By: Patricia Kellner, MD, Clinical Assistant Professor of Family Medicine and Community Health, Case Western Reserve University School of Medicine
Reprinted from the Fall 2020 Issue of The Ohio Family Physician
Many Ohioans don’t know that scores of migrants who crossed our southern border have ended up in Immigration and Customs Enforcement (ICE) detention centers in our own state.
I have seen photos of kids in cages and read about ICE detainees not receiving needed acute care and flu vaccinations while in detention. As a family physician, I know these are not acceptable ways to care for human beings, so when I received an invitation from Doctors Organized for Health Care Solutions to attend a presentation given by two Catholic charities lawyers about ICE detention, I decided to see what I could learn.
The lawyers shared information on the circumstances that are driving people to our borders to request asylum. We learned about the plight of the people who are detained for not having legal status in our country. Asylum seekers are typically fleeing violence or threats of violence against them and/or their families, often waged against them following extortion, forced labor, rape, or because of their political or social beliefs. Murder rates in El Salvador are about three times the present death rate from coronavirus (COVID-19) in the United States.
The lawyers sought to enlist physicians to assist them with understanding and reporting on the medical issues of asylum seekers. They asked for physicians who would be willing to accompany them as volunteer legal assistants to meet with these detained asylum seekers—I signed on.
My visit to the Northeast Ohio Correctional Center, a privately-run state prison in Youngstown, OH, where as many as 400 detainees are held, was a sobering experience. The lawyer and I went through a double set of chain link barricades, with one closing behind us before the other one opened. We registered, gave up our keys, and went through a metal detector. We were not allowed to bring phones, computers, or food into the prison – just paper, a pen, and water. Once we were ushered into a windowless, concrete, 10-foot-by-10-foot room, we began meeting with detainees. A prison guard stood by the door during our encounters. I took medical histories, mostly with a volunteer translator present, to assess whether detainees were receiving proper attention to their acute, chronic, and mental health problems, as well as documenting injuries and conditions related to torture and persecution in accordance with the United Nations’ Istanbul Protocol. I reviewed records and wrote affidavits.
Other physicians volunteered to attend public protests and county health department meetings; to write letters to the editor and op-eds; and to lobby Congress. Zoom meetings to discuss jail conditions were held at the Morrow County Health Department. During a meeting, advocates for the detainees posted photos of a man and his daughter – the man, who had lived in Ohio with his family, had died in detention. Two family physicians spoke at this meeting.
- Asylum seekers are detained in prisons and jails all over the United States.
- Asylum seekers are not just from Central America and Mexico – there are asylum seekers from countries in Africa and Asia too.
- Asylum seekers flee undeclared civil wars and local conflicts. Some have been persecuted for their belief in things like democracy, freedom of speech, a particular religion, or for being a particular ethnicity or homosexual. Some have fled because they feared for their lives after seeing something they weren’t meant to see.
- Applying for asylum starts with the credible fear interview. “Credible fear” refers to establishing that there is “significant possibility” that the individual has been persecuted, or has a well-founded fear of persecution or harm if returned to his or her country.
- Border Patrol operates within 100 miles of any national border, so northern Ohio is a hunting ground for undocumented immigrants. Raids have occurred in businesses in Norwalk, Sandusky, and Painesville, OH. People have been arrested at their homes and in public, too.
- Incarceration is not mandated for people requesting asylum if they have someone willing to take them in. Taxpayers pay as much as $240 a day in Ohio for a cell that holds two people. Ankle bracelets with geolocators cost as little as $4 a day. Private, for profit prisons and municipal jails are eager for the money they get from ICE to house detainees.
- Conditions in many of the detention facilities are inhumane and unsafe. Beds are closer than six feet apart. Soap and disinfectant are not available much of the time. Medical care is substandard or non-existent.
- COVID-19 can, and does, run rampant, infecting detainees and staff as well. The Morrow County Jail, one of the ICE detention facilities, is still accepting new ICE detainees even though 100% of the inmates there have tested positive for COVID-19.
- The journey to America is long and arduous, and it takes a special person to make that journey.
After all that I’ve learned, there are many ideals that have inspired my efforts. First, seeking asylum is not a crime.1 Entering the country to request asylum is now considered a misdemeanor, though it results in detention in a prison or jail. Second, no human is illegal. Lastly, we as physicians have ethical responsibilities. In the American Medical Association Principles of Medical Ethics, three of the nine principles are relevant to the care of asylum seekers, undocumented immigrants, and resettled refugees:
Principle 1: A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
Principle 3: A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
Principle 9: A physician shall support access to medical care for all people.
- Doctors For Camp Closure
- The Ohio Immigrant Alliance
- Doctors for America
- Istanbul Protocol – Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment from the Office of the United Nations High Commissioner on Human Rights.
References available on the OAFP website.