Undocumented children need charitable help: Column

The justified outrage over detained minors in California, Oklahoma and Texas has focused the nation's attention on what is only the tip of the iceberg. While the number of apprehended, unaccompanied Central American children could reach 90,000 this year, an estimated 1 million undocumented children already live among us.

But this is not just a Southwestern story. In New York and other cities with large immigrant communities, newly arrived children are desperate for medical attention, legal services, and help finding family members.

Ask pediatrician Alan Shapiro, medical director of Children's Health Fund's Montefiore-based medical programs for highly disadvantaged kids in New York City. In cooperation with Catholic Charities New York, he recently co-founded Terra Firma, an innovative medical-legal partnership designed to meet the complex medical, psychosocial, and legal needs of unaccompanied minors. "Their life experience is marked by multiple traumas in their home countries, on their journey north and here in the U.S.," Shapiro explains. "As a society, it is our responsibility to heal them, not to compound the trauma."

"Tomás," a teenage boy participating in a support group at Terra Firma's south Bronx clinic, recently showed Shapiro a photo of a relative who had been killed as punishment for not joining a Central American gang. When the pediatrician asked who else has seen anyone killed, all hands were raised. Needless to say, this is part of a humanitarian crisis rooted in severe international poverty.

Predictably, Tomás suffered from severe post-traumatic stress disorder, which in his case manifested as depression, frequent nightmares and insomnia. But thanks to the care he (and the other kids lucky enough to have found Terra Firma) is receiving, Tomas is now going to school, learning English, and working.

But what about the tens of thousands of other young unaccompanied immigrants who need help and a chance to grow up without fear and with a plausible opportunity to, one day, live normal lives?

First, many more service programs are needed to deal with the immediate medical- legal crises facing these kids. In fact, right now, excellent care is being provided by the U.S. Public Health Service and other private, voluntary efforts around the country. But they are only dealing with a fraction of the need.

In addition, there are two domestic policy changes that could alleviate massive suffering: include undocumented children of all ages in Obamacare and make targeted changes to immigration law that will create a safe haven for kids like Tomas.

When, in 2010, the Affordable Care Act excluded undocumented immigrants from the provision mandating health insurance for all, a major gap was created in the safety net for 1 million children, most of whom already shouldered unconscionable health risks because of severe poverty. We are only beginning now to tabulate the exorbitant cost of leaving so many uninsured — billions of dollars in emergency room visits and even more from missed opportunities in preventive care. Some states have dealt with this challenge on their own.

In New York, for instance, children are covered under the state Child Health Plus program regardless of immigration status. But this is not the case in most states.

And for those worried about runaway health care costs, it must be noted that care for children represents a minimal percentage of our nation's health care budget, and, furthermore, costs spike when you don't treat kids. Confronting tuberculosis before it spreads, for example, not only saves money for that child's care but for that of all of his or her schoolmates who might otherwise catch the disease.

Immigration advocates have put forth some common sense ideas that could shield vulnerable children through a few relatively straight-forward strategies. For example, the courts or Congress could revise eligibility rules for asylum to include those fleeing gang violence, now at epidemic proportions in El Salvador, Honduras and Guatemala.

Yes, we do have a crisis involving vulnerable children now in the U.S., but we have the capacity to do the right thing — if we have the will to act quickly and respond effectively. Isn't that the American way?

Irwin Redlener, MD, is president and co-Founder of the Children's Health Fund and director of the Program on Child Well-Being and Resiliency at Columbia University's Earth Institute

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