Reflections
Feature
John Moore/Getty Images
For more about exploited
migrant youth working in the
USA see www.nytimes.
com/2023/02/25/us/
unaccompanied-migrant-child-
workers-exploitation.html
For more about migrants
crossing the Rio Grande see
https://www.houstonchronicle.
com/politics/texas/article/border-
trooper-migrants-
wire-18205076.php
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Migrant youth after the US COVID-19 public health order
On May 11, 2023, the Biden
Administration formally ended the
COVID-19 public health emergency, and
with it, a controversial Trump-era policy
that has kept millions of people fleeing
violence, persecution, and poverty from
crossing the USA–Mexico border to
seek asylum. Yet, more than 2 months
later, migrant youth remain in harm’s
way, cautioned experts contacted by
The Lancet Child & Adolescent Health.
Invoking federal Title 42, part of
a 1944 public health law, in March,
2020, the US Centers for Disease
Control and Prevention issued a public
health order allowing border agents
to indiscriminately expel migrants
without asylum hearings, and even to
deport them back to the homelands
they had fled, lest they bring COVID-19
into the USA. A separate Trump-era
anti-immigration policy known as
Remain In Mexico was overturned in
June, 2022, by the US Supreme Court.
The policy required asylum seekers
to stay in Mexico, where they face
sexual assaults and other violence,
extortion, kidnapping, and murder,
while they wait for their applications to
be processed.
“Many people, including young
children, would sleep outdoors in
camping tents, even in the cold winter
months”, said Ernesto Castañeda
(American University, Washington,
DC, USA). “Many people would get
sick because of that. The need to
travel by land over long distances
made it extremely difficult for people
with disabilities and chronic or severe
illnesses to be able to ask for asylum if
they did not have visas.”
Criminal gangs extort rents from
migrants waiting in Mexican cities
and charge fees for passage through
those cities en-route to the USA to
seek asylum. Mexican border cities are
“highly criminalised out on the street”,
said Josiah Heyman (University of Texas
El Paso, El Paso, TX, USA). Smugglers
demand exorbitant fees for helping
migrants cross the border between
official ports of entry. Migrants face
a “huge and coercive debt system”
in Mexico that reaches into the USA,
Heyman added.
Migrant children are put to working
dangerous jobs at meatpacking and
food factories, in violation of child
labour laws, the New York Times recently
reported—laws that many Republican
states are now seeking to roll back
to ease labour shortages, even as
government investigators scrutinise the
death, in July, 2023, of a Guatemalan
teenager working at a meat processing
plant in Mississippi.
Despite campaigning for the
presidency with promises of a more
humane approach to immigration
policy, the Biden Administration
initially left both policies in place. That
put migrant youth in peril, according
to Julie Linton, chair of the American
Academy of Pediatrics Council on
Immigrant Child and Family Health
(Greenville, SC, USA). “Children
first and foremost need consistent,
nutritious food, shelter, education, and
healthcare”, Linton said. “They need
a stable, safe place to live, not a tent.
Under Title 42, children weren’t able to
have these basics. Months to years of
education were interrupted.”
Thousands of migrant children were
separated from their families, in part
because of a November, 2020, federal
court ruling that Title 42 could not
be used to deport unaccompanied
children back into dangerous situations.
Desperate to get their kids out of
border shelters and tent encampments
in Mexico, many parents who had
migrated with their children to the
border sent youth ahead to the US
border without them, to seek asylum.
Other unaccompanied youth, mainly
from Central America but also from
Venezuela and Haiti, made the perilous
journey north on their own.
www.thelancet.com/child-adolescent Vol 7 September 2023
Title 42 was controversial among
public health experts, who rejected
the government’s claim that barring
migrants at the border would stem the
spread of COVID-19. “While Title 42
was supposedly implemented on public
health grounds, better policies, like
testing and quarantining, could have
been put in place instead, as other
countries did at the height of the
pandemic”, Castañeda said. “Blocking
access even to asylum seekers escaping
persecution and fearing for their lives
put people at risk and weakened the
right to asylum.”
“COVID-19 was so widespread that
no particular groups of people were
bringing it into the country; it was
already here”, Linton agreed. “Title 42
created unsafe, crowded conditions for
thousands and thousands of children
and families. While waiting for a chance
to have their case heard, they were left
without safe housing and sufficient
food, and they most certainly didn’t
have consistent access to appropriate
medical care.”
In April, 2022, the CDC declared that
Title 42 was no longer needed to halt
the spread of SARS-CoV-2. But a month
later, ruling in a lawsuit brought by
Republican governors, a federal judge
barred the administration from lifting
the CDC’s order. The Supreme Court let
that ruling stand. But with the federal
government’s lifting of the COVID-19
public health emergency, the legal
pretext for the Title 42 immigration
order disappeared. The Biden
Administration ended the programme
and has expanded humanitarian parole,
permitting people to fly to the USA
to work so long as they have a private
sponsor lined up.
