AMSA recently hosted a panel discussing immigrant health rights, detention, and COVID-19. A transcript of the discussion is below. It has been lightly edited for length and readability.
Panel Moderator: Ashi Arora, REACH Chair
Panel Members
Rose Murray, Direct Services Attorney, Southeast Immigrant Freedom Initiative
Dr. Ian Kim, Doctors for Camp Closure
Dr. Asim Shah
Dr. Chanelle Diaz
Introductions and Background
Dr. Ian Kim
The way that our government is treating asylum seekers and people in immigrant detention in general is one of the places of the worst human rights violations and medical neglect that we have in our society. As a physician with my background, I cannot be silent, I cannot stand aside and allow that to happen without taking some action against it.
There are many ways an individual can end up in detention—you may be seeking asylum, showing up at a U.S. border seeking asylum from a living condition at home that is unsafe. Or, you can end up in detention as a result of an ICE raid on U.S. communities. People can be in ICE detention for years awaiting a decision on their immigration status.
This issue didn’t begin with the Trump administration, and it won’t end with the Trump administration. Obama was also responsible for deportations and was enacting policies that came before him.
Dr. Asim Shah
Dr. Shah is a psychiatrist who among many things runs a refugee and human trafficking clinic in Houston.
Dr. Chanelle Diaz
Dr. Diaz is currently working as an attending at Montefiore in South Bronx. After seeing the detention centers that immigrants are placed in, it is important to keep the goals clear. The goal is not to improve the conditions in immigration detention centers, it is the abolition of immigrant detention. “There is no healthy or safe detention that would leave asylum seekers without trauma, health risks, and PTSD. There is no way to do this and maintain a state of health for someone. It’s really important for us to keep in mind that the goal is abolition, that there is no need for immigration detention. This is a system that has been designed and built to make profit, and it’s not necessary. Coming from the perspective of medicine, the human rights violations are so clear, the harms to health are so evident, that that is what we need to be advocating for.”
Dr. Diaz emphasizes that as physicians, one of the most powerful things that can be done is to find the community groups that have been advocating for the end of immigration detention in your state or area, and join them.
She states that the voices of those in detention centers is one of the most powerful things to move people to action. Their voices and their stories are at the center of this movement, and we can’t allow them to go unheard.
In Dr. Diaz’s experience, as a physician she was given access to detainees that even their lawyers or their families aren’t given. In that time she found the most important aspects of her medical evaluations to be connecting with the individual, gaining their stories and their experiences.
Question & Answer
What does resilience look like for those that are currently in the detention centers?
Dr. Asim Shah
What is resilience? Resilience is the ability to recover from any difficulty or stress. People recover from stress based on their social support. If you have good social support, if you have a good life, if things are positive in your life, you recover better. For people in detention centers, unfortunately life is not good for them. Unfortunately it is stressful, and they have lots of medical conditions. For them, resilience is very different than if the same person was outside of detention. So while human beings are generally very resilient, when we add stressors, and tragedy and trauma, our abilities for resilience change. That’s the problem. Resilience is very different for everybody in detention centers. If you think about even the principles or skills of resilience, the first is the belief. So if someone in detention has the belief that they will be released soon, then they will be more resilient. If they feel that there is no hope at the end of the tunnel, it is very difficult to be resilient. If they are connected to somebody, whether it’s family or their attorney or something, that will be helpful for the recovery phase of resilience. If they have somebody to talk to or positive emotions or social support, that will help their resilience. There are so many factors involved, the same person in and out of detention can have very different capacities for resilience. All of the factors I mentioned like social support, and also things like their outlook whether they’re a very positive person, or maybe they’ve had mental health issues even before being placed in detention. All of these factors determine a person’s resilience.
Dr. Chanelle Diaz
As a recent survivor of residency training, I will say that I find the term resilience to be very problematic in a lot of ways. It’s not a badge of honor to be resilient. It’s not necessarily a badge of honor to survive conditions that are designed to break you, to break down your humanity. I think we have to be really clear that immigration detention is designed to do just that. The ways in which solitary confinement are used indiscriminately, is used period, we know that solitary confinement is a form of torture. As clinicians we know that. The conditions in detention, the separation from community, the arbitrary detention not as a result of any criminal case—even if it were, it would be no justification for the things that are done in detention. So, have I seen incredible resilience? I have, and I’m always amazed by it. And I’m always shocked by what people are able to endure, and how they’re able to maintain their humanity when faced with such trauma, and how they’re able to maintain hope. It doesn’t negate what we’re doing still as a country. I will say that I will never forget one interview where we talked about how they had heard the protests outside the detention center, and they talked about just what it meant to hear folks outside supporting them—what that did for them emotionally and how that gave them strength.
Dr. Asim Shah
I’d like to add something to that—when we talk about resilience, and the circumstances for which we should feel proud of being resilient, resilience fits better for circumstances which are unavoidable. So for things like 9/11, hurricane Katrina, for these kinds of things we can be proud to recover from these difficulties. But how does resiliency fit when these things shouldn’t even be happening? That’s the difference, resiliency is otherwise very good and we should be proud of resilience. But I think the bigger issue is, can we avoid this? Detention is something that is man-made, and it is something that can be avoided.
