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Last month, without notice or explanation, the undocumented parents of many seriously ill children began receiving letters from US Citizenship and Immigration Services informing them that their requests to remain in the country for life-saving medical care had been summarily denied. They were offered no recourse for appeal and were given only 33 days to complete treatment and leave the United States. These children, who suffer from diseases like cancer and cystic fibrosis, would be unable to obtain the specialized care they need in their home countries, and could well die as a result. After public outcry, USCIS agreed to reconsider some of their cases, but the fate of the medical deferred action program remains uncertain.

As pediatricians, we are appalled by this latest cruel attack on the health of immigrant children, but sadly unsurprised. The Trump administration alleges that immigrant parents exploit their children to gain entry to the United States via legal loopholes, when in reality such parents take grave risks to save their children from violence, disease, and poverty, as any good parent would. Rather, it is the administration that exploits these children, recognizing their parents’ love as their greatest vulnerability and seizing upon it as a means to target and punish them.

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Government officials acknowledged as much last year when they separated thousands of terrified children from their caregivers at the border under the “zero tolerance” policy, a practice meant to serve as a deterrent to illegal immigration. Some separated children, reclassified as unaccompanied minors, were then used as bait for Immigration and Customs Enforcement to ensnare their would-be sponsors. We may never know how many families were affected, since the Department of Health and Human Services continued arguing well into this year that it would present too much of a “burden” to identify and reunite all of the children separated under zero tolerance, due to their own haphazard record keeping. Meanwhile, though the president made a public show of ending family separation after strong backlash, the practice has in fact continued. The American Civil Liberties Union estimates that nearly 1,000 immigrant children have been separated from their parents in the past year for violations as minimal as an unchanged diaper or $5 worth of property damage.

With desperate families continuing to take their chances at crossing the border, the administration has now made a bid to detain immigrant families indefinitely while their asylum claims wend through the overwhelmed courts. It argues that ICE can be trusted to maintain family detention centers up to the child-welfare standards mandated by the 1997 Flores settlement, without external oversight from state agencies or pro bono medicolegal organizations. Yet it was only two months ago that the government asserted immigrant children in Customs and Border Protection custody need not be provided with soap, toothbrushes, or a place to sleep, and threatened to withdraw all funding for educational and recreational activities in Office of Refugee Resettlement shelters. Children in federal immigration detention have reported verbal, physical, and sexual abuse, and since 2018 at least seven children have died during or shortly after their stints there. Crowded and unsanitary conditions fueled influenza outbreaks that contributed to several of those deaths, yet the government reports no plans to provide influenza vaccines to the children it detains.

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Administration officials derisively exhort families not to undertake the dangerous journey to the United States with their children, while simultaneously endeavoring to make the journey more perilous. They have proposed multiple rules to punish those who cross the border between legal points of entry, but endanger those who do try to enter legally by metering asylum applications and enforcing the cynically named Migrant Protection Protocols. Such measures require asylum seekers to wait months in crime-ridden Mexican cities where migrant families are targeted for extortion, kidnapping, and murder. Protest attempts led to the now infamous images of border patrol agents lobbing tear gas at children in diapers. Families too desperate to wait attempt unsafe crossings; multiple young children have drowned in the Rio Grande this year as a result.

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Meanwhile, the administration seeks to make life in the United States intolerable for immigrant families already living here. The new public charge rule is frightening immigrant parents out of accessing the nutrition and health care benefits to which their US citizen children are legally entitled, including such basic preventive care as vaccines. A proposed Department of Housing and Urban Development rule would ban mixed-status families from accessing public housing benefits, which could precipitate homelessness for more than 55,000 children who are US citizens or otherwise legally eligible. The White House has reportedly even looked into ways to block undocumented immigrant children from attending public schools. The president injected a current of fear into immigrant communities across the country when he threatened mass deportation raids targeting families. ICE subsequently conducted the largest single-state workplace raid in US history on the first day of school in Mississippi, leaving many terrified children uncertain when they would see their parents again, and some children still unaccounted for by state child protective services days after the arrests. Immigration agents have detained children in ambulances, and parents seeking care for their children in emergency rooms.

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The president’s policies pose a direct threat to the well-being of children, but so does his divisive rhetoric about an “invasion” from undesirable countries. Research suggests that the anti-Latinx hostility engendered by the 2016 election contributed to higher rates of preterm births among Latinas and increased anxiety, sleep problems, and elevated blood pressure among US-born Latinx adolescents. Latinx children have encountered chants of “build the wall” and “send them back” from classmates. Such bullying becomes all the more menacing when children are being gunned down in bouncy houses and orphaned at Walmarts by shooters espousing anti-Latinx rhetoric that closely echoes the president’s own words.

One in four children in this country comes from an immigrant family. Their health and safety must not be wielded as cudgels in pursuit of a political agenda, nor can we accept their traumatization as collateral damage. Their well-being is crucial to our future; a more humane immigration policy must be administered now.


Fiona Danaher is a pediatrician at MGH Chelsea. Ron Kleinman is physician in chief of MassGeneral Hospital for Children. Elsie Taveras is chief of the Division of General Pediatrics at MassGeneral Hospital for Children.