Since January, executive orders issued by
the government and discussions in the me-
dia regarding immigrants seeking refuge or
living in the United States have challenged
us to look deep into our own value systems
and ask, “Am I my brother’s keeper?”
As pediatricians, the national discussion
about immigration policy is not an abstract
political issue but a reality in the lives of our
patients and their families. I have witnessed and you have told
me that the impacts of the immigration debate are evident
every day in pediatric practice for our patients and families.
As caregivers and citizens, we are challenged to reevaluate our
value system and resolve the competing interests of values,
laws, morality, ethics and politics.
I have had the privilege of joining AAP leaders visiting the
southwest border of the U.S. and the detention facilities there
along with community efforts to help immigrant families and
children who have been released after being legally processed.
In these places, one truly sees it all. There are moments of
compassion and warmth where the best of what society and
human beings can offer is present for the scared children and
adults. There you also can see and touch “the wall” that separates nations and people. And most importantly, there are the
families and children who are entering the country looking for
refuge. They are fleeing abject poverty, violence and hunger.
Let me describe what we saw.
Capture and processing
Motorized vehicles of various sizes come to the detention center. A tall warehouse building with 25- to 40-feet-high thick and
hard chicken wire-like metal separations for each area. Women
with children, unaccompanied minors, occasional adult males
with children and rarely an entire family constitute the deliveries that come all day and all night. Clothes are removed,
standard issued clothing replaces their own and possessions are
confiscated and placed in individual plastic bags. (This includes
shoes, security blankets and other simple possessions.) A mountain of these bags forms quickly near the door.
Adult males are separated from young males and young
males from male children. Same for women, although young
children can stay with their mothers. About 1,000 individuals
per day are processed at the Ursula (Texas) detention center
alone, according to the Customs and Border Protection officials we spoke to during our visit. The place is clean but
cold, and the lights are on 24 hours a day for security reasons.
Simple food and drink are provided. The guards are kind and
polite but stern. Many are immigrants themselves.
Separation and reunion
There are cries of desperation when brothers and sisters are
separated because of age or gender — fear exacerbating existing trauma — but they will be reunited usually in less than
48 hours. After being photographed, cursory biometrics, an
even more cursory health check (inspection with no vitals unless appearing ill or complaining of illness) and an interview,
the detainees are released. There is no capacity to hold them
because there will be 1,000 more arrivals the next day. Ankle
monitors are placed on all adults. Possessions are returned.
Community to the rescue
The communities of Harlingen, Del Rio and McAllen
are not exactly wealthy, and yet they send buses to pick up
the children and families at the release site and bring them
to churches and other community facilities.
At Sacred Heart Church, volunteers line up in two rows.
As the children and families walk in, they are received with
applause to make them feel welcome. They were served a
warm, hearty meal, and each child is given a bag or backpack that includes a set of clean, age-appropriate clothes and
personal hygiene items for the journey across the country to
I personally spent time with several beautiful, loving families. They cried as they told me stories that support the concept
of “credible fear”: family members killed, boys threatened
with death if they don’t join drug gangs, threats of sexual
abuse and kidnapping. These families made heart-wrenching
decisions to leave their homes, often having to leave some of
their loved ones behind.
I believe we have a moral duty to help these families and
children. It has been said that not everything that is legal is
moral and not everything that is moral is legal.
I hope you stand with me and the AAP leadership when
we say, “Yes, I am my brother’s keeper!”
I would like to acknowledge AAP Immediate Past President
Benard Dreyer, M.D., FAAP, for his help in writing this letter.
Undocumented immigrant children:
Am I my brother’s keeper?
Fernando Stein, M.D., FAAP
President, American Academy of Pediatrics
• Study: Many physicians not
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•Following watchful waiting
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•CDC: Birth defect rate 20
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• ACIP: Reduce HepB revaccina-
tion doses for infants, http://bit.
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