The death of Carlos Hernandez Vazquez, a 16-year-old Guatemalan teenager, in a Border Patrol shelter in Texas on Monday is the third death of a child in Customs and Border Protection custody in six months.

Before December 2018, no children had died in CBP custody in a decade.

The death of Hernandez Vazquez — and of two other minors, including a toddler, who have died in recent weeks after being apprehended by Border Patrol agents but who were released from CBP custody before their deaths — has renewed national attention and outrage from December, when two young children died in CBP custody in three weeks.

The details of the cases have raised some specific questions about CBP practices. Hernandez Vazquez, for example, was in Border Patrol custody for more than six days; the standard, except in emergency situations, is for CBP to hold migrants for no more than 72 hours before transferring them to Immigration and Customs Enforcement or the Office of Refugee Resettlement, which responsible for migrant children who come to the US without a parent.

But it’s becoming increasingly clear that the government is in the midst of a broader public health crisis regarding migrants, especially children, in its care. The processing center in the Rio Grande Valley where Hernandez Vazquez had been held is in the midst of an apparent flu outbreak; on Tuesday night, the government announced it would stop sending migrants there, essentially quarantining it. In recent weeks, pictures of children being held outside — having to sleep on the ground — have raised alarms, as temperatures climb into summer.

The health crisis isn’t just the children who are dying, but those who are being taken to hospitals and treated successfully, and those who are in custody without needing medical care.

Children are dying in CBP custody because more children are in CBP custody, for longer, than ever before. No one believes that’s a good or safe place for them to be. But no one can agree on what the alternative is.

Three children have died in Border Patrol custody, and two more after being apprehended

One way to put the alarming trend is that five children have died in the past six months after crossing the border. Three of them have died in Border Patrol custody:

Carlos Hernandez Vazquez , a 16-year-old Guatemalan boy, died in a Border Patrol facility on May 20. He had reportedly been in Border Patrol custody for six days before his death. He had been slotted for a transfer to an Office of Refugee Resettlement shelter for children who arrive in the US without parents, but the transfer wasn’t initiated until three days after he was apprehended and still wasn’t complete more than three days after that. A nurse at the station where he was being held diagnosed him with influenza A on Sunday and prescribed him Tamiflu.

, a 16-year-old Guatemalan boy, died in a Border Patrol facility on May 20. He had reportedly been in Border Patrol custody for six days before his death. He had been slotted for a transfer to an Office of Refugee Resettlement shelter for children who arrive in the US without parents, but the transfer wasn’t initiated until three days after he was apprehended and still wasn’t complete more than three days after that. A nurse at the station where he was being held diagnosed him with influenza A on Sunday and prescribed him Tamiflu. Felipe Gomez Alonso , an 8-year-old Guatemalan boy who died in a New Mexico hospital on December 24. He was apprehended on December 17 and spent six days in CBP custody before being sent to the hospital; he was discharged with a prescription for amoxicillin after a few hours, and held in a Border Patrol highway checkpoint — a facility not designed for any migrant to be held for any length of time — for several hours. He was returned to the hospital when he started to vomit, and died the next day. Guatemalan officials announced in April that he died of flu compounded by a staph infection, but New Mexico medical officials said the autopsy report hadn’t been completed.

, an 8-year-old Guatemalan boy who died in a New Mexico hospital on December 24. He was apprehended on December 17 and spent six days in CBP custody before being sent to the hospital; he was discharged with a prescription for amoxicillin after a few hours, and held in a Border Patrol highway checkpoint — a facility not designed for any migrant to be held for any length of time — for several hours. He was returned to the hospital when he started to vomit, and died the next day. Guatemalan officials announced in April that he died of flu compounded by a staph infection, but New Mexico medical officials said the autopsy report hadn’t been completed. Jakelin Caal Maquin, a 7-year-old Guatemalan girl who died in a Texas hospital on December 7. Caal Maquin was apprehended the night of December 6 with her father in the remote New Mexico “bootheel,” and held in a concrete “sally port” — essentially a garage — for several hours while the only bus at the station was used to transport unaccompanied children to a facility at Lordsburg 90 miles away. When the bus returned to transport families with parents to Lordsburg, her father told Border Patrol agents Caal Maquin was sick; she was kept on the bus to Lordsburg, then taken to the hospital.

Two other children have died in recent weeks after being apprehended by Border Patrol agents, but were not in CBP custody when they died.

Juan de Leon Gutierrez , a 16-year-old Guatemalan boy, died in a Texas hospital on April 30. He had been apprehended crossing the border on April 19 and was transferred to an Office of Refugee Resettlement shelter April 20. He was taken to a hospital on April 21, released the same day, then taken to a different hospital on April 22 — where he was ultimately transferred to intensive care and then to the children’s hospital, where he died. The Guatemalan foreign ministry said he had a severe infection in his frontal lobe; his mother said Juan had complained that his neck hurt when she spoke to him over the phone while he was traveling through Mexico.

