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Migrant Protection Protocol's Effect on Children Should Be Top Concern


Vidya Ramanathan, MD, MPH, FAAP
January 16, 2020

My flight landed in Brownsville, Texas, close to midnight. I took a shuttle to the hotel with my new acquaintances--a psychologist and an immigration lawyer who would be part of our group of 8 crossing the bridge on foot into Matamoros, Mexico the next day. The lawyer pointed out landmarks from his past trips along the way.  


“This is where we used to eat,” he noted. “This is where I brought groceries. And this is where I visited the children kept in cages, separated from their parents.”


At the last declaration, he pointed at several large, unmarked buildings that looked like warehouses typical of any town. I steadied myself for what I would see in the coming days.


I went to Matamoros as a pediatrician and human rights advocate, part of a multidisciplinary team working to understand harmful conditions migrant children and families face and determine long-term solutions that might eventually be viable.


Matamoros is the easternmost crossing point from Mexico into the United States, and thus the closest from Guatemala, Honduras, and El Salvador. It is still a formidable 1,500-mile journey to flee violence and starvation, much of it on foot, for hope of eventual safety in the United States.


The city is in Tamaulipas, one of 5 Mexican states with a Level 4 “Do Not Travel” threat advisory. Kidnappings, grenade attacks, and sexual assaults are rampant, owing to the drug cartels’ stronghold in these regions. A recent survey by the U.S. Immigration Policy Center at the University of California, San Diego, found that more than one out of 1 out of every 5 families with children seeking U.S. asylum said they’d been threatened with physical violence while waiting in Mexico.


I was admittedly on alert as I crossed the windy Gateway International Bridge. Yet, what I found in Matamoros was enough to affirm to me that I was in the right place. The first people I met were some seasoned volunteers, local to the area, who went back and forth frequently distributing supplies as needed and orienting newcomers like us. They had been around long enough to know what pitfalls to avoid, and yet were refreshingly kind and honest.

The Migrant Protection Protocol rule (“remain in Mexico” policy) puts children and families seeking asylum in harsh, dangerous conditions, @RamanathanVidya writes in #AAPvoices.

Awaiting asylum beyond the border: harsh, dangerous conditions take toll
Walking through the border camps, I saw how the difficult journey and harsh living conditions in the flimsy tents were causing health problems for the children there. I saw many kids with coughs, colds, vomiting, and diarrhea.  Mothers brought me their dehydrated babies in their arms. Luckily, I had Pedialyte in my backpack, so they didn’t have to carry the little ones all the way to the clinic that time. But I wondered how many more times they’d need to make the trek once we left. Soon thereafter, we received news of children dying from the flu in immigration custody.

We also visited a second refugee settlement in a Matamoros sports complex, which felt surreal. Maybe it was driving through the city without a full grasp on the danger it posed. Or, perhaps it was seeing familiar establishments such as McDonalds juxtaposed with a sea of cars without license plates, signaling cartel members above the law. In either case, as we entered the large structure, it was striking to see rows upon rows of bunkbeds and the families cowering nearby, curious about who we were.

The lawyers started an impromptu legal clinic with the adults, as they had not yet been informed at all about the legal process of seeking asylum. I couldn’t imagine traveling 1,500 miles and then being stuck in a holding pattern without even knowing the process to move forward.

Realizing this might take some time, I took out my only gadget – a drawing device on my phone. I found myself surrounded suddenly by a large group of bright-eyed children, and we began to draw. Some of them excitedly showed me that they could write their alphabets. Others made flowers and stars typical of hundreds of similar pages I had at home from my own children. Then one girl drew a ship.


“Walking through the border camps, I saw how the difficult journey and harsh living conditions in the flimsy tents were causing health problems for the children there.  I saw many kids with coughs, colds, vomiting, and diarrhea. Mothers brought me their dehydrated babies in their arms.”


“Estamos juntos en la barca” (we are all together on the ship), she said. The scene was ripe for story time. So there I was, in the midst of these beautiful children, telling them a convoluted tale about our adventure on the sea, looking for treasure.Then, all of a sudden, I couldn’t recall the phrase “choppy waters” in Spanish.

I stopped short, confused.  One small girl couldn’t hold back her smile and piped up, “It’s alright! We all know English - we learned it in school in Honduras!” There I was, struggling to make this story exciting in Spanish, and these kids were so much more agile in a second language! We all looked at each other and erupted in laughter before finishing the story easily in English.  

I realized then that this is the beauty of children: they have the incredible ability to live and truly enjoy life in the moment, to create and imagine worlds far greater than we can dream, and the adaptability to adjust to their environment.

As we consider that the Migrant Protection Protocol (the MPP rule, or the “Remain in Mexico” policy) caused more than 50,000 people to be sent to unstable and often unsafe living environments in Mexico while awaiting asylum decisions, our first thought must be on the toll this takes on the children. Even more worrisome is the “safe third country agreement” by which people were starting to be sent to Guatemala, likely to cause a far more dire human rights crisis.

The American Academy of Pediatrics put out a report on the effects of trauma on children in 2018. They noted that there are myriad consequences of trauma on children’s physical and mental well-being, but the vast majority of these negative effects are reversible when children and their families are placed in nourishing environments together.

Children have a tremendous capacity for joy and hope. As physicians and child advocates, let’s work together to create sustainable child-centric solutions for this complex problem of forced human migration. It’s the call of our time. Let’s #PutKids1st and answer it.


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


About the Author


Vidya Kumar Ramanathan, MD, MPH, FAAP, is pediatrician and human rights advocate in Ann Arbor, Michigan. She practices in a pediatric emergency room, and is a medical consultant for Freedom House Detroit. Starting in February, she also will be an Adjunct Clinical Instructor at the University of Michigan.













Additional Information 


The Effects of Armed Conflict on Children (AAP Technical Report)

Providing Care for Children in Immigrant Families (AAP Policy Statement)

Protecting Immigrant Children (AAP Federal Advocacy)