Half a dozen children gazed up at the camera, their eyes wide beneath hats and hoodies, hands buried in their pockets or nuzzled in the necks of their mothers. Floodlights illuminated some faces and left others in darkness.

It was after midnight in New Mexico’s remote Bootheel region, and with the temperature hovering near freezing, a Border Patrol agent snapped the photo. Nearly 150 miles away, the tiny emergency room of the Gila Regional Medical Center in Silver City – the nearest 24-hour hospital – was on notice. Some of the children would need medical care for illness, others for injury.

“The Border Patrol has been very cooperative in giving us advanced warning,” said Doug Oakes, director of marketing for GRMC. “There are just so many. They are dehydrated. They are often sick.”

As the Trump administration shifted tactics to deter asylum seekers from crossing the border, authorities in New Mexico say the humanitarian needs have only grown.

The most pressing concern is health care, especially for kids. Two Guatemalan children died in Border Patrol custody in December, underscoring the extreme risks the youngest migrants face on the arduous, more than 2,000-mile journey.

Hospitals and clinics from Silver City to Deming, Lordsburg, and Alamogordo have treated children for flu, dehydration, rashes, scabies, sprains and other ailments. Border Patrol reported that one of the adults in the group of 306 that arrived last week was suffering from a “flesh-eating bacteria,” or necrotizing fasciitis – an infection that rarely spreads person to person.

Dehydration, poor nutrition and harsh weather leave migrants susceptible to stomach viruses and the flu, and then there is the emotional trauma of leaving behind family and country. For the kids, “the risks are enormous,” said Marlene Baska, a physician assistant who runs a clinic in Animas – a Bootheel ranching town with a population of 267 – that sees children in Border Patrol custody.

While overall apprehensions remain near a 40-year low, there has been an uptick in family arrivals – especially in the state’s remote southwestern corner.

The large numbers of single parents traveling with one child is a signal, CBP officials say, that migrants recognize the value of traveling with a child. A 1997 court order bars the holding of children in immigration detention facilities for more than three weeks. The order was reaffirmed after the Trump administration separated thousands of migrant parents from their children last summer.

Immigrant advocates also point to what are called push factors – the very real forces of poverty, political strife and gang violence that have engulfed Central America. Whatever the reason spurring parents to travel with children, it has spelled crisis for Hidalgo County, which encompasses the Bootheel.

On Dec. 26, Hidalgo County Manager Tisha Green fired off “an urgent request” to then governor-elect Michelle Lujan Grisham and the state’s congressional delegation pleading for assistance.

“Our Hidalgo County Emergency Medical Services team consists of seven full-time employees and five volunteers” who cover 5,000 square miles, she wrote. “At the very least we can say they are stretched very thin. Please send emergency medical services to assist us with the overwhelming number of immigrants coming in daily.”

Since October, at least 26 groups of more than 100 people have crossed near the tiny Antelope Wells port of entry – a more than 200 percent increase from the eight large groups reported in fiscal year 2018, according to Border Patrol. Among the largest groups were two in January, of 247 and 306 people, that swamped the few agents on overnight duty at a forward operating base at the crossing.

Antelope Wells is hardly a place, other than for port infrastructure at the terminus of State Road 81. Ranch land sprawls to the Hatchet Mountains to the east and the Animas Mountains to the west. Winter nights out here are dark, starry and dangerously cold.

Hidalgo Medical Services chief executive Dan Otero says the nonprofit’s clinics have seen an average of 30 migrants a month for the past four months – six times the usual rate.

Meanwhile, the volume of ambulance runs by Hidalgo County Emergency Medical Services has jumped threefold, according to director David Whipple. When the group of 306 arrived at Antelope Wells, his six-person team transported three patients to hospitals. One run – from Lordsburg to the border crossing to Deming and back – took six hours.

“Border Patrol needs more than EMTs,” Whipple said. “They need an RN or PA or someone of a higher level, so people get proper screenings. But they are not set up for it. They were never set up for families coming across.”

In December, after the deaths of the two Guatemalan children, Department of Homeland Security Sec. Kirstjen Nielsen issued a directive that all children under the age of 10 be screened by a medical professional. Since then, DHS has brought in medical personnel and, according to Border Patrol, will provide 24/7 medical service at the Lordsburg station beginning Feb. 1.

But local hospitals and clinics are likely to continue to see migrant patients needing acute care.

Unlike the churches in Doña Ana County sheltering migrants released by U.S. Immigration and Customs Enforcement, the hospitals expect to be reimbursed for the health care they provide. Annually, ICE spends more than $250 million on health care for detainees, according to an agency spokesman.

The funds have been slow to be disbursed. As of December, Hidalgo County had recovered just 40 percent of claims submitted to the federal government – a financial strain on a sparsely populated county that is perennially short on cash.

With fewer than 5,000 residents, “we have a very low tax base,” Green said. “Our revenues are very limited. Our ambulance fund should be self-sufficient, but it is supported by county fund dollars.”

Lauren has covered the financial and energy markets in New York, the drug war in Mexico and immigration and border security in New Mexico. Formerly the Albuquerque Journal's border correspondent, she has...