In America today, history is repeating itself with ardent voices calling for division between “aliens” and “nationals,” instilling an “us” versus “them” mentality. What is happening under our watch is eerily reminiscent of the internment camps of World War II and the separation of individuals based on ethnicity that we have seen throughout history. We have created a climate of widespread fear, detaining immigrants and asylum seekers in abhorrent conditions, without a basic standard of care, and separating parents from children.
As a resident physician at Harbor UCLA, I had the opportunity to volunteer at the California-Mexico border where I witnessed the psychological and physical consequences caused by fleeing violence in Central America. Migrants journeying north are often unwelcome in their temporary stays, and exhibit PTSD from the trauma incurred along the way. A patient I saw described daily insomnia, severe anxiety, fear of violence and hypervigilance due to the hostile climate in Tijuana. Yet the fear of violence in his hometown dissuaded him from returning south.
The situation in Central America — in El Salvador, Guatemala, Honduras and parts of Mexico — is unique with the legitimate threat of unchecked gang violence, including violence and rape against women and children. In January 2019, instead of expanding asylum approval and relocation for people experiencing these circumstances, the Trump administration approved expansion of detention centers, even though alternatives to detention centers would save upwards of $1 billion dollars in tax-payer revenue.
Detaining refugees, in addition to being costly, is simply inhumane. Once in detention facilities, individuals are denied access to basic needs and hygiene, including flu shots, maintenance prescriptions, and care for mental health needs. Among the most vulnerable, there are nearly 2,000 migrants experiencing mental illness in Immigration and Customs Enforcement (ICE) custody; at least three have committed suicide, one individual after being improperly placed in solitary confinement.
According to a comprehensive Human Rights Watch report on medical care in ICE detention facilities, a significant proportion of deaths in detention centers were due to substandard care, which could have been prevented had these individuals been treated with the basic standard of care. Instead, individuals are denied basic health needs, details are censored from the public, and physicians like me are refused the ability to volunteer.
In October 2019, my union, the Committee of Interns and Residents, joined a group of over 2,000 physicians known as Doctors for Camp Closure to lobby Congress in support of alternatives to detention such as community support and release on recognizance. A case management program in which people were paired with social workers and connected with housing and legal resources found that 99% percent of program enrollees attended court dates, making it effective, safe and more humane than detention.
With the expansion of detention centers and attempts to ban or deny asylum to individuals fleeing for their lives, people are dying. There is a better way. As a physician, it is my responsibility to speak out against the inhumane and harmful treatment of people in these camps.
This is a public health issue — as well as a life-and-death human rights issue — and we cannot afford to silently watch on the sidelines. By ignoring what we read and hear, we are condoning the inhumane treatment of people whose apparent right to freedom and to a life free from persecution is less than ours. We must speak up for immigrants and asylum seekers in their time of need, or who will speak for us in ours.