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What level of health care should detained children receive?
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Migrant children are at an increased risk for numerous health problems. Infectious Diseases in Children asked Janine Young, MD, FAAP, medical director of the Denver Health Refugee Clinic and associate professor of pediatrics at the University of Colorado School of Medicine, and Elizabeth Barnert, MD, MPH, MS, assistant professor of pediatrics at the University of California, Los Angeles David Geffen School of Medicine, about the level of care migrant children should receive at federal detention and processing centers.
Young: Unaccompanied and accompanied immigrant children who are detained by U.S. Customs and Border Protection (CBP) and Department of Homeland Security (DHS) at U.S. border crossings are at high risk for significant medical and psychological conditions requiring both immediate and long-term management. Detention centers are not the place for children. Every effort should be focused on facilitating immediate placement with family members or in other supportive home environments.
Notwithstanding whether a child is in the custody of CBP, DHS or the Office of Refugee Resettlement, interagency systematized, comprehensive, coordinated and evidence-based medical and mental health evaluations should be provided for all migrant children. Transfer of medical information between agencies and to health centers after release needs to be prioritized and standardized to ensure that diagnosis and treatment plans are not lost. These evaluations should be directed and monitored by well-trained pediatricians, child psychiatrists and psychologists skilled in medical and psychological screening and treatment standards of immigrant children.
Children in group settings, such as detention facilities, are at high risk for spreading a multitude of infectious diseases — from hepatitis B virus and tuberculosis to vaccine-preventable illnesses such as varicella and pertussis. Systematized medical screening and vaccinations must occur. As outlined in the AAP Immigrant Toolkit and the CDC’s Domestic Refugee Screening Guidelines, many migrant children also are at risk for parasitic infections, including soil-transmitted helminth (STH) infections. In such settings, federal government-negotiated low-cost albendazole could be administered to all migrant children to presumptively treat STH infections.
Children do not choose to immigrate; they flee countries with some of the highest homicide rates in the world. Detaining children and depriving them of essential medical and psychological care sets the stage for short- and long-term failure — failure to allow for children to thrive and a failure of our country to protect our most vulnerable population.
Barnert: Each year, the CBP detains more than 100,000 children and adolescents. Most of these children migrate from El Salvador, Guatemala, and Honduras (95%), seeking safe haven from violence.
To best care for migrant youth in detention, as a priority, policies and practices should avoid family separation whenever possible. Family reunification should be supported. Further, as asserted in the AAP policy statement on detained children, immigrant and refugee children, including those in detention, “should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them.”
Currently, however, DHS detention facilities do not meet basic standards, and the provision of health care is insufficient. Conditions within detention facilities have been reported to include children sleeping on floors without bedding, exposure to bright lights and cold temperatures, and insufficient food and water.
Youth in detention centers may have a significant burden of unmet health issues, such as physical injuries, untreated infectious diseases and undiagnosed or inadequately managed chronic disease. Additionally, mental health conditions, including anxiety and depression, may develop or become exacerbated, related both to the conditions that prompted migration and the migration journey, as well as the conditions of confinement.
The AAP supports that all children, including detained youth, should have access to a comprehensive medical home. Although detained youth, by law, are screened for trafficking, the health assessment is often incomplete. For example, it may include only limited screening for conditions such as scabies and lice and may not be conducted by a medical professional.
The care of immigrant children should be based on guidelines. The AAP Immigrant Health Toolkit outlines clinical approaches for the care of immigrant youth. Infectious disease priorities include screening for TB; when prenatal labs cannot be verified, screening for HBV, HIV and syphilis; and providing immunizations, as needed.
Timely, comprehensive care in the short term during detention and in the long term, following release and once under the care of community health providers, is important for supporting youth through the physical and emotional traumas of immigration and detention. Every child deserves access to health care, especially those who may be most vulnerable.
Disclosures: Barnert and Young report no relevant financial disclosures.