The names of migrants in this story have been changed to protect their identities.
After walking for hours alone under an August sun, Cynthia reached the United States exhausted and dehydrated.
Five months pregnant and showing, the 21-year-old Honduran had been traveling for over a month, riding in trailers and trekking by foot. U.S. Border Patrol agents were waiting for her once she crossed the Rio Grande into Texas. She said she told the agents her stomach was hurting and she needed water, but they ignored her pleas to see a doctor or give her something to drink. After asking how many months pregnant she was and taking her photo and fingerprints, the agents drove her back into Mexico, she said.
A few weeks earlier, Karina and her two daughters had traveled from El Salvador to sleep on the banks of the Rio Grande amid thorn bushes, mosquitoes and snakes. Early in the morning, they walked with a group toward the border, feeling ill. The girls, ages 15 and 9, hadn’t eaten in three days. By the time they encountered Border Patrol agents they were faint from starvation and dehydration. The agents, Karina said, gave the family one small water bottle to share. The children were sprawled on the ground in midday heat for three hours, awaiting transportation to Mexico. Karina said she pleaded with an agent for Gatorade, crackers or anything else to sustain her children but was rebuffed.
Mari and her 7-year-old daughter arrived at the border in July, the girl crying because of stomach pains. They were fleeing violence in Honduras and encountered Border Patrol agents in Texas. Mari said she was hopeful her daughter, who had developed diarrhea during their journey, could see a doctor. The agents accused her of lying about her daughter’s condition and refused to offer water or medical help even as the girl soiled her pants, Mari said. The two of them were promptly driven to Reynosa, Mexico.
Over the past year, the Border Patrol has encountered upwards of 1.5 million migrants seeking to enter the United States. Some die in the extreme heat of the desert. Many more arrive needing medical attention, to which they are entitled under U.S. law. This includes pregnant women and people with life-threatening conditions such as dehydration and starvation.
From 2017 through the first nine months of the Biden administration, advocacy organizations have filed dozens of complaints with U.S. Customs and Border Protection on behalf of hundreds of migrants whose medical needs allegedly went unaddressed upon their initial encounters with agents or once they had been taken into custody.
“From the documentation that we do daily and the stories that we hear from migrants that are constantly arriving here, we know that there absolutely is systemic abuse,” said Sister Tracey Horan, an associate director at the Kino Border Initiative in Arizona. “The longer that it goes unchecked, the deeper-seated it becomes within the agency.”
The Emergency Medical Treatment & Labor Act, passed by Congress in 1986, ensures that migrants, along with homeless and other low-income people, have access to treatment, regardless of their ability to pay. Federally qualified health centers, public and not-for-profit hospitals, and migrant health centers receive government funding to treat migrants. The Border Patrol is supposed to operate in partnership with these facilities, transporting migrants in need of medical care to nearby hospitals once they are in custody. But it hasn’t always worked out this way.
Asked about allegations of medical neglect by the Border Patrol, a CPB spokesperson wrote in an email that “while in CBP custody, migrants are cared for in a manner consistent with the CBP Transport, Escort, Detention and Search Policy (TEDS). Border Patrol agents and medical staff provide safety, security and basic medical care consistent with (Centers for Disease Control and Prevention) guidelines.”
Agents Must Watch for Symptoms
Border Patrol agents have been given guidance on how to treat migrants seeking health care.
The TEDS policy says they must make medical assessments available to anyone with known or reported health issues, and “must be alert to medical symptoms such as coughing, fever, diarrhea, rashes or emaciation, in addition to obvious wounds, injuries, cuts, bruising or bleeding, heat-related injury or illness, and dehydration” if transportation of a migrant is required. Agents must be sensitive to observed or reported injuries or illnesses — the very conditions Cynthia, Karina and Mari said they and their children were experiencing when they were denied medical attention.
In 2019, CPB adopted an additional policy to help agents identify migrants in need of medical attention. Any migrant can alert agents to a health concern and be interviewed by contract medical staff or someone at a local hospital system. The policy dictates that, at a minimum, all minors should receive such an interview. Adults with known or reported conditions come next. Depending on how the interview goes, a more formal assessment may be done.
All Border Patrol agents receive basic first-aid training during their time at the academy, according to the CPB spokesperson. Some agents are trained EMTs and “can make assessments in the field regarding the level of treatment needed” by migrants seeking help.
Even though the number of migrant encounters has grown, the CBP spokesperson said the surge has not stopped agents from performing medical assessments or administering care.
But the Border Patrol’s credibility has taken a blow — and the agency is under investigation by the Department of Homeland Security’s inspector general — for the aggressive behavior of agents on horseback who repelled a flood of Haitian migrants in September near Del Rio, Texas. Even before that episode, there were discrepancies between CBP’s policies and the alleged behavior of agents in the field.
A July report from the DHS inspector general found that “CPB needs better oversight and policy to adequately safeguard migrants experiencing medical emergencies or illnesses along the southwest border.” The inspector general reviewed 98 migrants’ cases and concluded “CBP could not always demonstrate staff conducted required medical screenings or consistent welfare checks” for all of them. In one case, a migrant woman with a fractured pelvis was supposed to receive a welfare check every 15 minutes. Instead, agents saw her once an hour, neglecting “critical” checks meant to help “ensure (migrants) are not experiencing medical emergencies.”
