July 13, 2018 (ACP) – The American College of Physicians has sent powerful and firm messages to the Trump administration in recent weeks: The families who have been separated at the border must be immediately reunified, and the president's June 20 executive order that would allow for indefinite family detention is not an acceptable alternative to this deeply harmful practice.
“As an organization of specialty and subspecialty physicians who take care of adults, ACP is committed to supporting the health and well-being of our patients through disease prevention and health promotion,” said Dr. Ana María López, ACP's president. “This policy of family separation induces trauma and induces illness, and the health impact of prolonged family separation would be similar. Thus, these actions are in direct opposition to our goal and mission as physicians.”
The Trump administration's family separation policy took effect in April, when Attorney General Jeff Sessions ordered a “zero-tolerance” crackdown as a deterrent to illegal border crossers, including those seeking asylum. As a result, more than 2,300 children were separated from their parents at the border and placed in government-licensed shelters or in temporary foster care with families across the country,” according to a New York Times report.
“Family separation induces trauma to the child and to the adult,” López said. “This level of trauma has both short- and long-term health sequelae that last a lifetime. Immediate effects may include delays in development and regression of development, including cognitive delays. Even after being reunited, the child may exhibit signs and symptoms of post-traumatic stress with difficulty separating from the parent. This level of trauma has been associated with increased incidence of chronic diseases, including behavioral problems such as depression and anxiety. Chronic illnesses span diabetes, heart disease, respiratory illnesses, and cancer.”
After a national outcry against the policy, the president issued an executive order that the administration has portrayed as ending the problem. But, ACP noted that “it calls for children and parents to be detained together” while the parents undergo criminal proceedings.
ACP does not consider this to be a solution to the family separation issue.
In a new policy ACP issued last week, it emphasized the negative health impact of forced family detentions in immigration cases. Dr. López noted that when the American Academy of Pediatrics reviewed the evidence on the health impact associated with detention of immigrant children for a 2017 policy paper, it found that “studies of detained immigrants, primarily from abroad, have found negative physical and emotional symptoms among detained children, and post-traumatic symptoms do not always disappear at the time of release.” ACP considers the evidence that Adverse Childhood Experiences lead to adult mental and physical health and sociobehavioral disorders to be strong.
“The order also fails to address what is going to happen with the thousands of children who have already been separated from their families and remain in the custody of the U.S. government since the zero tolerance policy went into effect,” López said in a statement that was issued the day of the Executive Order.
ACP called for immediate reunification of children and parents, noting that “any delay in reunification will exacerbate the negative health consequences inflicted on the children and their families.”
In addition, the College reiterated its support for the Keep Families Together bill that has been introduced in Congress by Democrats but has not been voted upon. It would permanently end family separations as a means to enforce border security.
On June 30, hundreds of thousands of Americans participated in more than 600 “Keep Families Together” rallies across the country, according to CNN reports.
López said her thoughts are with both the families and the doctors who are treating them.
“As a physician, it is very difficult to see people suffering,” she said. “It is also very difficult to see people suffering from a preventable cause. All of us can imagine the horror of the events imposed on families. … It is a unique privilege and honor to work with colleagues to give voice to the most vulnerable – those most impacted by these policies.”
As for the physicians working with these families, López noted that they have much work to do.
“The reunification of families is an essential first-step to allow healing to start,” she said. “Children and families will then need close follow-up to address signs and symptoms of physical and emotional distress, illness and disease.”
“This is trauma at all levels,” she said. “It is exhausting. As physicians, we need to remember to care for ourselves so we may continue to care for others.”
Back to the July 13, 2018 issue of ACP Advocate