For Dr. Theresa Cheng, the scene was “apocalyptic.”
She came to Valley of the Moon, an open-air detention facility in San Diego’s rural Mountain Empire region, to provide volunteer medical care to asylum seekers who had crossed the U.S.-Mexico border wall and were waiting to be detained by U.S. authorities.
Among the crowds in this and other places, she found children with deep lacerations, broken bones, fever, diarrhea, vomiting and even seizures. Some people hid in garbage cans and overflowing chamber pots. An asthmatic boy without an inhaler wheezed in the acrid smoke from fires lit to warm bushes and garbage.
Due to limited capacity at immigration processing centers, migrants, including unaccompanied children, wait for hours and sometimes even days in open-air farms where the lack of shelter, food and sanitation has in most cases resulted in a series of health problems public sensitive.
“From a public health standpoint, there are infectious diseases and exposures that can take down anyone, much less this medically vulnerable population,” said Dr. Cheng, an emergency room physician at Zuckerberg General Hospital and Trauma Center in San Francisco .
A federal district court judge in California could rule as early as Friday on whether the government is legally obligated to shelter and feed waiting children.
In the lawsuit, Justice Department lawyers argue that because the children have not yet been formally detained by U.S. Customs and Border Protection, they are under no obligation to provide such assistance.
“The minors in these areas – near the California-Mexico border – have not been arrested or detained by CBP and are not in CBP custody,” the lawyers wrote.
“CBP quickly apprehends and transports minors to safe and sanitary U.S. Border Patrol facilities. But until that happens, plaintiffs are not in DHS custody,” they wrote, referring to the Department of Homeland Security.
When asylum seekers cross into the United States between official ports of entry, they often present themselves to Border Patrol agents near the wall with the intention of being detained. They are taken to a processing plant where they undergo medical examinations, background checks and basic supplies as they begin the legal claims process.
However, unlike immigration processing centers, open-air processing centers do not provide shelter, meals or government-affiliated medical staff. According to Erika Pinheiro, executive director of the legal and humanitarian nonprofit Al Otro Lado, which has provided aid in the camps, some centers have no toilets, causing people to defecate in the open. According to them, with a limited supply of diapers, wipes and creams from volunteers, children were kept in dirty diapers for longer periods of time. court exhibitscausing severe diaper rash.
A senior Customs and Border Protection official acknowledged in an interview that people sometimes waited several days for processing to begin, but said vulnerable groups such as children had always been prioritized and wait times had decreased significantly in recent months. He said the agency has more than tripled the capacity of processing centers in San Diego and increased the number of transport buses and staff to speed up detentions.
However, he said the system was not designed for migrant encounters on the current scale, and moving crossings to more remote regions made the process even more resource-intensive as vehicles and staff had to travel further between encampments and Border Patrol. stations. He said a significant increase in federal funding would be necessary to fully address the problem.
At least seven migrant holding areas have been established at various points along the border with California. One is a large patch of dirt in the desert next to a highway; another is a plateau in a mountainous wilderness; another is the narrow gap between two parallel border walls that were built just a few meters from the Mexican city of Tijuana.
None of the centers have been formally set up by immigration officials, but they have become a mainstay of their operations – makeshift camps where they instruct asylum seekers to line up for a count, remove their shoelaces, strip down to a single layer of clothing and wait. .
Adriana Jasso, who runs a volunteer aid station on the steel slats of the border wall in San Ysidro, California, on behalf of the nonprofit American Friends Service Committee, said the lack of government-provided food, water and baby formula was particularly troubling. “There is no logic if the most powerful country in human history, the country with the greatest concentration of wealth, is unable to provide children with basic needs,” she said.
Migrant support groups do filed many complaints with the Office for Civil Rights and Civil Liberties at the Department of Homeland Security and a group of lawyers representing children in immigration detention under a 1997 federal court settlement known as the Flores settlement, brought a lawsuit over these terms.
