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“You Will Never See Your Child Again”: The Persistent Psychological Effects of Family Separation

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Physicians for Human Rights
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By Hajar Habbach, MA, Kathryn Hampton, MSt, and Ranit Mishori, MD, MSH

Asylum-Seeking Families Separated by U.S. Government Experienced Torture, PHR Concludes in New Investigation

Forcibly separated children and parents suffer PTSD, depression, anxiety

A new investigation by Physicians for Human Rights (PHR) documents evidence of severe psychological trauma among children and parents who were separated at the U.S. southern border by the U.S. government.

According to PHR’s report, based on in-depth psychological evaluations of 26 asylum seekers (nine children and 17 parents), the U.S. government’s forcible separation of asylum-seeking families constitutes cruel, inhuman, or degrading treatment and, in all cases PHR evaluated, meets criteria for torture.

The practice of forced family separation specifically as a means of deterring migrants from coming to the United States was secretly piloted by the Trump administration in 2017 and ramped up along the southern border from April to June 2018, before it was halted by a court injunction. However, family separation has continued, and many families are yet to be reunited, according to government statistics.

The new PHR report, ‘You Will Never See Your Child Again’: The Persistent Psychological Effects of Family Separation, provides the first medical and psychological evidence of the long-lasting harm associated with family separation. It is the first analysis to date that relies on medical-legal affidavits written by medical experts based on in-depth psychological evaluations of asylum-seeking children and parents. These asylum seekers fled their countries of origin (El Salvador, Guatemala, and Honduras) in search of refuge in the United States, only to be forcibly separated at the border before June 26, 2018 and sent to detention facilities hundreds or thousands of miles away from family members.

PHR’s unique cohort revealed that all separated children (9) and all but two of the adults (15 of 17) who were evaluated met diagnostic criteria for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), or generalized anxiety disorder (GAD) – diagnoses which independent clinicians assessed as being highly consistent with and linked to the experience of family separation. While this study focuses on the experience of a limited group of people, the narratives of the 26 individuals evaluated help illustrate the experiences of other families who endured separation under Trump administration policy.

In line with the definition contained in the United Nations Convention Against Torture, PHR experts concluded that U.S. officials intentionally carried out discriminatory actions that caused severe pain and suffering, in order to punish, coerce, and intimidate Central American asylum seekers to give up their asylum claims. PHR also finds that family separation as implemented was a form of temporary enforced disappearance, which occurs when the state conceals the fate or whereabouts of a person who is deprived of liberty.

“The cases of family separation PHR documented represent a form of torture by the U.S. government,” said Ranit Mishori, MD, report co-author and PHR senior medical advisor. “Even when evaluated by medical professionals a year after being reunited with their families, these kids and parents still exhibit signs of compound trauma, including PTSD, depression, and anxiety.”

Despite broad public outcry in recent years, separation of asylum-seeking families in the United States continues to date. More than 1,110 families have been separated since the nationwide injunction on June 26, 2018 which halted separations, according to government numbers provided to the American Civil Liberties Union. A total of 5,512 children have been separated from their families since July 2017.

“Our findings provide compelling evidence of the adverse and long-lasting mental health effects associated with family separation forced by the Trump administration,” said Dr. Mishori.

Due to targeted acts of violence in their home countries, the families PHR evaluated arrived at the border with trauma exposure from death threats, physical and sexual assault, relatives having been killed, and extortion, mostly due to gang activity. PHR’s report – through the narratives of these individuals – describes how, shortly after migrants’ arrival in the United States, immigration authorities forcibly removed children from their parents’ arms, removed parents while their children slept, or simply “disappeared” the children while their parents were in courtrooms or receiving medical care.

According to the medical-legal affidavits analyzed by PHR, most families did not receive any information as to why they were being separated, where their family members were being sent, and if or how they would be reunited. Children were often sent to detention facilities in different states than their parents.

The report documents instances of cruelty toward these families, such as officials telling parents that “you will never see your child again” or telling a young girl that if she did not “behave” she would never see her mother again. Families also reported terrible conditions in detention, including overcrowding and mistreatment. One child reported being hit with shoes by staff in a detention facility.

The PHR report also outlines how the Department of Homeland Security had no plan in place to reunite families, and the eventual reunions that did take place were haphazard and chaotic.

“U.S. officials operated under the guise of legality while depriving parents and children of their right to family integrity. They intentionally caused severe harm, in order to punish asylum seekers and coerce them into dropping their asylum claims,” said Kathryn Hampton, report co-author and PHR senior asylum officer. “The U.S. government must uphold domestic and international law by fulfilling its obligations to provide reparations to victims of torture, including mental health treatment, to those affected by this repugnant policy.

“Family separation has not ended, nor have all separated families been reunited,” said Donna McKay, PHR executive director. “We call on the Trump administration to immediately reunite families, including deported parents, and end this deplorable family separation practice for good.”

The 20 PHR clinicians who interviewed the asylum seekers – including psychiatrists, psychologists, pediatricians, and other mental health professionals – documented nearly every parent as exhibiting symptoms and behaviors consistent with trauma and its long-lasting effects: being confused, upset, and worried, frequent crying, sleeping difficulties and nightmares, severely depressed and anxious moods, and physiological manifestations of panic and despair. The evaluating clinicians noted that the children exhibited reactions that included regression in their age-appropriate behaviors, inability to hold urine, crying, not eating, and nightmares and other sleeping difficulties, as well as clinging to parents and feeling scared even following reunification with parents.

The vast majority of mental health diagnoses (PTSD, MDD, and GAD) given by the evaluating clinicians are highly consistent with the effects of the trauma recounted by the parents and children during detention and family separation. The clinicians recommend that nearly all parents and children evaluated receive therapeutic support, including psychotherapy, removal from detention, and/or psychiatric medications.

“The seven-year-old girl I interviewed displayed some of the most inhibited behavior on a drawing task that I’ve ever encountered in my 20 years of child psychiatry,” said Stuart Lustig, MD, a child psychiatrist who conducted one of the evaluations that informed the report. Dr. Lustig has conducted numerous forensic evaluations for asylum seekers and is a PHR expert trainer in this subject. “She displayed hallmark features of Separation Anxiety Disorder, including a level of inhibition that is very consistent with high levels of deep-seated anxiety, likely associated with the trauma of family separation.”

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.