Immigration Reform and Health Care: Leaving the Undocumented in the Breach – Lori Nessel

Lori Nessel
Seton Hall University School of Law

Any effort at comprehensive immigration reform must also address the health care needs of millions of immigrants with long-standing ties to this country. Absent such reform, immigrants needing ongoing medical care will remain vulnerable to the unethical practice of de facto deportation by hospitals, which is fueled by a lack of government reimbursement or oversight of international discharges.

In fact, a recent study from the Center for Social Justice and New York Lawyers for the Public Interest cites hundreds of cases of forced or coerced medical deportations. Acting alone or in concert with private transportation companies, as my colleagues and I report, hospitals are functioning as unauthorized immigration officers and engaging in de facto deportation of seriously ill or injured immigrant patients directly from their hospital beds to their native countries.

Reading Between the Lines: Need to Know’s “Crossing the Line” Suggests a Reexamination of the Border Patrol’s Culture – Rachel Stonecipher

Rachel Stonecipher

SMU

In 2012, a series of PBS investigations into Border Patrol abuses corroborated years of humanitarian volunteers’ reports, finding that the agency’s institutional culture cultivates a climate of medical neglect – and sometimes outright harm – toward migrant detainees. In July 2012, the PBS show Need to Know aired the second installment of its U.S.-Mexico border series “Crossing the Line,” an investigation into abuses of migrants in Border Patrol custody. The program reported that agents in the Tucson Sector, the busiest of nine regional divisions of the Border Patrol on the U.S.-Mexico border, have been accused of thousands of physical, verbal, and sexual abuses against migrants who are usually deported before they can report the crimes. “Crossing the Line, part 2” focused on the problem of poor treatment during detention, while Part I addressed agents’ excessive use of force. In light of my own research with humanitarian volunteers,[1] the two programs prove the frequency and injuriousness of abuse. Although PBS stops short of claiming that the Border Patrol’s “war on illegal immigration” actually promotes harm against migrants, to some volunteers’ dismay (including my own), “Crossing the Line” effectively conveys that abuse is an institutional problem that takes direct and indirect forms – including impunity.

Flouting International Law: Violating the Human Rights of Asylum Seekers, Including Victims of Torture and Human Trafficking, in and en route to Israel – Laurie Lijnders

Laurie Lijnders
Physicians for Human Rights-Israel

My 15-year-old brother Habtom disappeared after he was released from an underground cell in the trafficking compound of Abu Khalid, where he was tortured for three months until we paid US$35,000 for his release, a young Eritrean woman told me during a visit to her home in a Tel Aviv suburb. Habtom, who fled forced military conscription and institutionalized slavery in Eritrea, was kidnapped in April 2012 from Shagarab refugee camp in Eastern Sudan by Rishyada tribesmen. Through a well-organized network of human traffickers operating in Eritrea, Ethiopia, Sudan, Egypt, and Israel, he was transferred to the northern Sinai desert, near the Egyptian border with Israel.

The Israeli Ministry of Interior estimates that 60,000 African asylum seekers, mainly from Eritrea and Sudan, have arrived in Israel in recent years via the country’s southern border. According to Israeli human rights organizations, arriving asylum seekers face serious rights violations on both sides of the border.

Narrowing Our Moral Community of Concern: A Critique of Canada’s New Refugee Policies – Ben Langer

Ben Langer
Western University School of Medicine and Dentistry

The doctors of Canada are angry. Last May in Toronto, a group of 90 physicians clad in white coats and scrubs occupied the office of a high-ranking member of the Canadian Parliament. Since then, physicians have consistently interrupted press conferences held by Conservative members of Parliament to protest cuts to the country’s Interim Federal Health Program (IFHP), which since 1957 has provided basic health care to refugees and asylum seekers.

Under the new policy, many refugees will receive care only in “urgent and necessary” cases or if their illness is deemed a threat to public health. Ironically, these cuts came into effect on the July 1^st celebration of Canada Day, when this nation of immigrants and refugees celebrates its independence and its core values of generosity, openness, and multiculturalism.

Photo: Doctors for Refugee Care

“Doing No Harm” in an Age of Medical Repatriations: Challenges and Opportunities for Health Professionals – Juliana Morris

Juliana Morris
Harvard Medical School

How often do doctors cause harm to their patients when they discharge them from the hospital? For a sizeable group of immigrant patients who are “discharged” to their countries of origin each year, the answer may be: more often than not. The story of Quelino Ojeda Jimenez, an immigrant from Oaxaca, Mexico, who became quadriplegic after a fall at his roofing job in Chicago, Illinois, is case in point.

Conceptions of Reciprocity: The Navarro Transplant Case, Organ Allocation and Undocumented Immigrants – Emily Avera

Emily Avera
TransplantInformers

Organ donors give the gift of life, but the sheer volume of patients hoping for transplants far outstrips donor generosity. How should we make decisions to ensure the equitable distribution of a limited supply of organs? In a system that depends on the goodwill of donors and public trust, this question becomes further complicated when undocumented immigrants seek transplants – especially in the United States, where undocumented immigrants consent to donate organs more often than they receive them. In light of this fact, should citizenship be a substantial consideration? Or should allocation decisions be made according to a claim of reciprocity – i.e., that individuals or groups who are willing to donate are more entitled to receive organs than others?

