Paper given by GDP Director Michael Flynn at the conference “Crimmigration through Time, Space, and Culture,” organised by the CINETS scholars network at Lewis & Clark Law School (Portland, Oregon, 1-2 March 2024)
Introduction
This paper provides a summary of key findings from an ongoing research project at the Global Detention Project aimed at broadening evidence on the health implications of expanding immigration detention regimes across the globe, both in terms of health impacts on detainees as well as with respect to broader public health policies on preventing disease outbreaks, easing strains on healthcare systems, fostering social cohesion, and preventing health disparities in societies.
An important backdrop for this study has been the COVID-19 pandemic and the many lessons we should be learning from it, including importantly that effective responses to public health crises require implementing measures that take into account all parts of society. This lesson was underscored by the devastating impact that COVID had when it spread uncontrollably through many prisons and detention centres, and to surrounding communities. In many countries, detainees were released or detention centres closed shortly after onset of the pandemic as a public health measure aimed at stemming the spread of disease.
As we all know, however, when the intensity of the pandemic began to recede, detention centres were re-opened and detainee populations have begun to grow again, especially as public panic has been stoked over mass migration and border control.
Another lingering lesson of the pandemic, one which has not gotten the attention it deserves, is that in those countries where large numbers of migrant detainees were released—including notably in Spain, which quickly emptied and closed all of its detention centres—there was no ensuing public panic or security crisis. This of course begs the question: what is the point of spending enormous amounts of money to lock up these people in the first place?
When we began work on this study some three years ago, a key motivation was to harness these pandemic lessons by carefully documenting the individual and public health harms of immigration detention and underscoring an important—and, one might argue, rather obvious—solution: end mass immigration detention. Unfortunately, much of the data we have developed points to another darker, more pessimistic lesson: that there may be something intrinsic to immigration detention that makes it immune to reform, that makes it inherently harmful.
Before exploring these lessons and the evidence behind them, I would like to take a couple of minutes to provide a bit of background on the study, including about the Global Detention Project as well as the current status of this research initiative.
Background to the study
The GDP is an independent civil society organization based in Geneva that seeks to bridge academic and advocacy communities by systematically investigating and documenting immigration detention systems in every country and using the resulting data and analyses to support advocacy initiatives at the local and international levels. A key target of our work are UN and regional human rights monitoring bodies, including the various committees and individual experts who monitor states’ implementation of their treaty-based human rights obligations, like the UN Committee on the Rights of the Child, the Working Group on Arbitrary Detention, the Special Rapporteur on the Human Rights of Migrants, amongst others.
Most of our work is publicly available through our website, where we have documented more than 2,500 detention centres spanning nearly every country on the globe, as well as the laws, institutional contexts and detention statistics of all major detaining countries. Our website receives annually more than 300,000 visitors who come from every corner of the globe. Despite this body of work, which is more than 15 years in the making, there has been an important gap in our research, one that the COVID pandemic put a glaring spotlight on: Our data on health indicators in immigration detention was only rudimentary.
As we began to develop more systematic health data—which included undertaking a global survey of COVID measures related to migration and asylum enforcement—we sought out opportunities to publicize this work, which included collaborating with external academic researchers to methodically review available evidence and draft a paper presenting our research. An important partner in this work has been Sanja Milivojevic from the University of Bristol and co-director of Border Criminologies based at Oxford University. Working with Sanja, we have been developing a draft paper the presents key findings from our research, which we hope to publish in the next year.
Data Model
An initial stage of our project was to develop a comprehensive model for building data on health indicators in immigration detention. To do this we relied on a range of international normative rules and principles—including the UN Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules) and UN Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment. We also relied heavily on detention monitoring guidelines including those used by the European Committee for the Prevention of Torture and the UK Inspectorate of Prisons. Using these and other sources, we developed an initial data collection model which then grew and evolved as we proceeded with our evidence review.
Although we don’t have time to review the full scope of the resulting data framework, it is important to note some of its basic elements and structure. The framework is divided into two sections: healthcare provision and health outcomes. The section on “healthcare provision” is used to build evidence regarding the delivery of health services in detention; whereas “health outcomes” is intended for collecting evidence of the impact of detention, including as a result of the conditions in detention centres and specific types of detention practices, as well as the impact on different groups who present particular vulnerabilities in detention situations, such as children, pregnant women, victims of torture, among others.
Evidence & Findings
While the task of building health-related evidence is and will remain on ongoing activity of the GDP, during our initial phases of work on this initiative, including during our collaboration with Sanja, we reviewed two overarching groups of sources: academic literature (focusing on English, Spanish, and French publications) and the reports, recommendations, and concluding observations of UN human rights special procedures and treaty bodies and the Council of Europe’s Committee for the Prevention of Torture. The evidence discussed here is limited to these sources and only include publications up to 2021. A fuller discussion of this review and our methods will be provided in our paper when it is released.
Here I would like to highlight just a few of our key findings from this initial review of evidence.
I. Two key overarching findings are: (1) the lack of detailed or systematic information and data concerning both healthcare provisions and health outcomes in countries outside the Global North, and where evidence does exist, the focus is often limited to mental health impacts; and (2) the harmful impact that migration-related detention has on all people, and not just with respect to at-risk individuals like children. Despite the lack of comprehensive data, the available evidence reveals consistently harmful impacts of this enforcement measure, which raises challenging questions about whether states can guarantee minimum health standards when placing people in immigration detention.
II. In total, the evidence from both human rights monitors and academic sources revealed health-related concerns in immigration detention settings in 61 countries spanning all regions of the world during the period 2011-2021.