“The new regulations are supposed
to keep arriving families together after
they cross the border, although there
are reports of cases where families are
being separated, for example, with the
mother and children being allowed to

apply for asylum and stay to wait for
their appointments at immigration
court, while the husband is put in
deportation proceedings”, Castañeda
said. “These are not instructions from
the White House, but some agents on
the ground may be deciding to act this
way, reproducing the adverse effects
of the intentional family separation
policies of the Trump Administration.”
“Nonetheless, the new administrative
procedures that came into effect just
as Title 42 ended make it even harder
to apply for asylum at the border and
aim to have people apply further away”,
Castañeda said. Under its new “transit
ban” policy, the Biden Administration
can refuse to process asylum claims for
migrants who cross in between official
ports of entry or who passed through
third countries between their homes
and the USA, without seeking asylum
there. Migrants must now apply for
asylum before reaching the USA, using
an error-prone Customs and Border
Protection app, CBP One.
“I think it’s better now than it was
initially, but at the beginning there was
a tonne of problems; people couldn’t
put family groups in the app’s form
and had to get separate appointments
for children”, noted Jeremy Slack
(University of Texas El Paso, El Paso, TX,
USA). “They had problems with facial
recognition for migrants with darker
skin. Now the main problem with the
app is that they only have a limited
number of appointment slots.” A week
before the Title 42 order was lifted
on May 11, 2023, US border agents
saw a rush of up to 10 000 migrants
a week arriving at the border. But the
anticipated subsequent surge of arrivals
in the weeks after Title 42 was lifted did
not materialise.
Once in US Government custody,
unaccompanied migrant youth often
experience trauma and anxiety over
their separation from loved ones. They
faced a 10-day COVID-19 quarantine,
despite a legal prohibition on keeping
children at border patrol facilities for
more than 72 h. Linton has learned of
“many, many” cases of prolonged stays
www.thelancet.com/child-adolescent Vol 7 September 2023
in custody for migrant youth in recent
years. “It tends to be in overcrowded
facilities. It is not safe.” According to
Slack, that’s largely because of staffing
shortages and backlogs.
Inadequate medical care at
immigration facilities can be deadly.
An 8-year-old Panamanian girl with
sickle cell anaemia, fever, and heart
disease died on May 17, 2023, after
US immigration agents ignored her
mother’s pleas for medical care. “For
children with sickle cell anaemia,
fever is considered an emergency
and warrants immediate medical
attention”, Linton noted. “Any child in
chronic medical care needs 24/7 access
to paediatricians.”
Border agents then hand migrant
youth over to the US Department of
Health and Human Services Office
of Refugee Resettlement (ORR) for
housing in tent camps and other
shelters until they can be sent to family
members or sponsors already in the
USA. As President Obama did in 2019,
the Biden Administration ordered the
US Government to pay for asylum-
seeking youth’s transportation to
sponsors, rather than requiring their
sponsors to pay those bills.
Even those youth who are granted an
asylum hearing are not out of danger.
Immigration court hearings can be
bewildering, and migrant youth who do
not understand their legal rights are at
a disadvantage. People do not have an
automatic right to legal representation
in immigration courts, unlike criminal
courts, so even children may not have
lawyers”, Heyman said. “They would
need to pay tens of thousands of dollars
for private lawyers or have the luck
to have non-profit service providers
or volunteers, whose numbers are
stretched thin. Children who do not
speak English in many cases face
immigration judges without legal
representation. Many children arriving
from northern Central America speak
Mayan, not Spanish, and Indigenous
language interpreters are in short
supply. “The lack of lawyers is a fiasco”,
Heyman said. Deportations, family
Reflections
separations, and experiences during
migration can cause post-traumatic
stress disorder and have “life-long
and even intergenerational sequelae”,
Castañeda noted.
The American Civil Liberties Union
and other civil rights groups have
filed lawsuits, saying the transit ban is
illegal. Meanwhile, Texas officials filed
separate lawsuits to halt humanitarian
parole and use of the smartphone
app. Republican governors in Texas
and elsewhere are also seeking a
larger role in shaping US immigration
policy. Officials in Texas and Florida
sent migrants to states and cities with
Democratic leadership, like New York
and Massachusetts, without warning or
coordination. Texas has also deployed
its National Guard to the border to
capture migrants crossing the border
in between official ports of entry. The
governors of Oklahoma, Virginia, West
Virginia, and South Carolina have
ordered their own National Guards to
the Texas border as well. Texas officials
strung razor wire along the Rio Grande,
ensnaring and wounding young
migrants, including a young woman
who had a miscarriage as a result. State
troopers were told to deny exhausted
children drinking water and to push
them back into the river.
“The USA continues to make
migration harder and harder by relying
on a real but hurdle-filled asylum
process”, Heyman said. As restrictive
anti-immigration work policies in
Florida have left construction sites
and farm fields largely abandoned, an
alternative on many people’s minds is
re-establishing a Bracero guest worker
programme. But a sharp partisan
divide over immigration policy and
anti-immigrant rhetoric that tends
toward hyperbole precludes widespread
support for compromise and reform.
“The end of Title 42 does not mean
the border is wide open”, Castañeda
noted. “The new regulations just make
it more difficult for people.”
Bryant Furlow
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