Crossing over the Rio Grande on the Gateway International Bridge from Brownsville, Texas, to Matamoros in Tamaulipas, Mexico, we saw a swath of dilapidated tents behind wire fences lined up against the street as soon as we crossed the border. More than 2,500 families were being forced to live in a tent encampment in Matamoros as a result of the Migrant Protection Protocols—often referred to as the “Remain in Mexico” program—instituted by the Trump administration in 2019, which required certain individuals seeking asylum in the US to wait in Mexico until the time of their immigration court proceedings. The policy did not call for vulnerable people, including unaccompanied children, people with mental or physical health conditions, or those whose lives were in danger, to be returned to Mexico, although compliance with these exceptions was sporadic. In February 2020 we—a group of psychologists and trainees—toured the refugee tent camp, where we met Maria. She had fled Honduras with her six-year-old daughter, Lucy, along with Maria’s brother Jose and his eleven-year-old daughter, Carlita, after several family members were murdered by gang violence.
Maria was making handmade tortillas with butter and salt over a campfire outside her small, rickety tent home, constructed with plastic tarps and sticks that seemed to be barely holding everything up. Surrounding her tent were many others like it, mismatched and clustered between mesquite trees. Families without tents slept under unsupported plastic tarps. As she clapped the dough together to make the tortillas, Maria averted her gaze as she shared that Lucy and Carlita were gone. They had crossed the US border alone a few weeks before. She began to weep, trying unsuccessfully to wipe away her tears with her t-shirt.
Nine months earlier, Maria had arrived at the US-Mexico border to seek asylum and was shocked to find out that she not only would need to wait to get a number before waiting again for her initial processing by Customs and Border Protection but also—even after she passed her initial “credible fear” interview—would be forced to remain in Mexico while she waited for her immigration hearings, as part of the Migrant Protection Protocols. Her hopes for solace and safety disappeared, and her despair grew stronger. Around that time, devastating storms passed through south Texas, almost wiping out the entire tent encampment and causing many migrants to drown in the Rio Grande. Maria knew several of the dead.
Life in the tent encampment was harsh.When she first arrived, there were no bathrooms or showers. Families bathed in the Rio Grande, only steps away from the refugee camp where others were living and from the area where families harvested vegetables, beans, and fruit.With no interior living facilities, a campfire was the only option to keep the refugees warm during the winter months. A large potable water pump system was installed to draw water from the river. Later, in the absence of any US government efforts to provide aid, international nonprofit organizations arrived to provide food and basic medical services in the camp. The only schooling the children were able to receive amounted to just a few hours a week and was organized by a pastor and a loose coalition of volunteers.
With no end to the insecurity of life on the border in sight and overwhelmed by fear of what such a future could mean for Lucy and Carlita, Maria and Jose made the desperate decision to send them across the Gateway International Bridge alone to seek asylum as unaccompanied minors, recognizing that the Migrant Protection Protocols made an exception for unaccompanied children. On that unfathomable day, a group of other families gathered alongside the bridge next to the Rio Grande to offer Maria comfort and support as she watched her daughter and niece cross the bridge. As they walked across the bridge in tears, Maria cried, “Take care of each other, and God bless you!”
After that day, at times Maria felt hope about the future for the children, but at other times she felt only despair. No parent should be forced to make that decision. Both options—waiting in the inadequate refugee camp together or sending your children ahead alone—are fraught with peril and leave a parent to agonize and second-guess whether the option chosen was the best one. The wounds left on both parents and children will likely lead to irreparable lifelong psychological damage. The sense of loss and grief was evident in Maria. Even if she were reunified with her daughter someday, their bond may be disrupted and may lead to an insecure attachment. Both would likely feel guilt or shame for years to come. These are the overwhelming risks that come with all family separations.
A Nightmare In Juarez
More than eight hundred miles away in Juarez, Mexico, a town on the US-Mexico border that ranks among the most dangerous cities in the world because of violence from organized crime, a family from El Salvador awaited their asylum hearing. Because of the COVID-19 pandemic, their hearing was currently unscheduled: Approximately 850,000 immigration cases or hearings had been put on hold by the pandemic at that time. In the meantime, the family—Antonio and his parents—was staying at one of the many migrant shelters in Juarez.
