Conclusion and Recommendations

The investigators acknowledge that the 21st century is witnessing the largest refugee crisis in history, with four million refugees from Syria alone (Tufekci 2015 U.N. High Commission for Refugees 2015). The problem eclipses any individual government’s resources. For this reason, we believe that the global refugee crisis warrants a multinational effort to solve the causes of the problem. In the Americas, this means a joint effort through North, Central, and South America to resolve the problem of gangs. The Mara Salvatrucha gang was formed in the United States and exported to Central America, where it has caused so many problems for the refugees to whom we spoke. Surely the United States has some responsibility to ease the pain of Central American refugees, just as it shares in the problem of drug trafficking.

The failure of ICE to treat refugee women and children humanely appears to emanate from current policies that treat immigrants, including asylum seekers and refugees, as criminals and security risks. The events of September 11, 2001, have had significant impact on policymaking. In 2003, reversing itself from a spring 2001 decision, the Supreme Court ruled 5–4 that immigrants entering the country without appropriate documentation can be detained indefinitely without having the opportunity to show lack of criminal history or terror/security risk. The potential for traumatic stress reactions resulting from the 9/11 event on the part of political leaders is rarely discussed but appears to drive some of the more exigent and intolerant policy decisions at the highest levels. This shared psychic reactiveness affects the ability or willingness of policymakers to distinguish between real threats to national security and innocent immigrants and refugees, ordinary human beings who are seeking a better life or fleeing from dangerous and violent situations. The argument that immigrants present risk to national security to the point that they all need to be detained indefinitely and without due process is specious.

Moral considerations

In medical ethics literature, an individual does not have to be a Good Samaritan to be considered ethical. Individuals are not expected to put themselves or their interests at risk to help others, including refugees, to fulfill ethical responsibilities. However, the moral is quite different from the ethical the archetype of the Good Samaritan illustrates moral character (Beauchamp & Childress 2013).

We see that many citizens feel that moral responsibility keenly, and many are acting on their moral character. We refer to the selfless attorneys providing legal service pro bono, to try to make things right, and to the many volunteers supporting their efforts and sacrificing time and their own families to provide essential assistance to refugees. Outrage from citizens at the treatment and detention of asylum seekers and refugees comes from a place of the moral among U.S. citizens. Volunteers assisting refugees are acting on moral values and from personal moral character. We do not believe that anyone to whom the moral is important could spend time with the refugees we met and not want to help them.

The political ambivalence surrounding immigration and refugees illustrates that there is a strong moral mandate to help in the “local moral world” of the United States (Kleinman 1980, 2007). For anyone with strong moral character, the moral trumps every other consideration. The challenge for the U.S. government, in determining how and whether to assist refugees and in

reexamining its detention policies, lies in deciding how moral we as a nation wish to be, to balance the ethical with the moral.


End family detention

It is a misnomer, as families are separated and can be harmed in the detention process.

A mother and child recently released from immigration detention. Photo: Jeff Pearcy.

Preserve family integrity

Change policy so that families are not separated. Keep family groups, including fathers, intact. If families are separated, facilitate contact. Never separate special-needs children from their families. Recognize nontraditional unions such as common-law partnerships and lesbian, gay, bisexual, and transgender unions. Do not separate fathers even if the partners are not legally married and have different last names. Do not separate children because they have a different last name.

  • Family unity is especially important in Latino cultures; U.S. policymakers and immigration personnel seem to minimize this. Family separation contributes to negative mental health outcomes.

Recognize refugees as refugees

Refugees and asylum seekers are not terrorists. They have a right to asylum hearings and should be treated with special consideration for their mental and physical health and well-being. The terms and language used to describe refugees should reflect their special status and suffering. The term “refugees” is more appropriate than “migrants,” “immigrants,” “detainees,” “undocumented,” “illegal,” etc.

Provide adequate language support

Ensure appropriate and available language services for speakers of indigenous languages be aware that refugees from Central America may neither speak Spanish nor English. Maintain a roster of individuals, such as academics or community members who are fluent in indigenous languages, who can be called upon via phone or Skype to provide translation services in detention facilities, resettlement areas, and where legal services are provided.

Provide adequate school services for children

Young children need preschool programs. Provided tutors as necessary, identify special-needs children and children with learning disabilities immediately, and assign each child a social worker. Provide appropriate education for special-needs children and children with learning disabilities.

Support necessary mental health services

Refugees are in particular need of mental health services family residential centers should develop adequate resources and make such services available to refugees. Reports from participants housed in Dilley indicated mental health staff were unable to serve the needs of refugees and likely inadequately trained and overworked.

  • If detention continues in any capacity, ensure independent oversight of mental health services in the center so that incompetent or bullying service providers are discharged and there is an ombudsman to address reported abuses.

Ensure proper trauma training

Mandate obligatory and appropriate mental health training for ICE/DHS, CCA, and GEO staff. Training in trauma, complex trauma, secondary trauma, and compassion fatigue is necessary for ICE personnel and for personnel of prison contractors from CCA and GEO — all personnel who are responsible for the care of refugees. Provide trauma and caregiver training for attorneys for self-care in this difficult work to improve mental health and reduce burnout.

Provide for ongoing mental health support

In resettlement areas, there must be ongoing access to mental health professionals trained in working with trauma and refugees in resettlement areas and access to support groups where resettled refugees can learn and share information about mental health services and practical needs such as transportation, housing, child care, school enrollment, etc.

  • Foster resilience and post-traumatic growth using proven, validated strategies. These include the Trauma Resilience Model and/or Community Resilience Model and building on indigenous strategies for resilience that women bring with them from sending countries.
  • Facilitateaccesstofaith-basedsupportindetentioncentersandresettlement areas as faith was widely reported to contribute to resilience.

Provide formal resettlement support

Asylum seekers should not have to hope for Good Samaritans to help them on their bus journeys to resettlement. They should be resettled formally with appropriate care. Resettlement protocols — that provide for food, water, appropriate clothing, blankets, diapers, and sanitary napkins — need to be developed and followed. Enlist a physician to write short-term prescriptions for refugees traveling to resettlement areas. Establish a fund for incidental expenses for families that have been released. Provide sack lunches at the detention center for refugees being released to the bus station so they do not go all day without food or water. Provide up-to- date maps of the United States and bus routes to volunteers and refugees.

Support meaningful alternatives to detention

Eliminate the use of ankle monitors on refugees they are dehumanizing and stigmatizing. Ensure court dates are scheduled in locations that are accessible to resettled refugees and in reasonable time frames. Ensure that refugees are not stranded in resettlement areas, miss their court dates, and end up in criminal contempt.

  • Fund community support programs that support refugee populations. Invest in alternatives to detention that are not run by private prison firms with no accountability.

Ensure transparency

ICE and DHS should terminate relationships with CCA and GEO with regard to refugee and immigrant (i.e., noncriminal) housing. Any relationships between the government, DHS and ICE, and prison contractors such as CCA and GEO must be made completely transparent to taxpayers. Close the FOIA loophole for private prison contractors: legally require contractors to respond to Freedom of Information Act requests.

  • There must be independent, civilian, or nongovernmental oversight of government and subcontracted immigration detention practices or alternatives to detention.

Solicit a UNHCR investigation into U.S. treatment of Central American refugees

The findings of this and other studies show that refugees’ human rights can be abused through their contact with U.S. immigration authorities and their detention in hieleras, perreras, and “family” detention facilities.