Migrant children in U.S. custody are at risk without key health protections

Important public health measures designed to protect unaccompanied minors held in U.S. custody at the southern border are set to expire nine days after President-elect Trump takes the oath of office.  

With mass deportations expected on the horizon and the fate of children in limbo, America must show compassion and extend these initiatives to ensure their safety while being detained by U.S. law enforcement.  

Few can argue that our immigration system is broken. The surge of migrants coming to America in recent years has been the largest in U.S. history. 

The Congressional Budget Office found that net immigration to America rose from 2.6 million people in 2022 to 3.3 million in 2023. These statistics eclipse the number of crossings from 2010 to 2019, where the net immigration average totaled just 900,000 people annually.  

Children, of course, are the most vulnerable. Since 2012, over 600,000 unaccompanied minors have come to America. The U.S. government has been challenged to respond and handle this crisis.   

Earlier this year, the watchdog for the Department of Homeland Security found that Immigration and Customs Enforcement was unable to “monitor all unaccompanied migrant children” released from U.S. custody.   

It also concluded that over the past five years, more than 32,000 children had failed to show up for their court-ordered immigration proceedings and that ICE could not identify their whereabouts. 

Last December, a federal judge prohibited the separation of migrant children from their parents after more than 5,000 families were disjoined under Trump’s “zero tolerance” border initiative.   

A legal settlement was reached blocking the practice for the next eight years, but as many as 1,400 children remained isolated from their families as of May of this year.  

A legal settlement with the U.S. government in 2022 created a series of baseline requirements to help ensure the health and safety of children detained at the southern border. It was reached after three children from Guatemala died while under Customs and Border Protection control.  

Unless the courts act to extend these provisions, detained children could be at risk of similar atrocities happening in the future.  

The settlement mandates that border agents supply children with emergency assistance and basic humanitarian essentials, such as toothbrushes, blankets and access to showers.   

It also requires that facilities housing children at the border receive visits from independent physicians — juvenile monitors — to evaluate the conditions of children in detainment and work with border agents to identify areas and policies to keep them safe.  

Should it expire, these outside observers will no longer be able to report on the environment at these guarded facilities where public access is heavily restricted.  

These juvenile monitors offer a critical window into the way detained children are being treated while they are held at the border. And their valuable insights offer important guidance that the federal government must heed so the needs of vulnerable children can be met. 

One court-appointed pediatrician, Dr. Paul Wise, highlighted a number of areas that required “urgent remediation” at the CBP. Five months later, 8-year-old Anadith Danay Reyes Àlvarez died while in CBP custody during an eight-day detainment.  

Wise conducted a comprehensive review of the incident, where he concluded that the child’s death was avoidable. “Based on the currently available information,” his report stated, “the death of [Anadith] was a preventable tragedy that resulted from a series of failures in the CBP medical and custodial systems for children.”  

“These failures,” his report continued, “occurred at multiple levels and should not be viewed as rare anomalies but rather as systemic weaknesses that if not remedied, are likely to result in future harm to children in CBP custody.” 

If the 2022 agreement expires, independent authorities like Wise will no longer be able to monitor these facilities and flag areas of concern to ensure the well-being of migrant children in U.S. care.  

Every unaccompanied minor has the right to be treated humanely. Those detained at the southern border deserve the same dignity and respect as any other child in America.  

Extending independent monitor access to these facilities is our best shot at achieving this goal. They offer an important opportunity to hold the U.S. government accountable as they advocate for children who are unable to fight for themselves.    

Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.