By Bayla Ostrach, Kathleen Lynch, Ashley Houston, and Megan A. Carney
By mid-August, half of all Immigration and Customs Enforcement (ICE) detainees in a single facility tested positive for the novel coronavirus. As COVID-19 cases surge uncontrolled in the United States, the specific conditions of ICE detention place detainees at a higher risk of exposure. Following the release of a report from the Department of Homeland Security Inspector General that cited overcrowding, inadequate medical care, and denial of treatment as significant health risks for the more than 30,000 current detainees, a federal judge ordered the immediate transfer of all children from detention centers. Disease outbreaks, lack of food and water, and improper sanitation, all of which contribute to COVID-19 risks, have been documented and denounced as ongoining human rights violations in ICE detention.
As three of the authors currently study, conditions of ICE detention facilitate respiratory infection spread and interaction with other illnesses. Of 310 reported tuberculosis (TB) cases in U.S. carceral facilities in 2018, nearly half were diagnosed among ICE detainees. Like COVID-19, TB is a highly contagious respiratory illness that spreads quickly in confined areas, putting detainees at risk. Insufficient responses to TB, widespread in contracted facilities, foreshadowed how ICE would insufficiently respond to COVID-19 as an evolving threat.
There is widespread consensus in public health and the social sciences that structural conditions cause interactions between multiple illnesses, in turn worsening suffering. When this happens for a particular population due to marginalization, policy, or a social factor, medical anthropologists call it a syndemic. Detention centers are a particularly grave risk environment for syndemics. For example, the structural conditions of ICE detention promote multidirectional biological interactions between malnutrition, Type II diabetes, and TB. In this syndemic model, the structural-biological-biological interactions produced in ICE detention as a result of U.S. government policy exacerbate each illness and increase risks for wider communities.
ICE detention now also produces a syndemic risk environment for COVID-19 to interact with other illnesses. In unsanitary facilities where health care is inadequate and medications (including inhalers) are confiscated, rapidly spreading COVID-19 is likely to interact with and worsen other respiratory illnesses, such as asthma. Asthma is itself a risk factor for COVID-19. When someone with asthma contracts COVID-19, there is also greater risk for progression to severe acute respiratory disease (SARD), and mortality. There is a pressing need for research on the potential for asthma/COVID-19 syndemics produced by the conditions of ICE detention.
All such illness interactions are particularly urgent to evaluate in light of COVID-19 spreading rapidly in detention facilities. By late March, a federal judge ordered agencies operating child detention facilities to account for their efforts to release children, citing COVID-19 risks after four children tested positive at a New York facility. In early May, the first confirmed detainee death from COVID-19 was that of an individual who petitioned for release after other detainees in the facility tested positive. As we submit this, ICE had confirmed more than 5,000 COVID-19 cases among detainees – double the number of cases from when we began drafting this piece just a few months ago. While the CDC did issue guidance for addressing COVID-19 in carceral settings, ICE’s implementation appears uneven and insufficient. Government-issued health guidelines for detention centers are not enforceable and many centers choose not to comply.
ICE released only some 900 individuals from mid-March to late August, a grossly inadequate response to address the syndemic conditions of detention. Over 4,000 physicians signed an open letter demanding ICE release detainees with health conditions that may interact with COVID-19. Policymakers should heed this call and demand the immediate release of all those detained solely due to crossing borders without authorization papers.
It is in the public health interest to not only halt transfers to ICE custody during the COVID-19 pandemic, but to decriminalize migration and take meaningful steps toward closing detention centers. The inhumane system of criminalized migration and detention primarily produces profit for privatized prisons, inflicting irreversible harm and trauma on individuals and communities through forced family separation and deportation without regard for safety and support or public health risks upon arrival in their country of birth. During an infectious disease pandemic, detention centers also threaten the health of the community at large, as commuting staff — potential asymptomatic carriers — present potential risks to detainees, their own families, and communities. Even optimistic models predict ICE facility COVID-19 outbreaks would overwhelm Intensive Care Units within a 10-mile radius of any detention center.
With the science behind COVID-19 disease interactions still evolving, acknowledging ICE detention as a clearly conducive structural factor in potential syndemics forces recognition of inequitable social policies as active disease amplifiers, rather than passive “determinants of health.” In the context of COVID-19 a syndemic perspective requires that we not only cure interacting biological conditions but also dismantle structures that enable these conditions to coalesce and flourish. We cannot ensure public health and human dignity while detention persists.
Bayla Ostrach, MA, PhD is appointed faculty in Medical Anthropology and Family Medicine at Boston University School of Medicine; author of eight peer-reviewed articles on syndemics including infectious disease syndemics, and co-editor of two volumes on stigma syndemics.
Kathleen Lynch, MS, MPH is an applied medical anthropologist, methodologist, and health disparities researcher; on the advisory board of the Master’s in Medical Anthropology program at Boston University School of Medicine, and co-led a project to propose a syndemic model of malnutrition, Type II diabetes, and TB produced by ICE detention (with Houston and Ostrach).
Ashley Houston, MS is a doctoral student in Population Health at Northeastern University, works in the Institute for Health Equity and Social Justice Research, and led a project to propose a syndemic model of malnutrition, Type II diabetes, and TB produced by ICE detention (with Lynch and Ostrach).
Megan A. Carney, PhD is assistant professor in the School of Anthropology at the University of Arizona, director of the UA Center for Regional Food Studies, author of “Sickness in the Detention System: Syndemics of Mental Distress, Malnutrition, and Immigration Stigma in the United States” as well as of two books examining the intersections of migration and health.
Houston, Lynch, and Ostrach.
As proposed in a manuscript in preparation for a special “Health and Wellbeing of Migrant Populations” issue of the International Journal of Environmental Research and Public Health.