At the Berks Family Residential Center, an immigrant detention facility in Leesport, Pennsylvania, advocates and former detainees say it’s normal for children held there to have health problems.
One mother, who asked to use her middle name Arely, told the Guardian that children often had fevers or vomited when she was detained at Berks. She said she watched helplessly as her two-and-a-half-year-old daughter threw up blood for three days.
Another woman – who asked to be referred to only by her middle name Fernanda because she still fears her antagonists in her home country – remembered children with the flu and respiratory illnesses, and how the on-site medical professionals would take their temperatures but never give out medicine. When Fernanda’s own daughter had fever, she had to go to the hospital just to get Tylenol, she said.
Since attorney Jacquelyn Kline began representing immigrant families detained at Berks in the summer of 2014, she said the majority of her clients have gotten sick. Usually, the illnesses have been minor. But sometimes, when common problems have gone ignored or untreated, they have spiraled to become something more.
“In my experience, they (the staff) do the bare minimum and they don’t want to do more than that unless it becomes a situation where they have to do it,” Kline said. “Because they don’t address things when there are minor issues, it allows them to become more serious issues.”
One Berks resident wrote to US Immigration and Customs Enforcement (Ice) in late-2015 that though her son’s skin disease had spread to his genitals and bled when scratched, the clinical team had not provided him with medication.In May 2016, a three-year-old boy who had been suffering from fevers and loss of appetite for months was finally diagnosed with an intestinal parasitism after his mother found a worm in his diaper.
Berks did not respond to a request for comment. Ice’s public affairs officers are out-of-office for the duration of the government shutdown, according to an automated email from the Pennsylvania officer’s account. Ice confirmed that he is currently furloughed.
The fact that serious medical conditions occur and go untreated for days, weeks or months while immigrant children are under the government’s protection may come as a surprise to many. But advocates who have been on the ground at detention facilities under the purview of the Department of Homeland Security (DHS) are well acquainted with stories such as these that point to a wider trend.
“I am surprised that more children or parents have not died while in DHS custody, given the systemic failure on the part of the government to provide medical services,” said Kathryn Shepherd, national advocacy counsel for the Immigration Justice Campaign at the American Immigration Council.
In late 2018, the deaths of two migrant children while in US custody near the southern border made national headlines and refocused attention on immigrant children who are in the country illegally. First, seven-year-old Jakelin Amei Rosmery Caal Maquin died from cardiac arrest associated with dehydration on 8 December after being apprehended by DHS’s Customs and Border Protection (CBP).
Then, on Christmas Eve, eight-year-old Felipe Gómez Alonzo became the second child in a matter of weeks to succumb to illness after being taken into custody by CBP. It was later determined that he had the flu.
At first glance, the deaths appeared an exceptional phenomenon. Homeland security secretary Kirstjen M Nielsen has said that before last December, an immigrant child had not died in CBP custody in more than a decade.
But for those familiar with the ways in which DHS holds immigrant families beyond the border through Ice, the deaths felt part of a long medical history of neglect, misdiagnoses and close calls associated with undocumented children. This history dates to at least 2014, when the department ramped up mass incarceration of immigrant families under President Barack Obama.
“I don’t think that this is a new problem,” said Shepherd. “I think that this is something that’s been a problem for a long time.”
Before accepting her current post, Shepherd served as managing attorney for a pro-bono project representing asylum-seeking families at the South Texas Family Residential Center in Dilley, Texas. Women and children detained there have been airlifted or rushed to a hospital in an ambulance on a number of occasions, she said. Last summer, Vice News reported that a toddler had died six weeks after leaving the Ice detention center, where she contracted what started as a common cold but evolved into a deadly virus.
Brad Berman, a clinical professor of pediatrics at the University of California- San Francisco and fellow of the American Academy of Pediatrics, said the DHS facilities he is aware of that hold immigrant families crossing through the US’s southern border appear to be “providing inadequate or substandard medical care”.
“They are violating their own standards – federal standards, as well as state standards, as well as ethical standards,” he said.
Vincent Picard, deputy assistant director to Ice Public Affairs, said that Ice spends more that $250m annually on healthcare for their charges. He cited the June 2017 DHS Inspector General’s report that found the agency’s family residential centers to be “clean, well-organized, and efficiently run”.
“Ice takes very seriously the health, safety and welfare of those in our care,” Picard said in a statement. “Ice is committed to ensuring the welfare of all those in the agency’s custody, including providing access to necessary and appropriate medical care. Comprehensive medical care is provided to all individuals in Ice custody.”
An independent medical evaluation Berman did tells a different story. He found that “the standards of pediatric medical care and mental health evaluations and care” for one immigrant child “were breached during her stay” at Berks, the Ice family detention center in Pennsylvania, in 2016. The girl, whose mother Maria requested she be referred to by her middle name Beatriz, was bedwetting after traveling to the US from El Salvador. She was nine years old.
Soon after arriving at Berks, Beatriz had several appointments with Michael Mosko, a psychologist provided by the facility. In his notes from one of the sessions, Mosko wrote that after conferring with an interpreter , he was under the impression that the bedwetting “was related to nothing more than laziness”.
After Beatriz was released from Berks, she visited a pediatric urologist and nephrologist who diagnosed her with chronic renal failure – or loss of kidney function. Though the condition was likely associated with Beatriz’s premature birth, it was exacerbated by a misdiagnosis during her time in detention, Berman said.
Now, Beatriz takes pills every night for her illness, which Maria said can’t be cured.
“She looked good when we were in El Salvador,” Maria said. “It was when she came here that she got sick.”
For Maria and Beatriz – as for many of the families from Central America who have crossed the US-Mexico border in recent years – leaving El Salvador was an attempt at self-preservation. When licensed clinical social worker Kathryn S Miller evaluated Beatriz, her report indicates that Beatriz and Maria shared stories about how the child watched her mother get robbed at knifepoint, experienced a home invasion, and overheard accounts of family friends being murdered by gang members.
Over the course of a year, Miller evaluated a handful of children who were detained at Berks. She said there was no doubt that each of them had been exposed to repeated trauma while in their home countries and had legitimate reasons for requesting asylum.
While families seeking asylum make their case, many of them fall into DHS custody and rely on the medical professionals the department supplies.
“There’s just basic needs that children have,” said Miller. “And if they’re going to be tasked with taking care of vulnerable children, they need to have the training and support to make sure they’re taking good care of them.”