Persistent Concerns over the Health of Immigration Detainees

Matthew Anderson — Fri, 03 Apr 2009 13:24:29 +0000

Rev. Joseph Danticat died in Immigration Detention. Shown here with his wife & niece Edwidge

In July of last year we wrote about the activites of RPSM alumni Dr. Homer Venters to bring attention to the medical conditions in the detention facilities of Immigration and Customs Enforcement (ICE). Two reports issued in March – one from Human Rights Watch and the other from the Florida Immigrant Advocacy Center - provide further evidence that ICE is not adequately caring for those in its custody.

A bit of context

To understand the health problems in ICE facilities it is necessary to have some sense of the massive growth in ICE’s detention operations. In March of this year Amnesty International USA produced a report on ICE entitled Jailed without Justice which notes:

More than 300,000 men, women and children are detained by US immigration authorities each year. They include asylum seekers, torture survivors, victims of human trafficking, longtime lawful permanent residents, and the parents of US citizen children. The use of detention as a tool to combat unauthorized migration falls short of international human rights law, which contains a clear presumption against detention. Everyone has the right to liberty, freedom of movement, and the right not to be arbitrarily detained.

According to the ICE website the average daily number of “detained aliens” in custody rose from 20,838 in 2002-2005 to 31,2345 in 2008 (fiscal years). By contrast the Amnesty reports notes that as recently as 1996 the immigration system had the capacity to detain only 10,000 people a day. While the absolute numbers of detainees has increased, ICE has also decreased time each detainee spends in custody. The result is a massive machine to detain and incarcerate.

It is important to remember that the vast majority of those detained are not criminals. Those who are in the US without authorization have committed a civil violation not a crime. In the language of ICE they are “deportable aliens.” As Human Rights Watch notes it is precisely their status as civil – and not criminal – detainees that deprives them of their right to a lawyer.

In fact, many of those detained are victims of crime themselves. In July of last year our journal, Social Medicine, published an interview with Victor Toro, an immigration activist in the Bronx. Victor, who had been severely tortured in Pinochet’s Chile, described his experience with ICE detention:

On 6 July of 2007, when I was traveling from California to New York in an Amtrak train, when we had just passed the city of Buffalo, in one of the stations, the Immigration service entered the train with dogs producing great alarm and upsetting the English-speaking passengers, asking for papers from everyone and acting especially rude and hateful toward the persons who had Hispanic features or looked as if they were from some other part of the world than the USA. I was among these persons, among them I was traveling and had lived nearly 25 years in this country. Without many questions I was hand-cuffed and forced with blows from the train, then handcuffed to the others and taken to the regional immigration offices, afterwards to the Cayuga jail, where I was stripped and forced to wear the orange prison jump-suits, which are the same that everyone in the world saw on the prisoners tortured and tied-up in Guantanamo and Abu Ghraib. This squeezed and cramped all the fibers and vibrations of my body, it took me immediately to sessions of torture and mistreatment that I lived through in Chile, in the torture centers and the concentration camps of Pinochet. It was horrible, I cannot even talk about it and just thinking about and seeing the photos of the prisoners in Guantanamo converted into animals by the authorities of the United States, this has no name. It is pure savageness, a total lack of humanity.

Concerns about immigrant health care

Given the rapid expansion of the ICE facilities it is not surprising that health problems have arisen. Indeed the Inspector General of the Department of Homeland Security had issued a report in December of 2006 noting “instances of non-compliance at four of the five detention facilities, including timely initial and responsive medical care.” Among other concerns the Inspector noted that procedures did not exist for detainees to report abuse or human rights violations.

During May of 2008 the poor care provided in ICE facilities was highlighted in a series of articles in the Washington Post entitled: Careless Detention: Medical Care in Immigrant Prisons. This report drew an angry response from ICE and a careful rebutal by the Washington Post’s Ombudsman.

In November of last year the ICE issued a fact sheet on Detainee Health Care which stated that detainees received care for both acute and chronic medical conditions in accordance with community standards. Further ICE claimed that health care in its facilities was evaluated using “applicable health care standards from the American Correctional Association (ACA), the National Commission on Correctional Health Care (NCCHC), the Joint Commission, and the ICE National Detention Standards to evaluate the care provided to detainees.”

