Irwin Redlener is a pediatrician and directs the National Center for Disaster Preparedness and is professor at the Mailman School of Public Health at Columbia University and president emeritus of Children’s Health Fund. He is the author of “The Future of Us: What the Dreams of Children Mean for 21st-Century America.”
U.S. Customs and Border Protection announced Monday the death of a 16-year-old boy from Guatemala who had just days earlier crossed the southern border illegally as a so-designated “unaccompanied minor.” While only minimal details were released, the young man was likely headed to relatives waiting for him somewhere in the United States.
CBP oversees the Border Patrol which, as required, had custody of the boy when he was noticed to be sick with respiratory symptoms and fever. He was seen by a nurse practitioner who diagnosed him with the flu and prescribed an anti-viral medication and fever control. The patient was then returned to a Border Patrol detention facility where he was checked by agents at “regular intervals.” Early in the morning of May 20, Carlos Gregorio Hernandez Vasquez was found unresponsive in his holding unit.
There is a lot to be concerned about in this loss, and more details are coming. But ultimately, Carlos’s death makes the crisis at our border tragically clear: Our government is overwhelmed by unprecedented numbers of people streaming across the border, and it is essential that our elected leaders address this crisis with a complete overhaul of U.S. immigration policies.
In the meantime, CBP’s acting commissioner, John Sanders, has been seeking guidance from experts and organizations, including the esteemed American Academy of Pediatrics, to help his agency find ways to safeguard the lives and well-being of the tens of thousands of children coming across the U.S. border every month, either unaccompanied or with their families. He has also reached out to me and my colleague, Michael VanRooyen, director of the Harvard Humanitarian Initiative, to help develop a practical, feasible strategy to address what the acting commissioner himself characterized as a humanitarian crisis at the U.S. southern border.
Given the urgency of the issue, this was a mission we could not refuse. Carlos was the fifth death of a child after being taken into federal custody since December 2018. Just six days earlier, a 2-year-old toddler, also from Guatemala, died from a severe respiratory illness. His family, which had arrived in the United States illegally on April 3, had been apprehended on the north bank of the Rio Grande River, near the center of El Paso.
Before jumping to conclusions about who is responsible for these heartbreaking losses, there is a great deal to sort out, starting with the fact that federal agencies responsible for apprehending and assuming custody of people crossing the borders illegally are beyond overwhelmed.
Last February, about 76,000 migrants were apprehended by the Border Patrol. The number jumped to 103,000 apprehensions in March and again to 110,000 in April. Projections for May suggest that almost 150,000 immigrants will be taken into custody. But detention facilities are already jammed. The El Paso processing center, alone, is, according to CBP, at 323 percent capacity.
It is in this unfathomable and unmanageable situation that the much-maligned (often unfairly) Border Patrol agents, with essentially no medical training whatsoever, are doing a thankless job that most of us would not consider taking on.
Last year, I had an opportunity to tour a portion of the border separating Texas and Mexico where I spoke with many Border Patrol agents. One officer, a father of three, said, “I am truly sympathetic to families who are trying to escape misery in their home country and risk everything to get to America. But we have a job to do.”
What the Border Patrol and those desperate to get to the United States really need — what the nation needs — is a coherent, effective and humane plan to manage immigration going forward.
First, CBP agents need a standardized, but basic health-screening tool to help determine whether a child might need urgent medical attention. Second, we need an organized system of medical response that includes rapid transfer of sick children from the border to hospital care. Third, we need a deployment of mobile clinics at strategic points along the border, combined with state-of-the-art telemedicine strategies to bring virtual medical specialty assessment to children anywhere there’s an Internet connection.
Another concern merits attention: In some instances of child fatalities among migrant children, the problem may not be with Border Patrol actions but rather the quality of care for sick children at local hospitals. I am concerned that, in at least two cases of pediatric fatalities, emergency departments in community hospitals may have inappropriately discharged children back to federal detention facilities. Clearly, all of these cases need to be thoroughly reviewed.
Whatever the complexity of the policy challenges or the deeply frustrating partisan political battles, we need to respond to the humanitarian needs of people who end up on U.S. soil, no matter how or why they got here. This is not a message for just my medical colleagues, but for all Americans, especially elected officials. They have the power to change conditions and make sure that the policies they create — or tolerate — do not cause inadvertent harm to anyone, especially children.