Healthcare Disparities Faced By Unaccompanied Minors at the US-Mexican Border

Matthew Morrones, Tareck Haykal, and Rishabh Lohray

Every year a large number of unaccompanied minors (UM) cross the US border and are placed in shelters by Customs and Border Patrol (CBP). Last year, a record breaking 130,000 unaccompanied minors were apprehended at the border (Montoya-Galvez). Hence, it is not surprising that one in three migrants in US custody is a child (Nawaz). As per settled law established by the Flores settlement agreement in 1997, the onus for the health and safety of these children falls on the US Department of Health and Human Services (HHS). UMs are to be processed in a “safe and timely” manner through a shelter and then placed in the care of a sponsor in the United States (Siegel 219). This is the law, and yet many challenges plaguing the system make it harder to uphold.

A rise in poverty and crime in Central America has created the conditions for the unprecedented influx of UMs at the border (Montoya-Galvez). After escaping grueling conditions in search of a better life, minors are placed by the CBP custody with limited access to proper health services. US law mandates that UMs cannot be kept in these crowded conditions beyond seventy two hours; however, according to the Marshall Project one-third spend more than that amount in CBP custody (Nawaz). After this, DHHS takes over and they move the UMs to a migrant shelter like Fort Bliss where they await placement with a sponsor (usually a family member) in the United States. In the meantime, it comes down to the government to make sure that UMs have adequate healthcare access, a task which continues to become more challenging every year.

Complicating matters is the Title 42 policy, established in 1944 before the COVID era (Pensack). Title 42 states that if “by reason of the existence of any communicable disease in a foreign country there is serious danger of the introduction of such disease into the United States . . . the [government] shall have the power to prohibit, in whole or in part, the introduction of persons and property from such countries.” However, US and international laws state that individuals who seek asylum have a right to submit their claims to the US. Two international treaties signed by the US, including the 1951 Refugee Convention and the Convention against Torture, guarantee asylum seekers the right to request asylum (Beckett, et. al, 1). The government chose to prioritize Title 42 over international laws to enforce a closure of the border to all asylum seekers (Beckett, et. al, 1). While asylum seekers at the border were denied entry, other groups such as international students and truck drivers were allowed entry into the US without a COVID test (Beckett et. al, 1). The government claimed that asylum migration at the border would be a significant contributor to COVID-19 case rates despite the U.S having the highest case rates at the time in all of the Americas (Beckett et. al 1).

Physicians, public health experts, the CDC, and the WHO have repeatedly asserted that application of Title 42 in relation to COVID-19 is not backed by scientific evidence (Pillai and Artiga). With the use of public health mitigation measures like vaccinations, masking and social distancing, the risk of COVID-19 transmission in the asylee population can be reduced and any concerns for spread in the USA can be addressed (Pillai and Artiga). Hence, enforcing a closure of the border to asylees in ignorance of international laws that protect the basic human right to seek asylum, is not a sound policy. Moved by the opposition to Title 42, the Biden administration has tried to revoke it. The CDC released a statement in May 2022: “While the introduction, transmission, and spread of COVID-19 into the United States is likely to continue to some degree, the cross-border spread of COVID-19 due to covered noncitizens does not present the serious danger to public health that it once did, given the range of mitigation measures now available”(Pillai and Artiga). Despite the government’s efforts to repeal the law, a Louisiana Federal judge struck their efforts down in June 2022 and pro-Title 42 governors continue to use it to police their border (Sacchetti). The CDC has decided to exempt UMs from Title 42 in February of 2021 (Coronavirus Disease 2019). While UMs are exempt under Title 42, they continue to face separations from their families as a consequence of the policy (Montoya-Galvez).

The COVID-19 pandemic has also worsened the healthcare challenges for UMs at the border. Social distancing is important in preventing the spread of the virus. Crowded conditions at shelters/CBP custody sites can be a breeding ground for transmission. UMs have limited access to healthcare while under the care of DHHS or CBP. However, they lose that access when they leave the care of the federal government and go on to live with their sponsors. As per the Patient Protection and Affordable Care Act, UMs are specifically excluded from Medicaid, CHIP, and Refugee Medical Assistant Programs, including any healthcare assistance related to COVID-19 (Siegel 221). Based on location, UMs have varying coverage for testing and treatment which can exacerbate the COVID-19 burden in their community (Siegel 221).

In addition to the health effects of COVID, UMs face poor access to both physical and mental health services. This poor healthcare access worsens the pre-existing health burden on this community. According to numerous studies, UMs are more likely to have nutritional deficiencies (Vitamin D and Iron Deficiency Anemia), dental caries (as high as 65% prevalence in some studies), skin, respiratory and gastrointestinal infections, low vaccination rates, and high incidence of mental health disorders (Migration Data Portal). The issue seems to be exacerbating as there have been at least 6 deaths of children since September 2018 whereas there were none in the prior decade (U.S. Commission on Civil Rights). These deaths were caused by a number of reasons including the flu and other respiratory infections when some of these children were detained twice as long as is supposed to be permitted by federal law (U.S. Commission on Civil Rights). Therefore, it becomes an even greater challenge to ensure that these pre-existing conditions are managed well in the context of the pandemic.

