Risk behind bars: Coronavirus and immigration detention

When news broke last week that the Justice Department’s Executive Office for Immigration Review ordered immigration courts to remove posters with information about COVID-19, it raised a huge red flag for those of us working with asylum seekers. The poster in question, placed by a union, displayed important public health advice about not touching one’s eyes, about cleaning and disinfection, about avoiding contact with sick people. 

Though the reason for the removal order was mundanely bureaucratic (no flyers are allowed there, period), the initial response of the agency to the urgency of the unfolding crisis was incredibly worrisome. We are in the middle of a coronavirus pandemic for which we don’t seem to be ready. We are all at risk in varying degrees. 

But consider those in immigration detention: populations numbering in the thousands, living together in confined settings, completely unable to “self-quarantine” or to exercise the “social distancing” advised by health authorities. 

And consider, at the same time, the “contagiousness” of this novel coronavirus: its R0 (the number of people who can get infected from a single infected person) is twice that of the flu. It is plain to see that the migrants held in detention awaiting disposition of their immigration requests face extremely high risks for a worsening COVID-19 outbreak.

And yet, we don’t really know what is being done to protect them. Worse, we know the precedents are worrisome. In recent years in immigration detention facilities, there have been disease outbreaks (including mumps and chickenpox); overcrowding; and a litany of media and human rights reports documenting poor hygiene measures, terrible conditions, and poor access to resources and medical care.

Appallingly, there is no mechanism for routine monitoring of the medical conditions in these facilities, and there is an alarming recent history of neglecting detainees’ health.  

This does not inspire much confidence in the government’s ability to prevent or manage a possible COVID-19 outbreak in the immigration detention system, despite statements from ICE that: “The health, welfare and safety of U.S. Immigration and Customs Enforcement (ICE) detainees is one of the agency’s highest priorities.”

Picture what could happen. On the one hand, there is a captive population. On the other hand, there is a revolving door of exposure. The guards come and go; health staff come and go; visitors come and go; food workers come and go. 

All can potentially carry infection with them, in either direction. A coronavirus brought into a detention facility can quickly spread among the dense detainee cohort. Soon enough many are sick — including high-risk groups such as pregnant women or those with chronic conditions — quickly overwhelming the already strained health infrastructure within the facility.

There’s a parallel in what we have seen happen in other confined settings, such as prisons. In China, the coronavirus has infected hundreds of prisoners. In Iran, the government took the drastic step of releasing 70,000 prisoners to prevent the virus from spreading. In Italy, coronavirus restrictions prompted mass riots in dozens of prisons. In Israel, an entire prison was quarantined. 

There is a lot we don’t know: are there enough isolation units? In their statement, the ICE spokesperson noted that, of 20 detention facilities, 16 are equipped with airborne infection isolation rooms.

But is that enough for a detainee population topping 55,000? What about all the other 100+ facilities? There are only so many testing kits, and there’s a shortage of face masks. Who gets them? The staff? The detainees? Does the local hospital have the capacity to receive multiple cases? 

And consider: an outbreak in a facility threatens the outside community as well. An outbreak in a detention facility endangers all who come in contact with migrants, from immigration enforcement staff to workers at detention facilities, asylum officers, lawyers, and judges. All those people come in contact with the detainees and go home to their families at night.

This is new for all of us, but transparency needs to be at the heart of the response. Again, past experience receiving data and information from ICE about health-related goings-on in their facilities does not bode well for a smooth flow of information.

Immigration detention authorities should explain if and how they are preparing for the inevitable, not only to the public but to the detainees as well. 

I am hopeful that as I write this, they have teams of experts reviewing their care and transfer measures, creating isolation procedures, and discussing equitable testing protocols that do not discriminate between staff and detainees. They should be considering worst-case scenarios where detention center staff are unavailable due to illness or quarantine. 

They should already be arranging for shipments of masks, soap, sanitizing wipes, and bleach to facilities around the country. Training ought to be underway to teach staff the symptoms and proper response to detainee requests for health care. Discussions should even now be taking place between the Centers for Disease Control, local health departments, and those running federal and private detention facilities. 

More importantly, discussions should take place about letting many of the detainees go, either via parole or bond, or other mechanisms. Most of them should not have been in detention in the first place. Some jails are beginning to do just that.

In an ideal world, we would be assured that all of this is happening right now. But we have no such assurance. It has often been said that the greatness of a country can be judged by how it treats its weakest. Our government’s response to this crisis has been sorely lacking thus far. We must act quickly. The prevention window is closing. As we spend energy trying to protect ourselves, our family members, colleagues, and those in our immediate vicinity — we cannot forget those the government is keeping behind bars.

Dr. Ranit Mishori is a senior medical advisor at Physicians for Human Rights and a professor of family medicine at the Georgetown University School of Medicine.