The Endless Vulnerability of Migrant Children In-Transit across the Darién Gap

ABSTRACT.

Many people from poverty-stricken countries are migrating across South and Central America to reach the México–United States border, a movement exacerbated by the COVID-19 pandemic. Migrant people who begin their northbound journey in South America must transit across a significant geographic bottleneck, the Darién Gap, a mountainous rainforest region between Colombia and Panama. Most migrant people crossing this region originate from Cuba, Haiti, and Venezuela. Other people reach the shores of South American countries from west and central Africa or central and southeastern Asia and continue to the Darién Gap. Poverty and violence drive families with children to flee their homes and endure incalculable risks in their path. Children traveling with their families or as unaccompanied minors across the Darién Gap are exposed to life-threatening situations and human rights violations, including abuse, exploitation, malnourishment, and limited access to medical care. In addition to experiencing untreated medical illnesses, children experience mental health disorders during migration and after they reach their destination as a result of victimization and adverse traumatic experiences. Therefore, providing migrants, especially children, with rapid medical screenings and mental health support when they arrive at their destination is critical to reduce health inequities. Furthermore, making these interventions available during their transit and ensuring their safety may prevent further human rights abuses in children and families. Latin American governments must address the ongoing humanitarian crisis endured by migrants throughout their migratory path by offering access to essential healthcare services and safeguarding the rights and security of children and vulnerable groups.

CHILD MIGRATION IN THE NEW MILLENNIUM

Population migration has been part of the social evolution of humankind across millennia. By mid-2020, an estimated 280 million people and approximately one in every 66 children worldwide lived outside their country of birth.¹ Human migration often responds to hopeless and desperate social, political, and economic pressures.² A wide range of forces, including social and political conflicts, food insecurity, natural disasters, climate change, environmental degradation, financial hardship, and violence hinder the most vulnerable populations around the globe from building healthy and sustainable livelihoods. The lack of opportunities compels individuals, entire families, or groups to seek a better living elsewhere.¹ Migration is, for many, the only chance to improve living standards and financial security and accomplish aspirations that would otherwise be unattainable. Migration often enables people to secure employment, reunite with family members, obtain educational and other life-enhancing benefits, and improve access to medical care and cultural and recreational activities.^2,3 Exodus from Venezuela, Cuba, and Haiti exemplifies the mass migration phenomena in Latin America. The critical economic, political, and social crises prevailing in Venezuela, once one of the wealthiest countries in the region, have resulted in food shortages, lack of access to essential services, diminished means of livelihood, and increasing systematic violations of the human rights of children and women.^3,4 This situation has led to significant migration outflows.⁴ Venezuela’s migratory crisis contributes to more than one million displaced children.⁵

Child migration is the movement of people aged 3 to 18 within or across political borders with or without their parents or guardians. This term also includes children recently arriving in a host country, including migrants, asylum seekers, refugees, and internally displaced children.⁶ All individuals younger than 18 years, including migrant children in transit across international borders, are protected under Article 1 of the United Nations Convention on the Rights of Children.⁶ This protection is essential during early childhood, from gestation to 7 years of age. This period is decisive because the motor, language, cognitive, social, and affective development of minors depends on it. These factors will give society independent and productive adults capable of contributing to personal and social development.^7,8 The increase in children’s migration represents a major global challenge compromising their safety, health, and overall well-being.⁸

MIGRANT CHILDREN ACROSS THE DARIéN GAP

On their transit from South America to the México–U.S. border, migrant people must travel across the Darién Gap, an extensive forested area located on the border between Panama and Colombia. This area covers 575,000 hectares with 266 km of impassable roads, turbulent rivers, wild animals, and the significant presence of criminal groups, which makes this area one of the most challenging and dangerous contemporaneous migratory paths⁹ (Figure 1).

Figure 1.

Main human migratory routes across the Darién Gap.

