Public Health Crisis on the US Border: Health & Immigration Policies Collide

Children Escaping Violence & Poverty

Over 50,000 undocumented children (UAC) have entered the United States through the Southwestern border in the last 8 months, creating what some a calling a humanitarian crisis. As many as 90,000 children are expected to enter the country by the end of the year.

Child Hand Immigration Camp

Many children are being sent to the United States alone without any adult supervision by family members hoping that by entering the United States their children will be spared the harsh realities of gang violence, drug cartels and civil unrest in their home countries. Categorized as Unaccompanied Alien Children (UAC), these children hail mostly from Mexico, Guatemala, El Salvador, Honduras and Ecuador.

uac nationality

Increases in Migrant Children 2013-2014

Increases in Migrant Children 2013-2014

Legal Definitions & Dilemmas

On December 28, 2008, President George W. Bush signed the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 into law as one his final pieces of legislation.  The law, as described in a US Homeland Security memo, made the following modifications:

First, it expanded the group of aliens eligible for SIJ (Special Immigrant Juvenile) status. An eligible SIJ alien now includes an alien:

• who has been declared dependent on a juvenile court;
• whom a juvenile court has legally committed to, or placed under the custody of, an agency or department of a State; or
• who has been placed under the custody of an individual or entity appointed by a State or juvenile court.

The second modification made by the TVPRA 2008 to the definition of special immigrant juvenile concerns the findings a juvenile court must make in order for a juvenile court order to serve as the basis for a grant of SIJ status. Previously, the juvenile court needed to deem a juvenile eligible for long term foster care due to abuse, neglect or abandonment. Under the TVPRA 2008 modifications, the juvenile court must find that the juvenile’s reunification with one or both of the immigrant’s parents is not viable due to abuse, neglect, abandonment, or a similar basis found under State law. In short, the TVPRA 2008 removed the need for a juvenile court to deem a juvenile eligible for long-term foster care and replaced it with a requirement that the juvenile court find reunification with one or both parents not viable. If a juvenile court order includes a finding that reunification with one or both parents is not viable due to a similar basis found under State law, the petitioner must establish that such a basis is similar to a finding of abuse, neglect, or abandonment.

These children do not technically qualify as ‘refugees’  because under US law, a refugee is someone who:

  • Is located outside of the United States
  • Is of special humanitarian concern to the United States
  • Demonstrates that they were persecuted or fear persecution due to race, religion, nationality, political opinion, or membership in a particular social group
    Is not firmly resettled in another country
  • Is admissible to the United States

Because they are already within the United States, they do not qualify for this status. Semantics aside, these children are leaving behind dire home situations for a chance at a new life within the United States. The United Nations High Commissioner for Refugees compiled a report based on a series of interviews with 440 of these UAC children, and it found that many of them were leaving situations that qualified for ‘international protection,’ regardless of refugee status.

percent children needing international protection

This Vox article summarizes the current situation. No time to read? Watch the 2 minute summary.

Complex Maze of Protocols

The management of these children once they enter the US is left to the responsibility of the previously obscure Unaccompanied Alien Children Program within the Office of Refugee Resettlement’s (ORR) Division of Children’s Services within the Department of Health and Human Services.  The infographic below details how children were traditionally managed through the UAC program.

uac process dhhs orr

Public Health Issues and Children

The influx of children crossing the border, however, has strained this system, which was not designed to handle such a surge. Just take a look at the bed-to-child discrepancy noted in the HHS FY2015 budget.

bed dystocia

With this flood of migrants, fears and rumors have begun to swirl regarding the possibility that these children may be bringing dangerous diseases along with them across the border. Representative Gingrey, a physician from Georgia states:

Reports of illegal migrants carrying deadly diseases such as swine flu, dengue fever, Ebola virus and tuberculosis are particularly concerning. Many of the children who are coming across the border also lack basic vaccinations such as those to prevent chicken pox or measles. This makes those Americans that are not vaccinated – and especially young children and the elderly – particularly susceptible. … Reports have indicated that several border agents have contracted diseases through contact with the unaccompanied minors. As the unaccompanied children continue to be transported to shelters around the country on commercial airlines and other forms of transportation, I have serious concerns that the diseases carried by these children may begin to spread too rapidly to control…

Scabies outbreaks have also been reported in some of the immigrant processing centers.

Government officials from DHHS and US Customs and Border Protection, however, are disputing these claims.  A spokesman from CBP stated, “We are conducting public health screens on all incoming detainees to screen for any symptoms of illnesses and contagious diseases of possible public health concern … If any serious symptoms are present, individuals are referred to a medical provider or healthcare facility for treatment and medical clearance.”