III. There is evidence of inadequate or non-existent health screening for people entering detention in at least two dozen countries, indicating a widespread problem that requires particular attention. Importantly, in some cases, the evidence indicates that shortcomings in health screenings can be persistent, even when monitoring bodies provide precise recommendations. For instance, during the UN Committee against Torture’s 2019 review of Germany, the Committee noted how its previous recommendations to the country, made during its review in 2011, had gone unheeded: “Medical examinations are still not conducted systematically and on a mandatory basis by qualified and independent staff upon arrival in detention centres … to identify vulnerable persons, such as victims of torture, record any indications as to their claims and provide them with support services.”
Importantly, this failure to implement reforms despite sometimes repeated recommendations over many years by independent and official monitors permeates much of the evidence we have developed and includes numerous other healthcare indicators, including everything from lack of access to doctors and medicines, to failures to eliminate unhealthy conditions of detention.
IV. Lack of access to basic heath provisions like medicines is also pervasive. During the period under review, no fewer than 32 countries were issued recommendations or otherwise cited for shortcomings in some aspect of their detention healthcare provisions by detention monitoring bodies. There are several key indicators for assessing whether countries provide adequate basic medical care for immigration detainees, including access to doctors, nurses, hospitals, specialist care, emergency services, medications, and medical equipment. The evidence reviewed indicates that access to even minimum care is uneven from country to country, and often severely inadequate. This situation has been reported in high-, low-, and middle-income nations.
Academic research on this issue in Europe has repeatedly shown limited availability of health workers, irregular or infrequent doctor visits, shortages in staff or supplies, and delays in prescription and distribution of medicine. Delays in medical treatment are also widespread, with numerous studies indicating severe shortcomings in the UK and the U.S., where people in detention reported long delays (2-6 months) before getting a doctor’s appointment.
A study in Mexico found that only four detention centers in that country provided access to specialist care such as gynecology or forensic medicine. Likewise, in the U.S., access to specialist care can be sporadic and reserved only for people with complex diseases such as HIV or TB, which experts argue is a result of the cost-cutting efforts of private contractors who operate much of the U.S. detention system. Similar to the access to general healthcare, the length of detention was identified as one of the obstacles to accessing specialist care in the U.S.
V. Lack of access to mental healthcare is also endemic. Evidence provided solely in the observations of UN treaty bodies during a 10-year period reveal mental-health related recommendations for more than 20 countries, including: Bulgaria, Canada, Croatia, Cyprus, Germany, Greece, Hungary, Kosovo, Liechtenstein, Lithuania, Malta, Nauru, Netherlands, North Macedonia, Norway, Poland, South Africa, Spain, Sweden, and Turkey.
Academic studies focusing on Europe have highlighted several countries for having a lack of mental health services in detention, including Sweden, Belgium, the Netherlands, Luxembourg, and the UK. Sweden—in contrast to Belgium, the Netherlands and Luxembourg—was found not to have mental health professionals working in detention centres. If nurses visiting the centre deem it necessary, detainees can be referred and taken to the local medical centre to see a mental health professional. As such, the complex mental health needs of detainees were often unmet.
An important and widely reported problem in addressing mental health issues in detention is that security personnel are sometimes making key decisions rather than healthcare professionals. One U.S. study reported that in the U.S. “some security personnel and private prison officials are responsible for developing and managing health services, there is often a punitive instead of therapeutic approach to mental health care.” Numerous source in the US have pointed to “increasing lapses in mental health care in ICE detention” such as delayed psychiatric appointments, use of solitary confinement for patients with mental health issues, and have revealed how false observation logs for suicidal patients may be the cause for the increase in suicide rates in 2020.
Such shortcomnings can be found across the globe. The UN Subcommittee for the Prevention of Torture, for instance, after visiting immigration centres in Cyprus, reported that police officers often make recommendations to judicial authorities resulting in detainees being taken “taken to a psychiatric hospital for treatment” in police vehicles under restraints even though “police officers appeared not to have received any specific training regarding detainees with mental disorders.”
Conclusions
These are just a few of the examples of severe health-related problems in immigration detention that we have documented. While we do not have time to review the entire scope of evidence, I think that it is important to highlight before I wrap up some of the larger reflections that this research has provoked. For instance, what can explain the pervasive failure in country and after country to adopt health-related reforms in their immigration detention systems despite repeated recommendations from both official and independent monitoring bodies? I think an important explanation lies in the distinct nature of immigration detention. In contrast to prisons systems, which are at least nominally intended to encourage the re-introduction of prisoners back into society, immigration detention has no such claims to a reform agenda; rather, one of its main purposes is to permanently exclude people from society by ensuring their removal from the country. This fact increases the vulnerability to abuses and as well to official apathy vis-à-vis the implementation of appropriate healthcare measures.
Perhaps it is precisely because of this reason that there appears to be a growing recognition among key a actors of the inherently harmful health impacts of migration-related detention. But this is not a new revelation, in fact public health experts have been warning us about this problem for decades. In 2003, the WHO reported that because of “the inability and/or unwillingness of host countries to invest significantly in the health and sanitation of detention centres and refugee camps, many of these camps are overcrowded and lend themselves to communicable disease transmission. Detention has also been found to negatively impact the availability and accessibility of health care, as well as the right to privacy.”Ultimately, if a policy measure is inherently damaging to the health of those subject to it, arguably there are no “best practices” to promote, only harm-reducing ones. And when it comes to immigration detention, it seems clear that the most obvious way to prevent damaging health impacts is to avoid imposing this measure at all.