, a 16-year-old Guatemalan boy, died in a Texas hospital on April 30. He had been apprehended crossing the border on April 19 and was transferred to an Office of Refugee Resettlement shelter April 20. He was taken to a hospital on April 21, released the same day, then taken to a different hospital on April 22 — where he was ultimately transferred to intensive care and then to the children’s hospital, where he died. The Guatemalan foreign ministry said he had a severe infection in his frontal lobe; his mother said Juan had complained that his neck hurt when she spoke to him over the phone while he was traveling through Mexico. A 2.5-year-old Guatemalan boy, who has not yet been identified, died in an El Paso hospital on May 14. The boy was apprehended on April 3 and spent three days in federal custody before being sent to a hospital. He was formally released from CBP custody on April 8, but remained in the hospital until his death. While a medical examination is ongoing, sources told the Washington Post that the boy suffered from a severe case of pneumonia.

The deaths are unprecedented — but so are the number of children coming

For the past several months, tens of thousands of children a month — most of them traveling with a parent — have been coming to the US from Mexico, getting apprehended, and spending time in Border Patrol custody.

The number of children and families coming to the US without papers (most of them Central Americans from the “Northern Triangle” of Guatemala, Honduras, and El Salvador) is to all appearances higher than it was even in the early 2000s, when unauthorized immigration overall was much higher.

It’s also possible, though it’s difficult to measure for sure, that the people coming now are more likely to have medical issues than those coming in the past. The rise of quick bus smuggling routes through Mexico allows people to be brought to the US more quickly and comfortably than before — potentially making it possible for someone to leave who might have been too sick to risk a dangerous journey on foot.

The US immigration enforcement system isn’t built to care for these people; it isn’t built to deal with anyone who can’t be quickly deported. One consequence of the system being overwhelmed is that migrants may not be quickly picked up by ICE for transfer to a detention center or to an ORR unaccompanied-child shelter; instead, they remain in Border Patrol custody, perhaps for longer than the 72 hours the government is supposed to use as a guideline.

Those resources are crunched even further by caring for the medical needs of migrants. It takes people, vehicles, and time to take people to the hospital. From December through February, agents spent a combined 57,000 hours at hospitals; at one point, a Border Patrol official said that half of all agents were on duty at hospitals with migrants seeking care. That results in fewer people checking on the migrants staying behind, and less ability to quickly respond if someone else is showing signs of illness as well.

This doesn’t mean agents acted blamelessly or that none of the children could have been saved. It’s entirely possible that in some cases — for example, the ones where migrants spent little time in CBP facilities and were sent to the hospital shortly after their arrival in the US — agents acted appropriately, while in others, more could have been done.

Ongoing congressional and Office of the Inspector General investigations into the December deaths aim to answer these questions. But investigations into individual deaths may not be asking the right question: whether more children will die, and what — if anything — can be done to prevent it.

The conditions of custody continue to inspire outrage, but it’s really not clear whether enough will be done

If it were the case that individual bad actions done by individual bad agents led to children’s deaths, the problem would actually be easier to solve: get rid of the bad agents.

If the deaths are a symptom of a broader resource crunch at the border that makes it simply impossible for everyone to get the care and attention they may need, however, it’s not as easy to fix.

While Customs and Border Protection got some funding in February to care for children and families, the agency claims it’s not nearly enough.

CBP doesn’t have many fully equipped processing facilities. Even the ones it does have are now affected by the health crisis — the central processing center in the Rio Grande Valley has been held up as a model for what CBP wants to build more of, but it’s now been essentially quarantined with the flu outbreak.

Many more people are in CBP custody than could fit in processing centers even without the quarantine. And CBP is essentially improvising.

For a few weeks, migrants were being held in an outdoor pen under a bridge in El Paso; more recently, photographs show children sleeping on the ground at another Border Patrol facility.

Both became nationwide outrages. But the outrage hasn’t yet led to clarity about what, exactly, ought to be fixed — and whether it can be.

Border Patrol is already releasing thousands of families from custody directly, rather than holding them until ICE can pick them up and complete their processing. But before a family can be released, border agents have to check their identification to prove that, for example, the child isn’t being trafficked; they have to conduct a medical check on the children (now mandatory after the December deaths); they have to start up an immigration file for the family and issue them a notice to appear in immigration court.

These things take time, and officials generally argue that they’re necessary in order to keep child migrants safe. It’s not clear that all families are being processed and released with maximum efficiency, but the easiest fix — simply releasing people before their processing is completed — would be unlikely to satisfy anyone.

The alternative would be to not apprehend family members at all, a radical departure from decades of border policy. It’s also not clear how it would be possible — or even safe. Right now, many families are taken by smugglers to remote parts of the border and then dropped off to seek out Border Patrol agents. If agents weren’t patrolling the area, it’s possible they could end up languishing in the desert, unaided.

Policymakers don’t have the luxury of time to work through the intricacies of the problem. Border crossings generally peak in early summer — and while they drop in late summer when the heat becomes unbearable, it’s not like the New Mexico desert in June is always a safe place to be.

The argument made by the Trump administration is that the best way to protect children is to stop them from coming to begin with, and that it needs to be able to deport families quickly so that potential future migrants will understand it’s not worth it to come to the US. Accepting that solution requires making assumptions about what exactly will stop people from coming — and also, of course, requires agreement that it’s more dangerous for a migrant to be in the US than her home country.

Democrats don’t grant those premises. And Congress hasn’t yet moved to make the changes the administration says it needs. But it’s not at all clear what would be done, instead, to prevent more deaths.