Harmful by Design—a Qualitative Study of the Health Impacts of Immigration Detention

Abstract

Background The USA has the largest immigration detention system in the world with over 20,000 individuals imprisoned by Immigration and Customs Enforcement (ICE) daily. Numerous reports have documented human rights abuses in immigration detention, yet little is known about its health impacts. Objective To characterize how the US immigration detention system impacts health from the perspective of people who were recently detained by ICE. Design Qualitative study using anonymous, semi-structured phone interviews in English or Spanish conducted between July 2020 and February 2021. Participants Adults who had been detained by ICE for at least 30 days in the New York City metropolitan area within the previous 2 years, and that were fluent in English and/or Spanish. Approach We explored participants’ health histories and experiences trying to meet physical and mental health needs while in detention and after release. We conducted a reflective thematic analysis using an inductive approach. Key Results Of 16 participants, 13 identified as male; five as lesbian, gay, bisexual, or queer; and four as Black; they were from nine countries. Participants had spent a median of 20 years living in the USA and spent a median of 11 months in immigration detention. Four themes emerged from our analysis: (1) poor conditions and inhumane treatment, (2) a pervasive sense of injustice, (3) structural barriers limiting access to care, and (4) negative health impacts of immigration detention. Conclusions The narratives illustrate how structural features of immigration detention erode health while creating barriers to accessing needed medical care. Clinicians caring for immigrant communities must be cognizant of these health impacts. Community-based alternatives to immigration detention should be prioritized to mitigate health harms. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07914-6.

A call for increased transparency and accountability of health care outcomes in US Immigration and Customs Enforcement detention centers

“…Finally, understanding of health outcomes has also come from interviews with individuals previously detained in ICE facilities, 7 , 27 however this approach is unable to provide a voice to those currently in detention and limited by fears about documentation status.…”

“…6 Finally, formerly detained individuals describe neglect of basic human needs, including harmful living conditions, insufficient access to health care, and new conditions arising as a result of detention. 7 …”

Advancing Research To Address The Health Impacts Of Structural Racism In US Immigration Prisons

“…While detained, people are subjected to the neglect of basic needs, such as nutrition, and are placed in a physical environment that accelerates illness through overcrowding, poor sanitation, and lack of recreation. 23 Physical violence and sexual assault are prevalent in immigration prisons, 24 with sexual and gender minorities at increased risk. 25 In addition, people experience emotional distress related to dehumanization, perceived injustice, and isolation while facing systemic barriers in accessing high-quality health care.…”

“…25 In addition, people experience emotional distress related to dehumanization, perceived injustice, and isolation while facing systemic barriers in accessing high-quality health care. 23 These conditions cumulatively worsen health outcomes among imprisoned immigrants. 26 …”