Photo by Sgt. 1st Class Gordon Hyde – http://www.ngb.army.mil

For various reasons, unaccompanied children try to cross the border into the United States on a regular basis. The federal government has a standard process in place for addressing the needs of these children, transferring them from Customs and Border Control (CBP) facilities to shelters run by the Administration for Children and Families Office of Refugee Resettlement (ORR), which is located in the U.S. Department of Health and Human Services (HHS), until they can be released to a sponsor, typically a parent, relative, or family friend. However, in recent months the United States has witnessed a large of influx of children entering the country unaccompanied by adults. As of July 31, the number of unaccompanied children attempting to cross the southwest border has doubled compared to last year. At the peak of this influx, authorities were encountering 400-500 children per day.

HHS, charged with maintaining the health and safety of this highly vulnerable population, has had to surge its normal activities to appropriately work with the unusually high number of children. Usually, these children are housed in temporary shelters in Texas. The number of children has exceeded the capacity of these shelters, however, resulting in the need to use beds in military bases and to open additional temporary shelters in other areas of the country. Local citizens have expressed concern about the effects of having these shelters located in their communities and whether there will be financial or public health-related ramifications. Local health departments and other community organizations can play a positive role by helping their communities to better understand the situation, communicating accurate information, and clarifying common misconceptions.

No matter where the shelter is located, HHS/ORR has full responsibility for the health and well-being of the children staying there. While the children are given an initial basic health screening at the CBP facilities where they are initially detained, ORR provides them with a more comprehensive screening when they reach the shelter. Children without vaccination records are fully vaccinated through the Vaccines for Children (VCF) program. Children are also screened for a wide range of communicable diseases, including tuberculosis (TB). Any children found to have communicable diseases are separated from the other children and treated as needed, and the cost of their medical care is fully paid by the federal government. If costs are incurred by local healthcare facilities, the federal government will reimburse them.

Because the children in ORR shelters are heavily supervised and do not interact with the residents of the communities in which the shelters are located, there is a low risk that they will spread any diseases they may have to the general public. The primary health risks in this situation are those faced by the children themselves, who comprise a highly vulnerable population. Health issues most commonly identified in the children crossing the border are tied to the difficulty of their journey and crowded and unsanitary conditions they experienced before arriving in the United States. Scabies, lice, rashes, respiratory infections, and diarrhea are most common. Small numbers of children have been found to have chickenpox, seasonal influenza, pneumonia, and TB.

Because HHS has assumed complete responsibility for the care of these children, there is no need for local response efforts at this time. However, if a shelter opens in your community, the local health department can assist through outreach and communication efforts that clarify misconceptions and support the provision of care for this highly vulnerable population. The following information, provided by HHS, may be useful for public health-related communications efforts:

• If the federal government is considering opening a shelter in your state, they will notify the state health department in advance.
• ORR provides and assumes the cost of all services for the children while they are in a shelter, including food, clothing, education, medical screening, and any needed medical care, including vaccinations. Any costs incurred by local healthcare facilities will be reimbursed by the federal government.
• If a child in an ORR shelter is sick, there is little risk that the disease will spread to the local population. Children are supervised at all times while at the shelter and are not released to sponsors if they have medical conditions that could be considered public health threats.
• All notifiable conditions identified in the children, such as TB, will be reported to the state health department. No serious diseases, such as multi-drug resistant TB, unusual flu viruses, dengue fever, or Ebola have been identified in unaccompanied children crossing the border.
• If a child does require medical care, ORR shelters may reach out local health departments or hospitals for assistance (though not financial assistance) with obtaining treatment.
• Children spend 35 days on average in ORR shelters before being released into the care of a sponsor. Once in the care of a sponsor, the children may enroll in community schools and require the support of the community to recover from their difficult journey.

For more information on the unaccompanied children program:

• HHS Office of Refugee Resettlement: About Unaccompanied Children’s Services
• HHS Administration for Children and Families: Frequently Asked Questions