SAN DIEGO — The line for the free clinic that serves migrant families in Tijuana, Mexico, starts before sunrise.
After the clinic opens, its staff, a mix of employees and volunteers, take patients one by one to tables in an outdoor hallway — a mitigating measure in the ongoing pandemic. Patients needing more in-depth exams are taken to one of the clinic’s two private rooms. Pregnant women meet with midwives in another area.
With Mexico’s already struggling medical system further hamstrung by COVID-19, asylum-seekers who are waiting indefinitely for the United States to begin processing them have turned to Refugee Health Alliance for help with conditions both chronic and acute. But the clinic isn’t equipped to handle the more complex cases it receives or the follow-up care they need.
For the most urgent or severe, the doctors there often have only one option: They refer the patient to attorneys to request special permission to enter the United States based on a serious medical need — a process known as humanitarian parole.
But the outcome is far from guaranteed.
Customs and Border Protection officials at the San Ysidro Port of Entry have denied the majority of their requests, even for urgent medical cases involving children, according to Al Otro Lado, a legal services nonprofit that partners with the clinic to make the requests.
“Who is reviewing these cases? Who’s making these decisions?” said Dr. Hannah Janeway, a Los Angeles-based emergency room doctor who volunteers at the clinic and is one of its co-directors.
Janeway doubted that a doctor is involved.
“If a pediatrician saw this letter, they would say this kid needs to cross the border,” Janeway said, referring to the recent denial of a months-old baby with severe hydrocephalus — an abnormal buildup of fluid in his brain.
CBP did not respond to a request for comment or questions from the Union-Tribune about the humanitarian parole process. When asked about specific cases in the past, the agency has said that it cannot comment on individual requests and has declined further comment on the issue.
Inconsistent results
Though President Joe Biden campaigned on creating a humane asylum system, his administration has left many restrictive Trump-era policies in place. That includes Title 42, which has made accessing asylum screenings nearly impossible for many migrants since the pandemic began.
Under that policy, asylum processing has been closed at ports of entry, and officials have often expelled asylum-seekers who cross between ports without giving the migrants an opportunity to request protection.
Last summer, because of temporary agreements in an ongoing lawsuit against Title 42, attorneys could request exemptions from the policy for people who were especially vulnerable during their extended waits in Mexico, whether for medical reasons or other serious dangers. That exemption process ended in August 2021.
Since then, humanitarian parole has been the only way to ask permission for an asylum-seeker to enter the United States. In that time, Al Otro Lado has sent 185 requests for humanitarian parole, according to attorney Ginger Cline. About 66 percent were denied, 24 percent were approved and the rest are still pending. The results are similar for the cases specific to children with serious medical conditions.
The agency has an especially high rate of denials for Haitian cases that the organization has submitted. Cline recalled submitting three similar cases for children with cerebral palsy who needed urgent medical attention. Two of the three were allowed into the United States. The one who was turned away was Haitian.
“I have been unable to discern any reason why the Haitian child with cerebral palsy was denied,” Cline said. “They don’t provide us any reasoning for the denials or for cases that were approved — and I have asked.”
When Cline got a congressional staffer’s help in inquiring about the Haitian child’s case, she was told that humanitarian parole is discretionary, and there’s no appeal process.
“When I found out that my request was denied, I was really discouraged with life itself,” said Martine Exantus, a Haitian mother whose son has a condition that could cause severe developmental delays if left untreated, through an interpreter from Haitian Creole. “I did not know what to do, and each time I laid my eyes on my child, I could not stop crying.”
Exantus said she was so distraught by the denial that she tried to enter the United States anyway and ended up sent back to Haiti with her child.
“I will not be discouraged,” she said. “I will persevere even more.”
Cline said that her organization spends a lot of time trying to identify which cases are vulnerable enough that they might have a chance. But that filtering is difficult without clear guidance from CBP about whom the agency will accept.
Janeway said that the clinic is very judicious about referring cases to the process.
“We’re not just submitting them willy-nilly,” Janeway said. “We’re treating and managing most people.”
