DHS should integrate health workers into their screening process

Although we cannot know his tone, when Dr. Alexander Eastman said to the New York Times, “Border Patrol is a law enforcement agency…not a humanitarian agency,"we might hope that as a doctor his words came out as a lamentation. Regretful or matter of fact, these remarks of Eastman — the senior medical official at the Department of Homeland Security responsible for standing up health services at facilities operated by border protection and ICE — point to what is needed to guide the comprehensive approach to migrants’ care he aims to establish: the ethical norms of humanitarian health services.

The principle of respect for humanity reminds us that all people deserve respect. This encompasses respect for the capability to be healthy, a foundation for a live worth living. DHS is not responsible for upholding the capability to be healthy; neither should the agency threaten it.

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Its border facilities, rather, should be designed to minimize and, where possible, prevent further harm to health. In practice this means several things. Ending the detention of asylum-seekers for protracted periods is the principal reform required in light of the health consequences of the carceral conditions that characterize border facilities.

Eastman should campaign for this tirelessly. The integration of health workers into admission processes and providing health screenings for asylum-seekers is also essential. Canada, for example, provides an Immigration Medical Exam: an examination of physical and mental health, and tests for specific infectious diseases.

This is done only partly for the sake of migrants, and it raises vexing ethical questions concerning bodily integrity and privacy, in addition to fair resource allocation; still Canadians have opted for a harm prevention and reduction approach, and determined that asylum-seekers found to be in need of health services should receive not only emergency but also a set of basic services as they await hearings on their immigration status (and not usually in detention).

Even before the reach CBP, preventing and mitigating harm effectively in the particular context of forced migration and displacement involves reckoning with people’s rupture and flight due to violence and deprivation, and their perilous journey.

The Blue Dot Hubs developed by UNHCR and partners provide basic care and services to uprooted people between borders and in remote areas outside camp settings. National Red Cross and Red Crescent Societies in Niger, Italy and elsewhere have established similar hubs, responding to migrants’ health problems along the routes they travel, trying to avert health crises and connect services. Reform at border agencies should include systematic efforts to map routes of transit and collaborate with humanitarian health organizations to prevent and reduce harms before vulnerable people reach borders.

Health services should be provided by professionals who are impartial, independent and neutral. They should be able to provide care on the basis of need, without approval or interference from immigration authorities, and should never be intimated or subjected to criminal penalty for providing care. There should be clear divisions between responsibilities for immigration processing and health. Current efforts to train border agents in EMS risk conflicts of loyalty and moral distress.

The ethical norms of clinical medicine also offer guidance. Respect for bodily integrity and decision-making autonomy, should guide the treatment of people in US border facilities. Much more thinking is needed on respecting the privacy of health information for asylum-seekers and others. In Europe health officials are designing systems for managing migrants’ health records electronically to give people more control over their health information and help manage care over time wherever they go, and at the same protect privacy.

Critics will ask about entitlement. It is true that we in the U.S. are compelled to have thoughtful conversations about the nature and extent of our obligations to protect the health of asylum-seekers and irregular migrants. Still, a multitude of moral perspectives — secular and religious — maintain that at a minimum we should not add to the harm suffered by vulnerable people and indeed, should come to their aid if we have the capacity.

Eastman should do all he can to move DHS to the moral high ground where migrant health is concerned. Even though the administration has seemingly refused to adhere to international standards regarding the treatment of asylum-seekers, we might await Eastman’s reforms with cautious optimism. In places where the norms are a far cry from those of the clinic, we can hope that this physician’s loyalty to people in need will guide him in upholding the ethical norms of humanitarian health and medicine.

Lisa Eckenwiler Ph.D. is a professor of philosophy and health policy at George Mason University specializing in health ethics: bioethics, global health ethics, humanitarian health ethics, public health ethics.