Demand for medical access for individuals held in de jure detention pursuant to the Migrant Protection Protocols

Last week, news outlets around the country reported on the death of a 16-year-old Guatemalan boy, Carlos Gregorio Hernandez Vasquez, while in Customs and Border Patrol (“CBP”) custody. People have been understandably outraged over the lack of medical attention and basic human compassion given this obviously ill child in US government custody. This outrage is justified, and should be even greater given that thousands of additional migrants are effectively being denied basic humanitarian support by virtue of the Trump Administration’s Migrant Protection Protocols (“MPP”). Also known as “Remain in Mexico,” this policy has created a dire humanitarian situation for nearly 70,000 people. Under MPP, asylum seekers are forced to live in Mexico while awaiting their immigration court proceedings. Many have set up a de facto refugee tent camp on the banks of the Rio Grande in order to stay near the bridge where they cross to attend their court hearings. These asylum seekers are routinely denied access to medical care, even in the most dire of circumstances, and are routinely victims of the cartel violence so prevalent in this very dangerous part of Mexico.

The Trump Administration's guidance with respect to MPP indicates that "individuals from vulnerable populations may be excluded on a case-by-case basis." Since MPP was implemented in the Rio Grande Valley in late June 2019, border patrol agents have routinely recognized certain individuals with emergency medical conditions as being "vulnerable populations" and have taken them into custody in Brownsville when their medical conditions were such that the limited resources in Matamoros were unable to serve them. Although this process was stressful and time-consuming, individuals with serious medical conditions--paralysis resulting from stroke, advanced pregnancy, serious flu, et cetera--have until recently been able to receive adequate medical care in Brownsville after obtaining these MPP medical exceptions. 


Earlier this week, border patrol officers in Matamoros informed health care workers that CBP will no longer be observing the medical emergency exception guidance provided within the Department of Homeland Security's MPP implementation documents. As a result, the little girl who is the subject of the attached letter was initially prohibited from crossing to Brownsville to obtain medical care for her serious condition. No medical professional in Matamoros is capable of treating her.


After several hours of advocacy, the girl and her mother were temporarily able to be evaluated by  emergency physicians in Brownsville. However, they were returned after just five hours and are now living without access to basic hygiene and food and water, not to mention adequate medical support. Without this medical support, the girl's condition will likely worsen and could lead to her death. She and her mother must be recognized as "individuals from vulnerable populations" and must be provided with an exception to MPP given her medical emergency. Instead of following their own rules and conducting a medical evaluation, CBP interviewed the family about fears of returning to Mexico then returned them to live on the streets of Matamoros.  Moreover, there must be standards of care implemented and consistent policies for treating people held in the MPP program.


The individuals detained in Mexico under MPP cannot be left to die in de jure U.S. government custody. It is incumbent on the U.S. government to provide these individuals with a high standard of medical care as it is for them to provide services to immigrants held in U.S.-based detention centers. 

We demand that the Department of Homeland Security issue guidance to its CBP agents at the Brownsville Port of Entry with respect to emergency medical exceptions and that this border crossing cease prohibiting individuals with life-threatening conditions and illnesses from obtaining the medical care in the U.S. they need to survive. Allowing someone to die in a cell is no different than forcing them die in a tent.

-Project Adelante

-Lawyers for Good Government

December 15, 2019

We, the undersigned, are physicians and lawyers, and we believe that it is medically necessary for Ms. Ajlee Nicole L M, a 7 year old female from Honduras, to be exempted from the Migrant Protection Protocol program and allowed access to the medical resources in the United States available to other detainees seeking asylum, for her survival.  She has been found to have an enterocutaneous fistula, which is a connection from her intestines (specifically, her colon) to her skin, which causes leakage of stool to the outside of her body. This is very dangerous for her health as can lead to potentially fatal complications such as infection and rupture.

Mortality from enterocutaneous fistulas is most commonly from sepsis, malnutrition, and fluid/electrolyte imbalances, all of which must be addressed in a hospital setting not available to her in her current setting.  This child was initially presented by Global Response Management and Lawyers for Good Government on December 11, 2019, assessed by an emergency room physician at Valley Baptist Hospital in Brownsville, TX, but subsequently returned to Matamoros merely five hours later despite the fact that she lacks access to the necessary medical infrastructure while living in the makeshift refugee camp. With absolutely no access to hygiene, she will likely become septic. 


We demand that she be allowed into the United States to receive the necessary care at a hospital with pediatric surgical facilities on an urgent/emergent basis. 


This is our professional opinion.  We believe the time to act is now.

-Project Adelante

-Lawyers for Good Government

December 13, 2019