For Dr. Theresa Cheng, the scene was “apocalyptic.”
She had come to Valley of the Moon, an open-air detention site in rural San Diego's Mountain Empire, to provide voluntary medical care to asylum seekers who had breached the U.S.-Mexico border wall and were waiting to be arrested by the American authorities.
Among the crowds at this and other sites, he found children with deep lacerations, broken bones, fever, diarrhea, vomiting and even seizures. Some hid in overflowing dumpsters and porta-potties. An asthmatic boy without an inhaler panted in acrid smoke from brush and garbage fires, which had been lit for warmth.
With immigration processing centers at capacity, migrants, including unaccompanied minors, wait for hours – sometimes days – in outdoor holding areas, where housing, food and sanitation facilities are lacking. it has mostly triggered a series of public health problems. vulnerable.
“From a public health perspective, there are communicable diseases and outdoor exposures that would affect anyone, much less this medically vulnerable population,” said Dr. Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center.
A federal district court judge in California could rule as early as Friday on whether the government is legally obligated to shelter and feed children while they wait.
In a court filing, Justice Department lawyers argue that because the children have not yet been formally taken into custody by U.S. Customs and Border Protection, they are not obligated to provide that service.
“The minors in these areas – near the California-Mexico border – have not been apprehended or apprehended by CBP and are not in the lawful custody of CBP,” the lawyers wrote.
“CBP apprehended and transported the minors to safe and sanitary U.S. Border Patrol facilities in a timely manner. But until that happens, plaintiffs will not be in DHS custody,” they wrote, referring to the Department of Homeland Security.
When asylum seekers enter the United States between official ports of entry, they often present themselves to Border Patrol agents near the wall with the intention of being arrested. They are taken to a treatment facility, where they receive a medical screening, background check and basic provisions as they begin the legal claims process.
But unlike those immigration processing facilities, the outdoor sites do not have shelter, meals or government-affiliated medical personnel. Some sites have no toilets, forcing people to defecate in the open, according to Erika Pinheiro, executive director of the legal and humanitarian nonprofit Al Otro Lado, which has provided aid to the camps. According to court findings, with limited supplies of diapers, wipes and cream from volunteers, babies were kept in soiled diapers for long periods of time, causing severe diaper rash.
A senior Customs and Border Protection official acknowledged in an interview that people sometimes waited days to enter the process, but said vulnerable groups such as children had always been prioritized and that wait times had decreased significantly in recent months. He said the agency has more than tripled the capacity of San Diego's processing centers and increased the number of buses and transportation personnel to speed arrests.
However, he said, the system was not built for migrant encounters on the current scale, and moving crossings to more remote regions has made the process even more resource-intensive, as vehicles and staff must travel further away between the camps and border patrols. stations. He said a major increase in federal funding would be needed to fully address the problem.
At least seven migrant holding areas have sprung up at various points along the California border. One is a large dirt patch in the desert next to a highway; another is a plateau in the midst of wild mountains; another is the narrow space between two parallel border walls that have been erected a few meters from the Mexican city of Tijuana.
None of the holding areas were formally established by immigration officials, but they have become a mainstay of their operations: makeshift camps where they order asylum seekers to line up to be counted, remove their shoelaces, shed a layer of get dressed and wait.
Adriana Jasso, who runs a volunteer border wall steel-slat relief center in San Ysidro, California, for the nonprofit American Friends Service Committee, said the lack of food, water and Infant formula provided by the government has caused particular concern. “There is no logic if the most powerful country in the history of humanity, the country with the highest concentration of wealth, is not able to provide for the basic needs of children,” she said.
Migrant advocacy groups have filed numerous 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 custody as part of a federal court settlement in 1997 known as the Flores Agreement they agreed to do so. the courts on the conditions.
