Animation by Paola Roman for the Florence Project

“Stick out your tongue if you can understand,” a nurse told Emiliano*. The 16-year-old boy lay in a pediatric care facility in Phoenix, Arizona, paralyzed and unable to speak or move his head. “Blink your eyes if your name is Emiliano,” the nurse suggested. And he did. Sticking out his tongue and blinking his eyes were the only movements he could use to communicate.

Emiliano became disabled while migrating into Arizona through the rugged Sonoran Desert. In 2020, when these events occurred, a record number of migrants died in the U.S. borderlands; Customs and Border Protection found 254 human remains that year. And 2021 would prove even more deadly.

The ongoing militarization of the Southern border and policies halting access to asylum at U.S. ports of entry have forced people to attempt treacherous crossings in hostile climates and mountainous terrain.

Border Patrol agents found Emiliano alone and near death after receiving an emergency call. Severe dehydration had caused him to suffer a stroke that resulted in debilitating brain damage. He was taken to a hospital, and later to a long-term pediatric care facility. The Florence Project’s Children’s Program meets with unaccompanied children in Arizona to provide them with free legal and social services. But Emiliano’s condition was so dire, our Children’s Program was informed by the government that he was unlikely to survive.

The Office of Refugee Resettlement (ORR), which holds custody over unaccompanied immigrant children, identified Emiliano and contacted his family. His mother gained permission to enter the U.S. temporarily to be with her son. If Emiliano remained in a coma, it would be up to her to decide whether to continue life support or end his palliative care.

Fortunately, Emiliano awoke. Shortly afterward, he gained the ability to communicate through facial gestures. Then in April 2021, the Florence Project was alerted that he did, in fact, need our advocacy. The Department of Homeland Security had already sought to expel Emiliano back to Mexico through Title 42—the policy blocking access to asylum at the time—until his doctors warned that he would likely die in transit.

Without immigration status, Emiliano remained vulnerable to deportation. The Florence Project’s legal and social services team responded immediately, understanding the life-or-death ramifications of his case. Emiliano was on a breathing tube and a feeding tube, under the care of trained specialists. If he declined to pursue his immigration case and chose to end the lonely anguish of hospitalization in the U.S., he had to accept that the journey back to Mexico could end his life. And although his family was willing to provide round-the-clock care back in their home in Mexico, they did not have the resources to make home care a possibility. It would have required weeks of intensive training to learn to provide the support Emiliano needed, as well as expensive medical equipment and nearby access to specialist services.

The Florence Project’s legal and social services team, drawing upon their expertise in trauma-informed approaches to legal counsel and crisis management, worked to make Emiliano feel comfortable and to provide accompaniment and meaningful counsel in the most challenging of circumstances.

Emiliano likes pets, so his attorney brought her dog on their video call. Mexican music makes Emiliano feel at home, so the social worker played it in the background. He likes soccer. Emiliano’s attorney and social worker expressed their fondness for the sport as well. Recognizing Emiliano’s limited ability to communicate, the Florence Project advocates moved, with compassion and patience, to a carefully planned conversation regarding his wishes. Did he want to pursue continued care in the U.S., or did he prefer to stop? They listened with their eyes as he used limited body gestures to communicate.

For anyone, let alone a teenager far away from home, collapsing in the desert and waking up paralyzed and unable to speak is the stuff of nightmares. Yet, Emiliano had come to the U.S. to pursue a dream to stay in school. In Mexico, he was unable to continue his education. His journey didn’t work out as planned, but that didn’t mean that he wanted to die. He extended his tongue and blinked to express his desire to keep recovering in the U.S.

Anna Marie, a manager in the Florence Project’s Social Services Program, recalls, “My first thought as the social worker was: He really needs health insurance.” Emiliano’s healthcare coverage was set to expire in mere months when he turned 18, as he would no longer be in custody of the ORR system. His quality of life would dramatically deteriorate if that occurred.

At the same time as our Social Services Program worked to identify possible resources, our legal team learned more about Emiliano’s decision to migrate. Florence Project Legal Assistant Elizabeth Arrazola talked to his dad and quickly learned that Emiliano was a victim of human trafficking. In Mexico, Emiliano worked part time growing corn and coffee and selling chickens until he connected on Facebook with men who promised to provide food, lodging, and the opportunity to work and go to school in the U.S. They offered to help him cross the border. It is believed that they called emergency services when Emiliano suffered his stroke, and that they intended to exploit him for labor.

Based on this information, the Florence Project’s legal and social services team recognized Emiliano’s eligibility to access health insurance and other benefits as a survivor of trafficking. After much coordination, the team submitted an application to the Office on Trafficking in Persons and it was
approved. He could continue receiving the care he needed. 

By then, Florence Project advocates could recognize when it was best to communicate with Emiliano based on how his moods and energy levels corresponded to meals, baths, trachea tube cleanings, and medications. They coordinated with his caregivers to schedule video calls when he was least likely to be tired or overwhelmed.

Ultimately, having his mother at his bedside helped Emiliano the most. His loving gratitude for her was profoundly visible in his eyes and face. While she’d already been granted permission to temporarily enter the U.S., the Florence Project partnered with other organizations to help her access lodging, a cell phone, and financial support to allow her to focus on spending time with her son. With her present, Emiliano’s condition improved. He started to regain movement in his fingers.

The Florence Project legal team identified that Emiliano was eligible for asylum relief. Moreover, the only way for the family to reunify would be through an asylum win for Emiliano. His parents and siblings could then apply for residency as “derivatives” on his case. The Florence Project worked on his asylum claim, arguing that no testimony should be required since Emiliano remained nonverbal and unable to participate in hours-long interviews. The government pushed back, requesting that Emiliano’s parents or social worker give testimony for him. The Florence Project argued that this would violate Emiliano’s rights by placing him in more hostile court proceedings due to his disability. The government conceded. The case was decided based on the potential dangers Emiliano faced in a Mexican institution for incapacitated people, where abuse, neglect, and death are common.

In May 2022, Emiliano won asylum and remains in the United States. His mother is seeking to reunify the family and shares that Emiliano’s condition is improving. While he is still unable to move most of his body, with physical therapy he is regaining use of his hands, he appears more awake and alert, and can move his head and smile. “What great support [The Florence Project] gave him,” she says. “The asylum and everything happened very fast. It’s not easy for Emiliano, but now everything is possible.”

Anna Marie, a seven-year veteran of the Florence Project Social Services Program, acknowledges that, “This is the saddest case I’ve ever worked on.” Yet, the outcome made her proud and grateful. “We accompany and advocate for people every day as they are forced to make very difficult decisions, sometimes decisions with life-or-death implications. You don’t get to see the results of that work right away a lot of the time. The fact that this result happened relatively quickly—I don’t want to say it gave me faith in the system, but it did make me think our advocacy can make a difference in holding the government accountable. It was a good feeling knowing I was a part of the advocacy that led to [the government] making the right decision.”

*psuedonym used to protect privacy