During the first trimester of 2021, around 33,000 unaccompanied children arrived at the México–U.S. border.¹⁰ In recent years and associated with the crisis due to the COVID-19 pandemic, the number of migrants has increased exponentially, representing three times more migrants in 2021 than were registered during the previous 5 years combined. More than 32,000 migrants crossed the dangerous Darién route in the first 5 months of 2022 versus 16,000 during the same period in 2021. In May 2022, more than 2,000 children and adolescents migrated through this route, four times more than in May 2021, representing 15% of the migrant population in this area^11–13 A recent assessment conducted by UNICEF over 14 days across migratory reception stations in Panama identified approximately 170 children as unaccompanied or separated from their families and several cases of children without any paperwork confirming their identities, such as a birth record or passport, leading to the risk of statelessness and further risk of abuse and poor health.¹³ Migrant families often stay in temporary accommodation facilities that are overcrowded and inadequate for children. Water and essential services do not match the growing humanitarian needs, leading to higher health risks for newborns and mothers.¹³ By the end of 2023, UNICEF estimates that more than 300,000 people will cross the Darién Gap.^5,6 Of these, approximately more than 60,000 will be children.^14,15 During the migratory journey, children in transit across the Darién Gap are particularly vulnerable to poor health and human rights violations.

HEALTH INEQUITIES AMONG MIGRANT CHILDREN CROSSING THE DARIéN GAP

Medical assessment of migrant children in transit across the Darién Gap is a challenging task. Multiple factors influence this activity, including the child’s country of origin, socioeconomic status, and health history; availability of reliable health care in the country of origin; the migration route, countries passed through; and sanitary conditions during the journey.¹⁶ Several studies have described a higher risk of food insecurity and nutritional deficiencies (e.g., rickets and iron deficiency) in the migrant population. Factors such as low socioeconomic status and lack of knowledge about nutritious food led to that situation in this population.^17–20 However, insufficient studies have addressed this risk among migrants in transit through Latin America.

Infectious diseases have been the most frequently identified medical diagnosis affecting refugee and migrant children at the time of arrival to the host country (e.g., the United States, western Europe, and Australia), probably because they come from countries affected by endemic infections or were exposed to infectious agents during their journey.²¹ Vaccine-preventable diseases including measles, acute respiratory tract infections, skin infections (e.g., scabies, pediculosis), gastrointestinal infections (e.g., shigellosis), hepatitis A, tuberculosis, and malaria are frequent medical diagnoses among migrant people reaching their destination host country.²² Under-immunized infants crossing the Darién Gap present a critical public health concern as they can harbor infections acquired in their home countries where there has been a reemergence. For example, measles, diphtheria, varicella, and other vaccine-preventable diseases have reemerged currently in Venezuela.^14,23 Ensuring that this vulnerable population receives timely vaccinations is crucial due to the increased prevalence of vaccine-preventable diseases among migrant children as compared to non-migrant children.²² A systematic review of the vaccination status of migrants arriving in European countries identified factors that may limit migrant people’s access to immunizations. The most relevant factors identified in this study were mobility from place to place, impeding their completion of routine immunization schedules, and insufficient documentation of immunization records in some countries where migrants originate. Moreover, countries hosting migrants may experience an economic downturn, leading to challenges in accessing healthcare. Furthermore, migrant individuals may refrain from registering with medical authorities due to legal concerns.²¹ Disparities in vaccination coverage among migrant communities in some settings depend on parental education levels, religious/cultural beliefs, government policies around incentives, and the efficiency of health service delivery.²⁴ There are limited data on the completion of routine immunization schedules in children crossing the Darién Gap.

The prevalence of parasitic intestinal infections in migrant children (most frequently in the United States, Canada, Australia, and western European countries) varies according to country of origin and age. Studies performed among migrant children in the United States showed that 15–35% of migrant children had evidence of parasitic infections in stool examinations.¹⁶ In addition, a prospective evaluation in Spain performed on 373 minors from sub-Saharan Africa, north Africa, and Latin America found at least one parasitic infection in 176 (47.1%) immigrant children.²⁵ In this same study, 77 out of 373 (20.6%) minors were infected with two or more parasitic infections (filariasis plus strongyloidiasis and filariasis plus schistosomiasis).

