July 24, 2015
The Honorable Jeh Johnson Secretary
U.S. Department of Homeland Security Washington, D.C. 20528
Dear Secretary Johnson:
On behalf of the American Academy of Pediatrics (AAP), an organization of 64,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists, dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults, I write to express our concerns for the health and well-being of children and mothers who are being detained in family detention centers in Texas and Pennsylvania. We applaud the recent announcement by the Department of Homeland Security (DHS) that Immigration and Customs Enforcement (ICE) will generally not detain mothers and children absent a threat to public safety or national security. Yet we remain concerned that continued detainment of any children and mothers in the existing facilities puts them at greater risk for physical and mental health problems and unnecessarily exposes children and mothers to additional psychological trauma.
Children and mothers from Central America who have crossed the border to enter the United States have high rates of exposure to trauma in the form of threat of death, physical and sexual abuse, and exploitation that leave serious physical and psychological scars. The act of detention or incarceration itself is associated with poorer health outcomes, higher rates of psychological distress, and suicidality making the situation for already vulnerable women and children even worse.i For children, exposure to early adverse experiences, often referred to as toxic stress, has long-term consequences. Alterations in a child’s ecology as a result of toxic stress can have measureable effects in his or her developmental trajectory, with lifelong consequences for educational achievement, economic productivity, health status, and longevity.ii
As pediatricians, we believe that children are our most enduring and vulnerable legacy. All children deserve optimal health and the highest quality health care. This includes access to preventive care consistent with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (see brightfutures.aap.org). We question whether the existing family detention facilities are capable of providing generally recognized standards of medical and mental health care for children.
Many mothers and children fleeing their homes in Central America have been exposed to unspeakable violence and trauma. As such, the rates at which these families meet the standard to apply for asylum or other protections from removal based on persecution or torture are quite high. As DHS and ICE work to implement the new policies set forth in mid-July, the AAP stands ready to work with the Department to ensure that the medical and mental health needs of children are being met. Over the course of the past year, the AAP has worked closely with the Department of Health and Human Services’ Administration for Children & Families and its Office of Refugee Resettlement (ORR) to ensure unaccompanied minor children receive an appropriate set of preventive screenings, immunizations, and other services. In particular, the AAP has worked with ORR on the documentation of this care so that there can be a more seamless transition once unaccompanied children are placed with sponsors and receiving follow- up care by pediatricians throughout the country. Regardless of the setting, DHS personnel are routinely interacting with children and their mothers, oftentimes when they may be at their most vulnerable. As such, the AAP would like to work with the Administration to put more protective policies in place for children. We would welcome the opportunity to meet with you and your staff and stand ready to participate on your Family Residential Centers Advisory Committee.
Above all else, we urge you to remember that these are children. They are scared, vulnerable children, many of whom have been victims of violence, and they need our compassion and assistance. We urge you do what’s best for their health and well-being.
Sandra G. Hassink, MD, FAAP President
i Physicians for Human Rights and Bellevue/NYU Program for Survivors of Torture. From persecution to prison:
The health consequences of detention for asylum seekers, 2003
ii Shonkoff, J.P., Garner A.S., AAP Committee on Psychosocial Aspects of Child and Family Health, et al. The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 2012; 129;e232