Another inspector general’s report issued in July focused on a widely publicized incident at the California-Mexico border last year. A migrant woman gave birth in her pants next to a trash can while in Border Patrol custody after agents allegedly refused her husband’s pleas for medical attention. The inspector general found that agents “provided adequate medical assistance to the mother and her newborn and complied with applicable policies.”
But it also identified some systemic problems. It found, for example, that the Border Patrol did not always “expedite the release of U.S. citizen newborns, resulting in some being held in stations for multiple days and nights” — not the healthiest environment for infants. And it urged the agency to develop guidelines “on interpreting for Spanish-speaking detainees at hospitals … Border Patrol personnel risk misinterpreting medical information, which may have serious health implications for detainees.”
“There have been many cases where the agency only takes someone for medical care when it’s absolutely clear that it’s needed, like dramatically so,” he said. “There’s been cases down here in the (Rio Grande Valley) of pregnant women being given medication at the hospital to stop early contractions and Border Patrol deporting them back to Mexico immediately after the hospital visit.” Agents, Drake said, are “trying to basically get rid of them, get them out of Border Patrol’s hands before their medical condition worsens again.”
The inspector general has proposed reforms the Border Patrol says it will put in place by February. These include the addition of an annual training presentation to help agents recognize migrants in medical distress. The Border Patrol also plans to outfit 6,000 agents with body cameras by year’s end to improve accountability.
Horan, of the Kino Border Initiative, said the Biden administration’s immigration policies play a role in the medical neglect of migrants. Amid the COVID-19 pandemic and on the advice of the CDC, the administration has invoked a public health authority, Title 42, which allows the government to expel migrants before they can apply for legal protection. Title 42 was used during the Trump administration and remains the status quo despite a court challenge by migrant advocates.
The regulation emphasizes speedy deportation, which can make medical care an afterthought, Horan said. “The priority is not humane treatment,” she said. “The priority is not to make sure people get the medical care that they need. The priority is to get them out and get them expelled as quickly as possible.”
Not everyone is critical of the Border Patrol’s performance. Dr. Oscar Tijerina, emergency room medical director of Mission Regional Medical Center in Mission, Texas, said agents bring migrants into his hospital every day. Tijerina has treated patients with fractured spines and limbs. Children have arrived in respiratory distress, in some cases battling multiple viruses at once. Some migrants come in with such severe heat exhaustion that they die even after hospitalization. “Nobody in the hospital makes them feel that they shouldn’t be there,” he said. “We’re happy to take care of them.”
Tijerina believes most Border Patrol agents are attentive to migrants’ medical needs. “It’s heartbreaking to see Border Patrol agents come in with kids in their arms, caring for them,” he said. He’s seen agents watch cartoons on their phones with migrant children when they’re in the hospital’s waiting room without parents, keeping the children distracted and entertained.
For the first time in recent years, DHS set aside a portion of CPB’s budget for migrant medical care — about $160 million in 2022. This includes money for Loyal Source Government Services, a contractor that conducts health interviews and medical evaluations and provides limited treatment for low complexity medical complaints. If necessary, Loyal Source refers migrants to local health systems.
Some, however, aren’t convinced CPB will spend the money as intended. “I can’t speak enough to the need for oversight,” Horan said. “And unless there are very strict restrictions on this funding that are very clear, and there’s a way to hold CBP accountable for using the funding in a very specific way, I would not trust those dollars actually going to medical aid.”
In fact, the Border Patrol has misused government funds in the past. In 2019, the U.S. Government Accountability Office found that the agency spent millions of dollars earmarked for medical care on items such as dog supplies, printers, speakers and motorcycles. DHS had to implement almost a dozen recommended reforms that were supposed to increase oversight and improve documentation in the future. At the time a CPB spokesperson told the Los Angeles Times the agency planned to take “prompt remedial action.”
Non-governmental organizations have tried to fill the health-care gap for migrants as they wait to see if CPB reforms will stick. One such group, Catholic Charities of the Rio Grande Valley, filters hundreds of migrants a day through its facilities in McAllen. Its respite center has nurses who see pregnant women and a makeshift pharmacy where volunteers administer over-the-counter medication for fevers and colds.
Volunteers and lawyers with the Kino Border Initiative and the ACLU help migrants file complaints against the Border Patrol through outlets such as DHS’ Office for Civil Rights and Civil Liberties and CPB’s Office of Professional Responsibility. But some migrants are afraid to complain because they have pending immigration cases. Drake believes the Border Patrol perpetuates a “culture of internal protectionism” because complaints about the agency — and any related disciplinary actions — aren’t dealt with externally. Rather, he said, the agency itself is responsible for doling out its own punishments.
Until substantial changes occur, migrants face uneven handling of their medical conditions at best, outright neglect at worst. Cynthia, Karina, Mari and their children were forced to seek care at a Catholic migrant shelter in Reynosa after being expelled from Texas. There, doctors administered antibiotics for Cynthia’s infection, Karina and her children recuperated in quarantine from COVID-19 and Mari’s daughter was given medication for her diarrhea. The nuns gave them plenty of food and water.
Arianna Flores is a contributing writer for Public Health Watch.