Asylum-Seeking Children from Northern Triangle Suffer Multi-Dimensional, Recurrent, Sustained Trauma

Since 2014, the number of children arriving at the U.S. border has risen dramatically, as unaccompanied children, adolescents, and young families have fled gang and other forms of violence in the Northern Triangle countries of El Salvador, Guatemala, and Honduras. In a new report, "There Is No One Here to Protect You: Trauma Among Children Fleeing Violence in Central America," Physicians for Human Rights (PHR) presents the first case series of child and adolescent asylum seekers arriving in the United States, detailing their trauma experiences and resulting negative health outcomes. The report demonstrates the acute physical and psychological impact of domestic, gang, and gender-based violence on these children, as well as the failure of authorities in their home countries to provide effective protection or to prosecute abusers. The findings in this report and the relevant legal standards demand an effective and humane policy response both in countries of origin, to prevent the violation of child rights, and in the United States, to fairly recognize claims of persecution and end practices that expose these young migrants to further trauma.

The report is based on forensic evaluations of 183 individuals age 18 or under conducted by PHR's Asylum Network, a national network of expert volunteer clinicians who evaluate individual cases of physical and psychological trauma from torture or persecution experienced by asylum seekers involved in U.S. immigration proceedings. The report's findings identify the features of an escalating child rights crisis, from persecution in countries of origin to compounding trauma experienced by the children while in transit and at the U.S.-Mexico border.

"Children are being met at the U.S. border with harsh, punitive policies that both violate their rights and severely affect their wellbeing," said Kathryn Hampton, PHR's network program officer, who coordinates the Asylum Network. "U.S. immigration officials have justified such policies in the name of deterrence. However, if violence is a major factor driving children to seek refuge in the United States - as demonstrated by the people PHR's clinicians evaluated, and whose cases were utilized for this study - harsh border enforcement will not serve as an effective deterrent and will only cause more harm to an already traumatized population."

The report analyzes data from child and adolescent asylum seekers who recount experiences of extreme violence and sexual abuse at the hands of gangs, family members, and even law enforcement in their home countries. Children reported being forced to join gangs or be murdered, told to kill their families if they did not want to be killed by gang members, or forced to endure sexual assault at the hands of gang members or their own family members. With states' consistent failure to protect children, investigate crimes, or prosecute or punish perpetrators, and the existence of both gang intimidation of police as well as gang infiltration into the police, the children expressed fear and lack of trust in local authorities.

One young woman "reports having been beaten all over her body including her head, being dragged through the woods, being tied to her friends, blindfolded and raped by multiple people."

Among the children evaluated, the vast majority were from the Northern Triangle countries (89 percent). 78 percent of the children evaluated reported that they survived direct physical violence. Eighteen percent reported surviving sexual violence, 71 percent experienced threats of violence or death, and 59 percent witnessed acts of violence. This violence was most often gang-related (60 percent), but a significant portion of children (47 percent) faced violence perpetrated by family members. PHR's clinicians documented negative physical aftereffects of this abuse, including severe head injuries and musculoskeletal, pelvic, and dermatologic trauma. More than three quarters (76 percent) of children were suspected to have or were diagnosed with at least one major mental health issue, including post-traumatic stress disorder (64 percent), major depressive disorder (40 percent), and anxiety disorder (19 percent). These statistics show that these children experience not only experience high rates of trauma, but often are subjected to multiple forms of trauma by multiple perpetrators. These results add additional context for the extraordinary suffering and abuse described in our qualitative findings.

PHR's research shows that children arriving in the United States are fleeing severe forms of harm which may amount to persecution if their home government is unable or unwilling to control the perpetrators, and if their persecution is based on their race, religion, nationality, political opinion, or membership in a particular social group. In accordance with international and U.S. law, people with a credible fear of persecution arriving at the U.S. border have the legal right to apply for asylum. Child asylum seekers are entitled to additional protections, including accommodations in the asylum process which consider their level of development and maturity and their specific health and mental health needs.

Dr. Joseph Shin, co-medical director of the Weill Cornell Center for Human Rights, said that obtaining asylum in the United States offered significant relief for children. "Despite the extreme trauma these children have experienced, and the resulting developmental, psychological, and physical harm, many demonstrated remarkable resilience and significant physical and psychological improvement once they were safe from physical harm and had the opportunity to begin rebuilding their lives in the United States."

The report includes comprehensive recommendations to U.S. government agencies, Congress, the governments of Northern Triangle countries, international refugee and migration bodies, and international bodies mandated to protect children's rights.

PHR advises the U.S. administration to safeguard access to asylum in order to meet immediate protection needs of asylum seekers, as well as maintain aid to Northern Triangle countries to address gang-related violence, corruption, and impunity. PHR calls on the administration to ensure that all children receive pediatric medical screening on arrival and uphold child protection standards in custody, prioritizing least restrictive settings and increasing use of alternatives to detention. It is not safe for any child to be detained for longer than 24 hours in Customs and Border Protection holding cells. Children should be transferred to enhanced reception centers with access to appropriate medical care and other essential services, from which they should be released within 20 days as per the Flores settlement agreement.

PHR calls on the governments of El Salvador, Guatemala, Honduras, and Mexico to ensure resources for violence prevention measures as well as resources to investigate, prosecute, and punish violent acts committed by state and non-state actors, while ensuring due process protections for the accused, and establishing or maintaining independent investigatory bodies to address corruption and impunity.

The remainder of the recommendations can be found in the report.