How U.S. Immigration Policies Threaten Access to Health

He looked out from the window in the door – the only window in the cold, cement room in which he was being held. Inside was only a bed and a urinal. It’s called a “suicide watch room” and he’s being held there because he suffers from mental illness, the guards explained. Far from a therapeutic environment, I thought to myself.

I’ve been a health professional for over two decades and my work has taken me from the United States to Latin America to Türkiye, to the offices of the United Nations and to hospital beds in the Caribbean. Much of what I do is focused on evaluating and developing health systems and behavioral interventions which respect human rights and which enable patients to be treated in the most therapeutic ways possible. So, on this day in August 2018, in the West Texas Detention Center, I was deeply dismayed by the sight of this elderly man – an asylum seeker who crossed the U.S.-Mexico border – locked away in solitary confinement, left to deal with his psychological issues alone, denied any adequate medical care or treatment.

We know from extensive research that detainees in solitary confinement are often subjected to excessive force, harassment, or abuse by authorities. We also know that prolonged solitary confinement can cause severe and often permanent damage to a detainee’s health, including panic attacks, overt paranoia, random violence, and self-harm. Many asylum-seeking migrants suffered persecution and torture in their home countries – or survived gang violence, domestic violence, human trafficking, and other crimes – before reaching the United States. Many of them suffer from post-traumatic stress disorder (PTSD), which, without treatment, can result in a deteriorated psychological state. Within a solitary confinement setting, the PTSD can rapidly be exacerbated.

But this detainee, along with thousands of others, will almost certainly never speak out about the lack of care in this facility. Some of the detainees who spoke to me during my trip to Sierra Blanca, Texas with Physicians for Human Rights (PHR) admitted that they would simply be too afraid to complain about anything. There is a so-called complaints procedure in place in the detention center, but it seems to merely be a bullying tactic masquerading as a feedback mechanism. If a detainee has a grievance or a health-related issue, they can put a note in a “complaint box” for the appropriate authorities to read and consider. But the system is fraught with intimidation. A detainee has to walk up to a guard at a caged-in corner of their detention room, which houses up to 80 migrants, to request the “anonymous” complaint slip. The level of unhappiness that a detainee has to reach in order to have the courage to actually make their grievances known is terrifying. As expected, the complaint box is never full. It became immediately clear to me that fear is the main hurdle preventing detainees from demanding adequate care, including medical treatment and other basic human rights.

This fear extends outside the walls of detention centers. Within the communities themselves, people – even those who are in the United States legally – are gripped by panic at the thought of having to go to a clinic or hospital to seek treatment. When we were in Brownsville, Texas, my PHR colleagues and I heard stories of border patrol agents parking their vans in front of hospitals, in search of undocumented immigrants. Many sick and injured members of the largely Hispanic community along the border, who often have a family member or two who is undocumented, will simply turn around outside the hospital and walk away, thereby denying themselves medical care. For some, this might include life-saving treatment. But the fear of being apprehended and having their family member exposed to the authorities is too much to handle.

Dr. Deborah Ascheim, who accompanied me on the trip, explained the extent of the intimidation perfectly: “You cannot underestimate the effect that the border patrol agents have on these communities and their access to health. Border patrol is sometimes present in the emergency room or even in the labor and delivery room while a patient is birthing a baby. If they bring someone in, or see someone being brought in who is suspected of being here illegally, the border patrol agents will make themselves present in the very room where the patient is being evaluated by the doctor or nurse. There is no privacy unless the doctor or nurse takes a stand,” she explained. “There are some health care professionals who will tell the border patrol agent to leave. But then the border patrol agent sits in the waiting room and causes those people waiting for treatment to be fearful,” she added.

For me, one of the saddest realizations was that people come to feel that they are without value, or that they are not worthy of being protected or defended – that no one cares about them at all. Some nights, at around 10:30 p.m., white vans turn up at a parking lot outside the bus terminal, not far from the detention center, and the doors open. Dozens of migrants are released, pending their asylum hearings, and they have less than 30 minutes to make it onto the last Greyhound bus. Most will not have sufficient time, money, or directions to go anywhere, and will spend the night in the parking lot. Volunteers arrive to offer food, hygiene products, and even shelter. One night, I saw an elderly man exit the white van and be greeted by 20 smiling faces of volunteers. He was taken aback and a little uncertain. “Who are you?” he said. “Welcome. We’re here to help you,” one volunteer said. And with that, he began to cry.

My mind immediately went back to that man whom I had seen in solitary confinement back in the West Texas Detention Facility, and to how he, too, needed human interaction and some semblance of care and compassion.

Dignity and respect should not be reserved for select people. Regardless of policy or politics, every human being, including those being detained for crossing the U.S.-Mexico border while fleeing violence and persecution, deserve the right to seek asylum, and to access adequate medical treatment. These rights are protected under international law. The time to remain silent has long passed.  

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