Death of 8-year-old girl in Border Patrol custody highlights challenges providing medical care

The recent deaths of an 8-year-old Panamanian girl and 17-year-old boy from Honduras who were under U.S. government supervision have again raised questions about how prepared authorities are to handle medical emergencies suffered by migrants arriving in the U.S., especially as agencies struggle with massive overcrowding at facilities along the southern border.

Anadith Tanay Reyes Alvarez became unresponsive on a what was at least a third visit to medics Wednesday at a Border Patrol station in Harlingen, Texas, and died later in a hospital, U.S. Customs and Protection said. The girl had complained that day of vomiting and stomach pains.

She died on her family’s ninth day in custody; the most time allowed is 72 hours under agency policy.

The family told agents that the girl had a history of heart problems and sickle cell anemia, CBP acknowledged in its second statement on the death. She was diagnosed with influenza on the family’s sixth day in custody, which prompted them to be move to another station.

CBP published a detailed account on Sunday, confirming key aspects of what the girl’s mother said two days earlier in an interview with The Associated Press. It initially published only a brief statement.

Mabel Alvarez Benedicks told the AP that agents repeatedly ignored pleas to hospitalize her medically fragile daughter as she felt pain in her bones, struggled to breathe and was unable to walk. She said the daughter was finally taken in ambulance after falling limp and unconscious and bleeding from the mouth.

Agents said her daughter’s diagnosis of influenza did not require hospital care, according to the mother.

The girl’s death came a week after 17-year-old Ángel Eduardo Maradiaga Espinoza of Honduras died in U.S. Health and Human Services Department custody. He was traveling alone.

Why are so many people in border patrol custody?

A rush to the border before pandemic-related asylum limits known as Title 42 expired brought extraordinary pressure. The Border Patrol took an average of 10,100 people a into custody a day the second week of May, compared to a daily average of 5,200 in March.

The Border Patrol had 28,717 people in custody on May 10, one day before pandemic asylum restrictions expired, which was double from two weeks earlier, according to a court filing. By Sunday, the custody count dropped 23% to 22,259, still historically high.

Custody capacity is about 17,000, according to a government document last year, and the administration has been adding temporary giant tents like one in San Diego that opened in January with room for about 500 people.

Those who qualify to be released from custody to pursue asylum are processed for immigration court, which takes 90 minutes to two hours for a single adult and longer for families and creates severe bottlenecks.

By contrast, it takes only 20 minutes to release someone with instructions to report to an immigration office in 60 days, a common practice in 2021 and 2022. A federal judge in Florida who ordered an end to quick releases in March also blocked the administration’s attempt to resume them last week in what officials described as an necessary emergency response to overcrowding.

Amid this month’s surge, hundreds of migrants slept on the ground, many for days, on U.S. soil between two border walls in San Diego as hundreds more holed up in a remote mountainous area east of the city in huts made of tree branches. The agency provided a limited diet of water and chips or granola bars. Pedro Rios, director of the American Friends Service Committee’s U.s.mexico border program, said the Border Patrol told him to call 911 when volunteers encountered an 8-monthold between the walls who was “listless and vomiting.”

What happens when someone is taken into custody?

Border Patrol holding facilities are short-term, with people sleeping on floormats with foil blankets. Thick plastic curtains have replaced chainlink fences to prohibit free movement.

Single adults may be transferred to U.S. Immigration and Customs Enforcement to be deported, released in the U.S. with notices to appear in immigration court or held for long-term detention.

ICE had nearly 26,000 people in long-term detention in April. Its facilities resemble prisons and often are prisons, operated by local police agencies or prison companies like Corecivic and The Geo Group Inc.

The government generally cannot hold families more than 20 days under a 2015 court order. President Joe Biden broke with predecessors Donald Trump and Barack Obama by refusing to detain families at all beyond their initial 72 hours with the Border Patrol.

His administration recently adopted curfews with electronic monitoring for families released in four cities until they pass initial asylum screenings.

Children traveling alone are transferred to the U.S. Health and Human Services Department, which generally places them with parents or relatives after short stays in contracted holding facilities.

In 2021, the department was unprepared to take children in 72 hours, causing them to languish in Border Patrol care. It eventually contracted for convention centers in California, military bases in Texas and other temporary sites.

The Border Patrol returns some migrants who do not qualify for release in the U.S. to Mexico, including Cubans, Haitians, Nicaraguans and Venezuelans, as well as Mexicans.

To deport non-mexicans, ICE runs charter flights and, in rare cases, flies commercial. In April, ICE chartered 117 flights, including 33 to Guatemala, 21 to Colombia, 20 to Ecuador and 17 to Honduras, according to Witness at the Border, an advocacy group that relies on flight data.

What medical care is available at border patrol holding facilities?

The Border Patrol’s parent agency, Customs and Border Protection, created a chief medical officer position in 2020 but services are limited. During a tour of a major holding center in Mcallen this month, officials said they had about 100 medications on hand and that 23% of detainees had medical needs. The center has a medical booth and a more private exam room with two stethoscopes hanging on the wall.

Medical personnel screen for infectious disease — a critical job during COVID-19.

They also ensure detainees have needed medications, deliver babies and respond to any need that can avoid a trip to the hospital.

Its facilities added more than 1,000 “medical contractors” in the last two years, Troy Miller, CBP acting commissioner, said Sunday. He promised “immediate action to review and, where needed, strengthen practices to ensure immediate and appropriate care is being provided to all individuals, especially those who are medically at-risk.”

Are current challenges new?

No, and the growing presence of families and unaccompanied children at the border over the last decade has presented U.S. authorities with enormous responsibilities for medical care.

At least six children died during a roughly yearlong period from 2018 to 2019 during the Trump administration; they were held in either Border Patrol or Health and Human Services custody. In March, a 4-year-old “medically fragile” Honduran girl who was in the care of the Health and Human Services died in a Michigan hospital three days after cardiac arrest.

In 2019, amid a previous surge of border crossings, the Homeland Security Department’s internal watchdog observed 750 adults crammed in a space for 125 in El Paso, Texas. People stood on toilets for space to breathe. Another watchdog report in 2019 from Rio Grande Valley found that men were held in standing-room only for a week and some children under 7 were in overcrowded conditions more than two weeks.