Before they traveled to the border, Antonio’s family had been extorted for months by members of a local gang in El Salvador. The gang demanded a weekly fee (or renta) for protection. When Antonio’s father was assaulted for not making the payment, leaving him severely injured and permanently blind in one eye, the parents knew it wasn’t safe to raise Antonio in their hometown. So in early 2019, when Antonio was just six years old, the family fled from El Salvador toward the US to seek asylum. After almost two months of grueling travel, the family arrived in Juarez. But their nightmare was far from ending.
As their days in the shelter dragged on, Antonio was becoming increasingly withdrawn and fearful. Both of his parents were away most days trying to earn money to survive. The shelter was run by a local church group, and Antonio’s parents had to contribute financially, as resources were very scarce because of the hundreds of families being housed there. They both worked making zippers in a warehouse near the shelter. One afternoon after returning from work, Antonio’s parents noticed that he was not himself. Normally a joyful child, he was now quiet and tearful and had bouts of anger. Although Antonio did not tell his parents for several days, he eventually responded to his mother’s constant plea of “¿Que te pasa?” (“What is wrong?”): Six-year-old Antonio had been sexually assaulted on multiple occasions by a teenager in the shelter. In addition to the change in mood his parents had first noticed, he now struggled to sleep, was not eating well, and was soiling himself.
The family needed to get out. They crossed the border without inspection but were deported immediately and sent back to Mexico without an opportunity to request asylum. The Customs and Border Protection officers told them they needed to wait in Juarez until their number was called. Antonio would have to return to the scene of his assault.
At this point, in the summer of 2020, one of us (Alfonso Mercado) and a doctoral student were brought in for a virtual psychological evaluation of Antonio at the request of the nonprofit organization that was helping him. The aim was to assess Antonio’s emotional and social functioning and gauge the impact of the repeated sexual assaults that he endured while awaiting asylum. A case manager helped connect Antonio and his mother with the virtual platform. When the camera turned on, Antonio sat on a chair looking at the computer with a blank stare. To his right, his mother seemed nervous. The two were greeted in Spanish. His mother began to cry and expressed her gratitude for the meeting. After introductions, Antonio was handed crayons and a coloring book by staff members of the nonprofit and began to color.When it came time for his mother to share the family’s story, Antonio was taken to another room; he was brought back later to continue the evaluation.
Unlike so many forensic evaluations, which serve to document past torture and trauma endured in clients’ countries of origin, Antonio’s case detailed the abhorrent consequences of a series of US policies at the border that placed him in an unsafe environment where he was vulnerable to predation and then returned him to that environment after his family once again sought safety. If the family’s asylum case had been processed when they first arrived at the US border, the sexual abuse that Antonio experienced would not have occurred.
The evaluation will be used as evidence to invoke the principle of “non-refoulement,” which guarantees that no one should have to return to a country where they would face torture or irreparable harm. This principle protects not only refugees but also those who have not had their status formally declared. It forbids a country receiving asylum seekers from returning them to a country in which their lives would be in danger.
There are multiple examples of US obligation to this principle. For one, the US is one of 148 signatories (as of 2015) to the 1967 Protocol Relating to the Status of Refugees. This international treaty ensures that the protections provided in the 1951 Refugee Convention are extended to refugees worldwide. In addition, the Refugee Act of 1980, an amendment to the Immigration and Nationality Act of 1952 and the Migration and Refugee Assistance Act of 1962, created the federal Refugee Resettlement Program in an effort to provide humanitarian support and self-sufficiency for refugees entering the US. Finally, the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment, from the United Nations High Commissioner for Refugees, contains a ban on the return of an individual to any state in which the possibility of being subjected to torture exists.
The principle of nonrefoulement should prevent countries from forcing families such as Antonio’s to await asylum hearings in unsafe environments where they are at great risk for assault, mistreatment, and compounded trauma. As some of us witnessed, this is not what is actually taking place. Advocacy and policy efforts are needed to protect the human rights of these at-risk immigrants.
