For Dr. Theresa Cheng, the scene was “revealing.”
He had come to Valley of the Moon, an outdoor holding in San Diego’s rural Mountain Empire, to provide volunteer medical care to asylum seekers who had breached the US-Mexico border wall and were waiting to be apprehended by US authorities.
Among the crowd at this and other locations, he found children with deep wounds, broken bones, fevers, diarrhea, vomiting, and even seizures. Some were hidden in garbage cans and overflowing portajons. An asthmatic boy without an inhaler was wheezing in the thick smoke from brush and trash fires lit for warmth.
With capacity at immigration processing centers strained, migrants, including unaccompanied children, wait for hours — sometimes days — in open-air shelters, where a lack of shelter, food and sanitation infrastructure has raised a number of public health concerns For the most. vulnerable.
“From a public health perspective, there are communicable diseases and outdoor exposures that would hit anyone, much less this medically vulnerable population,” said Dr. Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center.
A Federal District Court judge in California could rule as early as Friday on whether the government is legally required to house and feed the children while they wait.
In a court filing, Justice Department attorneys argue that because the children have not yet been formally taken into custody by U.S. Customs and Border Protection, they are not required to provide such services.
“The minors in these areas — near the California-Mexico border — have not been apprehended or detained by CBP and are not in CBP’s lawful custody,” the attorneys wrote.
“CBP apprehends and transports minors to safe and sanitary US Border Patrol facilities in a prompt manner. But until that happens, the claimants are not in DHS custody,” they wrote, referring to the Department of Homeland Security.
When asylum seekers enter the United States between official ports of entry, they often present themselves to Border Patrol agents near the wall with the intention of arrest. They are taken to a processing facility, where they receive a medical, background check and basic provisions as they begin the legal claims process.
But unlike these immigration processing facilities, the open spaces have no government-affiliated shelters, meals or medical staff. Some sites have no toilets, causing people to defecate outdoors, according to Erika Pinheiro, the executive director of the legal and humanitarian nonprofit Al Otro Lado, which has provided aid in the camps. With limited diapers, wipes and creams from volunteers, babies are kept in dirty diapers for long periods of time, according to court exhibits, causing severe diaper rash.
A senior Customs and Border Protection official acknowledged in an interview that people sometimes waited days to enter processing, but said vulnerable groups such as children were always prioritized and that wait times had decreased significantly in recent months. He said the agency had more than tripled capacity at processing centers in San Diego and increased the number of buses and transportation staff to expedite arrivals.
However, he said, the system was not built for migrant encounters on the current scale, and moving crossings to more remote areas has made the process even more resource-intensive, as vehicles and personnel must travel further between camps and Border Patrol stations. He said a significant increase in federal funding would be necessary to fully address the problem.
At least seven immigration detention areas have sprung up at various points along the California border. One is a large patch of dirt in the desert next to a highway. Another is a plateau in the mountain wilderness. another is the narrow gap between two parallel border walls that have been erected a few meters from the Mexican city of Tijuana.
None of the detention facilities were formally established by immigration officials, but they have become a mainstay of their operations — makeshift camps where asylum seekers are instructed to line up for a count, remove their lanyards, strip down to a layer of clothing and wait.
Adriana Jasso, who runs a volunteer aid station against the steel bars of the border wall in San Ysidro, California, on behalf of the nonprofit American Friends Service Committee, said the lack of government-supplied food, water and infant formula has was particularly disturbing. “It makes no sense if the most powerful country in the history of mankind, the country with the greatest concentration of wealth, is unable to meet the basic needs of children,” he said.
Immigrant advocacy groups have filed multiple complaints with the Office of Civil Rights and Civil Liberties at the Department of Homeland Security, and a group of lawyers representing children in immigration detention as part of a 1997 federal court settlement known as the Flores settlement have filed lawsuits over the terms.
