U.S. Border Expulsion Policy Results in Family Separations, PTSD, Human Rights Violations: PHR Report

A new investigation by Physicians for Human Rights (PHR) documents the severe health and human rights tolls of the Title 42 border expulsion order, under which the United States government has expelled children and adults seeking refuge at the U.S. border nearly one million times since March 2020.

"Neither Safety nor Health: How Title 42 Expulsions Harm Health and Violate Rights" exposes some of the consequences of the expulsion policy, including family separations, abusive actions by U.S. and Mexico government officials, and acute medical and psychological impacts on asylum-seeking children and adults. Based on in-depth interviews conducted in Ciudad Juarez and Tijuana, Mexico in May 2021 with 28 expelled asylum seekers and six health professionals who provide medical care to migrants, the report underscores the dire consequences of the Title 42 ban and the urgency for the Biden administration and the Centers for Disease Control and Prevention (CDC) to revoke the order.

Despite the order being implemented under the guise of a COVID-19 pandemic safety measure, public health experts have long objected to Title 42 expulsions and called out the lack of epidemiological evidence to justify banning only asylum seekers to the United States while keeping the borders largely open to other travelers. Although the ban was conceived by Trump administration officials, the Biden administration continues to expel hundreds of thousands of families and adults to countries where they face severe harm and persecution, violating their rights, threatening already traumatized people, and failing to protect public health.

In a first-of-its-kind approach to documenting the psychological effects of these expulsions and family separations, PHR researchers used validated Spanish-language screening tools to screen participants for mental health symptoms, including the PCL-5 Civilian scale for post-traumatic stress disorder (PTSD) symptoms, and the Hopkins Symptom Checklist (HSCL25) for anxiety and depression symptoms. Of the 26 participants who were administered validated screening tools, 96 percent screened positive for at least two disorders, and 88 percent screened positive for PTSD, anxiety, and depression. Parents interviewed by PHR reported that the family separations produced by Title 42 expulsions caused severe psychological harms to their children, resulting in excessive crying, disturbed sleep, and developmental setbacks such as resuming bed wetting. Eleven interviewees stated that their children were not eating and had lost significant weight due to the trauma of family separation.

The PHR report also sheds new light on abusive and dangerous actions by U.S. officials during the expulsion process. All 28 asylum seekers interviewed described gratuitously cruel and inhumane treatment at the hands of the U.S. government, including physical and verbal abuse by border agents, inhumane detention conditions, active deception about their expulsion and the whereabouts of their family members, and unsafe returns that put people at great risk of harm. Of those interviewed by PHR, 11 people were forcibly separated from family members by U.S. officials and eight people were separated from family members they traveled with who were not their biological children, but for whom they were the primary guardian (such as younger minor siblings or nieces and nephews). Asylum seekers reported that U.S. border officials also deceived and actively provided false information to them, such as telling people they were being reunited with family members while actually separating them.

These accounts reflect how the Title 42 order both directly and indirectly separated families without considering the best interests of the child during the separation process, increasing the trauma and vulnerability of family members. Family support is a critical resilience factor for children and separations have been associated with long-term adverse mental health outcomes.

After being expelled across the U.S.-Mexico border, asylum seekers interviewed by PHR reported that they had been assaulted, kidnapped, extorted, and subjected to physical and sexual violence in Mexico. Interviewees reported that they did not have access to state protection from Mexican authorities, and several were even robbed or extorted by Mexican authorities after they were expelled from the United States.

"U.S. policy is ensnaring people in a deadly dilemma, where they are unsafe in their home country, unsafe in Mexico, and yet unable to seek safety at the U.S. border," said Michele Heisler, MD, MPA, report co-author, medical director at PHR, and professor of internal medicine and public health at the University of Michigan. "From a public health perspective, the Title 42 order was junk science from the moment it began. Rather than protect anyone's health, these expulsions accelerate a health and human rights emergency in Mexican border cities.

"Since the beginning of the pandemic and with the rise of new COVID-19 variants, the best way to protect public health remains vaccines, masking, and social distancing - not a targeted and unscientific ban on asylum seekers," said Dr. Heisler.

A letter from public health experts, including Dr. Heisler, to the Biden administration in July 2021 reiterated that the latest scientific knowledge regarding transmission of the virus that causes COVID-19 did not support expulsion as a public health measure, and that the order undermined trust in the CDC itself as a scientific body.

"The United States has the means and the know-how to process asylum seekers safely at the border and to welcome them with dignity, but every day the Biden administration instead chooses to condemn people to kidnappings, extortion, and violence in northern Mexico," said Cynthia Pompa, report co-author and asylum program officer at PHR. "Asylum seekers told us searing accounts of being separated from family members, brutalized by U.S. officials, and abused by Mexican authorities. Title 42 expulsions are nothing short of a human rights catastrophe and, by continuing them, the Biden administration is responsible for devastating harms to children and adults who are fleeing persecution."

"U.S. officials actively deceived people about their expulsion and family separation, while denying them access to basic information, such as where they were being transported, where their family members were, and what was happening to them," said Kathryn Hampton, report co-author and senior asylum officer at PHR. "Title 42 expulsions are a flagrant violation of people's rights under both the U.S. Constitution and multiple international treaties. With each passing day, the Biden administration is trampling on its professed commitment to science-based policymaking and a humane immigration system. The administration must stop playing politics and start saving lives: Revoke the Title 42 order now."

"Our findings make it clear that the Biden administration's recent announcement that it will expedite removal of some asylum-seeking families from the United States without a hearing in front of a judge will only increase the vulnerability and risks of harm for children and adults. This change will result in wrongful removals and undermines efforts to create a humane, safe, rights-respecting asylum system," said Hampton.

PHR is calling on the Biden administration and the CDC to immediately nullify the Title 42 expulsion order and restore access to asylum at the border by working with public health experts to ensure that border COVID-19 screening guidelines are implemented in line with scientific evidence and U.S. asylum laws and treaties. The PHR report provides detailed recommendations for the CDC, Department of Health and Human Services, U.S. Congress, and government of Mexico to safeguard the health and human rights of people who seek asylum in the United States.

Read the full report here.