While the number of unauthorized immigrants in the United States has declined over the past decade (from a peak of 12.2 million in 2007 to 10.7 million in 2016), more people are coming from Central America, the majority from El Salvador, Guatemala, and Honduras-countries known as the Northern Triangle. In December 2018, 95% of apprehended migrant families were from this region.

Since February, the Registered Nurse Response Network-a disaster-relief project of the California Nurses Foundation and National Nurses United-has been sending volunteer nurses to care for migrants at a shelter operated by Catholic Community Services of Southern Arizona in Tucson.

Diane McClure, an RN at Kaiser Permanente South Sacramento Medical Center in Sacramento, California, volunteered over a weekend in March. In an interview with AJN, she explained that the shelter is a monastery temporarily repurposed to receive migrants-most from Guatemala and Honduras-who, on arrival from Immigration and Customs Enforcement (ICE) detention centers, undergo a health assessment and receive food and other necessities. From there, they take buses to sponsors (family members or friends) who house them until their scheduled court dates.

"While no one spoke of overt mistreatment by ICE, they did say they were freezing at night and were give only a thin, crinkly sheet to lie on," McClure said. Nutrition, too, was poor. Migrants received water, juice, and crackers, and "very bad burritos." The most common illnesses were upper respiratory tract infections, colds, flu-like symptoms, dehydration, urinary tract infections, and digestive issues. Many migrants also seemed withdrawn and nervous.

One family's story illustrates the complexities: "There was a little girl exhibiting classic signs of appendicitis," McClure recounted. "I stayed with her mother for eight hours at the hospital; it turned out to be a bladder infection. As we waited, the mother disclosed that in Guatemala an extortionist had threatened to kill her and her husband unless they handed over one-third of their income from their small transportation business. Her husband had stayed behind while she and her daughter fled. She headed north, switching buses, each time getting off before the bus stop to avoid being apprehended by the police. She spent her last penny on a bag of potato chips for her daughter." (For an account of the migrants' experience from another nurse volunteer, see this month's AJN Reports.)

The countries of the Northern Triangle are among the most violent in the world, with gang-related activities and extortion particularly rampant. In Guatemala, for example, the homicide rate in 2016 was 27 per 100,000 people compared with five per 100,000 in the United States.-Dalia Sofer