Importance of releasing asylum seekers from detention during the COVID pandemic

As the coronavirus pandemic rages across the globe and the U.S. holds the unenviable lead in confirmed coronavirus cases, many continue to voice concern over the impact that social distancing is having on the economy and the daily lives of Americans. 

We are physicians who work directly with some of the world’s most vulnerable populations — refugees and asylum seekers — and we are worried about those in immigration detention who are being deprived of the ability to engage in social distancing and other basic precautions recommended by the Centers for Disease Control and Prevention and the World Health Organization. 

With an average of 37,000 individuals detained daily, the U.S. has the largest immigration detention system in the world, one that has history of failing to protect the health and basic human rights of immigrants. In the midst of this volatile and dangerous outbreak, it is once again poised to fall short, and the consequences may be more dire than ever. 

Less than a year ago, five cases of mumps in the immigration detention system led to an epidemic that ended with 898 confirmed infections in facilities across the country. Three children have also recently died of influenza after Customs and Border Control (CBP) refused to vaccinate those held in their detention facilities. 

Unlike mumps and influenza, there is no vaccine for COVID-19, and its mortality rate is 10 times as high as the flu. Even in the nation’s best-equipped hospitals where we work, access to rapid COVID testing and PPE is limited. 

In detention centers in New Jersey immigrants have begun protesting lack of access to soap, hand sanitizer and poor sanitation. There are reports from other facilities of guards coming to work with symptoms of upper respiratory infection, poor sanitation, and a lack of medical screening for newly arrived detainees.  

Given the existing strain on healthcare resources, it is highly unlikely that ICE would be able to adequately respond to an outbreak. And given how easily the disease is transmitted, an outbreak would likely spread beyond an individual facility, involving those in the surrounding communities where detention staff live. Infected detainees and detention workers could quickly strain or overwhelm the hospitals in nearby towns and cities. 

At the urging of doctors, judges, lawyers, immigration advocates, and even the former head of Immigration and Customs Enforcement (ICE), the federal government has begun to release individuals it has determined to be at increased risk of complications from a COVID-19 infection. 

So far, ICE has reviewed the cases of 600 detainees who are either over the age of 60 or are pregnant. Out of those 600, only 160 were considered qualified for release.  

This is despite the fact that the CDC considers all older adults to be at risk of severe illness. ICE has yet to systematically review the cases of other groups who are at increased risk, including those with chronic medical conditions such as asthma, chronic kidney disease, diabetes, and HIV. However, if ICE continues to release fewer than 30 percent of those the institution itself identifies as high risk, COVID-19 will still causes serious illness and death within the walls of immigration detention centers. 

And while the focus of most advocates has been on those immigrants who are most medically vulnerable, conditions in detention centers leave all  immigrants vulnerable to infection. It is also important to remember that anyone who is vulnerable to infection can experience serious complications from the virus. Just this week, one of our own patients, a young woman in her 30s with no preexisting conditions, had to be intubated in the ICU because of a COVID infection.

In light of this epidemiologic reality, the most sensible and humane response is to release all nonviolent detainees. Prisons across the U.S. and the world are releasing nonviolent offenders in light of the growing threat. At our hospitals, inpatient mental health units where patients mingle in common areas and participate in group treatment have stopped accepting patients, making unfortunate but necessary compromises to patient care. 

More than half of those in immigration detention have no criminal charges or convictions and releasing all nonviolent individuals would pose no risk to surrounding communities. Furthermore, unlike many of the other public health interventions the nation requires to fight the pandemic, releasing detainees would actually result in financial savings given the ongoing costs of keeping so many immigrants in civil detention. 

Given the number of experts and immigrants themselves who have already sounded the alarm, the remaining question is not when an outbreak will occur, or even how bad the outbreak will be. What remains to be seen is how much America values the lives of those kept in immigration detention. As physicians who conduct forensic evaluations of asylum seekers, we have heard their life stories. 

We have measured their scars, read their x-rays, and diagnosed their traumas. We hope that most Americans retain the ability to see them as we do, as individuals with astounding resilience and drive who deserve to be treated with the same basic care and consideration as United States citizens.

Dr. Samara Fox is a physician at Beth Israel Deaconess Medical Center’s Harvard Psychiatry Residency Training Program. In addition to conducting forensic evaluations of asylum seekers, she previously worked as an immigration attorney representing asylum seekers at Greater Boston Legal Services.

Dr. Katherine McKenzie has been on the faculty at Yale School of Medicine for 25 years. As the director of the Yale Center for Asylum Medicine, she has evaluated hundreds of asylum seekers and detainees.