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VI. PHYSICAL HEALTH, MEDICALPROBLEMS AND MEDICAL CARE INDETENTIONDetained asylum seekers reported to Bellevue/NYU-PHR researchersnumerous physical health/medical complaints during their detention experience.Musculoskeletal pain, headaches and gastrointestinal symptomswere among the most commonly reported problems. Many detaineesbelieved that in addition to worsening psychological health, as previouslynoted (See Chapter V: Mental Health), their physical health worsened aswell while in detention.Medical services are available on-site in all of the detention facilitiesvisited in the course of this study, providing detained asylum seekers withaccess to services many did not have in their countries of origin. Nevertheless,detainees interviewed for this study were frequently dissatisfied withtheir level of access to medical care, particularly specialized care, includingdental services. Dissatisfaction with the quality of care received was alsocommon. Detainees frequently complained of repeatedly being given thesame medication without improvement or being dissatisfied with theirinteractions with health staff, including what they often perceived as rudeand dismissive behavior.Information regarding detainee’s medical problems and the care theyreceived is based on interviews conducted with detainees. Physical examinations,review of detainees’ medical records, or discussions with careproviders were not part of the design of this study. Furthermore, the limitedsample size and the subjective nature of the detainees’ perceptions of theirhealth and the care they received also must be acknowledged. Investigatorswere not able to determine in a particular case whether or not appropriatetreatment was provided. Nevertheless, these findings suggest the need forfurther study and review of care provided in detention facilities housing asylumseekers. Given their non-criminal status and distinct medical history,their care must go beyond the correctional health care model and be tailoredto the needs of asylum seekers, including a strong mental health component.In understanding the physical health of detained asylum seekers, theinterdependence with psychological health must be considered. Given thelarge proportion of detainees who reported having experienced torture intheir country of origin, including frequent reports of severe beatings, it isnot surprising that many participants suffered from musculoskeletal painand headaches. However, in addition to physical problems from beatings,symptoms such as pain, headaches, and gastrointestinal complaints, mayPHYSICAL HEALTH, MEDICAL PROBLEMS AND MEDICAL CARE 87
e somatic manifestations of the psychological distress that accompaniessevere trauma. Furthermore, as described previously, the stress of incarcerationas well as limited mental health services may be compoundingthese problems. Thus detainees may frequently present to medical staffwith physical manifestations of their stressful conditions. Such somaticcomplaints are frequently described by health care providers in multiplesettings, not just clinics for incarcerated persons, as difficult to adequatelyidentify (i.e., distinguish from symptoms with an organic etiology) andtreat. This can lead to frustration on the part of both the doctor andpatient. The patient is actually describing mental health problems, whilethe doctor is focusing on a physical health problem.Improved access to mental health services would perhaps result indecreased need for medical services to address psychological symptoms.At the same time, improved access to certain medical services, such as dentaland other specialized care, might also improve the physical and emotionalwell-being of detainees. Furthermore, medical staff may beunfamiliar with the impact of trauma on the health of asylum seekers.Additional training in effective communication skills to better address thepsychosocial needs of these individuals would be beneficial. 148Health Services Available in DetentionHealth services are available on-site at all of the detention facilities whereinterviews were conducted by the Bellevue/NYU-PHR team. At the INS’sElizabeth and Wackenhut contract detention facilities, health services areprovided by staff employed by the US Public Health Services, which is partof the US Dept. of Health and Human Services. Health services in countyjail facilities visited are provided by private contractors. For specialized services,including dental care, individuals are taken to outsidepractitioners/local hospitals. 149Clinics in contract detention facilities and county jails generally operateMonday through Friday during the daytime, although on-call services arealso available. Costs for health services are covered by the INS, andapproval for a number of off-site procedures, such as dental or other specializedcare, is required. The Wackenhut, Elizabeth and York facilitieshave all been accredited by the National Commission on CorrectionalHealth Care (NCCHC), and the Wackenhut and Elizabeth facilities havebeen accredited by the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO).148The INS and health staff responsible for detention facilities have shown willingness to havesuch trainings, and local NGO’s have previously been invited and permitted to conduct trainingsat several INS detention facilities.149Basic information concerning available health services came from general discussions withhealth providers at several different facilities, non-profit organizations working withdetainees, and discussions with detainees themselves.88 FROM PERSECUTION TO PRISON
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From Persecution to Prison:The Heal
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CONTENTSAcknowledgements . . . . .
