Chronic problems, common-sense cures: Volunteer health professionals bring expertise to detention health care reform

Each night the Department of Homeland Security (DHS) holds 32,000 civil immigration detainees in over 300 facilities, the majority of which are contracted prisons. Although DHS detains more persons daily than the prison systems of New Jersey or Missouri, no enforceable legal standards exist for the provision of immigration detention health care. Moreover, DHS's managed care system has focused on emergency health care, although by the agency's own estimate as many as one-third of immigration detainees need ongoing skilled treatment for chronic conditions. The failings of immigration detention health care have been implicated in detainee deaths, and contributed to DHS's establishment of a detention-reform process incorporating input by outside experts. Physicians for Human Rights (PHR) operates a project that recruits, deploys, and supports health professional volunteers to make key contributions to detention health care reform. To spearhead PHR's efforts we are turning to members in our Asylum Network, who, since 1992, have provided pro bono forensic evaluations to indigent asylum seekers. They are bringing directly to Washington policymakers their long-term “hands on” knowledge of community standards of care, and an understanding of the special needs of torture survivors and other low-income immigrants separated from their regular care-givers by immigration enforcement. Volunteers are also communicating the need for reform to local and national “new” and traditional media. Expected outcomes of this project include uniform and early screening of incoming detainees for potentially life-threatening conditions, and a managed care system that creates fewer unnecessary roadblocks for clinicians in detention centers.