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An Immigration System in Need of Healing

Louis Appel, MD, FAAP
July 10, 2018

“Are all the passengers in the vehicle US citizens?” the Customs and Border Protection (CBP) agent asked through my window as I pulled to a stop at the checkpoint. My wife, our two teenage children, and I were driving east on Interstate-10 from Tornillo, Texas back to our home in Austin. We’d spent the morning in the far western corner of the state with about 100 physicians, nurses, nurse practitioners, social workers, medical students, and other allies demanding an end to family separations and the detention of children.
My “yes” response to the agent’s question of citizenship was readily accepted. We were quickly on our way, though feeling somehow unnerved. My family is white. From the backseat, before I could bring it up, my children were already discussing how our experience at the checkpoint might easily have been different if the color of our skin had been different.
I was at the Texas-Mexico border again a few days later, this time in the Rio Grande Valley with a delegation of American Academy of Pediatrics (AAP) members and staff. Hosted and guided by local pediatrician and advocate Marsha Griffin, MD, FAAP, our group included AAP President Colleen Kraft, MD, FAAP; the academy’s Immigrant Health Special Interest Group Chair Julie Linton, MD, FAAP; AAP Interim CEO Mark Del Monte, JD, as well as UNICEF USA CEO Caryl Stern. It was about a week after the executive order ending family separations was issued, and we’d made the trip seeking a deeper understanding of how rapidly changing immigration directives are impacting the health of children.

In #AAPvoices, Dr. Louis Appel describes asylum-seeking parents at the southern U.S. border desperate to escape their home countries to protect their children.

Shortly after arriving, we walked across the McAllen-Hidalgo-Reynosa International Bridge toward our southern neighbor. The feeling of intimidation I had experienced at the Tornillo checkpoint echoed as we crossed the bridge from Mexico to reenter the U.S. We first encountered two Mexican immigration agents at the foot of bridge who stood imposingly in front of pedestrian turnstiles. As we approached the international border halfway across the bridge, we had to pass through three U.S. Customs and Border Protection agents blocking the walkway. Then, as we approached the CBP building, we encountered several additional agents.

We were free to enter the inspection building, but a young Latina woman with tears streaming down her cheeks and a boy in her arms clearly was not. She told us she was from Honduras and was trying to seek asylum for herself and her 5-year-old son. As the agents instructed our group to keep moving into the building, we continued to talk to the woman. She said she wanted her son to see a doctor.
With our group starting to ask the agents questions about getting medical care for the child, the agents allowed the woman with her son to enter the building. None of us were allowed to accompany her as she was whisked to the back.
I don’t know what ultimately happened to the woman or her child. But I do know from attorneys who spoke with our group that the government has been using tactics such as increasing the presence of agents halfway across the bridge and making families wait hours, days, or upwards of a week on the bridge to intimidate families and discourage them from seeking asylum at ports of entry.

"We met a father and daughter just released from an immigration processing center. The father explained that his friend's daughter was murdered by gang members for dating someone other than a member of that gang. He'd left his wife and young son to try to protect his daughter from that fate."   

The AAP’s 2017 policy statement, Detention of Immigrant Children, spells out clearly why children should not be separated from their parents, placed in detention, or left to represent themselves in court. Currently, each of these is the norm at the border.
The recent and unconscionable family separations and prospect of prolonged or indefinite family detentions have, thankfully, led to large protests in the streets. No one needs a presentation on toxic stress and its effects on brain architecture to understand that ripping children apart from their parents is harmful to their health. But the attorneys, physicians, and others we met at the border who have been working in the immigration trenches point out that there is much more wrong with our current immigration system than these most egregious recent policy changes. Even without family separations, the system strips people of their dignity, ignores their humanity, and affords them little in the way of the legal representation or the due process protections we associate with our Constitution and our country.
Attorneys told our group about cases that were shocking to us, but part of their everyday experience: A parent told that to reunify with her child, she had to give up her asylum case; a child told that reuniting with her father would not occur if she spoke to an attorney; adults and some children held in detention for prolonged periods up to 2 years and beyond until, in despair, they gave up seeking asylum and asked to be deported; an attorney denied access to her client and her client’s relevant records.
At a respite center run by Sister Norma Pimentel with the Catholic Charities of the Rio Grande Valley, we met a father and daughter just released from an immigration processing center. The father explained that his friend’s daughter was murdered by gang members for dating someone other than a member of that gang. He’d left his wife and young son to try to protect his daughter from that fate. Many other parents spoke of their desperate need to escape their home countries to protect their children. They want only what any of us wants for our children—their health and safety.
Sister Norma told us that the purpose of the respite center she founded and runs is to “restore humanity.” It seems our country’s immigration system is in need of a respite center.
My few days along the border in Tornillo and South Texas demonstrated clearly to me why we must continue to raise our voices and act urgently to stop family separations, ensure reunification of all the separated children, and end family detention. But what I saw and heard from those who have spent years on the front lines is that we must also be preparing ourselves to sustain our outrage beyond the issue of family separations to bring humanity, respect, dignity, and due process protections to our entire immigration system. If we don’t, we risk winning a battle but losing the war.

The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Louis Appel, MD, MPH, FAAP, serves on the AAP’s Council on Community Pediatrics and is a former Community Access to Child Health (CATCH) Facilitator for AAP District VII. He practices in Austin, TX, where he is Chief Medical Officer and Director of Pediatrics for the People’s Community Clinic.