A child developed a rash after he was prevented from changing his underwear for four days. A little boy, bored and overcome with despair, began hitting himself in the head. A child with autism and attention-deficit/hyperactivity disorder was forced to go without his medication, despite his mother’s pleas.
“I heard one officer say about us ‘they smell like sh–,'” one detained person recounted in a federal court filing. “And another officer responded, ‘They are sh–.'”
Attorneys for immigrant children collected these stories, and more, from youth and families detained in what they called “prison-like” settings across the U.S. from March through June, even as the Trump administration has requested a federal district court judge terminate existing protections that mandate basic rights and services — including safe and sanitary conditions — for children held by the government.
The administration argues that the protections mandated under what is known as the Flores Settlement Agreement encourage immigration and interfere with its ability to establish immigration policy. U.S. District Court Judge Dolly Gee, who is in California, is expected to issue a ruling on the request after an Aug. 8 hearing.
With the Flores agreement in place, children are being held in “unsafe and unsanitary” U.S. Customs and Border Protection facilities such as tents, airports, and offices for up to several weeks despite the agency’s written policy saying people generally should not be held in its custody longer than 72 hours, according to the June court filing from immigrants’ attorneys. In addition to opposing the U.S. Department of Justice’s May request to terminate the Flores consent decree, the attorneys demanded more monitoring for children in immigration detention.
“The biggest fear is that without Flores, we will lose a crucial line of transparency and accountability,” said Sergio Perez, executive director of the California-based Center for Human Rights and Constitutional Law. “Then you have a perfect storm for the abuse of individuals, the violation of their rights, and the kind of treatment that this country doesn’t stand for.”
The Flores agreement has set minimum standards and oversight for detained immigrant children since 1997, when it brought an end to a decade-long lawsuit filed on behalf of unaccompanied immigrant minors who had been subjected to poor treatment in unsafe and unsanitary conditions without access to medical care. It is named for Jenny Lisette Flores, a 15-year-old from El Salvador who was taken into U.S. custody in the mid-1980s, subjected to strip searches, and housed alongside unrelated men.
The agreement established national standards for the protection of immigrant children detained by federal authorities, with requirements for safe and sanitary detention facilities, access to clean water, appropriate food, clothing, bedding, recreational and educational opportunities, sanitation, plus appropriate medical and mental health care. Children in immigrant detention range from infants to teens.
In 2015, Gee ruled that the agreement includes children accompanied by adults.
The Justice Department and the Department of Homeland Security, which includes both the Customs and Border Protection agency and Immigration and Customs Enforcement, declined to answer questions about the administration’s intent to end the Flores agreement or about the conditions in which kids are detained. In a May court filing, government attorneys argued, among other points, that the agreement improperly directs immigration decisions to the courts, not the White House. U.S. Attorney General Pam Bondi also has said that the Flores agreement has “incentivized illegal immigration,” and that Congress and federal agencies have resolved the problems Flores was designed to fix.
ICE detention facilities have the “highest standards,” Abigail Jackson, a White House spokesperson, said in an email to KFF Health News. “They are safe, clean, and hold illegal aliens who are awaiting final removal proceedings.”
Immigration lawyers and researchers have pushed back on the idea that the Flores agreement encourages migration, arguing that the conditions in people’s homelands are driving them to move.
President Trump is not the first president to seek to modify, or end, the agreement.
In 2016, President Barack Obama’s administration unsuccessfully sought to exempt accompanied minors from the Flores agreement, arguing that an influx of immigrants from Central America had overwhelmed the system.
In 2019, following a policy that caused family separation, the first Trump administration announced it would replace Flores with new regulations to expand family detention and eliminate detention time limits. The courts rejected that plan, too.
In 2024, President Joe Biden’s administration successfully requested to remove the Department of Health and Human Services from the agreement after the Office of Refugee Resettlement incorporated some Flores standards into agency regulations.
Allegations of unsafe conditions under the agreement also predate this latest immigration crackdown under Mr. Trump. One court filing from 2019 said that attorneys visiting two Texas detention centers found at least 250 infants, children, and teens, some of whom had been held at the facility for nearly a month. “Children were filthy and wearing clothes covered in bodily fluids, including urine,” the filing said.
Seven children are known to have died while in federal custody from 2018 to 2019, according to media reports.
And in 2023, 8-year-old Anadith Danay Reyes Alvarez became sick and died while in Customs and Border Protection custody in Texas for nine days. Her parents had turned over medical records detailing the girl’s medical history, including diagnoses of sickle cell disease and congenital heart disease, upon their detention. Yet her mother’s repeated pleas for emergency medical care were ignored.
Her family filed a wrongful death claim in May.
Advocates attributed the deaths partly to prolonged detention in increasingly crowded facilities and delayed medical care. Officials have said they increased medical services and acknowledged failures in the wake of the deaths.
But with the Trump administration’s unprecedented push to detain and deport migrants — including families — the threat to the health of children caught up in those sweeps is alarming child advocates.
“Very rarely do you have spikes in populations of detained folk that you don’t see a drastic decrease in the quality of their medical care,” said Daniel Hatoum, a senior supervising attorney at the Texas Civil Rights Project, one of the groups that filed the wrongful death claim for Anadith’s family.
Recent reports from court-appointed monitors cite continued lack of access to appropriate medical care; temperature extremes; few outside recreational opportunities; lack of appropriate food and clothing; and an inability to dim lights to sleep.
Terminating the Flores agreement would remove all outside oversight of immigration detention facilities by court-ordered monitors and attorneys. The public would have to depend on the government for transparency about the conditions in which children are held.
“Our system requires that there be some oversight for government, not just the Department of Homeland Security, but in general,” Hatoum said. “We know that. So, I do not believe that DHS could police itself.”
In the months after Mr. Trump took office and the Elon Musk-led Department of Government Efficiency began cuts, the administration shuttered DHS’ Office for Civil Rights and Civil Liberties, the Office of the Citizenship and Immigration Services Ombudsman, and the Office of the Immigration Detention Ombudsman, which were intended to add a layer of oversight. After a lawsuit, the Trump administration reversed action and noted the offices would remain open, but it is unclear how those offices have been affected by shifts in policy and cuts in staffing.
Leecia Welch, an attorney with the legal advocacy group Children’s Rights, said the Flores agreement itself, or efforts to hold the government responsible for abiding by its requirements, are not rooted in partisan politics. She said she raised concerns about conditions during Biden’s administration, too.
“These are not political issues for me,” Welch said. “How does our country want to treat children? That’s it. It’s very simple. I’m not going to take it easy on any administration where children are being harmed in their care.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
