We must speak up about government sanctioned child abuse at the US border

The US’s intentional mistreatment of child refugees means that the nation has lost its moral compass, say Danielle Deines, Colleen Kraft, and Tony Waterston

In extraordinary scenes at the US border last month, four doctors and two allies were arrested while attempting to pressure Customs and Border Protection (CBP) to provide migrants in a detention camp with immunisation against influenza. After three children had died from the flu while in federal immigration centres since December 2018, this event was the culmination of increasing concern over the Trump administration’s stringent policies at the border, and the harm they are inflicting on children. 

Since 2014, hundreds of thousands of children and their families have migrated to the US, fleeing the violence in their home countries in the northern triangle of Central America. Yet the Trump administration’s overriding political goal of deterring immigration has seen the implementation of policies that intentionally disregard the rights and basic needs of those fleeing war, climate change, or corruption.

One of the key messages that Donald Trump formed his political platform around is his anti-immigrant rhetoric—a stance which has proliferated across Europe and beyond. After Trump’s inauguration in January 2017, his administration began to consider separating immigrant children from their parents as a way to deter asylum seekers. In April 2018 the policy was made public (although according to reports, it had already been instituted), and the US attorney general directed federal prosecutors “to adopt immediately a zero-tolerance policy for all offenses” related to improper entry into the US. These enforced separations included families seeking asylum—an internationally recognised human right—and were acts which “contradicted everything we know about children’s welfare.”  

Parents who had taken an already tumultuous and traumatic journey to flee threats to the safety of their families found themselves welcomed at the US border by agents of Homeland Security who would take their children from their arms. The goal was, horrifyingly, to create a trauma that was greater than that which they had just traversed thousands of miles to flee, with the intent of deterring other families from following. 

This policy led to an immediate reaction from health professionals and welfare organisations as the policy was seen to be a direct attack on the integrity of the family and on children’s health and wellbeing. A statement by more than 500 welfare organisations wrote that “Forced separation disrupts the parent-child relationship and puts children at increased risk for both physical and mental illness.” 

Members of the American Academy of Pediatrics (AAP) leadership visited a government shelter for children and found toddlers who were separated from their families; some children sobbing uncontrollably, others quiet and despondent. One of us (CK), as the then president of the AAP, branded this treatment “government sanctioned child abuse” in a report that helped to create a groundswell of public outrage, eventually leading to the rescinding of the family separation policy in June 2018. 

In the wake of these events, American paediatricians offered to provide medical care and oversight in facilities where refugee children were being held, but immigration officials declined this aid. Even more worryingly, reports of harm being inflicted on immigrant families have continued to come to light, leading to considerable concern on our part that child protection standards are not being met.

In Clint, Texas, for example, children were observed looking after other children, with “inadequate food, water, and sanitation.” Basic medical care has been neglected, and provisions of the Flores Settlement Agreement* to provide medical, psychological, educational, and recreational support for immigrant children in detention have been threatened and ignored. Families have been relocated south of the border to keep them “out of sight and out of mind,” where they are at risk of becoming victims of kidnapping, rape, and violence. Immigration and Customs Enforcement (ICE) has conducted numerous raids in immigrant communities, arresting people who are citizens as well as legal immigrants in their zeal to capture those who are undocumented. Children have arrived home from school to find that their parents are gone, with no plan in place to provide for them.

This escalation of measures and the way it has irretrievably damaged families is counter to all contemporary understanding of the physical and emotional development of children. As Pope Francis recently observed, “It is injustice that turns them (immigrants) away from places where they might have hope for a dignified life, but instead find themselves before walls of indifference.” This “wall of indifference” is exactly the policy promised by President Trump, and the flames of hatred and bigotry, fuelled by this president, have created this dire situation. With the intentional mistreatment of child refugees, America has lost its moral compass.

At the end of July 2019, after the wide publicity of such flagrant human rights abuses at the hands of our federal immigration agencies, Doctors for Camp Closure was created by three physicians, including one of us (DD). The group aimed to create a network of physicians who were committed to tackling these injustices by leveraging the power of privilege that comes with being doctors. The overwhelming support the group’s received has spurred further action, including congressional meetings and a march in Washington DC. Among the group’s most pressing concerns were the recent influenza-related deaths of three children in immigration custody and CBP’s refusal to offer vaccinations. For, despite a recommendation by the CDC to vaccinate all migrants aged over 6 months for flu, and the letters of concern written by congressional and medical professionals, the CBP has persisted in refusing to offer vaccinations.

The group sought permission to establish a funded flu vaccination programme as a pilot, but met a wall of silence. Having stalled in the more traditional means of influencing health policy, the group then opted to organise a protest, which led to the arrests of several doctors for non-violent direct action, as we described above.

A lack of compassion and an unwillingness to do what’s right were the only things keeping the gate closed between well trained physicians and those they sought to serve.

Doctors for Camp Closure formed out of an urgent, profound need to throw out the typical methodology for improving health. We wanted to create an avenue for those willing to risk and extort the power of our profession to publicise the deliberate torture of families at our nation’s borders.

It is our responsibility, and our privilege, to continue working on behalf of immigrants, particularly the most vulnerable, to ensure we do not remain complicit in the ongoing abuse, additional deaths, and trauma that will remain with those in our care for years to come. Love is action and we must act. We must. Not to do so is to tolerate state authorised child abuse.

*Reno v. Flores, 507 U.S. 292 (1993), was a US Supreme Court case that addressed the detention and release of unaccompanied minors.   

Danielle Deines is one of the founders of Doctors for Camp Closure.

Competing interests: None declared.


Colleen Kraft is the past president of the American Academy of Pediatrics. 

Competing interests: I serve on advisory boards to Cognoa and DotCom Therapy. These are tech companies looking to leverage technology to promote equitable access to paediatric developmental services.

Tony Waterston is a retired paediatrician and is on the executive committee of the International Society for Social Pediatrics and Child Health.

Competing interests: None declared.