Re-examining the Medical Needs of Unaccompanied Children
By Mayra Joachin, NILC staff attorney
OCTOBER 20, 2016
Now that the school year has begun and classrooms are filled with children eager to learn, we are reminded of the various inequities affecting low-income immigrant children. One particular inequity—the lack of access to affordable, quality health care—impacts more than just the immigrant child. It impacts the learning opportunities of everyone in the classroom. And despite expansions in health care coverage programs available to immigrant children, unaccompanied children remain an especially vulnerable population that demands our attention.
Unaccompanied children are statutorily defined as children who enter the United States with no lawful immigration status, who have not reached 18 years of age, and who have no parent or legal guardian in the U.S., or who have no parent or legal guardian in the U.S. able to provide care and physical custody for them.
Since 2012, the number of unaccompanied children entering the U.S. has increased significantly. Prior to 2011, the Office of Refugee Resettlement (ORR), which is in charge of housing unaccompanied children until they can be placed with a family member or sponsor, generally received between 7,000 and 8,000 children each year. The program served 13,625 children in 2012, but approximately 57,000 children in 2014. Though these children were fleeing poverty-stricken countries ravaged by gang and drug violence, and though many have witnessed family members being murdered or threatened with murder, some members of the media and public have focused their attention, rather, on the refugee children’s physical health.
Unaccompanied children receive their first medical screening within days of being taken into immigration custody. Most children in U.S. Department of Homeland Security (DHS) custody were apprehended by Border Patrol agents while they were trying to cross the border or at some time shortly after they entered the U.S. Detained unaccompanied children, for whom DHS is required to provide, usually are taken first to a U.S. Customs and Border Protection (CBP) facility. (The Border Patrol is an agency within DHS.)
After arriving at a CBP facility, the unaccompanied child receives an initial screening for visible conditions such as lice, rashes, diarrhea, and cough. This is known as the “fit to travel” screening, and it must be conducted before the child may be transferred to an ORR facility. If the child needs additional medical care, the facility is supposed to have onsite medical staff available to either provide it or refer the child to a local emergency room. Generally, unaccompanied children are supposed to be transferred to ORR custody within 72 hours of the time they are apprehended, though the process differs for nationals of Mexico or Canada.
In ORR custody, children receive vaccinations and a more comprehensive medical screening, including a tuberculosis screening. They also receive mental and medical health services through state-licensed, ORR-funded providers.
The U.S. Centers for Disease Control and Prevention has clarified that unaccompanied children “pose little risk of spreading infectious diseases to the general public,” according to U.S. Secretary of Health and Human Services Sylvia Burwell. Unaccompanied children rarely have infectious diseases, and most have been vaccinated in their home countries. Children who are unable to show documentation of previous vaccinations receive them while in ORR custody.
The majority of unaccompanied children report medical needs that are associated with their journey to the U.S. border. Children report mental trauma from violent conditions in their home countries, physical and sexual abuse during the trip, as well as mental and physical stress from the journey. Common conditions include diarrhea, scabies, lice, rashes, and respiratory infections. Those found to have lice or scabies are treated immediately before being sent to an ORR facility. Other common problems include dehydration, foot and ankle injuries, and heat exhaustion resulting from their long and arduous trip. Unaccompanied children’s medical needs, once they have been released from an ORR facility, thus revolve around trauma, stress, abuse, and physical injuries that require medical attention and that were not the focus of medical treatment in the ORR facility.
A major challenge for children released from ORR facilities is that only a few are able to access health care services. Categorically, this group is ineligible for health care coverage under the Affordable Care Act, the Refugee Medical Assistance Program, Medicaid, or the Children’s Health Insurance Program (CHIP). Access to comprehensive, affordable health care services thus depends on the state or the locality in which they reside. In California, Illinois, Massachusetts, New York, Washington, and the District of Columbia, for instance, all children under age 19, subject to income restrictions, are eligible for state-funded Medicaid or CHIP regardless of their immigration status. But this is not the case in other places. As a result, only a fraction of unaccompanied children can access necessary ongoing health services to combat their mental trauma and other medical conditions induced by that trauma.
As schools open their doors to welcome all incoming children regardless of immigration status, it is essential that we secure access to medical care for all our children, regardless of their national origin. Treating the symptoms of trauma that unaccompanied children develop as a result of their harrowing journeys not only increases the likelihood that they will do better in school, but also improves the learning environment for all their classmates.