Citation

Aggarwal NK. Pediatrics 2019; ePub(ePub): ePub.

Affiliation

Clinical Psychiatry, Columbia University Medical Center, New York City, New York; New York State Psychiatric Institute, New York City, New York; and Committee on Global Thought, Columbia University, New York City, New York neil.aggarwal@nyspi.columbia.edu.

Copyright

(Copyright © 2019, American Academy of Pediatrics)

DOI

10.1542/peds.2018-3840

PMID

31481416

Abstract

The United Nations (UN) defines an international migrant as “any person who changes his or her country of usual residence.”1 Migration can be voluntary or involuntary, the latter being considered reluctant when situations encourage relocation or forced when people relocate to avoid direct harm.2 Forced relocation occurs within a country or across countries for asylum seekers and refugees who cannot return home.2 The rise in violence worldwide raises questions if international agreements secure the health rights of various types of migrant minors and what more can be done.

The political crisis at the United States’ southwestern border exemplifies how health rights vary by migrant type. Since 2016, 147 745 unaccompanied minors and 253 000 families with at least 1 child aged ≤18 years have migrated from 4 countries to escape violence.3 El Salvador, Guatemala, Honduras, and Mexico have homicide rates of 82.84, 27.26, 56.52, and 19.26 per 100 000 people, respectively, compared with a global average of 5.30.4 Invoking national security, the Department of Homeland Security (DHS) has discouraged asylum seekers from illegal border crossings by separating children from adults, who are tried for prosecution,5 leading to >2737 separations in 2018.6 Unaccompanied minors and families are processed at centers whose conditions are inconsistent with American Academy of Pediatrics (AAP) guidelines on caring for children.7 Minors released into the public for asylum hearings must determine if local laws cover health services because there is no uniform national policy. DHS arranges services for detainees,8 which have not followed evidence-based guidelines.9 UN officials have found that although 48% of asylum seekers migrated to escape threatened or actual harm, the remainder migrated voluntarily or reluctantly for better social, economic, and political circumstances.10

Conflicts in the Middle East demonstrate how migrant minors face health restrictions during humanitarian …

Language: en