Cover art: Allison Arteaga Argumedo
BOSTON, MA – A groundbreaking investigation conducted by the Massachusetts General Hospital (MGH) Asylum Clinic at the MGH Center for Global Health, the FXB Center for Health and Human Rights at Harvard University, and the Harvard Global Health Institute, in collaboration with RAICES, has exposed the alarming impact of prolonged detention on children’s mental and physical well-being.
The study is the first and most comprehensive analysis of the medical records of children as young as six months old and a median age of nine years old detained between June 2018 and October 2020 at Karnes County Family Residential Center in Texas — cited by ICE itself as the first detention facility built from the ground up with its civil detention standards in mind. The report documents evidence of mental and physical harm relating to inadequate and inappropriate medical care experienced by children during prolonged detention, including key screenings and management of acute medical and mental health issues.
The study reveals that nearly 88% of children remain in detention for longer than 20 days and stay in immigration prisons for a median duration of 43 days — more than twice the length of the maximum time children are allowed to be in detention as determined by The Flores Agreement. During prolonged detention, the children in the study had limited access to basic healthcare, and existing health issues and care needs relating to physical and mental health were under-identified due to poor screening and minimal documentation of medical care, resulting in fragmented and inadequate medical care.
“The results of this study are deeply disturbing and establish that there is no humane way to detain children and no version of family detention that is acceptable,” says Javier Hidalgo, Legal Director at RAICES. “Many of these children were detained for prolonged periods, often under unsafe and unsanitary living conditions and without access to basic human rights, in direct violation of applicable standards including those protections set out in the precedent-setting Flores Settlement Agreement.”
Dr. Vasileia Digidiki, Harvard Instructor and Director of the Harvard FXB Summer Program on Migration and Refugee Studies, adds, “Detention is never in the best interest of children. The conditions that we documented in this study evidence a lack of some fundamental protections owed to children, whatever their immigration status.”
The Biden administration suspended ICE family immigration detention in 2021. However, detention of children and exposure to harm continues under Customs and Border Patrol, with the additional prospect of a future return of prolonged detention of children.
“Detention is harmful to the physical and mental well-being of children,” says Dr. Matthew Gartland, Director of the Massachusetts General Hospital Asylum Clinic and Assistant Professor of Medicine at Harvard Medical School. “Prolonged detention of children with disregard for their mental and physical health is immoral, and U.S. immigration family detention should end once and for all.”
Dr. Shela Sridhar, Clinical Instructor at Harvard Medical School, continues, “Access to healthcare is a human right which should be afforded to all children. The health care provided to children in immigration detention was inadequate and inappropriate.”
Read the full report:
EXECUTIVE SUMMARY
Between 2017 and 2021, more than 650,000 children were taken into custody at the border, with more than 220,000 of these children being detained for more than 72 hours and many transferred with their families to Immigration and Customs Enforcement (ICE) detention facilities.
Our study, a review of 165 medical records of children in an ICE family immigration detention facility at Karnes County Family Residential Center in Karnes City, Texas between June 2018 and October 2020, documents evidence of the mental and physical harm relating to inadequate and inappropriate medical care experienced by children during prolonged detention.
The study was performed by researchers based at the Massachusetts General Hospital (MGH) Asylum Clinic at the MGH Center for Global Health and the FXB Center for Health and Human Rights at Harvard University in collaboration with the Refugee and Immigrant Center for Education and Legal Services (RAICES). Medical records were fully de-identified, meaning any patient names, personal identifiers and dates of health care visits were redacted, before being made available to the research team. Ethical review was completed by the Mass General Brigham Institutional Review Board.
Key findings include the prolonged length of detention for children, a median duration of 43 days with 88 percent of children remaining in detention for longer than 20 days, the maximum limit of detention for children under the terms of the Flores Settlement Agreement. There was inadequate supervision and documentation of acute medical care, and inappropriate screening and follow-up care for existing chronic medical conditions, malnutrition, and tuberculosis. Screening for mental distress was inappropriate leading to the under-recognition of children at risk for mental health disorders. The same non-validated tool for screening for mental distress was used for children 6 months to 18 years old.
