Health Protections for Migrant Children in Custody Are Set to Expire
"A 2022 legal settlement established requirements to protect the health of minors detained at segments of the southern border. It ends nine days after Donald Trump takes office.
A court-ordered system for protecting the health of children detained at the southern border, put in place two years ago after several children died in custody, is set to expire nine days after Donald J. Trump takes office with plans to intensify the deportation of migrants.
The system, part of a July 2022 legal settlement between the government and lawyers representing migrant children in custody, set detailed protocols for detaining minors at Customs and Border Protection facilities in the Rio Grande Valley and El Paso sectors. It required agents to provide them with access to emergency care and basic hygiene items — showers, toothbrushes and blankets for sleeping, for example. It forbade agents to separate children from their parents for extended periods of time.
At the center of the reform was a new position: an independent pediatrician who was assigned to visit the facilities and work with staff members to improve them. That monitor role is set to phase out even sooner than the overall agreement, on Dec. 27.
Despite notable improvements, reports from the pediatrician — the so-called juvenile care monitor — showed that the conditions still sometimes fell short. Now, medical experts worry that, with the settlement expiring and the monitoring role set to disappear, conditions could worsen under an administration far less friendly to immigrants.
“This is not a bureaucratic shift — this should be everyone’s concern,” said Marsha Griffin, a pediatrician practicing on the southwest border who has visited the facilities. “This is a law enforcement agency with a law enforcement mentality, tasked with running a trauma-informed day care center. You just feel like screaming. Someone needs to watch them.”
A spokeswoman for Customs and Border Protection said that the agency had undertaken “extensive measures” in the past two years to “significantly expand and enhance its support efforts” for all people in custody — and particularly for children. She said the agency developed trauma-informed behavioral health training for employees, for example, and worked to better integrate pediatricians into the medical care process for minors in custody. It also issued a formal policy to define when agents could separate children from their parents.
“C.B.P. continues to work with Congress and other internal and external stakeholders, including pediatricians and other medical professionals, to ensure the safety and welfare of children in C.B.P. custody,” she said.
The federal border apprehension system was originally designed to respond primarily to adult men entering the United States for work. But in the last decade, the influx of families and children unaccompanied by adults revealed serious issues that were, according to Dr. Griffin, “an artifact of a system built for another purpose.”
A 1997 consent decree known as the Flores settlement first established the standards of treatment for immigrant minors who are detained by the government, given their particular vulnerabilities. That agreement remains in place. The 2022 settlement — negotiated after three children from Guatemala died in custody within months of one another — articulated in more detail what constituted the safe and sanitary conditions that had long been mandated.
As a result of the settlement, “there have been improvements, but it’s the sustaining of improvements that is the challenge,” Dr. Paul Wise, a pediatrician who served as the juvenile care monitor, said in an interview.
Mishan Wroe, a senior attorney at the National Center for Youth Law who represents young migrants in federal custody, said that the terms of the agreement “give us opportunities to point out areas where C.B.P. is falling short.” But, she said, even with the monitor and the settlement requirements, the group has been concerned about the safety of children. Without them, she said, “it’s possible that conditions may deteriorate further.”
Independent monitors are just one piece of broader efforts to reform troubled agencies. The pediatrician monitor role was particularly vital, plaintiff lawyers said, because it was virtually the only window into the realities inside heavily shrouded detention centers.
With unfettered access to the facilities, the monitor routinely visited to interview children and staff members. He received monthly reports on the number of minors held longer than 72 hours. He tracked things like overcrowding, toothbrush inventory, the rapidity of medical care and the emotional-distress levels of children who had been separated from their parents.
The monitor’s periodic reports to the court detailed the government’s ongoing struggle to meet the terms of the agreement. Children consistently reported that they were cold and did not have access to adequate clothing or blankets. Border officials struggled to provide age-appropriate meals. (Two-year-olds received the same food as adult migrants, for example, and there was no cutlery available to make eating more manageable, reports said.)
Agents also continued to separate children from their parents in the Rio Grande Valley, a practice that “can be profoundly traumatic” and “can have lasting, harmful effects,” Dr. Wise wrote in a report submitted to the court.
One of the most concerning events under Dr. Wise’s tenure was in May 2023, when an 8-year-old girl, Anadith Danay Reyes Álvarez, died in her mother’s arms after being detained for eight days. Dr. Wise, who was part of an investigation team that found major lapses in medical support, called the agency’s procedures and policies “catastrophically inadequate” and the death “clearly preventable.”
The failures, Dr. Wise wrote in his report, “should not be viewed as rare anomalies but rather as systemic weaknesses.” Without reform, he wrote, more children are likely to be harmed.
After this blunt assessment came improvements, and the documents show that monitors were effective not only at revealing important shortcomings, but also at helping to remedy them.
Dr. Wise had previously detected a disjointed medical records system that made it difficult to catch potential health crises. Subsequently, he reported that officials had put in place “a series of important reforms” in response to his concerns and recommendations. Among the measures taken was a protocol to define “elevated medical risk” and to require on-site health care providers to consult with a pediatric specialist on challenging cases.
Once, a site visit in El Paso showed that a facility was running at four times the maximum capacity. After working with the staff, the monitor reported no overcrowding, “a major improvement.”
And one report detailed that the border patrol agency had “recently expanded the number of caregivers” deployed throughout unaccompanied child holding areas, calling it an “important enhancement.”
Under the 2022 agreement, the monitoring role was designed to last only 16 months. But in December 2023 a district court judge decided that the agency had not established an adequate plan for monitoring its own performance, so the position was repeatedly extended. In the coming weeks, the court could decide to extend the agreement and the monitor role further.
Most pediatricians concur that, ideally, instead of continuous monitoring, a new system is needed for minors apprehended on the border — one that would outlive any administration and bring their care under a federal agency more inherently oriented around child welfare. But unless and until a new system is in place, they said, the lack of accountability is worrisome.
“If the monitoring role goes away, all hell breaks loose,” said Dr. Jeffrey L. Goldhagen, a pediatrician and the president of the International Society for Social Pediatrics and Child Health. “If you take it out, the system defaults to the state it used to exist in.”
Emily Baumgaertner is a national health reporter for The Times, focusing on public health issues that primarily affect vulnerable communities. More about Emily Baumgaertner"
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