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The Bellevue/NYU Program for Surviv
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don, Miranda Ip, and Meriam Alrashi
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Significant symptoms of depression
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Detained asylum seekers participati
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persecution, yet most emphasized ho
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In many facilities, the response to
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years in detention, she finally got
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abuse For example, while being take
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They didn’t let me use the phone
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intensely personal events they had
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Limitations of this study include t
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Non-governmental organizations serv
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22 FROM PERSECUTION TO PRISON
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the late 1990s ranging from 10 to 7
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Historical BackgroundFor most of th
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international standards with the 19
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apply for asylum make up the majori
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tion judge. 57 Yet in many parts of
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York and Newark, New Jersey has had
Page 45 and 46: trict began denying parole to them
Page 47 and 48: Correctional Facility in 2000. “[
Page 49 and 50: men of which 750 were detained on i
Page 51 and 52: from that same country from seeking
Page 53 and 54: Detention Facilities in this StudyF
Page 55 and 56: high reliability in numerous langua
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Page 59 and 60: York County Prison in York Pennsylv
Page 61 and 62: TABLE 2:Demographic Characteristics
Page 63 and 64: TABLE 4:Prevalence of Pre-Migration
Page 65 and 66: on a part time basis, researchers w
Page 67 and 68: Case #1(DK): “Loneliness and Fear
Page 69 and 70: TABLE 6:Hopkins Symptom Checklist-2
Page 71 and 72: TABLE 8:Harvard Trauma Questionnair
Page 73 and 74: think such services were available.
Page 75 and 76: When I am talking to you now it is
Page 77 and 78: After being granted asylum and rele
Page 79 and 80: “Being here is like going through
Page 81 and 82: In my country even though I became
Page 83 and 84: how long they were there - six mont
Page 85 and 86: Thoughts of SuicideSeveral asylum s
Page 87 and 88: here?’ I told the doctor, they br
Page 89 and 90: Another subject reported a positive
Page 91 and 92: substantial distance from their att
Page 93 and 94: eported that her experience in dete
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Page 99 and 100: Case #2 (JG): “Health Care in Cha
Page 101 and 102: TABLE 11:Detainee Perceptions of He
Page 103 and 104: TABLE 13:Availability and Quality o
Page 105 and 106: detainees, or because they did not
Page 107 and 108: Difficulty Obtaining Specialized Ca
Page 109 and 110: Another detained asylum seeker repo
Page 111 and 112: One detainee who speaks French and
Page 115 and 116: Detention Facilities in this StudyS
Page 117 and 118: even though many reported having ex
Page 119 and 120: CASE #3 (HN): “SOLITARY CONFINEME
Page 121 and 122: Here, I’m scared. In [the detenti
Page 123 and 124: emote control and watch what he wan
Page 125 and 126: Whenever someone misbehaves, they t
Page 127 and 128: This subject was himself threatened
Page 129 and 130: One detainee reported several incid
Page 131 and 132: Some Process Exists to Respond to R
Page 133 and 134: There were no witnesses other than
Page 135 and 136: tion. An INS officer said they put
Page 137 and 138: There is an Anglican minister who c
Page 139 and 140: The dentists didn’t explain anyth
Page 141 and 142: tion between dental age and chronol
Page 143 and 144: Case #4 (LK): “Fifteen-Year-Old G
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TABLE 16:Treatment/Abuses Reported
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“There is no political asylum her
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I was crying. I was so afraid with
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save her life, but was not able to
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Case #5 (CR): “Begging for Mercy
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ehind and told me to sign. He physi
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days and it is now 2 years and four
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viewers asked for additional inform
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y study participants. In evaluating
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trast, under US law, detention of s
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nation for an asylum determination
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very negative effects of detention
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authority to grant asylum and with
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absconding.” 250 Since the passag
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said “[F]reedom from imprisonment
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Standards relevant to this study ar
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“detained person” generally as
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which they are charged and a fair h
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esponse to substantial public press
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specified procedures, provided they
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PunishmentThe Detention Standard on
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any time the detainee complains.”
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while in detention, thus adding to
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Establish a Uniform National Parole
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that effect. These officers should
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Besides their inaccuracy, these exa
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friends so asylum seekers can maint
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appropriate staffing of such groups
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efugees and asylum seekers who win
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of thorough documentation. However,
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Human development is complex and di
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18. Country from which fleeing pers
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9. Being close to death.10. Forced
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Complete for each health problem:5.
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Explain:(Interviewer: Write brief n
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2. Depression SymptomsA How much we
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B. You said that you have experienc
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Explain:13. How was your physical h
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Yes ...........1No............22. W
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Explain:20. At the time of your arr
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