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While the administration of President Donald Trump is preparing to retain more and more migrants in detention centers, health professionals and health professionals are voicing their concerns and proposing to change how federal agencies provide medical care to detained immigrants,
Dr. Paul Spiegel, director of the Center for Humanitarian Health at Johns Hopkins, explained in a commentary published Friday in the Journal of the American Medical Association (JAMA) that the way the government provides health care services detained migrants go against the oath that doctors place on the welfare of patients at the top of their priorities.
"The mission of DHS is safety, but often decisions about health are not made by doctors," Spiegel told NBC News. "What can be done when health care standards are not respected?"
Spiegel's worries began to spoil after seeing job offers from the Department of Homeland Security and the immigration agencies he oversees, looking for doctors willing to provide care in their centers. detention.
He recalled that the job descriptions required doctors to "follow the spirit of the organization", which led him to wonder why "doctors were not asked to give priority to patients. "
In his research, Spiegel found that all employees, consultants and contractors of DHS are required to sign very strict confidentiality agreements and specify that, if it is violated, the person could make the object "d & # 39; 39, administrative, disciplinary, civil or criminal actions ".
In his article, Spiegel proposed three changes:
- Hiring independent health care providers that are not under the jurisdiction of the US government or government-owned businesses.
- Establish an independent oversight commission as an external auditor and with unrestricted access to detention centers to control all aspects of health services provided in DHS-run facilities, as well as the Ministry of Health and Social Services and the Refugee Resettlement Office and ensure that the appropriate standards are respected.
- Require immigration agencies to report regularly on their level of care as well as international standards. These reports should be provided to the independent monitoring commission and made public.
"We propose not to put health care providers in a position where they will not be able to express themselves," Spiegel said. "It's a difficult ethical dilemma. That's why we're asking agencies not to put doctors in such situations. "
Nearly 700,000 migrants have been apprehended on the south-western border and placed in detention centers by the Customs and Border Protection Service, also known as CBP, since January, when a growing number of migrant families started to come to the border to ask for asylum.
Lawyers, human rights groups and health professionals have described detention conditions in detention camps as "appalling", claiming that they are overcrowded and unhealthy and that their medical care is insufficient.
Concerns increased after the death of at least seven children while they were under guard of immigration under the Trump administration.
At least three of the children have died of infectious diseases, such as influenza, in the past year.
CBP told NBC News that it did not systematically administer vaccines against infectious diseases such as influenza, chickenpox and measles, "because of the short-term nature of CBP's detention and the complexity of vaccination programs ", although the agency" has about 200 medical staff engaged along the southwestern border ".
Spiegel said that "what they say does not make sense from a public health point of view because even if a child is there for 72 hours, it is better to vaccinate him earlier than later. health care providers, they should be able to do so without any problem. "
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