The Flores settlement agreement established standards of treatment for immigrant children held by the government. Among other things, it requires that children in immigration detention have access to restrooms, food, drinking water, and emergency medical care, and that they be released from custody to an appropriate sponsor, such as a parent or relative, “without undue delay. “
Attorneys for plaintiffs in the settlement, including the Oakland-based nonprofit National Center for Youth, have filed a new motion to enforce Flores’ terms on immigrant youth still awaiting processing in the open. They argue that children waiting at the border wall deserve the same safe and sanitary housing as those already detained, since they are prohibited from moving from the camps and have no way to return.
The burden of medical issues among children in the holding areas is difficult to measure, as volunteers are only allowed at the sites at the discretion of border agents, and a group of aid groups does not keep a collective record of wounds treated or electrolytes distributed .
In a December 2023 email to federal officials, a lawyer wrote that infants in the detention areas had begun vomiting due to severe dehydration and that some children were given one granola bar per day. Pedro Rios, director of the American Friends Service Committee’s US-Mexico border program, said he met migrants who ate leaves because they had been there for five days without food, as well as mothers who had stopped producing breast milk due to traumatic stress and infants no formula to replace it.
Hundreds of children have flocked to the sites each month since last summer, and Dr. Cheng, who is also a professor of emergency medicine at the University of California, San Francisco, estimated that she had evaluated or treated 100 children in just one week. . He met a 5-year-old and a 12-year-old who had spent three nights outdoors. an 8- or 9-year-old child who was stitched up in the face in the open air. a 13-year-old boy with a traumatic injury, with blood pouring from his ears and nose.
Children are not the only migrants with serious health problems. In remote areas of eastern San Diego County, those surrendered to border authorities have often endured arduous journeys through rugged mountain terrain and desert, arriving at the holdings in deteriorating health. Doctors said they encountered a man with a kidney transplant who ran out of immunosuppressants, a woman with a traumatic stroke who couldn’t reach her cords and an immigrant who traveled with an oxygen concentrator and had become hypoxic. Finally he died.
Doctors are particularly concerned about cases of hypothermia among children, as many have lower body fat than adults and may be malnourished from their travels. Migrants have been drenched by heavy rainfall in waiting areas overnight, which can cause body temperatures to drop. Two minors were hospitalized for hypothermia last month.
Karen Parker, a retired social worker in Boulevard, Calif., who does volunteer medical screening at eastern camps, said that in addition to broken legs and twisted ankles, she often encounters unaccompanied minors with panic attacks. “The stress, the exhaustion, the trauma makes them physically ill,” he said. “I look at them, thinking they’re finally here, but their eyes are so empty.”
The number of people and the length of waiting times have fluctuated since last summer. In recent weeks, Mexican military activity has pushed migrants to the west, a more urban area between Tijuana and San Ysidro, California, where asylum seekers who breach the main border wall must wait for federal agents 280 feet behind a second. Fewer gaps in the main border wall means more children are being dragged over it or smuggled under it, despite the concertina wire. Aid workers have documented an increase in deep head rashes, and local neurosurgeons have reported an increase in traumatic injuries.
In recent weeks, a 3-year-old and a 1-year-old have both fallen off the border wall into their parents’ arms.
“When you hear the babies just crying and crying, right on the other side of that wall, that’s the worst part,” said Clint Carney, the director of government affairs for the nonprofit Survivors of Torture, International, which provides aid through the slots in the border wall.
Local EMS teams have been inundated with calls from the sites, and aid workers said federal agents had often refused their requests to call 911, suggesting the immigrants were faking injuries. Those who suffered serious injuries often called on volunteer medical staff to give them advice over the phone.
When Dr. Cheng received such a call one recent morning and arrived on the scene to find a 13-year-old boy with a weak pulse and blood pouring from his ears and nose, two border guards were standing by but had not taken any steps to help, he said in court documents.
Dr Cheng performed CPR, but it took an hour for emergency services to arrive, she said. The boy died.