When any new legal immigrant enters the country, DHHS and the CDC require that  he or she receive a medical exam and show proof of vaccination for measles, mumps, rubella, polio, tetanus, diphtheria, pertussis, haemophilus strains, hepatitis A and B, rotavirus, meningococcus, chicken pox, pneumonia, and seasonal flu. On its website, DHHS states that UACs are housed in temporary shelters along the border for an average of 35 days or less.

When children come into the Department of Health and Human Services program, they are given a well-child exam and given all needed childhood vaccinations to protect against communicable diseases. They are also screened for tuberculosis, and receive a mental health exam. If children are determined to have any communicable disease or have been exposed to a communicable disease, they are placed in a program or facility that has the capacity to quarantine. If they have mental health problems, they are similarly placed in a specialized facility to meet their needs and not in a temporary shelter.

The Department of Health and Human Services pays for and provides all services for the children through its network of grantees. This includes providing food, clothing, education and medical screening to the children. All activities, including outdoor recreation time, take place on the grounds of the temporary facilities. Children do not attend local schools. Communities can expect increased use of local retail services (hotels, restaurants and retail) by those coming to work at and visit the shelter.

The large number of children in these shelters, however, is challenging the system. Texas DHHS spokeswoman Carrie Williams states “Our staff believe the children’s living conditions pose a high potential for infectious disease outbreak among the children and staff.” Concerns that medical screenings are only being conducted on a verbal and visual basis and that children eat, sleep and use the bathroom in crowded cells without running water or soap have been raised. Republican State Senator Jane Nelson of the Senate Health and Human Services Committee stated, “When individuals are held in unhealthy conditions and then released into the community without proper medical attention, the health of Texans is placed at risk.”

NOGALES, AZ - JUNE 18:  Two female detainees sleep in a holding cell, as the children are separated by age group and gender, as hundreds of mostly Central American immigrant children are being processed and held at the U.S. Customs and Border Protection Nogales Placement Center on June 18, 2014, in Nogales, Arizona.  Brownsville, Texas, and Nogales, have been central to processing the more than 47,000 unaccompanied children who have entered the country illegally since Oct. 1. (Photo by Ross D. Franklin-Pool/Getty Images)

NOGALES, AZ – JUNE 18: Two female detainees sleep in a holding cell, as the children are separated by age group and gender, as hundreds of mostly Central American immigrant children are being processed and held at the U.S. Customs and Border Protection Nogales Placement Center on June 18, 2014, in Nogales, Arizona. Brownsville, Texas, and Nogales, have been central to processing the more than 47,000 unaccompanied children who have entered the country illegally since Oct. 1. (Photo by Ross D. Franklin-Pool/Getty Images)

NOGALES, AZ - JUNE 18:  Young boys sleep in a holding cell where hundreds of mostly Central American immigrant children are being processed and held at the U.S. Customs and Border Protection Nogales Placement Center on June 18, 2014, in Nogales, Arizona.  Brownsville, Texas, and Nogales, have been central to processing the more than 47,000 unaccompanied children who have entered the country illegally since Oct. 1. (Photo by Ross D. Franklin-Pool/Getty Images)

NOGALES, AZ – JUNE 18: Young boys sleep in a holding cell where hundreds of mostly Central American immigrant children are being processed and held at the U.S. Customs and Border Protection Nogales Placement Center on June 18, 2014, in Nogales, Arizona. Brownsville, Texas, and Nogales, have been central to processing the more than 47,000 unaccompanied children who have entered the country illegally since Oct. 1. (Photo by Ross D. Franklin-Pool/Getty Images)

Public Health Resources

So how can we mitigate the spread of disease within these shelters?  The CDC offers this checklist for shelter environmental health assessment. Another potential resource are international standards put into place for refugee camps. In the Handy Guide to UNHCR Emergency Standards and Indicators  the following requirements for refugee camps are described:

  • 1 latrine per 1 family (6-10 persons)
  • 1 water tap per 1 community (80-100 persons)
  • 1 health center per 1 camp (20,000 persons)
  • 1 hospital per 200,000 persons
  • 2 refuse drums per 1 community (80-100 persons)

The Handy Guide also describes contributing factors and preventive measures which can be employed within refugee camps to minimize the spread of disease.

disease prevention table

In this op-ed published in the Texas Tribune the author minimizes the potential risk of deadly viruses being brought into the country by immigrants. Whether or not this is true is currently being hotly debated. A fact that has remained true throughout history, however, is that crowded and unsanitary living conditions can breed all sorts of diseases. Regardless of the politics surrounding these children, care must be taken to ensure that they remain safe and healthy while under the care of the United States government.

Report written by Vidya Eswaran

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