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Despite the consistent outcry of advocates, physicians, lawyers, and other human rights professionals, millions of newly arrived children in the United States have experienced and continue to experience life-altering and traumatic separation from their parents during their migration journey. Separation may occur premigration, during migration (such as during apprehension by border patrol), and postmigration. All forms of separation have implications for the child's health, with potential lifelong developmental, mental, and physical health sequelae.
Premigration separation occurs when a child migrates unaccompanied. According to the Office of Refugee Resettlement (ORR), more than 100,000 unaccompanied children (UCs) are referred to the ORR annually.1 These numbers have steadily increased during the last decade, with 13,625 children referred in 2012.1 Historically, most UCs originated from Honduras, Guatemala, and El Salvador, with a relatively steady, smaller proportion from Mexico.2 Of note, the reported numbers from Mexico are unlikely to be a full representation because many children are returned to Mexico shortly after coming into US custody. In recent years, the data indicate a shift, with most UCs still coming from Guatemala (42%) and Honduras (28%), but with decreasing proportions coming from El Salvador and increasing proportions coming from what is reported as “other” countries.2 Although most UCs are at least age 13 years, a striking 19% in 2023 were age 12 years or younger.2 Children as young as age 6 years have been reported.3
Although some UCs may be considered “runaways,” most are actually sent by families in dire situations who have made the heartbreaking determination that sending their child to flee alone is safer than staying put.4 Children may migrate alone or with a smuggler. Factors influencing the decision include persecution, violence (including from gangs and war), abuse, climate crisis–induced displacement, and severe economic hardship.5 UCs are uniquely vulnerable: an estimated 75% to 80% are victims of trafficking.4
Separation also occurs at the border when families are apprehended by US Immigration and Customs Enforcement. Historically, under former President Donald Trump's administration “zero tolerance” policy, families were apprehended, and children separated and sent to various ORR shelters. In these shelters, basic human needs were often not provided, and children suffered additional abuse, trauma, and even death.6 Furthermore, when the...