Detained Migrants Have a Right to Proper Medical Care
Advocating for the humane treatment of detained migrants
As medical students who will all take an oath to uphold the highest standard of patient care, we are profoundly disturbed by the detrimental treatment of detained migrants.
Detained migrants are dying, in large part from inadequate care. This neglect begins with their initial detainment, during which migrants do not receive proper health screenings, and continues under the adverse conditions of the detention centers. These dire conditions - under which the detainees are deprived of adequate nutrition and sanitation - particularly affect children, pregnant women, and individuals with chronic medical conditions. The treatment of these detained migrants is inhumane and goes against all our training as future physicians.
Duty as medical students
Within the first week of medical school, we discuss social determinants of health and how these factors may impact our future practices. These determinants include gender identity and expression, race, ethnicity, socioeconomic status, and immigration status. As future public servants, we dedicate our careers to the health of all human beings, regardless of race, sex, gender identity, ethnicity, ability, religion, or country of origin. Current practices by Immigration and Customs Enforcement (ICE) blatantly disregard and endanger detainees' health and wellbeing, and directly oppose our values and beliefs.
The situation provides us in the medical field with two general directions: either do nothing, or stand up for the values we vowed to uphold. Some may say that these public issues at the border are out of the scope of medical practice, but we believe that it is a medical concern wherever there is human health at stake. We swore to help all sick men, women, and children, regardless of any other characteristics.
Demanding change for migrants
As a collective of medical students nationwide, we wrote a petition outlining the changes that must take place to ensure the humane treatment of detained migrants. In collecting the signatures, we found that this issue speaks deeply to medical students. We quickly obtained more than 1,500 signatures from future physicians.
We call for the humane treatment of detained migrants through:
►Proper health screening of detained migrants;
►Clear orientation on the process of detainment for migrants;
►Access to appropriate nutrition and water;
►Access to suitable housing and sanitation;
►Access to proper medical care;
►Robust precautions to stop sexual assault toward minors;
►Prevention of detainment of children, pregnant women, and severely ill migrants.
There is a lack of thorough medical care for detained migrants. According to a May 2017 report from the American Academy of Pediatrics, some border processing facilities provide limited initial medical screening (e.g. screening for scabies, lice, or chickenpox) to migrants. Individuals with chronic conditions such as heart failure and cardiovascular concerns require regular monitoring that is not accessible at the detention centers due to lack of access to medical professionals.
According to a report by Human Rights Watch, in 8 of 15 cases reviewed by experts, they concluded that poor medical care contributed to or resulted in deaths. Some of the cases involved heart failure, heart attacks, and seizures. In none of these cases did the migrants receive adequate care.
Some detention centers have severely substandard care, with reports that detained migrants have sparse bathing and cleaning supplies, inadequate sleeping conditions, and insufficient food and water. Medical professionals at the front lines of the border continue to report these human rights violations.
Women, children worth more than this
Detained children are a particularly high-risk health population. Physicians for Human Rights reports that many children migrants have experienced violence in their home countries and show serious signs of trauma. At times, children and families are separated at detention centers, causing profound psychiatric harm.
Many of these unaccompanied migrant children have been detained longer than the 72 hours established by federal laws. Children are then placed in unsafe detention centers. From October 2014 to July 2018, there were 4,556 allegations of sexual harassment or sexual assault toward unaccompanied minors. The harm is compounded by the lack of nutrition and sanitation at the detention centers. Since September 2018, at least six migrant children have died in federal custody.
It is also dangerous for pregnant women to be detained. The stress of taking care of oneself during pregnancy is exacerbated by the extreme circumstance of being detained. Pregnant detainees have been separated from their families, have inadequate access to prenatal vitamins, and are ignored by detention staff when requesting medical attention, as outlined by a joint ACLU complaint to the DHS. This substandard care means that pregnant women in detention are not adequately screened for preeclampsia and other high-risk pregnancy concerns, putting both mother and fetus at risk. Yet from October 2017 to the end of August 2018, 1,655 pregnant women were booked into ICE custody.
In addition, there is a lack of transparency about the detainment process. Detainees are not fully oriented to the process of detention or the amount of time they will continue to be held in detention centers. Migrants also have limited access to appropriate legal counsel and interpreters. This process has a profound impact on the mental health of migrants, who report high levels of anxiety, depression, and post-traumatic stress disorder both during and following detention.
Furthermore, anti-immigrant policies and actions potentiate a detrimentally stigmatizing environment that inflames existing racial and ethnic health disparities by increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources.
We are impacted by the stories of the detained migrants both viscerally and intellectually. Medical students include DACA recipients, whose families are refugees and immigrants and whose friends are being deported.
One of our medical students writes, “The stories and images that come from the border are more than the day’s news to my family - it is a fresh, vivid nightmare that continues to evoke fear. As undocumented immigrants in the United States, my parents lived in perpetual apprehension. Life’s normal daily struggles were amplified by the added stress that my parents could be rapidly taken away by a monstrous, indifferent system. Though the stories of today’s migrants are their own, I cannot help but hear my parents’ woes. I hear these stories and realize that our story is more than a story: it is real lives being affected in concrete ways just as is so with today’s migrants.”
Future of medical profession at risk
Being new to medicine, we worry about the culture that may shape the guiding principles for our future careers. We worry that the word “migrant” will become synonymous with the word “inhuman.” We worry that migrants will lose their right to proper health care. We worry that legality, which is so arbitrarily defined, will dictate our humanity.
Medicine is the study of humanity, and those who study medicine must study human values. In fact, an accreditation committee requires medical school curricula to cover “medical ethics and human values” extensively. When human life is devalued, the very basis of our education and the guiding principles of our future careers are threatened.
By continuing to allow the inhumane treatment we have seen at US detainment facilities and elsewhere, we are setting a level of reference toward which future generations of medical students and professionals will look to measure their own actions. We risk propagating a culture that ignores human suffering and promotes a discriminatory approach to patient care. To lay a foundation for a healthier nation, it starts by us tackling this institutional atrocity.
How to help
For medical students, sign the petition here! The petition will be sent to US senators, and we will advocate for the passage of bills (such as HR 3239) that address the conditions at the border.
Wednesday, September 4th, 2019 is the “White Coats for Human Rights Nationwide Rally” hosted by the Latino Medical Student Association (LMSA). The LMSA is holding a nationwide rally in protest of the violation of human rights at the border and detention centers, and in advocacy for bill HR 3239. Join the Facebook event here.
Get involved in organized medicine, and continue to push for organizational support of the humane treatment of detained migrants. So far, multiple medical professional organizations, including Physicians for Human Rights, American Association of Family Physicians, American Medical Association, American Psychiatric Association, American College of Physicians, and American Academy of Pediatrics (PHR, AAFP, AMA, APA, ACP, AAP) are advocating for the humane treatment of detained migrants.
Thomas Pak - University of Iowa
Neha Siddiqui - Carle Illinois College of Medicine
Courtney Harris - Rosalind Franklin University of Medicine and Science
Anna Tran - medical students from New York
Harrison Khong - a medical student from California
Oscar Salas - a medical student from California
Tabitha Moses - a medical student from Michigan
May Chamma - a medical student from Michigan
This is an updated version of a piece published in USA Today.
All views expressed are of the authors, and do not represent the views of their respective institutions.