Dismantling ‘Remain In Mexico’
After President Joe Biden’s inauguration in January 2021, the dismantling of the Remain in Mexico policy began. On February 25, 2021, families living in the refugee camp in Matamoros were finally able to cross the Gateway International Bridge to seek asylum. The Biden administration said that it aimed to process and release about 100 families a day from family detention centers in South Texas.
Some of us returned to the camp after this change took effect to volunteer and meet with families. Even through masks and protective face shields, one could still see the tears in their eyes as they finally stepped onto US soil. “Gracias, mi Dios,” one family uttered as they stepped out of the Border Patrol van and waited in line to be processed. Some families were released with an ankle monitor and court documents. At the bus station in downtown McAllen, Texas, the Catholic Charities Humanitarian Respite Center was helping families with their transition to a new, uncertain world. Families were provided with a warm meal, clothing, shelter, and needed medical services. COVID-19 screening protocols were in place.
These individuals and families had endured so much as they waited during the past several years. In the summer of 2020 Hurricane Hanna had ravaged South Texas and decimated the migrant camp. In February 2021 the devastating and deadly Winter Storm Uri left millions of Texans without power for weeks. Stories emerged of people of all ages screaming that they couldn’t feel their toes and fingers as they bore the freezing conditions in their tents.
Among the families in line were certainly more like Maria’s and Antonio’s, who had also endured trauma and abuse. We have shared just two stories from among those of the thousands of people who were affected by the anti-asylum policies enforced by the Trump administration.
Advocacy, Policy, And Clinical Implications
There is a humanitarian crisis at the US-Mexico border, now set against the backdrop of a global pandemic. In addition to the Migrant Protection Protocols, policies such as “zero tolerance,” which required all illegal border crossings or attempted crossings to be prosecuted, have resulted in many families being separated at the border. In fiscal year 2019 the Border Patrol reported that nearly 474,000 family units were apprehended at the southwest border, representing a significant and alarming increase of 342 percent from 2018. The numbers fell sharply in 2020 after the virtual shutdown of the border because of the pandemic.
Similar to Maria and her family, thousands of families from Central America’s Northern Triangle countries (Guatemala, El Salvador, and Honduras) are fleeing extreme rates of gun violence and organized crime, despite numerous attempts by the US government to deter families from migrating north. A 2019 study by Amanda Venta and Alfonso Mercado (two of the authors of this essay) reported staggering trauma exposure and symptoms among migrant youth and adolescents from Central America. Another 2019 study by Mercado and colleagues documented that 70 percent of recently migrated families reported crime-related trauma and 50 percent reported physical or sexual trauma.
Trauma exposure in general, as well as in the specific context of migrant youth, exerts broad, negative effects on well-being known as toxic stress. Among migrant youth and their parents, trauma is associated with mental and physical health concerns. Yet mental health screenings and trauma-informed care are not routinely provided to this population during immigration processing. Instead, migration policies often exacerbate risks for physical and mental health problems in migrants by adding new sources of traumatic stress. Indeed, the vulnerability of migrant youth and families has received recent global attention as a result of both overwhelming growth in these groups and policies that compound their vulnerability, such as the Migrant Protection Protocols and zero tolerance. Family separations have been condemned by a slew of organizations including the American Psychological Association, the National Latinx Psychological Association, and the Latinx Immigrant Health Alliance, and they pose serious trauma risk for immigrant families, with long-term health consequences. The stories in this essay highlight the effects of compounded trauma on the physical and mental health of migrant families as they advance through the different stages of the migration process.
With a new administration, the US finds itself in a period of transition. In addition to reversing the requirement that asylum seekers await immigration proceedings in Mexico, President Biden has pledged to reduce family separation at the border and reunify families.