Owing to victimization and adverse childhood experiences, children in migration have an elevated risk of developing mental health problems. Migrants’ long-term well-being might be affected by childhood trauma or negative experiences endured during their migratory routes and may cause lifelong medical and psychological disorders.⁸

HUMAN RIGHTS OF MIGRANT CHILDREN CROSSING THE DARIéN GAP

Families in migration are escaping violence, gender violence, poverty, extortion, corruption, and climate change in their home countries, forcing them to flee to the United States.²⁶ However, when crossing international borders and particularly during their treacherous journey across the Darién forest, an increasing number of children and their families are victims of smugglers and criminal organizations involved in illegal trade, human trafficking, and the sexual exploitation of children and women.^3,4,27 This risk continues throughout international borders across Central America and México. In addition to risks from criminal organizations, migrant children may suffer harm at the hands of officials as they are often confined in immigration detention centers, separated from their parents and siblings. The language barrier, lack of documentation, and overwhelming court systems hinder the reunification of families.²⁷ Unaccompanied minors are particularly vulnerable to neglect, trafficking, abuse, and sexual exploitation. Additionally, the disruption in formal education is more evident in these unaccompanied minors.³ The impact of illness and abuse of children who crossed the Darién region has not been systematically assessed except for anecdotal and journalistic reports.^5,6 There is, however, a need for epidemiological studies to elucidate the medical and social impact of children, adults, and families of migrants who cross the Darién region.

There are also limited accounts of the impact on children recently arrived into the United States after traveling across Latin American borders, including those who crossed the Darién forest. According to the United Nations Convention on the Rights of the Child, 120 states are responsible for making primary and secondary education available and accessible to all children, regardless of migration status. Primary education should be free and compulsory, and states should take progressive steps to make secondary education accessible.⁶ Children deserve freedom to be kids and to have access to comprehensive, high-quality education.²⁸ For example, access to public schools is one of the most violated human rights for migrant children because of irregular migratory status and lack of health screening, making it more difficult to access education. Language barriers, unsuitable materials, or inadequately trained teachers to support student integration produce dropouts or poor educational attainment. Migrant children attending schools are often placed in groups with lower curricular standards and lower average performance levels. However, in settings with effective migratory procedures, where language and other barriers are appropriately addressed, migrant children can preserve their language, values, and customs. They have been shown to integrate quickly into a new system, with younger children assimilating particularly well.^3,29 However, many migrant children do not receive access to effective migratory procedures. Instead, they meet economic, societal, institutional, and other obstacles.²⁹ Additionally, they face discrimination and xenophobia, bullying from peers, or violence at the hands of their parents.⁸ Further studies addressing the impact of increasing migration across Latin America and educational opportunities and educational attainment of recently arrived migrant children may become available in the near future.

There are other consequences of migration that result in negative consequences for the well-being of children. As a result of increasing migration of parents searching for low-skilled jobs, children are often left behind in the care of other family members, mainly elderly individuals. Children whose parents sent remittances to their homes have benefited from improved education and reduced child labor, which could result in improved health. However, there are also negative long-term psychological and societal costs. Compared with non-migrant children, left-behind children and adolescents had increased risk of depression (52%), suicidal ideation (70%), and anxiety (85%).^3,29,30

CONCLUSION

Because of the increasing migration of children and their families across Latin America, there is a need for further efforts to perform medical assessments and identify this population’s health gaps, implementing interventions to reduce health inequities and ensure their safety across perilous migratory routes. In this sense, most migrant people bound to the México–U.S. border travel through the Darién Gap, which represents one of the most dangerous and inhospitable paths. Given the lack of data to support interventions targeting this at-risk population, there is a need for further evidence-based interventions to ensure the well-being and safety of children migrating across the Darién Gap and throughout their migratory journey across Latin American borders to reach the U.S. border. Therefore, it is imperative to better understand the devastating and disrupting experiences and insufficient medical care of migrant people who travel across South and Central America and Mexico, particularly of people who cross the Darién forest. Given the increasing challenges of climate change and the economic downturn resulting from the COVID-19 pandemic, many families from resource-limited settings will continue to migrate across the Darién Gap for security and financial reasons.^8,22,28 In addition to ensuring the safety of children and their families, medical screenings, provision of immunizations (routine and supplemental), nutritional assistance, and mental health support represent essential interventions to improve the well-being of children during migration across international borders and upon their arrival to their destination.²⁸