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June 14, 2018 phr.org
As medical and mental health professionals and researchers working in the United States, we
are gravely concerned about the Trump administration’s practice of separating migrant and
asylum-seeking families at the U.S.-Mexico border. Such a practice is profoundly harmful to
children and to families, in addition to violating fundamental human rights. We urge you to
immediately end forced separation of families at the border, and instead keep families together
in community-based settings while their immigration proceedings are pending.
The Trump administration has stated that its goal in separating children from their parents is to
deter people from crossing the border between ports of entry. According to statements by
Attorney General Jeff Sessions, this policy is intended to be punitive, to serve as such
deterrence. 1 The child welfare implications appear to be secondary at best. White House Chief of
Staff and former Department of Homeland Security secretary John Kelly has stated, “The
children will be taken care of — put into foster care or whatever. But the big point is they elected
to come illegally into the United States and this is a technique that no one hopes will be used
extensively or for very long. 2” Media reports indicate that government mechanisms for ensuring
that parents and children are in contact and know each other’s whereabouts are non-functional. 3
Using children as leverage to punish their parents is unconscionable, both with respect to the
health and well-being of children and as treatment of migrants and asylum seekers. The right to
family unity is enshrined in U.S. and international law, which recognize that families are the
foundation of society. The relationship of children and parents is the strongest social tie most
people experience, and a threat to that tie is among the most traumatic events people can
experience.
Forced separation of children and parents, especially in connection with the detention of a
parent, can constitute an adverse childhood experience (ACE). ACEs are linked with disrupted
1 Attorney General Jeff Sessions, "Attorney General Sessions Delivers Remarks Discussing the Immigration
Enforcement Actions of the Trump Administration," Speech, May 7, 2018,
https://www.justice.gov/opa/speech/ attorney-general-sessions-delivers-remarks-discussing-immigration-
enforcement-actions.
2 Transcript: White House Chief Of Staff John Kelly's Interview with NPR, NPR, May 11, 2018,
https://www.npr.org/2018/05/11/610116389/transcript-white-house-chief-of-staff-john-kellys-interview-with-npr.
3 Michael E. Miller, "‘They just took them?' Frantic parents separated from their kids fill courts on the border,"
Separation from parents has been shown to be linked with higher rates of PTSD in the affected
children. 7 For children, separation results in a low-support environment which places them at
increased risk of PTSD and depressive disorders. 8 The negative impact on the cognitive and
emotional functioning of the affected children can continue into adulthood, and contribute to
lower academic achievement, attachment difficulties, and poor mental health. 9
Among refugees, one research study shows that individuals separated from their families had
worse mental health outcomes in terms of depression, PTSD, and psychological quality of life
than those who remained with their families, after controlling for trauma. After testing the
contribution of 26 types of trauma to these outcomes, only the experience of being beaten and
tortured had a similar impact on all three mental health measures as family separation. 10
According to the new U.S. policy, children arriving with their parents will be placed in the
custody of the Office of Refugee Resettlement in foster families after separation. However, foster
care is not an appropriate substitute to a child remaining with his or her parents, and studies of
refugee children in foster care have shown that children fare worse when placed in foster
families than when cared for by their parents. 11 Placing these children into foster care will strain
the U.S. child welfare system and set these children up for worsened health and social
outcomes. 12
The best interests of the child is the recognized legal standard for the treatment of children
across a range of domains, including parental custody and immigration proceedings. This
standard requires that children not be separated from their parents except in extreme
circumstances, if required for the child’s protection. Indeed, the literature shows that parents
4 Vincent J. Felitti et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading
Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive
Medicine 14, no. 4 (1998); Debora L. Oh et al., “Systematic Review of Pediatric Health Outcomes Associated with
Adverse Childhood Experiences.” Pediatrics 141, no. 1 (2018).
5 Felice Le-Scherban et al. “Intergenerational Associations of Parent Adverse Childhood Experiences and Child Health
re-settled in the United States,” Archives of Pediatric and Adolescent Medicine 159, no. 6 (2005).
8 Matthew Hodes, “Psychopathology in refugee and asylum seeking children,” in Michael Rutter et al. (eds.), Rutter’s
Implications for policy and practice,” American Journal of Orthopsychiatry, 88, no. 1 (2018).
11 Amy Holtan et al. “A comparison of mental health problems in kinship and nonkinship foster care,” European Child
& Adolescent Psychiatry 14, no. 4 (2005); Geltman et al., “The ‘Lost Boys of Sudan.’”
12 Kym R. Ahrens, Michelle M. Garrison, and Mark E. Courtney. “Health outcomes in young adults from foster care
and economically diverse backgrounds,” Pediatrics 134, no. 6 (2014); Amy Dworsky, Laura Napolitano, and Mark E.
Courtney. “Homelessness during the transition from foster care to adulthood,” American Journal of Public Health,
103, no. S2 (2013).
are a vital buffer for children coping with severe stress. 13 A strong predictor of successful
adaptation for children is family support. 14 Separation from their parents denies these children
this vital resource, leaving them alone to face extremely stressful and likely frightening
conditions. It increases the risk that these children will experience severe and long-lasting
psychological problems, and may even contribute to the development of physical health issues. 15
The United States should follow the “best interests of the child” standard and immediately stop
the practice of forced separation. It should not be U.S. policy to traumatize children, especially
not as a form of indirect punishment of their parents. The intentional infliction of pain on
children and their families is not just inhumane, it also fails to meet the stated goals of
deterrence. Punishing parents with family separation may cause damage to their children, and it
will not change the realities that drove the parents to seek safe haven in the United States.
As experts committed to promoting health and well-being, including of children, we ask you to
immediately end the practice of family separation and take all measures to ensure that currently
separated families are reunited without delay.
Sincerely,
Homer Venters, M.D., M.S., Director of Programs, Physicians for Human Rights, New York
Kerry J. Sulkowicz, M.D., Chair, Board of Directors, Physicians for Human Rights, New York
13 John Bowlby, A secure base: Parent-child attachment and healthy human development (New York: Basic Books,
1988); Steven M. Weine et al. “Fostering resilience; protective agents, resources, and mechanisms for adolescent
refugees’ psychosocial well-being,” Adolescent Psychiatry 4, no. 4 (1988).
14 Tammy Bean et al. “Comparing psychological distress, traumatic stress reactions, and experiences of
unaccompanied refugee minors with experiences of adolescents accompanied by parents,” Journal of Nervous and
Mental Disease 195, no. 4 (2007).
15 Shanta R. Dube et al. “The impact of adverse childhood experiences on health problems: evidence from four birth
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