bellows of wire. Aid workers are recording an increase in deep head cuts, and local neurosurgeons are reporting an increase in traumatic injuries.
In recent weeks, children aged 3 and 1 have fallen off the border wall into their parents' arms.
“When you hear a baby just crying on the other side of this wall, that's the worst thing that can happen,” said Clint Carney, government affairs manager for the nonprofit Torture Survivors International. border wall.
Local emergency services have been flooded with calls from the scene, and aid workers say federal agents frequently refuse to call 911 and pretend migrants are injured. He expressed his view that this is not the case. Seriously injured people often called volunteer medical staff for advice.
On a recent morning, Dr. Chen received one such call and arrived at the scene to find a 13-year-old boy with a weak pulse and bleeding from his ears and nose. Two Border Patrol agents were standing nearby but not taking anything. she said in court documents.
Dr. Chen performed CPR, but it took an hour for paramedics to arrive. The boy died.
