Women, infants, toddlers, and the elderly packed and even piled on top of each other in a cold, windowless, concrete room—so many bodies you can’t see the floor. Open toilets in crowded cells without any privacy. Visibly sick children coughing on one another. Hanging over it all: the recent death of a seven-year-old girl.

I will never forget what I saw at the border patrol facility in New Mexico where seven-year-old Jakelin Caal was detained and spent her final hours. As an emergency physician, international humanitarian specialist, and an American, I was outraged by what I saw.


A 35-day government shutdown has yet to yield real solutions to the humanitarian crisis that cost Jakelin Caal her life. That isn’t how our nation was founded. It was founded on the belief that through rigorous debate and exchange of ideas, we can work together to move our nation forward. That’s why I joined Democratic leaders and the Congressional Hispanic Caucus to introduce legislation directing U.S. Customs and Border Patrol (CBP) to implement a set of minimum humanitarian standards for the treatment of individuals in CBP custody that respects human dignity. These common-sense reforms are crucial to ensuring the safety of our agents and the individuals in their custody.

Caring for children in life or death situations isn’t new to me: I’ve treated them as a physician in emergency departments, as medical command in pre-hospital situations, and as a first responder to humanitarian disasters around the globe. I travelled to Haiti immediately after the devastating earthquake in 2010, where I worked alongside the 82nd Airborne Division as the medical director of the largest camp of internally displaced people in Pétion-Ville, Part-au-Prince. Yet here, in the wealthiest nation on earth, the conditions I saw on my visit with the Congressional Hispanic Caucus were worse than those I saw in Haiti, the most impoverished country in the Western Hemisphere, after their most challenging and devastating disaster.

The U.S. Border Patrol facility in Lordsburg was under-staffed, underequipped, and unprepared to provide meaningful health screenings, let alone emergency medical services. The lack of privacy and equipment was dehumanizing. A hard, tiny utility table in a storage space served as Jakelin’s resuscitation bed. The facility lacked life-saving equipment and basic medications for infants and toddlers. And agents relied on spotty cell phones to directly contact emergency response teams.

Let me be clear: these deficiencies put children and our agents at risk. Both are endangered by a lack of access to emergency medical services. It is my opinion as a public health expert that if border personnel had the necessary resources, training, and medical back-up, we could have detected Jakelin’s illness earlier and most probably saved her life.

Our American values, moral conscience, and our constitution require us to create a basic set of uniform, humanitarian standards to guide the way we care for detained children who cross our borders. The legislation I spearheaded will direct CBP to implement three of the most urgent improvements needed at our border facilities.

First, we need meaningful medical examinations of asylum-seekers entering our borders—especially for vulnerable populations like women, children, the elderly and the disabled. That requires an initial medical screening including a basic physical exam and vital signs to identify risks, signs, and symptoms of life-threatening vulnerabilities. Jakelin received none of these things: only a cursory question to her father in a language he didn’t understand. Otherwise, she would have most likely presented with warning signs as a prelude to her fatal septic shock. Children don’t look well eight hours before dying of sepsis.

Second, we need emergency medical equipment and trained medical personnel available to respond to emergencies at the border. When medical care is so far away, as is often the case at the border, agents need the resources, equipment, and knowledge to administer emergency care not only to migrants, but to their fellow agents.

Third, we need to provide humane living conditions that are safe and hygienic. According to CBP’s own officials, the agency has substantial work to do to adapt to the increase of families in its custody: that starts with accessible food, water, and sanitation appropriate for women and children.

These are straight-forward reforms based on my experience working in the emergency department and alongside Disaster Medical Assistance Teams and the U.S. Army in Haiti. They will bring humanity back to our treatment of women and children seeking asylum and prevent needless loss of life.

I’m a doctor with twin three-year-old daughters. As a physician, the death of a child is your worst fear. As a parent, it’s your worst nightmare. Passing meaningful legislation is how we restore American values to our care for children. We have the blueprint: now it’s time for action to save the lives of children at the border.

Ruiz represent the 36th District of California.