In September of this year, a CBS report identified Fort Bliss, a child migrant shelter in Texas, as a place with low mental health access (Montoya-Galvez). A lack of case managers trained in dealing with traumatized children, due to staffing shortages and funding concerns, contributed to a situation where children frequently went months without seeing a case manager (Montoya-Galvez). Therefore, children experienced higher rates of anxiety and suicidal ideation, leading to their eventual retraumatization (Montoya-Galvez). After a whistleblower complaint and some major changes to operating practices, Fort Bliss now has more than 300 case managers to ensure that the situation is not repeated again (Montoya-Galvez).However, the effectiveness of these changes in improving the mental well being of UMs remains to be seen.

"Absent policy changes, we're likely to see a large number of unaccompanied minors for the foreseeable future," said Andrew Selee, president of the Migration Policy Institute, a non-partisan think tank (Montoya-Galvez). Later he commented, "Given the conditions in Central America, it makes sense for young people to try and make it to the U.S. to help their families or for families that are already here to bring their children” (Montoya-Galvez October 2022). In order to tackle the healthcare challenges posed by the growing influx of UMs at the border, the medical community can help by coming up with creative solutions. These solutions need to be targeted towards reducing the healthcare disparities in the UM community through patient advocacy for public policy changes and volunteering significant time and effort to projects such as charity clinics. Given that the rate of immigration of UMs is unlikely to slow down, it is imperative that a concerted effort is utilized to clarify policies and improve healthcare access that these individuals possess. Only through a unified effort involving physicians, the state and federal governments, public health experts, and policymakers can we hope to make a sustainable difference.

About the Author:

Currently the three of us are MD/MBA students at Baylor College of Medicine. We are interested in exploring the social determinants of health and creative healthcare delivery models. Matthew is interested in Orthopedic Surgery. Tareck is interested in Plastic and Reconstructive Surgery. Rishabh is interested in Cardiology.

About the Work:

This is a piece that seeks to address the challenges faced by unaccompanied minors at the border. In the paper, factors such as Title 42, an unprecedented rise in the number of immigrants at the border, staffing and funding shortages were explored. The purpose of this opinion piece was to explain what is occurring at the border and try to provide a nuanced perspective to all factors that play a role in and hopefully allow others to think of health solutions.

Works Cited:

Beckett, Anne G., et al. "Misusing Public Health as a Pretext to End Asylum — Title 42." New England Journal of Medicine, vol. 386, no. 16, 2022, p. e41.

"Coronavirus Disease 2019." Centers for Disease Control and Prevention, 9 Sept. 2022, www.cdc.gov/media/releases/2021/s0716-title-42-order.html.

Migration Data Portal. "Unaccompanied or Separated Children Face Increased Health Risks During Migration." Migration Data Portal, 6 July 2022, www.migrationdataportal.org/blog/unaccompanied-or-separated-children-face-increased-health-risks-during-migration-0.

Montoya-Galvez, C. "12,212 migrant children reentered U.S. border custody alone in 2021 after being expelled." CBS News - Breaking news, 24/7 live streaming news & top stories, 20 May 2022, www.cbsnews.com/news/immigration-migrant-children-us-border-custody-unaccompanied-minors-2021/.

Montoya-Galvez, Camilo. "Nearly 130,000 Unaccompanied Migrant Children Entered the U.S. Shelter System in 2022, a Record." CBS News - Breaking News, 24/7 Live Streaming News & Top Stories, 14 Oct. 2022, www.cbsnews.com/news/immigration-unaccompanied-migrant-children-record-numbers-us-shelter-system/.

Montoya-Galvez. "Watchdog Report Details Distress Among Migrant Children Who Languished at Fort Bliss Facility." CBS News - Breaking News, 24/7 Live Streaming News & Top Stories, 27 Sept. 2022, www.cbsnews.com/news/immigration-fort-bliss-hhs-inspector-general-report/.

Nawaz, Amna. "Hundreds of Children Have Been Held by Border Patrol for More Than 10 Days. The Legal Limit is 72 Hours." PBS NewsHour, 17 Mar. 2021, www.pbs.org/newshour/nation/hundreds-of-children-have-been-held-by-border-patrol-for-more-than-10-days-the-legal-limit-is-72-hours.

Pensack, Miriam. "The Bi-partisan Consensus Against Asylum Seekers." THIRTEEN - New York Public Media, 19 Oct. 2022, www.thirteen.org/blog-post/bi-partisan-consensus-against-asylum-seekers/.

Pillai, Drishti, and Samantha Artiga. "Title 42 and Its Impact on Migrant Families." KFF, 26 May 2022, www.kff.org/racial-equity-and-health-policy/issue-brief/title-42-and-its-impact-on-migrant-families/#footnote-555311-30.

Sacchetti, Maria. The Washington Post, 20 May 2022, www.washingtonpost.com/national-security/2022/05/20/title-42-asylum-border/.

Siegel, Jennifer L. "The COVID-19 Pandemic: Health Impact on Unaccompanied Migrant Children." Social Work, vol. 67, no. 3, 2022, pp. 218-227.

United States Commission on Civil Rights. "Trauma at the Border: The Human Cost of Inhumane Immigration Policies." 2019. pp. 1-197