It is equally important to facilitate access to health and social services with the goal of reducing risk and preventing further harm for immigrant families. First, there is an imminent need to build a workforce of physicians and mental health professionals equipped to meet migrants’ complex health needs. This entails increasing health care professionals’ cultural and contextual competence, providing an in-depth understanding of the immigration experience and its consequences, and building an expert support network for consultation on complex cases. In addition, mental health professionals should be trained in the assessment and documentation of trauma within the context of migration, particularly given the essential role that assessment and documentation play in the forensic immigration evaluations that are used in court proceedings. Further, resources should be allocated (by the US government, American Red Cross, and others) to create and coordinate emergency response teams to provide quick assistance in the face of compounded crises such as natural disasters and public health crises (including the COVID-19 pandemic).
Trauma-informed care systems should be embedded across institutions and organizations that come into contact with this immigrant population, including law and immigration personnel. Such systems focusoncreating environments that nurture and sustain trauma-informed practices and interactions that prevent retraumatization. To become sustainable, these systems need stable funding and support for research efforts to document their effectiveness while also providing evidence for needed adaptations.
The anti-immigrant rhetoric that has prevailed during the past several years in the US has fueled divisiveness among people, increased discrimination, and escalated fear among various immigrant communities, particularly the most vulnerable. For instance, during the COVID-19 pandemic, asylum seekers have been portrayed as potential carriers of disease and a public health hazard, which has been used as an argument to sustain discriminatory policies and practices. Educational programs and campaigns aimed at destigmatizing asylum seekers and undocumented immigrants are needed to build more inclusive and respectful environments and to restore trust in the US government among immigrant communities. One way to reduce stigmatization of immigrant populations is by facilitating avenues that increase social interactions between different sectors of society, such as building community work programs that involve asylum seekers and local volunteer associations. These actions are essential to helping integrate asylum seekers and at-risk immigrants into US society.
At A Crossroads
There is much work to be done, and the US stands at a crossroads. The actions taken to date cast a dark shadow over our sense of social justice and, ultimately, our humanity. Countless organizations and individuals have worked tirelessly during the past four years to mitigate the damage caused by inhumane policies geared toward instilling fear in people to deter them from seeking safety for themselves and their families. Yet because of the intolerable conditions in the countries from which people are migrating, these deterrents have not worked. Until recently, the US government’s response has been to ratchet up hateful rhetoric. The fact remains that tearing families apart—or creating such dangerous conditions that family separation may be a parent’s best avenue to keep their child safe—when they are most vulnerable is a violation of human rights. Health care providers have an ethical and humanitarian obligation to do no harm and are now in a position to implement policies that are sensible and humane. ▪
Footnotes
Identifying details of people mentioned in the article were changed to protect their privacy.
Policy Checklist
The issue: Recent US migration policies, such as the Migrant Protection Protocols and zero tolerance, exacerbate risks for physical and mental health problems in migrants by adding new sources of traumatic stress.
Contributor Information
ALFONSO MERCADO, psychological science at the University of Texas Rio Grande Valley, in Edinburg, Texas..
LUZ GARCINI, University of Texas Health Science Center at San Antonio, in San Antonio, Texas..
AMANDA VENTA, University of Houston, in, Houston, Texas..
MANUEL PARIS, Yale School of Medicine, in New Haven, Connecticut..
Related reading:
- Garcini LM, Domenech Rodriguez M, Mercado A, Paris M. A tale of two crises: the compounded effect of COVID-19 and anti-immigration policy in the United States. Psychol Trauma 2020;12(S1)S230–2. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- Paris M Jr, Antuña C, Baily C, Hass GA, Muñiz de la Peña C, Silva MA, et al. Vulnerable but Not Broken: Psychosocial Challenges and Resilience Pathways among Unaccompanied Children from Central America, American Psychological Association, Immigration Psychology Working Group, 2018, https://www.apa.org/advocacy/immigration/vulnerable.pdf
- US Border Patrol, “U.S. Border Patrol Total Monthly Family Unit Apprehensions by Sector (FY2013-FY2019),” https://www.cbp.gov/document/stats/us-border-patrol-total-monthly-family-unit-apprehensions-sector-fy-2013-fy-2019
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