O3211: Pediatric Medical Care in US Migrant Child Detention: Assessing Health Care Delivery at the Karnes County Family Residential Center

Background: In recent years, the US government has detained a significant number of child migrants, with over 70,000 unaccompanied children apprehended at the southwest border in fiscal year 2019. International law condemns use of child detention, stating that it should only be used as a last resort. Child detention must end; however, those who are currently detained have the right to timely and acceptable health care. Limited evidence exists on the quality of health care delivery and adherence to existing ICE policies and procedures. Our study aims to analyze the quality of health care delivery to children in one detention facility and outline the deficiencies in the implementation of existing ICE guidelines.

Methods: We conducted a medical chart review of 165 child migrants detained at Karnes County Family Residential Center (KCFRC) between June 2018 and October 2020. Medical records of clients who consented were de-identified by the RAICES Pre-Removal Services Unit, then provided to the Pediatric Immigration Medical Research Working Group. Data were analyzed to assess health needs, gaps in care, and adherence to ICE guidelines. We presented counts and percentages for selected categorical data describing demographics and clinical characteristics.

Results: Our study population was 90% male with an age range between 6 months to 18 years. Most children came from Central and South America with 4.9% from Europe, Asia, and Africa. 88% of children were detained at KCFRC for more than 20 days (median 43 days), in violation of the Flores Settlement Agreement. 26.9% of children were malnourished (stunted or thin), with 13% of children under 2 years of age considered malnourished. 82% of children were seen for ≥1 acute medical visit while detained; however, only 11% of children were evaluated by a medical doctor or advanced practice provider. 4.9% of children were identified with a mental health disorder despite evidence suggesting higher expected rates of depression in pediatric asylum seekers. Only 32% of children (throughout the year) received the flu vaccine. 8% of children screened for TB had a calcified granuloma present on chest x-ray with no follow-up.

Conclusion: These findings demonstrate serious deficits in pediatric health care delivery in detention facilities, particularly in addressing malnutrition, providing evaluations by clinicians trained to care for children, and flu vaccinations. Detention of children and families is never in the best interest of children; however, when children are detained as a last resort, these findings highlight the need for accountability mechanisms and oversight to ensure quality implementation and standardized monitoring across facilities. Facilities must provide adequate medical and mental health care, ensuring access to information, adequate staffing, trauma-informed care, and respecting cultural needs. Health care is a basic human right for children, and these standards at a minimum must be met.