The Flores settlement agreement established standards for the treatment of immigrant children in government custody. It generally requires that children in immigration detention have rights and protections similar to those afforded to children in the country’s welfare system, and that they be released from detention to an appropriate sponsor, such as a parent or relative, “without undue delay.”
Plaintiffs’ lawyers involved in the settlement, including the Oakland-based nonprofit National Center for Youth Law, filed the lawsuit new move enforcing Flores conditions for young migrants still awaiting outdoor processing. They argue that children waiting at the border wall deserve the same safe and sanitary housing as those already in official custody because they are not allowed to leave the camps and have no way to return.
It is difficult to measure the burden of health problems on children in detention centers because volunteers can only stay there with the permission of border officials, and the hodgepodge of aid groups does not keep collective records of wounds treated and electrolytes dispensed.
In a December 2023 email to federal officials, the lawyer wrote that the infants being held began vomiting due to severe dehydration and that some of the children were given one granola bar each day. Pedro Rios, director of the American Friends Service Committee’s U.S.-Mexico border program, said he encountered migrants who ate leaves because they had been there for five days without food, as well as mothers who stopped producing milk due to traumatic stress and infants without formula. , which could replace him.
Hundreds of children have been congregated at these facilities 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 assessed or treated 100 children in one week. She met a 5-year-old and a 12-year-old who spent three nights outdoors; an 8- or 9-year-old who had stitches put in her face outdoors; A 13-year-old boy was injured, with blood pouring from his ears and nose.
Children are not the only migrants who have serious health problems. In remote areas of eastern San Diego County, people who turned to border authorities often had to make a difficult journey through steep mountainous and desert terrain, arriving at holding areas in compromised health. Doctors said they encountered a man after a kidney transplant who was running out of immunosuppressive drugs, a woman after a traumatic stroke who couldn’t reach her own shoelaces, and a migrant who was traveling with an oxygen concentrator and suffered hypoxia. He finally died.
Doctors are particularly concerned about cases of hypothermia among children because many of them have less body fat than adults and may be malnourished during the trip. Overnight rainfall in waiting rooms left migrants soaked, which can cause body temperatures to drop. Last month, two minors were hospitalized for hypothermia.
Karen Parker, a retired social worker from Boulevard, Calif., who volunteers to perform medical triage at Eastern camps, said that in addition to broken feet and sprained ankles, she regularly encounters unaccompanied minors having panic attacks. “Stress, exhaustion and trauma make them feel physically ill,” she said. “I look at them, thinking they’re finally here, but their eyes are so empty.”
The number of people and wait times have fluctuated since last summer. In recent weeks, Mexican military activity has pushed migrants westward into the more urbanized region between Tijuana and California’s San Ysidro, where asylum seekers who breach the main border wall must wait for federal agents in a 70-meter-long space behind the other. Fewer gaps in the main border wall mean there are more children dragged over it or smuggled under it despite the concertina. Aid workers have documented an increase in the number of deep head wounds, and local neurosurgeons have reported an increase in the number of injuries.
In recent weeks, a 3-year-old and a 1-year-old fell off the border wall in their parents’ arms.
“When you hear kids just crying and crying on the other side of that wall, that’s the worst,” said Clint Carney, government affairs manager for the nonprofit Survivors of Torture, International, which provides aid through slats on the border wall.
Local EMS teams were inundated with calls from these locations, and aid workers said federal agents often rejected their requests to dial 911, suggesting that migrants were pretending to be injured. People who were seriously injured often called volunteer medical staff for telephone advice.
When Dr. Cheng received such a call one morning and arrived at the scene, he found a 13-year-old boy with a weak pulse and blood oozing from his ears and nose, two border officers standing nearby, but they took no action. steps to help, she said court documents.
Dr. Cheng performed cardiopulmonary resuscitation, but it took an hour for emergency services to arrive, she added. The boy died.