When the Ward is Your Mooring: The Human and Economic Costs of Long-Term Acute Care for Undocumented Immigrants in the U.S. – Nora Kenworthy

Nora Kenworthy
Columbia

A recent New York Times article by John Leland recounted the lengthy medical history of Raymond Fok, an uninsured and undocumented immigrant who ended up marooned at New York City’s Downtown Hospital for 19 months after surviving a stroke. Although suffering from chronic health problems, including kidney failure, and initially in need of acute care, Mr. Fok remained in the hospital long after his initial emergency because he had no other place to go.

Without insurance or public benefits, numerous immigrants in the U.S. find similar fates in public hospitals, learning that without chronic or community-based services to assist them in recovery, they cannot be discharged. Rather than qualifying for a home health aide, or getting transferred to a nursing home, Mr. Fok’s status left him in the expensive care of an already cash-strapped public hospital. As Leland writes: “Mr. Fok’s immigration status never kept him from receiving treatment, but it helped make sure that his care would be delivered in the most expensive setting possible and in a place no one wants to spend more time than necessary.”

The Psychiatric Hospital as Safe House? Strange Asylum for Undocumented Immigrants with Mental Health Needs – Nora Kenworthy

Nora Kenworthy
Columbia

Over the past few years, stories have trickled into the U.S. national media about hospitals struggling to cope with the burden of caring for undocumented immigrants who lack insurance and are ineligible for benefits. These reports, including a recent series by New York Times reporter Kevin Sack and an even more recent NYT piece by Sam Roberts, feature accounts of chronically-ill patients being removed from dialysis, or ‘repatriated’ to their countries of origin in comas, to be cared for by long-lost and poorly-equipped relatives. As Luis Plascencia wrote on this blog a few years ago, these rare glimpses into hospital decision-making processes indicate that rising costs and non-existent legal protections for immigrants have led to a ‘privatization’ and ‘outsourcing’ of deportation by health care institutions.

To date, this meager public attention has focused exclusively on hospitals treating physical illnesses. Virtually no mention has been made of how psychiatric and mental health institutions handle undocumented immigrants. 

How Can Medical Anthropologists Contribute to Contemporary Conversations on “Illegal” Im/migration and Health?

How can medical anthropologists contribute to contemporary conversations on “illegal” im/migration and health?

Click below to read a newly published commentary in Medical Anthropology Quarterly in which three of AccessDenied’s founders consider precisely this question.[1] We invite your comments and reactions below, and we hope the piece will encourage additional scholars, clinicians, public health professionals, migrant activists, and others to join our conversation here at AccessDenied as readers and/or contributors.

Take a Stand Commentary: How Can Medical Anthropologists Contribute to Contemporary Conversations on “Illegal” Im/migration and Health? Medical Anthropology Quarterly Sarah S. Willen, Jessica Mulligan, Heide Castañeda. Vol. 25, Issue 3, pp. 331–356.

ABSTRACT: Of the estimated 214 million people who have migrated from poorer to richer countries in search of a better life, between 20 and 30 million have migrated on an unauthorized, or “illegal,” basis. All have health needs, or will in the future, yet most are denied health care available to citizens and authorized residents. To many, unauthorized im/migrants’ exclusion intuitively “makes sense.” As scholars of health, social justice, and human rights, we find this logic deeply flawed and are committed to advancing a constructive program of engaged critique. In this commentary, we call on medical anthropologists to claim an active role in reframing scholarly and public debate about this pressing global health issue. We outline four key theoretical issues and five action steps that will help us sharpen our research agenda and translate ourselves for colleagues in partner disciplines and for broader audiences engaged in policymaking, politics, public health, and clinical practice. [unauthorized im/migration, “illegality,” social determinants of health, “deservingness,” public anthropology]

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[1] If you do not have online journal access via a personal subscription or academic institution, please email us at contactaccessdenied@gmail.com. To subscribe to AccessDenied, please enter your email address under “Email Subscription” on our homepage. If you are interested in becoming a contributor, please contact us via email.

News Round-Up (1/10/10) – The Dangers of Detention: Illness and Death in U.S. Custody

Sarah S. Willen
SMU

Just as we were dotting ‘i’s and crossing ‘t’s for this latest news round-up, Nina Bernstein’s front-page article in today’s New York Times, “Officials Hid Truth About Immigrant Deaths in Jail,” hammered home the risks and dangers of being ill or injured in a United States immigration prison.  The piece foregrounds the 2007 deaths – in ICE custody – of Nery Romero, originally from El Salvador, and Boubacar Bah, originally from Guinea.

Bernstein’s reporting was facilitated by the recent release of thousands of pages of confidential documents – among them memos, draft reports, “talking points,” and Blackberry messages – to the NYT and the ACLU under the Freedom of Information Act.