The evidence of this study demonstrates that immigration detention harms children’s mental and physical health at a crucial time of physical, mental, and social development. This evidence supports a conclusion that detention, in any form, is never in the best interest of children and the detention of children must end. This conclusion is in line with the policy and statements of the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the National Association of Social Workers, and numerous other professional societies. A Policy Statement by the American Academy of Pediatrics states, “Children, especially those who have been exposed to trauma and violence, should not be placed in settings that do not meet basic standards for children’s physical and mental health and that expose children to additional risk, fear, and trauma.”
The Biden administration paused the use of ICE family immigration detention in 2021, however, detention and residential care of children continue to occur during Customs and Border Patrol processing and for children in custody of the Office of Refugee Resettlement. There have been documented cases of harm and even the death of children in these settings and there is current policy consideration for the reinstatement of family immigration detention. The findings and recommendations in this report should be considered in any policy, current or future, involving the detention of migrant children in the United States. As long as child detention continues to exist in any form, children must be afforded one of the most basic of human rights, adequate medical care, and oversight must be in place to ensure this responsibility is met.
Study Authors:
Shela Sridhar, MD, MPH (Corresponding author: ssridhar2@bwh.harvard.edu), Harvard Medical School, Brigham and Women’s Hospital, Division of Global Health Equity
Vasileia Digidiki, MSc, PhD, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University
Dennis Kunichoff, MPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University
Jacqueline Bhabha, JD, MSc, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University
Margaret Sullivan, FNP-BC, DrPH, François-Xavier Bagnoud Center for Health and Human Rights, Harvard University
Matthew Gartland, MD (Corresponding author: mgartland1@mgb.org), Harvard Medical School, Massachusetts General Hospital, Department of Medicine and Division of Pediatric Global Health Equity, MGH Asylum Clinic at the Center for Global Health
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RAICES, formally known as the Refugee and Immigrant Center for Education and Legal Services, is a 501(c)3 nonprofit organization. Headquartered in Texas and with national reach, RAICES promotes migrant justice by providing legal services, social services case management, and rights advocacy for immigrants, asylum seekers, and refugees. Learn more at raicestexas.org and follow RAICES on Instagram.
The MGH Asylum Clinic at the MGH Center for Global Health provides forensic medical and mental health evaluations to survivors of persecution seeking asylum in the United States and educates, advocates, and performs research on the health of refugees and people seeking asylum. The MGH Center for Global Health, driven by the belief that everyone, everywhere has a right to good health, partners with diverse communities to exchange life-saving ideas, catalyze scientific discoveries, deliver compassionate care, and train the next generation of leaders in global health.
The François-Xavier Bagnoud Center for Health and Human Rights (FXB Center) was founded and endowed by Albina du Boisrouvray in 1993. Her goal was to provide protection to children by furthering the vision for health and human rights of first director Jonathan Mann, and it received the enthusiastic collaboration of then-Dean Harvey Fineberg. We use interdisciplinary approaches to promote equity and dignity for those oppressed by racism, poverty, and stigma, nationally and around the world. We are proud to partner with a diverse group of scholars, educators, elected officials, government agencies, nonprofit organizations, and members of the international policy community to advance health and human rights, and to show the harmful effects of violations on children. To learn more, please visit fxb.harvard.edu.
The Harvard Global Health Institute (HGHI) is an interfaculty initiative that facilitates collaboration across the Harvard community and partners worldwide to advance global health equity. We tackle the greatest health challenges of our time through innovative transdisciplinary research, education, and partnerships that build knowledge and drive positive change in global health. Our work is grounded in the fact that researchers, scholars, care deliverers, and communities must inform each others’ work to transform global health at every level.
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Press Contact: Faisal Al-Juburi, media@raicestexas.org