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was originally reported by Barbara Rodriguez of .

Dr. Lara Jones still remembers her visceral reaction to the image of Liam Ramos. It wasn鈥檛 the most famous one, of with ICE officers behind him. It was one from days later, of Liam while both were in custody in Texas.

鈥淗e looked pale, he looked sickly. He looked like a completely different child,鈥� she said. 鈥淲hen I saw that image, my doctor brain turned on. I was like, this kid is sick. He needs medical attention.鈥�

Jones, who is double board-certified in pediatrics and pediatric critical care medicine, can quickly assess a lot based on a child鈥檚 appearance.

鈥淚 can tell in the first 10 seconds that I look at you from the door, before I even put my hands on you, before I put a stethoscope on your chest 鈥� I can look at you, and I can know right away, you are going to be fine, or you are really sick and you need attention,鈥� she added. 鈥淗e looked very sick.鈥�

Jones couldn鈥檛 sleep that night. Liam鈥檚 well-being consumed her while at work the next day at a California hospital. After a round of patient visits, she went into a private room and 鈥渂roke down and cried.鈥� She needed to do something.

Since then, Jones has become part of 鈥� all pediatricians, all mothers 鈥� in immigration detention out of concern for their health. They warn that the detention of these children is causing severe and lasting harm to their mental and physical health, and say that of kids allegedly facing delayed and inadequate medical care under DHS demands urgency and transparency.

鈥淲e are traumatizing children, and we are putting them in dangerous environments,鈥� Jones said.

These doctors are in detention, to help families in need of emergency assistance and to demand accountability so that children who remain in custody receive evidence-based standards of care.

鈥淲e are mothers of young children, and we are doing all of this in between shifts, after working night shifts, during nap time,鈥� Jones said. 鈥淲e are just doing as much as we can, in the time that we have, while we are working full time and being full-time moms.鈥�

Just weeks ago, Jones and the other women 鈥� Dr. Ashley Marie Cozzo of Connecticut and Dr. Anita K. Patel of Washington, D.C. 鈥� did not know each other personally. Now they鈥檙e in contact daily through a group text that pings at all hours of the day. They use the chat to think through advocacy ideas, to troubleshoot potential challenges and to align their priorities.

鈥淲e鈥檙e trying to figure out every day in our brainstorming, 鈥榃hat鈥檚 next? What鈥檚 next?鈥欌�� said Cozzo, who is double board-certified in pediatrics and neonatal-perinatal medicine. 鈥淚 love a group project, and this is such a unique situation.鈥�

Patel, who is double board-certified in pediatrics and pediatric critical care medicine, said the quick camaraderie among the women has 鈥渞einvigorated鈥� her after years of online campaigns around unrelated advocacy issues.

鈥淵ou have three critical care doctors for kids, and there are certain qualities inherent in pediatric critical care specialists 鈥� we will not stop until we have either saved a kid or we know that there is no chance of saving them,鈥� she said. 鈥淲e all have that personality, because literally that鈥檚 what we do in our jobs.鈥�

Liam鈥檚 story propelled their cause. As the image of Liam seemingly in a lethargic state ricocheted across the internet, the women shared their outrage with medical peers. Jones and Cozzo circulated a small online petition calling for Liam to be returned home, and amid the national outcry, . (The Ecuadorian family has an active asylum case, and it鈥檚 unclear for now whether they will be able to permanently stay in the United States.)

The doctors then connected with Patel, and the three agreed to work together to bring more awareness to other children in detention. Patel said the power of imagery catapulted Liam鈥檚 story.

鈥淚f he was an older kid, or even if he was Liam without the bunny hat 鈥� the outcry may not have come,鈥� Patel said. 鈥淎nd all I could think was Liam deserved that outcry, and every single kid in detention needs that outcry.鈥�

The trio has fixated on the Dilley Immigration Processing Center, the facility near San Antonio that houses families, in part because they are in frequent communication with a journalist, Lidia Terrazas, on people impacted by detention.

When Terrazas highlighted in early February the story of a 2-month-old baby named Juan Nicol谩s, the case crystallized the doctors鈥� urgency. The boy had been in respiratory distress while at Dilley, but had allegedly received delayed care as his condition worsened. He was sent by ambulance to a hospital on February 16, according to Patel, after an unresponsive episode where detention officials could not wake him. DHS later deported the baby, his mother and other family members, including a 16-month-old, to Mexico.

Jones was able to connect by text with Mireya L贸pez S谩nchez, Juan Nicol谩s鈥� mother. The postpartum mother said that her milk had dried up while at Dilley. Patel is still nursing her toddler; the parallels 鈥� the universal urge a mother has to feed her baby 鈥� linger for her.

When Patel nurses her own child, 鈥淚 think of Mireya, whose milk dried up because she was so stressed and nutritionally deficient that she couldn鈥檛 breastfeed, and then when she couldn鈥檛 breastfeed, then she couldn鈥檛 afford clean water that wasn鈥檛 brown or smelled like chlorine to make formula.鈥�

, which has partnered with the doctors to raise money for commissary funds, detainees at Dilley have to spend $40 to buy a four-pack of large water bottles and $35 for a 12-pack of small water bottles.

