As family medical and mental health professionals, society entrusts us not only to care for children, but to protect children when they are in harm’s way. It is for that reason, and simply as compassionate human beings, that we write with profound concern about the ongoing conditions for migrant children and families at the US border, from the ongoing horror of family separation to the deteriorating medical, physical, educational, and sanitary conditions of vulnerable families. We have watched countless families flee violence and danger, only to find themselves newly at risk at our borders. If anyone in our profession knew of children living in conditions that our colleagues have witnessed at the border, we would face professional sanctions if we failed to report our concerns to child protection services.
We choose our vocations to protect and nurture children, the most important natural resource for any society’s resilience and sustainability. When we are not aiding children in danger, we work with them to develop resilience to overcome adversities and traumas that they may face. Yet perhaps more powerful than either healing or helping is to advocate for equitable systemic change that will minimize adverse childhood events and traumas.
This is important within, at, and even beyond our nation’s borders. Our work is to ensure that young people may grow up in healthier conditions to reach their full potential as thriving and contributing members of society. Addressing the human rights crises at our border and in the northern triangle, both of which US policy has and can impact, would prevent more of the horrors we have been seeing along the Rio Grande.
No Amount of Detention is Safe for Children
The science is unambiguous that adverse events, including the conditions these families are fleeing and those at our borders, have a profound negative impact on emotional, psychological, and even physical development. While one only needs compassion and common sense to know that children need to be with their families, the scientific literature on attachment tells us the same thing. Children need the consistent presence of a caregiver to grow healthy, happy and resilient, and contribute to society.
The forced separation from caregivers is traumatic to children and families, as well as to many ordinary Americans who have witnessed the photos and heard the cries of the children coming through our screens. This is why in 2018 the President of the American Academy of Pediatrics called this policy “nothing less than government-sanctioned child abuse.” Similarly, psychological organizations have made statements condemning family separations and acknowledging the negative consequences and costs for families and for society down the road. This persistent “toxic stress” and Adverse Childhood Experiences disrupts development, causing profound and lifelong damage to the brains and bodies of young people, costing our society far more in the long run. Recent news brings confounding and infuriating reports of physicians being unable to visit children in the facilities.
Despite the 2018 executive order to end migrant child separation, each week brings still more reports describing significant numbers of children who continue to be separated and held in inhumane conditions. Despite the binding legal settlement requiring that children are held under safe and sanitary conditions, the reports show that children are deprived of basic necessities such as soap and toothbrushes. One 15-year-old girl described caring for another child, age 5, in the “Ice Box,” sleeping on a mat on a concrete floor, and saying “There are no activities, only crying.” As pediatric health care professionals, if we knew of children living in the community being treated this way, we would be legally and ethically obligated to report to child protective services for abuse and neglect. From the perspective of child welfare and professional ethics, why should it make any difference whether the treatment is at the hands of an abusive adult in the community, or at the hands of our own government? Even if instant reunifications were possible, the impact on traumatized caregivers and children would be lasting.
We must remember too that the current crisis exists in a larger context of increasing racism in society, and increasing fear and dehumanization of immigrant and refugee children. Racism itself is a public health issue, impacting both physical and mental health, with the Society for Adolescent Health and Medicine recently calling for adolescent health professionals to address racism and promote equity at the individual as well as societal level.
All of these refugees are members of the human family. Most Americans living today had trauma as part of their family’s immigration story. For most, that trauma began to heal, not fester once they reached American shores. One of the authors of this piece, Dr. Vo is the son of Vietnamese refugees, and his partner was a child refugee herself in the last century. The other author of this piece, Dr. Willard, had ancestors that fled economic and political hardship in the 19th century, his partner’s family escaped Europe during WWII. Their own experiences have motivated them to continue to make the US better for the next generation, and continue to ensure the promise of our nation.
In a deeper sense, this debate is about far more than soap and toothbrushes. Children need to feel loved, they need to feel cared for, they need to feel protected and safe. This is a fundamental human need, and one of our most sacred duties as professionals who care about children. What’s more, parents, and by extension, societies need to love and care for vulnerable, so that they may continue into the future.
Call to Action
With that, we call for an immediate end to the detention of migrant children. As the American Academy of Pediatrics has recently reaffirmed, no amount of detention is safe for a child. All children have the right to basic humanitarian standards including medical care, nutrition, and sanitation. Recent reports have suggested that doctors have not been given access to children under five to assess health conditions in some facilities. We ask for this in a nonpartisan spirit of inclusiveness and compassion for people on all sides of this situation, including the separated families, their loved ones and advocates, as well as those who are suffering even as they implement this inhumane policy.
We were raised learning that the American dream, for immigrants and residents, was a better life for your children. Harming children and families who are seeking safety hurts not only those seeking refuge, but all of us who believe in continuing to make America an idea and place we believe in.