From "inconsolable" crying to refusing to eat to feeling "terrified," the emotional distress suffered by migrant children detained by the Trump administration at the southern border is conveyed by a new report from a government watchdog that emphasizes the trauma the children are going through.

The report (pdf) was released Wednesday by the inspector general's office for the Department of Health and Human Services and is based on interviews conducted in August and September of 2018 with roughly 100 mental health clinicians and directors at dozens of the Office of Refugee Resettlement (ORR) facilities.

Care providers at the facilities were dealing with an unexpected younger population—the number of kids under 12 increased from 14 percent in April 2018 to 24 percent in May 2018 at the advent of the Trump's so-called zero tolerance policy.

Experiences of "intense trauma" were common for those children in care even before their arrival in country, such as being a victim of abuse or witnessing murder, the report noted. Those separated from their parents by U.S. authorities went on to experience greater emotional and mental pain.

From the report:

According to program directors and mental health clinicians, separated children exhibited more fear, feelings of abandonment, and post-traumatic stress than did children who were not separated. Separated children experienced heightened feelings of anxiety and loss as a result of their unexpected separation from their parents after their arrival in the United States. For example, some separated children expressed acute grief that caused them to cry inconsolably.Children who did not understand why they were separated from their parents suffered elevated levels of mental distress. For example, program directors and mental health clinicians reported that children who believed their parents had abandoned them were angry and confused. Other children expressed feelings of fear or guilt and became concerned for their parents' welfare. The difficulties that some facilities had in locating parents in detention and scheduling phone calls also contributed to children's anxiety and fear for their parents' well-being.

Their psychological anguish sometimes manifested physically. "You get a lot of 'my chest hurts,' even though everything is fine [medically]," said one medical director quoted in the report. "Children describe symptoms, 'Every heartbeat hurts,' 'I can't feel my heart,' of emotional pain."

One problem noted by the observers was that kids couldn't distinguish between care providers and immigration agents. "Every single separated kid has been terrified. We're [seen as] the enemy," said one program director in the report.

Adding to the children's distress was the uncertain timeline for reunification with their families:

Facilities reported that some reunifications were scheduled with little advance notice, or suddenly canceled or delayed, which increased the levels of uncertainty and anxiety in separated children and other childrenin the facility. In one case, a child was moved from a facility in Florida to a facility in Texas to be reunited with her father. However, a mental health clinician reported that after the child made several trips to the detention center, she was returned to the Florida facility "in shambles" without ever seeing her father.

Providers reported that increased time in the ORR facilities for unaccompanied minors—which corresponded with the Trump administration's controversial June 2018 requirement of obtaining the fingerprints for children's sponsors—was linked to more emotional distress. The average number of days for children in the custody of ORR hit a high of 93 in November 2018 and dropped to 43 by April 2019, a month after the fingerprint requirement ended in most circumstances.

"According to facility staff, longer stays resulted in higher levels of defiance, hopelessness, and frustration among children, along with more instances of self-harm and suicidal ideation," said the report.

Those children who needed a higher level of care were likely to have been out of luck, as authorized facilities for such care, providers reported, were often at capacity or had wait lists, or the children faced significant wait times to get the needed transfer to such centers.

That was not without impact.

"Facilities noted that children who did not receive requested transfers to [residential treatment centers] displayed behaviors that put themselves and others at risk."

Children may also have been shortchanged because providers themselves were also overwhelmed. The report noted that the 1-12 ratio for caseloads was far exceeded in some instances, with some providers holding caseloads of 25. But the number of cases wasn't the only problematic issue for providers:

Mental health clinicians expressed concerns about feeling unprepared to handle the level of trauma that some children presented, despite their prior training and experience. [...] [M]ental health clinicians discussed how challenging it was to hear about children's traumatic experiences, which sometimes caused the clinicians to become overwhelmed or suffer their own mental distress.

The providers also mentioned roadblocks in accessing specialists for the children like psychiatrists, psychologistors, and psychiatric nurses. Some such experts were not available in all the states, may not have been bilingual in the needed language, and others were not available "because prior reimbursements had been late."

Progressive political group Latino Victory responded to reporting on the watchdog's findings in a pair of tweets, writing, "Trump's penchant for terrorizing and tormenting Latino children for political gain is literally causing irreparable trauma."

"Do not become numb to this," the group said.