Holding the Line for Children’s Right to Health at Europe’s Border: What Ceuta Can Teach Us About Abandonment and Care

Beyond their scars, minors in Ceuta are searching for dignity. A powerful look at the human cost of abandonment at Europe's borders.

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“Take my other side,” Adil told me, turning slightly before I took the photograph. “The one without cuts.”

He was sixteen, although he looked younger, one of the smaller boys living on the street in Ceuta, and like many of the boys we met that summer he had learned to carry himself with a kind of hardness. But in that moment, something shifted. The cuts were no longer only a sign of survival, or toughness. They were also something he wanted hidden, something he wanted to leave behind.

What has stayed with me since leaving Ceuta is not only what he said, but the way he moved his body before I took the picture, almost instinctively turning away from the scars. In public health, we have language for the forces that shape wounds like these: structural violence, institutional neglect, trauma, harm reduction, the social conditions that make self-harm and substance use more likely. But in that moment there was also something more intimate and more difficult to sit with: a boy trying to be seen beyond the wound, and carrying shame for scars that should have made the rest of us ashamed of the conditions that produced them.

1. An NNK basketball game in Ceuta gave the boys a chance to play together and shake off the day. 2. A packet of Lyrica (a medication widely misused in Ceuta), and a boy holding a cigarette with a bandaged hand. Substance use and self-harm often overlapped among unaccompanied minors navigating prolonged precarity, grief, and exclusion. 3. Healing and recent self-inflicted wounds on the arms of boys living on the street in Ceuta. These patterns of self-harm emerge as coping responses to chronic stress, violence, and systemic neglect. These are not marks of “ teenage rebellion,” but of survival. 4. Audrey Claire Benson in Ceuta. 5. A protest in Ceuta on June 24, marking the anniversary of the 2022 Melilla massacre. The sign reads in Arabic: “There is no illegal person. Freedom for all.” 6. The fortified border wall at Benzú, one of several barriers separating Ceuta from Morocco. Many unaccompanied minors attempt to climb these walls when they can’t swim across to reach Spanish territory.

On the Ground in One of Europe’s Most Invisible Borders

As a predoctoral epidemiologist at ISGlobal, I see borders not as abstract policy spaces, but as places where global inequalities, colonial histories, national decisions and transnational power structures become painfully visible in people’s bodies: as exhaustion, untreated wounds, hunger, anxiety, fear, substance use and self-harm.

Last summer, I went to Ceuta to understand what was happening at one of Europe’s most important and least discussed borders, a place that is Spanish territory and European territory and yet often remains politically and emotionally far away from the peninsula.

I worked with No Name Kitchen (NNK), a grassroots movement that supports people on the move across Europe’s borders. In Ceuta, we focused specifically on unaccompanied minors, most of them Moroccan boys living either in overcrowded protection centres or on the street. We organised simple activities, helped them access showers at a local mosque, distributed basic supplies, and spent a lot of time doing what sounds small but matters enormously in a context of abandonment: listening, remembering names, noticing when someone looked different, and trying to create moments where boys treated as problems could simply be children.

The Wounds that Made us Look Closer

As the health focal point, I handled first aid. Although most wounds were “normal”, it slowly became impossible for me to ignore the fresh cuts and old scars on arms and hands, often hidden beneath long sleeves despite the heat. We also noticed that these young boys were constantly under the influence of substances like hashish, pregabalin, or clonazepam.

What saddened me most was the mental state around these habits: exhaustion, rage, grief, boredom, fear, shame and a deep sense of having no agency. These were children who had crossed borders alone, many by swimming, and had arrived in Europe only to find themselves stuck in Ceuta, unable to legally move to mainland Spain. Adil was one of them. He was often under the influence when we saw him, but he was also proud to tell us that he had stopped taking pills, which he associated with cutting, and that now he was “only” smoking marijuana.

Substance use and self-harm in Ceuta should not be read as teenage rebellion, individual pathology or cultural deviance. They are coping strategies shaped by the conditions these boys are forced to live in. This matters because the way we name a problem shapes the way we respond to it. If we call these boys dangerous, we justify surveillance. If we call them disobedient, we justify punishment. If we call them broken, we risk reducing them to their wounds. But if we understand substance use and self-harm as responses to abandonment, then the question changes. It is no longer, “What is wrong with these children?” It becomes, “What have we allowed to happen around them, and what would it take to make survival not only less painful, but an act of joy and dignity?”

Why we wrote Sobrevivir al limbo

In public health, we often say that what is not counted does not count (inspired by Albert Einstein’s famous quote), and in Ceuta and Melilla the absence of data is itself part of the violence. There is almost no routine monitoring or peer-reviewed research on mental health, substance use or self-harm among unaccompanied minors in these border enclaves, yet on the ground, the pattern was visible every day.

That is why we wrote Sobrevivir al limbo, No Name Kitchen’s report on substance use and self-harm among unaccompanied minors in Ceuta. Based on daily field observation and spaces of trust, the report documents a reality that institutions should no longer be able to ignore. For me, this was personal. I delayed the start of my PhD writing it because I felt that what I witnessed could not remain invisible.

Documentation does not solve those failures on its own, but it can make denial harder. It can turn scattered observations into evidence, evidence into public responsibility, and public responsibility into pressure on the institutions that are legally and morally obliged to protect these children.

Holding the line for human rights-based public health

This reflection comes at a moment when migration discourse in Europe and across the Global North is becoming increasingly hostile, not only in the language of political debate but in the legal and administrative architecture being built around borders, returns, deterrence and control. Our standards should not become lower simply because the political debate has become more dehumanising; because once cruelty becomes normalised as policy, public health cannot pretend to remain neutral.

Pedro Sánchez’s recent regularisation measure matters, and it is important to recognise policies that expand rights rather than shrink them. But we cannot celebrate an isolated policy win while ignoring what is happening to children at Spain’s border; a society can recognise a positive policy and still demand better.

What helps is not mysterious

One of the painful things about what is happening in Ceuta is that what helps is not mysterious. We saw that when boys had access to safe spaces, sports, showers, conversation, games and trusted adults who returned day after day, there were visibly fewer crises. Connection and non-judgmental support did not erase trauma, but it interrupted it.

Spain must treat substance use and self-harm among unaccompanied minors as a public health and child protection emergency, not a police problem. That means urgent healthcare without delay, culturally adapted harm reduction, early detection of self-harm and problematic substance use, real mental health care, trained staff, safe complaint mechanisms and structured activities inside and outside the protection system.

Beyond healthcare, it requires faster regularisation before boys turn 18, stronger oversight of privately managed centres, accountability for rights violations, and European monitoring of what border policies are doing to children’s bodies and mental health. The message is simple, even if the politics are not: these boys need protection, care, safe spaces and futures.

When witnessing begins to bear fruit

I am grateful that this witnessing is beginning to bear fruit. This story was recently selected as one of the grand-prize winners of the 2026 Untold Global Health Stories Contest, organised by Global Health NOW and the Consortium of Universities for Global Health. This means that journalists will now investigate further and, I hope, help bring more attention to a reality too often absent from public debate.

My hope is that this attention does not stop at recognition, but becomes pressure, and that pressure becomes protection. Boys like Adil in Ceuta do not need to be turned into symbols of suffering; they need adults, institutions and societies willing to see them fully, beyond the wounds and beyond the behaviours that have been used to mark them as difficult, dangerous or undeserving. What we owe them is protection, care, safe spaces, futures, and the courage to insist that even at Europe’s borders, especially at Europe’s borders, human rights still apply.