A spokesperson for DHS did not respond to a request for comment from The 19th, but the agency of malnourished or mistreated children and claims people in detention have access to medical care and adequate food. Emergency crews were called to the facility at least 11 times since September for children with symptoms including bronchitis, respiratory distress and fever, .

CoreCivic, a private company that runs the Dilley facility, deferred questions to DHS but that claims of inadequate medical care are inaccurate and 鈥渄irectly contradicted by the comprehensive, around-the-clock care delivered by our licensed physicians, dentists, advanced practice providers, nurses and mental health professionals.鈥�

Jones doesn鈥檛 buy that when it comes to Juan Nicol谩s, whose mother reportedly told officials that her newborn was having difficulty breathing and was vomiting. Mireya said that instead of being seen by a medical professional, guards at the facility monitored the newborn for two days before he was sent to the hospital in distress.

鈥淚 don’t know what they were assessing, but they鈥檙e not assessing it through the lens of a pediatric expert,鈥� Jones said. 鈥淭hey’re not doing the appropriate medical workup. So that case alone is proof of delayed care and denied appropriate care, because the appropriate care for a 2-month-old with difficulty breathing and vomiting is to go to the emergency department.鈥�

Cozzo noted that several children died in 2018 and 2019 while in immigration , or . In 2023, 鈥� reportedly after her mother repeatedly sought medical care for her.

鈥淲e have a precedent of the highest degree of loss: children鈥檚 lives,鈥� Cozzo said. 鈥淚t has happened before, the things that these women are worried about 鈥� it鈥檚 only going to be a matter of time before we don鈥檛 learn from the mistakes of the past and another child dies.鈥�

As the doctors circulated Juan Nicol谩s鈥� story online, they connected to help . They also helped secure a hotel room for Juan Nicol谩s鈥檚 family amid their deportation to Mexico. They are now raising money . As they hear of specific cases, including those of and , they try to spring into action by either raising public awareness or funds.

The medical community has long expressed alarm about how children鈥檚 health can deteriorate in immigration detention. concluded that children鈥檚 mental health suffers and there鈥檚 a cascade of ripple effects, including anxiety disorders, depression and developmental regression and delays. The issue has been examined , with similar outcomes.

There are also standards of care for immigrant children in detention, and states that children should not be detained for more than 20 days. But that some children are being held in detention for much longer 鈥� weeks or months. The publication estimated at the time that at least 3,800 children under 18 had been booked into ICE since President Donald Trump, who campaigned on mass deportation, returned to office. More than 1,300 children were held last year for longer than 20 days.

The American Academy of Pediatrics (AAP) has its call for limited exposure of children in DHS facilities. Dr. Sural Shah is chair of AAP鈥檚 Council on Immigrant Child and Family Health. She said the council, which was very responsive during the first Trump administration鈥檚 family separation policy, has been accelerating its work in recent months.

鈥淲e鈥檙e always active, always sharing information. But the era that we鈥檙e in now 鈥� it鈥檚 been a heightened sense of need, of urgency, of hey, this is happening, and we need to do something about it,鈥� she said. 鈥淲e need to figure out how to band together, how to lift up voices, how to gather health care professionals and folks that care about children鈥檚 health to stop these practices because they’re so harmful to children.鈥�

Shah added that she鈥檚 not surprised that pediatricians are leading organic advocacy efforts.

鈥淚t is something that is deeply woven into the fabric of who pediatricians are,鈥� she said. 鈥淲e have a deep understanding of the range of factors that affect children and their families.鈥�

Over the past few weeks, the trio of doctors began drafting and circulating a letter, which was later signed by thousands of medical professionals, to be sent to DHS officials and several key senators with roles in immigration enforcement oversight. , dated February 26, alleges unsanitary detention conditions and inadequate access to food and clean water. It also expresses concerns of a measles outbreak within the Dilley facility. Infants are typically too young to be vaccinated against measles.

Kristi Noem鈥檚 ouster as head of DHS last Wednesday doesn鈥檛 alter the demand for accountability, said Cozzo.

鈥淚 actually don鈥檛 necessarily think that changing the face changes anything, because it鈥檚 just a complete system that is broken,鈥� she said.

All three agreed that the letter is a start.

鈥淭his letter is day one of a marathon,鈥� said Patel, who was a guest of Democratic Rep. Joaquin Castro at the recent State of the Union address, with the goal of elevating the issue. 鈥淭he point of the letter was to clearly and succinctly as possible, dictate what has been documented as known medical negligence or medical harm or human rights violations.鈥�

They want to grow public pressure while helping as many children and their families as possible. Jones said their advocacy is about the health and well-being of children. She doesn鈥檛 see that as political.

鈥淭his is an issue about child welfare,鈥� she said. 鈥淚 feel like if we can continue to stand our ground about the fact that we are causing preventable, measurable, well-studied, predictable harm to children that is not justified. There鈥檚 no context in which that is justified, and so I think we just have to continue to get that message across 鈥� to the public, to lawmakers. There will be challenges at every step of the way, no doubt, but I think the truth and what’s right is on our side.鈥�

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