The Flores settlement agreement established standards of treatment for immigrant children in government custody. Among other things, it requires that children in immigration custody have access to sanitation, food, clean water, and emergency medical care, and that they be released from detention to an appropriate sponsor, such as a parent or relative, “without unnecessary delays. “
Plaintiff attorneys in the settlement, including the Oakland-based nonprofit National Center for Youth Law, filed a new motion to enforce Flores' terms for migrant youth still awaiting open-air trial. They argue that children waiting at the border wall deserve the same safe and sanitary housing as those already in official custody, since they are barred from leaving the camps and have no way to return.
The burden of medical problems among children in detention areas is difficult to measure, since volunteers are allowed into the sites only at the discretion of border agents, and a hodgepodge of humanitarian groups do not keep a collective record of treated wounds or electrolytes administered.
In a December 2023 email to federal officials, an attorney wrote that children in detention areas had begun vomiting due to severe dehydration and that some children were given one granola bar a day for sustenance . Pedro Rios, director of the American Friends Service Committee's US-Mexico Border program, said he had encountered migrants who ate leaves because they had been there for five days without food, as well as mothers who had stopped producing breast milk due to stress traumatic and newborns without formula milk to replace it.
Hundreds of children have flocked to the sites every month since last summer, and Dr. Cheng, who is also a professor of emergency medicine at the University of California, San Francisco, estimated she had evaluated or treated 100 children in just one week. . She met a child aged 5 and 12 who had spent three nights outdoors; an 8 or 9 year old child whose face you stitched in the open air; a 13-year-old boy with a traumatic injury, blood pouring from his ears and nose.
Children are not the only migrants with serious health problems. In remote areas of eastern San Diego County, those turning themselves in to border authorities have often faced arduous journeys through steep mountainous terrain and desert lands, arriving at detention areas in deteriorating health. Doctors said they met a man with a kidney transplant who was low on immunosuppressants, a woman with a traumatic stroke who couldn't reach her shoelaces, and a migrant who had traveled with an oxygen concentrator and become hypoxic. Eventually he died.
Doctors are particularly concerned about cases of hypothermia among children, as many have lower body fat than adults and may be malnourished during travel. Migrants were soaked overnight by heavy rains in waiting areas, which can cause their body temperatures to plummet. Two minors were hospitalized for hypothermia last month.
Karen Parker, a retired social worker from Boulevard, Calif., who volunteers medical triaging in the eastern camps, said that in addition to broken feet and twisted ankles, she routinely encounters unaccompanied minors with panic attacks. “The stress, the exhaustion, the trauma is making them physically ill,” she said. “I look at them, thinking they have finally arrived, but their eyes are so blank.”
The number of people and the length of waiting times have fluctuated compared to last summer. In recent weeks, Mexican military activity has pushed migrants westward, to a more urban region between Tijuana and San Ysidro in California, where asylum seekers who breach the main border wall must wait for federal agents in the 280-foot space behind a second. Fewer holes in the main border wall means more children are dragged or smuggled under it, despite the barbed wire. Aid workers have documented an increase in deep cuts to the head, and local neurosurgeons have reported an increase in traumatic injuries.
In recent weeks, a 3-year-old and a 1-year-old both fell from the border wall into their parents' arms.
“When you hear kids crying and crying, right on the other side of this wall, that's the worst part,” said Clint Carney, the government affairs manager for the nonprofit Survivors of Torture, International, which provides aid through the slats in the border wall.
Local 911 teams were inundated with calls from the sites, and aid workers said federal agents had frequently denied their requests to call 911, suggesting that migrants were pretending to be injured. Those who suffered serious injuries often called volunteer medical personnel to notify them by telephone.
When Dr. Cheng received one such call one recent morning and arrived at the scene to find a 13-year-old boy with a weak pulse and blood dripping from his ears and nose, two border agents were standing nearby but they had taken no steps to assist, he said in court documents.
Dr Cheng performed CPR, but it took an hour for emergency services to arrive, she said. The boy is dead.