As we know as future physicians, we know that stress has an incredible impact on the human body. What are the mental and physical health impacts of detention on individuals?
Dr. Asim Shah
I can speak to the mental impacts. There are a range of effects, from insomnia, anxiety, depression, PTSD, and sometimes even psychotic symptoms. This can be stemming from the trauma that they endure- what was mentioned earlier in the form of solitary confinement, or it could be from beatings or even god forbid sexual harassment or trauma. That’s how it starts, and then it lingers on. When we have studied people in detention, there are few studies of people just in immigrant detention but plenty of other forms, and we see that this trauma lasts multiple years. It’s a multiple-year trauma which we have seen in these people, and it’s very important for everyone to understand that this can have a lasting impact on people. For young people, they have more lasting impact than older people. Why? The resilience is different, they are less mature, and they can have more of a lasting impact from these traumas than an older population.
Dr. Ian Kim
With a focus in particular on asylum seekers, they’re part of a global refugee crisis that’s been mounting in the hundreds of millions. When someone comes to our border seeking asylum, they’ve already experienced a great deal of trauma in their lives, and witnessed a great deal of trauma amongst their family members. So when they show up here, as resilient as they are, it’s remarkable—they’re already in quite a vulnerable state. So when we add additional traumatic experiences to that rather than treating them with dignity and respectfully hearing their asylum request, it’s particularly unconscionable what we add to that. In particular when Dr. Shah talked about children briefly, I’m sure you’ve heard of ACES, adverse childhood experiences, and there’s no question in my mind that a child going through detention is experiencing a formative traumatic experience that could stay with them throughout their lives. It’s really important to have that framework in mind. In particular there’s plenty of research about attachment theory, where for infants and young children, although not just under that age group, having a secure, trustworthy, and loving attachment to your parent or your primary caregiver is foundational for cognitive development and for social development. WHenever that primary attachment is threatened or removed, then that can lead to lifelong consequences in one’s cognitive and social development. Just to drill down on that for a moment, when a child is separated from their parent, there are three phases that a child can go through. There’s the acute phase, where there’s a lot of crying and a lot of protest, there’s a phase of despair where then a child after days or weeks actually seems to calm down, and an authority figure in an ICE detention center might think they’ve settled down and are better, they’re actually experiencing a deeper level of harm. And the third stage of threatened attachment is full detachment. And when someone is in that stage as a child, even when they are reunited with their parents, there is a very long lasting and perhaps permanent injury to that primary relationship. There are New York Times stories about three year olds reintroduced to their parents who don’t recognize their parents, children who had been potty trained regressing to diapers, and sometimes even calling out for their caretaker from the detention center and pushing away their parents. There’s really clear evidence in that reporting of severe injury to that primary attachment, and that has happened at the scale of not just dozens or hundreds, but for thousands and thousands of children.
Dr. Chanelle Diaz
Thank you for highlighting that effect on children. I’d like to talk about the physical effects of detention. What ends up happening is that anyone who had a chronic disease going into detention is likely to see a deterioration of their chronic disease. It’s a combination of the stress of detention and a lack of access to adequate medical care. It’s pretty clear that across the board, the care that people are receiving in detention is not at the standard of care across the community. For folks who have chronic conditions, who in spite of being in these confined conditions where you’d think there are no barriers to care because they’re there and medical professionals are there, but there are barriers and there are delays. The other issue is that when there are acute problems that present themselves, it can take days if not longer for there to be any assessment of the person. In these places, there tends to be several steps before you can actually see a physician. And I think that many reports have demonstrated that there are not adequately trained personnel in sufficient numbers at these facilities. It may take 24 hours or more for someone to just be triaged by a nurse, they may then be triaged and assessed properly, so they may be initially assessed by someone who doesn’t have the training to make these exams and consider their medical records. Adequate histories are not taken, often the examinations are done in English regardless of the primary language of the patient, and the patients are not made aware of their right to an interpreter. So you can see how these processes can lead to delays in medical care, and what you end up seeing is that someone who has gallstones for example, can be suffering for months. Rather than treating this in time, it may come to the point where they need to be hospitalized and have emergent surgery. This is something that could have been addressed easily with adequate care. We’re all shocked when we hear of the deaths that occur in detention, but the deaths are just the tip of the iceberg. It’s nowhere near the number of near misses that there are. And we have no grasp of what that is, and what the consequences are. So often I see cases of people from chronic pain from fractures that were never addressed in detention, and deal with the consequences of the pain because their bones never healed properly. I think it’s everything you’ll see related to a place of chronic stress, headaches, pain, body aches, along with we often see chronic illnesses not being controlled, diabetes not controlled, and we also have to look at the nutrition that they have available in detention. Oftentimes they may not have enough food, the food may be rotten, the food may be high carb and not nutritious, and then their options are that they can buy food in the commissary. And on top of being expensive, the food in the commissary is not nutritious. So we have to look at all of these impacts on health to be aware of how these things combined really impact people’s health severely.
