Physicians across the United States, and across political aisles, share one trait: We swear an oath to protect our patients and to serve humanity. As practicing physicians in Los Angeles County, who provide care over the border in Tijuana and work with asylum seekers and refugees on a regular basis, we cannot stand by while a group of Central American civilians fleeing violence and seeking a better life are threatened with human rights violations.
President Trump has called the caravan of civilians which has arrived in Tijuana an “invasion,” and stated that it contains dangerous gang members and “unknown Middle Easterners” – without offering any proof to back up his statements. He dispatched thousands of troops to the southern border of the United States to deal with the group of migrants without pausing to consider the estimated 2,300 children among them. It was this type of rhetoric that inspired the Trump administration’s enforcement of a “zero tolerance” policy which forcibly separated thousands of children from their families
– children who are, in far too many cases, still living without their parents.
This dehumanizing language sparks panic and fear in our immigrant patients whom we treat on a daily basis in southern California. They’re so afraid of being apprehended by authorities that they often delay or forgo vital emergency care. The tragic result is that doctors like us in Los Angeles regularly witness preventable deaths and avoidable illness. As physicians, we have a duty to educate when misinformation threatens the health of our communities. That is why we are speaking out.
Safety in Numbers
It was no surprise to us that the asylum seekers formed a caravan instead of trickling in in smaller clusters. Terrified to return to their homes, and fearful of braving the dangerous road north alone, families, children and individuals gathered together to make the long journey as a large unified group, in order to protect one another from kidnappers and traffickers.
They arrived with predictable pathology related to exposure along the grueling journey: sunburn, blisters, and swollen feet from walking dozens of miles a day in high temperatures, heavy rain, and flimsy footwear. Now, cramped by the thousands in a makeshift semi-outdoor shelter in Tijuana, more illnesses are likely. Accidental injuries, heat illness, hypothermia from sleeping outside in the cold, gastrointestinal illnesses, and cardiovascular events are to be expected. The thousands of children in the group are especially vulnerable to the health risks of living day to day without health care, clean water, or adequate sanitation. UNICEF teams reported that even before reaching Tijuana, many children were already suffering from gastrointestinal diseases, dehydration, and bronchitis. Women and girls were further at risk with rape reportedly so common that some were taking birth control to prevent pregnancy. Scuffles with local police and law enforcement, including a tear gas incident at the border, also resulted in numerous injuries. When we, as doctors, look at this picture of unrelenting threats of physical trauma amid unsanitary and dangerous conditions, we don’t see an invasion – we see thousands of desperate people risking their lives to flee impossible situations, and persevering despite the serious dangers they face.
A Desperate Flight from Violence
British Somali poet Warsan Shire once wrote: “No one leaves home unless home is the mouth of a shark.” The decision of the people in the caravan to leave home was not taken lightly. Last month, Dr. Schneberk sat with a young man who fled his Central American country after being persecuted for being devoted to his religion in a community threatened by secular gangs and violence. In his hometown, he was assaulted repeatedly, but kept going to Catholic Mass and keeping his faith alongside his family. His attackers brutalized him with increasing regularity and one day, he was held down and mutilated, and given the ultimatum: join their group or have his family members harmed. He decided to flee his country, albeit reluctantly, and head north in search of asylum. He recounted his story with tears in his eyes and spoke hopefully about the potential for safety within the United States.
Combating systemic violence of the sort experienced by this man, and by those fleeing other Central American nations, takes time. In the short term,international law provides a temporary solution: asylum. Refugee status was established after World War II in order to provide international protection for those with no other option – those whose governments are unable or unwilling to protect them at home. Extending asylum is not only the humane and ethical thing to do — it is within the United States’ legal responsibility under the UN Refugee Convention which it ratified, and to which its adherence is treaty-bound. Under both U.S. and international law, every individual seeking asylum in the United States has the right to have their claim fairly heard, and to be given safe haven while a decision is being made – and that safe haven should be in a non-traumatizing setting. Family jails like the tent city in Tornillo, Texas violate human rights and increase health risks. Research proves that alternatives, such as community-based settings, lead to over 90 percent of asylum seekers complying with immigration proceedings, so there is no excuse not to implement them.
Calling for Empathy
We call on the Trump administration to uphold its treaty-bound obligations to protect vulnerable children and families fleeing persecution. We call on the Department of Homeland Security and Department of Justice to respect domestic U.S.law by implementing the regular vetting process for those seeking asylum, and to allow individuals with well-founded fears of persecution to present their cases.
For years we have treated migrants – both documented and undocumented – and we have witnessed the effects of the U.S. immigration system firsthand. Simply put: it is failing. If we are to make any progress, we must put empathy and human rights at the forefront. Just as how we treat our patients reflects on our entire profession and our ethical commitments to do no harm, so too, how the United States treats these families, who are desperately fleeing violence and oppression, will forever reflect on its legacy.
Dr. Parveen Parmar and Dr. Todd Schneberk are both medical experts for Physicians for Human Rights and members of the PHR Asylum Network. Dr. Parmar is an associate professor of clinical emergency medicine and chief of the Division of International Emergency Medicine at the University of Southern California’s Keck School of Medicine. Dr. Schneberk is assistant program director of emergency medicine and resident assistant professor of clinical emergency medicine at LAC+USC Medical Center’s Department of Emergency Medicine