The rule, which was published in the Federal Register on Aug. 23 and takes effect 60 days after that date, withdraws the government from the Flores Settlement Agreement, a 1997 federal consent decree that has long guided policy for the detention of migrant children. Under that agreement and related court orders and other documents, such children could be held in custody no longer than 20 days; the new rule would end that limit while expanding federal authority to ramp up family detention.
The AAFP and its co-signatories -- the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and American Psychiatric Association -- strongly objected to the new policy.
"Conditions in federal detention facilities too often fail to ensure access to health care that meets guideline-based standards, treatment that mitigates harm or traumatization, and services that support immigrants' health and well-being," said the statement.
The organizations noted that the new rule would allow immigrant children and their parents to be "held in federal detention facilities that may be unsafe for months, years or even indefinitely."
Further, they said, "there is no evidence indicating that any time in detention is safe for children," pointing out that even short periods of confinement can have long-lasting consequences.
"When children are detained, they experience physical and emotional stress, placing them at risk for serious short- and long-term health problems such as developmental delays, poor psychological adjustment, anxiety, depression and suicidal ideation," the statement said.
"Studies of adults in detention have also demonstrated negative physical and mental health effects, including musculoskeletal, gastrointestinal, respiratory and neurologic symptoms, along with anxiety, depression, posttraumatic stress disorder, difficulty with relationships and self-harming behavior."
In addition, said the organizations, the lack of adequate sleep and added stress that those in detention experience compromise their ability to fight infection, "increasing the likelihood of illness among those who are detained for long periods of time."
The organizations' opposition to the rule is in step with an AAFP policy on the health impacts of immigration that the AAFP adopted in July.
The Academy, that policy states, "recommends timely access to health care for immigrant persons in detention facilities and measures to reduce toxic stress associated with the threat of detention and deportation."
The administration's dismantling of the Flores Settlement Agreement runs counter to recommendations made this summer by the Department of Homeland Security Office of Inspector General.
In July, Jennifer Costello, (then) acting inspector general for DHS, told lawmakers in a report, "We are concerned that the overcrowding and prolonged detention we observed in the El Paso and Rio Grande Valley sectors represent an immediate risk to the health and safety of DHS agents and officers, and to those detained."
Costello's report -- presented as testimony before the House Committee on Oversight and Reform under the title "The Trump Administration's Child Separation Policy: Substantiated Allegations of Mistreatment" -- noted that DHS already "struggled with compliance with certain Flores Agreement provisions, such as holding children no longer than 72 hours."
That document echoed a report Costello wrote for DHS leadership earlier that month titled "Management Alert -- DHS Needs to Address Dangerous Overcrowding and Prolonged Detention of Children and Adults in the Rio Grande Valley." Nine photographs included in this report documented that overcrowding as seen by Costello's office in June. Some detainees in the photos, including children, are wearing masks over their noses and mouths; no beds are visible in the images.
There are already significant medical issues in detention centers. In a May visit to one detention facility, Costello told legislators, her office "observed approximately 75 people being treated for lice, and some detainees were in isolation with flu, chickenpox and scabies."
Meanwhile, as of that same month, at least six immigrant children had died while in, or shortly after release from, U.S. custody. In at least three of those cases, the children had influenza.
This month, however, the Trump administration announced that Customs and Border Protection would not provide influenza vaccination to immigrants in U.S. custody.
"We urge this rule to be rescinded by DHS and rejected by the courts," the AAFP and its co-signatories said of the administration's Flores withdrawal.
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