Dr. Ian Kim
Since we’re talking about some of the harms that people in detention can experience, and Dr. Shah highlighted sexual assault earlier, I do think it’s important to highlight this. One thing that I’ve come across is that from 2012-2018, there were nearly 1500 allegations and complaints of sexual assault in immigrant detention. And that’s just the ones that were reported. So if you do the math, that breaks down to nearly one per day on average. And it’s both men and women, plenty of cases of rape, of forced oral sex, of inappropriate touching, groping, this is already in a setting where people have no privacy and where people can be forced to strip. Many instances of routine searches turning into groping and fondling. And I just want to highlight that that’s not a rarity in detention and it’s common and something that people are enduring.
While we’re here in case there’s not time I just want to further expand on what Dr. Diaz was saying that detention is not necessary. There are plenty of shockingly common sense alternatives to detention, which the federal government has invested in to the order of hundreds of millions of dollars a year, until recently when the Trump administration has pulled that funding. These alternatives are extremely effective—95-99% of people in alternatives to immigrant detention when it’s run well show up to their immigration proceedings. It’s more effective and less expensive than prison. It’s about $4 a day instead of $200 a day. Of course, these alternatives to detention mean that people can be at home with their families, they can have much more dignity and freedom. THere can still be problems and abuse with ankle monitors, it’s not the panacea or the golden solution, but it is much better than detention. So what we’re talking about in abolition of detention is not pie in the sky, it’s alternatives that we’ve done in the past and need to go back to that.
Dr. Asim Shah
Another thing that we need to talk about is that for many of these asylum seekers they have psychiatric issues, they can be in physciatric hospitals. Why do they have to be in detention? There are numerous places they can be, it doesn’t have to be detention centers. Those are some of the most expensive and most traumatic options.
How can we destigmatize the stories and narratives of these communities that we’re discussing today?
Dr. Asim Shah
We collectively include everybody in detention centers as the same. They are in jail…they are in jail. It’s the same. When somebody is in the detention center on an immigration charge, you can’t compare them to a criminal who is in jail. That’s one way to destigmatize. The next thing is that we should stop looking down on those who have an immigrant status. I can give you an example, it’s not an immigrant in detention, but there’s a county judge here in Texas who is an Indian immigrant. He gets all kinds of hate like go home, go home, and he’s been here for years. It’s our job to destigmatize the word immigration, everyone can play a part.
Dr. Chanelle Diaz
I agree that language matters a lot. When we’re talking about detention, it’s important to talk about individuals and people in detention. I avoid using the term detainee because it’s depersonalizing and strips that individual of their humanity. It’s also important to state that we’re talking about jails and prisons. When we say detention centers, camps, they’re jails and prisons. I think we need to be cautious when we talk about immigration detention, because anyone can end up in immigration detention. They may be asylum seekers, or they may be legal permanent residents who end up in detention. There may be some people who have criminal convictions in the past, and they have done their time, and they deserve their freedom. So they don’t deserve to be deported and locked away simply because they had a misdemeanor or a felony. So even when we talk about criminality, we need to be cautious. Because while we’re talking about the human rights violations in immigration detention, these are the same violations that are happening in our county jails and prisons. So we can’t focus on abolition within immigration detention and not look at our mass incarceration system and think about abolishment there too.
Dr. Ian Kim
I just want to double down on that. The immigration jails and prisons, the way they’re run, the policies and procedures and the staff and the hierarchy there, it’s all based on the incarceration system. And in fact, many ICE detention centers are the same as county jails and prisons. The majority of ICE detention centers are run by private prison corporations. There’s a really insidious profit motive that undercuts a lot of this. I think we do need to be very careful about drawing lines in the sand, with who is a criminal and who isn’t, when we talk about detention centers, prisons, and camps. It’s that association between criminality and immigration that is the problem. It’s this racism that is creating criminality, and actually creating criminals because they get stuck with these labels, where there wasn’t criminality before. So in the same way that we think about substance use and dependence, in other developed countries, substance use is treated as a health issue, and here we see it as a crime problem, and we see the consequences of all of that. In the same way, we have turned immigration into a criminal justice issue because of the racism and the culture that’s promoted here. So I think recognizing that is the first step.
Dr. Chanelle Diaz
I think really calling out the racism in the system, calling out the racism in our immigration policies—these are systems that we’re talking about that have been built to be racist. And specifically, anti-Black. So I think it’s really important when we talk about immigration to talk about it’s disproportionate impact on communities of color, on Black immigrants, and the ways in which it is weaponized and the ways in which the language is weaponized.
Rose Murray
I think you guys have made great points that the immigration system mirrors the injustices of the criminal legal system, it has the same disproportionate enforcement and the same anti-Blackness. And often when I talk to people in detention, they ask why they are being locked away and treated as a criminal, when they have committed no crimes. And I’ll just point out that you don’t deserve to lose your family and be deported and put in a prison even if you’ve committed a crime in the criminal legal system.
Action Steps
Here’s what you can do to take action:
- Identify local groups who are active in immigration reform and volunteer and learn from them
- Get involved with REACH!
