Originally published by The Washington Post
When we learned last week of the death of 7-year-old Jakelin Caal Maquin, we were serving as government experts briefing a delegation from Congress before lawmakers visited family detention facilities in South Texas.
The news that Jakelin had died in U.S. Customs and Border Protection custody after crossing the border from Mexico during her journey from Guatemala came as a shock to many, but not to us. This was the very danger we had warned of in 2014 during our first inspection of a family detention facility in Artesia, N.M.
For four years, we have been inspecting detention facilities as contractors for the Department of Homeland Security. We are government experts in the medical and mental health care of children and families in immigration detention. Jakelin was apprehended in a remote desert in New Mexico and never held in a family detention center, which makes her case slightly different from the ones we’ve studied closely. But we fear that unless U.S. authorities stop detaining children, Jakelin will not be the last child to die in government custody.
(Contacted by The Washington Post, a DHS spokesman said Jakelin’s case has nothing to do with family detention centers: “Upon encountering a large group of illegal aliens in one of the most remote parts of our border, Border Patrol agents professionally and promptly took the appropriate action to get Jakelin Caal Maquin the needed medical attention. She spent no time in a family detention center. The Border Patrol saves more than 4,300 people every year in the border environment; unfortunately, they were unable to save one more last week.”)
We first visited a family detention facility in Artesia four years ago on a contract with the Department of Homeland Security’s Office of Civil Rights and Civil Liberties. After that trip, we documented how ill-prepared DHS was in providing adequate care for children in its custody at the Artesia facility. We found systemic problems in the provision of basic care, including a lack of pediatric providers, widespread problems with language access and poor coordination among multiple agencies.
As we toured Artesia then, a member of our inspection team who had no medical training spotted a 16-month-old child who was listless and sickly. We referred the child to the medical unit and set about reviewing the child’s medical record with staff. That record documented that the mother had brought her child to the medical unit multiple times over a 10-day period for a diarrheal illness, yet the child received no definitive treatment, and the mother was repeatedly sent away with reassurance, some Pedialyte and instructions to continue breast feeding. Over the course of 10 days, under the care of government physicians (many of whom lacked adequate pediatric training and experience), the toddler lost nearly one-third of their body weight, a finding consistent with life-threatening dehydration.
Experienced pediatric providers would have considered serious dehydration at 10 percent body-weight loss and sent the child to an emergency room for intravenous fluids and further evaluation and treatment. Until we brought our findings about the documented weight loss to the attention of the medical staff, though, no medical provider had noticed how critically ill the child was. Once staffers at the facility recognized how close the child had come to death from the easily treatable condition of dehydration under the care and custody of the U.S. government, they expressed genuine humility and alarm.
In our debriefing to multiple agencies, including high-ranking DHS officials, we placed our government on notice. We warned them that the children arriving at these facilities were vulnerable and medically and psychologically at risk. These children required comprehensive medical and mental health care. We pointed out that the government had narrowly averted a tragedy in this case and warned that if it continued to detain at-risk children, loss of life was a real possibility.
Because of this and other findings of systemic failures to provide adequate care, our team recommended that the Artesia detention facility be closed immediately. Within two weeks, the recommendation of our inspection team was heeded, and Artesia was permanently shut down. Unfortunately, the closing of Artesia was followed by the opening of new family detention facilities at Karnes and Dilley, Tex., the facilities visited last week by the congressional delegation.
And despite our repeated efforts to warn the government of ongoing harm to children, family detention has not only continued but also been expanded greatly under the Trump administration. This rapid expansion has put more children in harm’s way. In July 2018, after our efforts to warn officials within DHS had failed to produce any results, we alerted Congress about our concerns that plans to expand family detention created an imminent risk to the health and safety of children.
Detaining immigrant children harms them and puts them at great risk. We are not alone in realizing this. Since we first spoke out, 14 medical professional associations, including the American Medical Association, the American Academy of Pediatrics, the American College of Physicians, the American Psychiatric Association and many others have all expressed unequivocal support for our call to prevent harm to immigrant children caused by detention. CBP officials and others working in the immigration system are not deliberately trying to harm children. But when the confinement of children is prioritized over care, risks already posed by conditions of detention foreseeably escalate.
A civilized and humane society would greet frail and vulnerable children arriving on our border with compassion and care. Children coming into the custody of the United States should be immediately screened for both physical and mental health problems by qualified health professionals. Children should be provided with humane care and treatment in a nurturing community setting. Only then should asylum and other legal procedures proceed, and those processes should proceed without the unnecessary detention of the children and their families. This approach, prioritizing care first, would have give children like Jakelin a fighting chance.
As physicians, we have a duty to speak out against policies and practices that threaten the health and safety of children and their families. For years, the medical community has warned that the toxic stresses of detention itself carry great risks to the health and safety of children, and as such, family detention cannot be justified.
We can and we must prevent more children from suffering like Jakelin. America is better than this. We owe these children care and compassion — not confinement.