Abandoned by the system
Dr. Psyche Calderon, co-director of the Refugee Health Alliance Clinic, said that in terms of urgent and complex cases among pediatric patients, the clinic’s doctors commonly see children with cancer, growth issues, sickle cell anemia, severe autism, congenital heart issues, pulmonary fibrosis and epilepsy.
Many of these cases require close monitoring by pediatric specialists, she said. But in Mexico’s health system, which has a combination of public and private hospitals, it is very difficult to find that kind of doctor without having work-provided insurance to see private physicians.
“Mexico is supposed to have a free health system, but it’s not,” Calderon said.
The family of the baby with fluid in his brain learned that firsthand.
The boy’s mother, who asked to be identified by only the last name Garcia because of the family’s vulnerable situation, fled her home country of El Salvador after the father of her daughter threatened her repeatedly. At the time, she was in a relationship with a man from Mexico, so the couple decided to try to make a life for themselves in his home country along with her daughter, who is now 7.
When their son was born in Mexico prematurely and with hydrocephalus, insurance from the man’s work provided access to specialty treatment with a pediatric neurosurgeon. But the couple’s relationship grew strained, Garcia said. After they separated, the man abandoned his son and cut off the insurance.
The doctor told Garcia that her son could no longer receive care. She ended up at Refugee Health Alliance, where Janeway, knowing that there was no way to give the boy the care he needs in Mexico, referred her for humanitarian parole.
“A child like this needs to be followed very closely by a pediatric neurosurgeon,” Janeway said. “In my time working in Tijuana on these cases, I have never been able to obtain pediatric neurosurgical consultations for patients who need it.”
If the fluid builds up too much, the neurosurgeon would have to intervene and put in a stunt, Janeway said. Otherwise, too much pressure from the fluid can cause brain damage or even death.
A friend in Los Angeles is willing to take in her family, Garcia said, so that her son can get the care he needs and she can apply for asylum. Women who faced domestic violence in countries where those crimes are not punished can win asylum in the United States, though the cases are often complex.
CBP denied the Garcia family’s humanitarian parole request. Garcia found out one morning in December from a long WhatsApp message sent by her attorney. When she read it, she couldn’t stop crying, she said.
“I can’t explain the disappointment I felt,” she said in Spanish. “It was my only hope to be able to go, and my children are in danger. I live with this every day. It’s a big worry.”
“I feel like I’m with my back against the wall,” she added. “I can’t go back, and I can’t go to the United States.”
Lack of access
Children’s conditions can deteriorate very quickly when they have severe and chronic medical needs, Janeway said.
Janeway gave the example of Carlitos, a young boy who was diagnosed with a type of cancer that couldn’t be treated in Tijuana. When the legal team submitted his humanitarian parole request, he was moving and playing. CBP didn’t respond to his request for more than a week until shortly after the San Diego Union-Tribune inquired about the delay in his case, and in that time, he ended up hospitalized and nearly died.
After being transported via ambulance across the border and airlifted to a hospital, Carlitos received the treatment he needed and is doing much better.
Even chronic conditions such as asthma can be especially lethal for migrant children stuck in Tijuana because of the lack of access to care, Janeway and Calderon said.
The general hospital in Tijuana is being used for COVID-19 patients, so a child having an asthma attack would be redirected to hospitals in Rosarito or Tecate — both more than 40 minutes away. Asthma can kill a child in the time it takes to get to those hospitals, Janeway said.
That’s one of the concerns for another family whose request was denied by CBP.
Ashlie, the mother in that family, said that when she tried to get help for her 9-year-old son, she was turned away from one Tijuana clinic because she was foreign.
She and her family fled El Salvador several years ago. They tried initially to live in Mexico, but after several traumatic experiences — including being kidnapped — they’ve decided that the country is not safe for them.
“I feel that because we’re foreigners, everyone abuses us,” Ashlie said in Spanish. She asked that only part of her name be used because her family is still in danger.
Ashlie has epilepsy, which was also part of the reason for her family’s request. She said she doesn’t like to talk about her own medical concerns in front of her children. A document provided by Al Otro Lado indicates that she has had at least seven seizures in the past year.
She spends most of her time worrying about her son. Every time he gets sick, his asthma flares up, she said.
About a month ago, she had to borrow money — roughly $90 U.S. — to get him a nebulizer. She’s still paying that loan back.