The reports by Human Rights Watch and the Florida Immigrant Advocacy Center paint a very different picture.

Detained and Dismissed

Detained and Dismissed:Women’s Struggles to Obtain Health Care in United States Immigration Detention is the title of the report by Human Rights Watch. It is based on a series of interviews & detention facility visits conducted in 2008. The interviewees included 48 women who were either in an ICE facility at the time or had been in the past. The report began by noting that the standards for medical care adopted by ICE were problematic:

Official ICE policy, which focuses on emergency care and keeping the individuals in its custody in deportable condition, effectively discourages the routine provision of some basic women’s health services. ICE’s Division of Immigration Health Services (DIHS) has chief responsibility for the medical care provided to detained immigrants, whether it provides those services directly or through a contractor at a local facility. The DIHS Medical Dental Detainee Covered Services Package, which governs access to off-site specialists, says that requests for non-emergency care will be considered if going without treatment in custody would “cause deterioration of the detainee’s health or uncontrolled suffering affecting his/her deportation status.” Although, on occasion, officials have offered generous interpretations of this policy in its defense, the message about the scope of care provided remains clear. “We are in the deportation business…. Obviously, our goal is to remove individuals ordered removed from our country,” ICE spokesperson Kelly Nantel told a reporter in June 2008. “We address their health care issues to make sure they are medically able to travel and medically able to return to their country.”

As Human Rights Watch notes, the decision by the US government to deprive someone of their liberty means the government is responsible for their care.

The report documented numerous violations of humane treatment:

We met women who were denied gynecological care or obtained it only after many requests, including a woman who entered detention shortly after receiving news of an abnormal Pap smear. She told detention authorities that her doctor instructed her to get Pap smears every six months, but after 16 months in detention and many requests, she had still not gotten a Pap smear.
We met women who complained of inadequate care during pregnancy, including one diagnosed with an ovarian cyst threatening her five-month pregnancy shortly before she was detained. Her doctor said the cyst should be monitored every two to three weeks, but during her stay in detention of more than four weeks, she was never able to see a doctor. The medical staff’s response to her last sick call request read, “be patient.”
We met women who had to beg, plead, and in some cases work within the facility just to get enough sanitary pads not to bleed through their clothes, and one woman who sat on a toilet for hours when the facility would not give her the pads she needed.

The report concluded with a series of specific recommendations.

Dying for Decent Care

Dying for Decent Care: Bad Medicine in Immigration Custody was released in February by the Florida Immigrant Advocacy Center. It begins with the story of Reverend Joseph Dantica (actually Danticat) who is one of more than 80 people who have died in immigration detention.

Rev. Joseph Dantica, an 81-year-old Baptist minister, fled Haiti after he was targeted for persecution. Gangs had burned and ransacked his home and church. Although Rev. Dantica had a valid visa to enter the United States, where he had traveled many times, he was detained at the Miami airport when he told officials he sought political asylum. At the Krome immigration detention center, he was accused of “faking” his illness and later transferred to the prison ward of Miami’s public hospital in leg restraints. Rev. Dantica died there alone five days after his arrival in October 2004. His family was allowed to see him only after his death.

Danticat’s case gained some public attention from the efforts of his niece Edwidge Danticat, a well-known novelist.

FIAC provides free legal services to detainees in Florida. The organization is, therefore, exposed to the realities of life inside the ICE facilities in Florida. The report provides detailed information on the following health issues:

Deaths in Detention
Abuses in Medical Care
Unacceptable Mental Health Care
Physcially Disabled Detainees
Mismanaged Medication
Forcible drugging to depart
Language barriers
Unhealthy living conditions
Detainees treated like criminals
Denied medical records

This report closes with a set of specific recommendations. Among these are that independent, external scrutiny needs to be exercised over the work of ICE.

Commentary

Deportable aliens are not criminals and alternatives to incarcerations should be fully utilized before we deprive someone of their liberty. Once someone is incarcerated they should receive humane treatment. ICE’s report of last December seems to say that “everything’s ok.” This is perhaps the most concerning part of the story and justifies FIAC’s claim that in an oversight vacuum “ICE tolerates a culture of cruelty and indifference to human suffering.”

posted by Matt Anderson, MD

The Social Medicine Portal » Florida Immigrant Advocacy Center

Persistent Concerns over the Health of Immigration Detainees