Neither Safety nor Health: How Title 42 Expulsions Harm Health and Violate Rights

Toward the beginning of the COVID-19 pandemic in March 2020, the Trump administration overrode the objections of public health experts at the U.S. Centers for Disease Control and Prevention (CDC) and compelled the CDC to issue an order under Title 42 U.S.C. section 265 of the 1944 Public Health and Service Act that closed the border to migrants and asylum seekers. The government used public health as a pretext to summarily expel children and adults seeking refuge at the U.S. border more than 980,000 times, while at the same time allowing other types of travelers to continue to cross the border with no testing or quarantine requirements. Public health experts strenuously objected to the ban, pointing out the lack of epidemiological evidence for only banning this category of entrants to the United States while keeping the borders open to other travelers.Nevertheless, six months into the Biden administration, the U.S. government continues to expel families and adults to countries where they face severe harm and persecution, violating their rights and failing to safeguard public health. The Biden administration also continues to carry out chaotic border expulsions that perpetuate family separation and further traumatize an already vulnerable population.In May 2021, a Physicians for Human Rights (PHR) research team conducted interviews in Tijuana and Ciudad Juárez, Mexico with 28 asylum seekers who had been expelled under the Title 42 order, and with six health care workers providing services to migrants. The team sought to document people's experiences during expulsion, including family separation, the actions of U.S. and Mexican government officials during the expulsion process, and the physical and mental health impacts of expulsion and family separation.People described an impossible situation, where they were unsafe in their own country, unsafe in Mexico, and yet unable to seek safety at the U.S. border. Every day that the Title 42 order continues to expel asylum seekers is another day that the U.S. government is harming people's health and violating their human rights

Contributions of photoautotrophy and heterotrophy to the carbon and nitrogen nutrition of Anthopleura elegantissima in three symbiotic states

The Pacific coast sea anemone Anthopleura elegantissima is an excellent model organism for the study of temperate symbiosis due to its unique relationship with two microalgal symbionts, Elliptochloris marina and Symbiodinium spp. In addition to hosting one or both of these symbionts, A. elegantissima can live aposymbiotically, allowing for the comparison of nutritional compositions of hosts with different symbionts. This study used stable isotope analysis to quantify the photoautotrophic contributions by symbionts and heterotrophic contributions by hosts. Algal, anemone-only, and algae+anemone samples were isolated from A. elegantissima symbiotic with E. marina, Symbiodinium spp., or anemones lacking symbionts. Samples were analyzed for δ¹⁵N and δ¹³C in the OSU Stable Isotope Laboratory. Isotope analysis showed that symbiotic anemone-only and algae+anemone samples were very close to the high δ¹⁵N and δ¹³C values of aposymbiotic samples, while algal samples were much lower. These results indicate that symbiotic anemones are relying primarily on heterotrophic nutrition, and receiving little-to-no benefit from hosting either E. marina or Symbiodinium spp. Key Words: Anthopleura elegantissima, Elliptochoris marina, Symbiodinium, stable isotop

Part of my heart was torn away: What the U.S. Government Owes the Tortured Survivors of Family Separation

When the news broke in 2018 that the U.S. government was forcibly separating thousands of parents and children as young as infants at the U.S.-Mexico border, nationwide outcry ensued due to the evident trauma caused by the separations. Physicians for Human Rights (PHR) found that the cases of forcible family separation by the U.S. government that we documented constituted torture. PHR's torture finding was cited by the Biden campaign during the 2020 U.S. presidential election. However, as the election passed, uproar and outrage around family separation abated, but parents and children who were eventually reunited struggle to recover from severe psychological effects of the trauma they endured. Parents who were deported and separated from their children for three or even four years continued to suffer and wait in desperation for the moment when they could be with their children again.This study documents the longer-term psychological impact of this inhumane policy of forced separation on parents who were deported by the United States government, most of them separated from their children for three to four years. The persistent and damaging psychological effects documented by PHR call out for acknowledgement, accountability, redress, and rehabilitation. This study also seeks to make visible the desires of the parents who were interviewed regarding means of redress owed to them by the U.S. government. In the context of a broad discussion about redress, it is essential that the views of affected communities be directly incorporated into research and policy recommendations

Clinicians’ Perceptions of The Health Status of Formerly Detained Immigrants

Background In the past decade, the U.S. immigration detention system regularly detained more than 30,000 people; in 2019 prior to the pandemic, the detention population exceeded 52,000 people. Inhumane detention conditions have been documented by internal government watchdogs, news media and human rights groups, finding over-crowding, poor hygiene and sanitation and poor and delayed medical care, as well as verbal, physical and sexual abuse. Methods This study surveyed health professionals across the United States who had provided care for immigrants who were recently released from immigration detention to assess clinician perceptions about the adverse health impact of immigration detention on migrant populations based on real-life clinical encounters. There were 150 survey responses, of which 85 clinicians observed medical conditions attributed to detention. Results These 85 clinicians reported seeing a combined 1300 patients with a medical issue related to their time in detention, including patients with delayed access to medical care or medicine in detention, patients with new or acute health conditions including infection and injury attributed to detention and patients with worsened chronic conditions or special needs conditions. Clinicians also provided details regarding sentinel cases, categorized into the following themes: Pregnant women, Children, Mentally Ill, COVID-19, and Other serious health issue. Conclusions This is the first survey, to our knowledge, of health care professionals treating individuals upon release from detention. Due to the lack of transparency by federal entities and limited access to detainees, this survey serves as a source of credible information about conditions experienced within immigration detention facilities and is a means of corroborating immigrant testimonials and media reports. These findings can help inform policy discussions regarding systematic changes to the delivery of healthcare in detention, quality assurance and transparent reporting

Trauma Exposures, Resilience Factors, and Mental Health Outcomes in Persons Granted Asylum in the U.S. for Claims Related to Domestic Violence and Persecution by Organized Gangs.

Survivors of domestic violence (DV) and of violence perpetrated by organized gangs (GV) face barriers to legal protection under U.S. asylum law. We abstracted data from 132 affidavits based on forensic medical evaluations of asylum seekers granted legal protection in the U.S. on the basis of DV and/or GV. We described claimants’ trauma exposures and resilience factors and used multiple logistic regression to quantify associations with Diagnostic and Statistical Manual-5 (DSM-5) diagnoses and improvement in mental health. People seeking asylum based on DV and/or GV have endured multiple types of trauma with significant impacts on their mental health. New experiences of trauma following migration to the U.S. were common and associated with DSM-5 diagnoses. Conversely, resilience factors were associated with improved mental health. Policies that aim to reduce ongoing trauma in the U.S. and to bolster resilience factors may promote asylee mental health and well-being

Letter to the editor: “Eliciting national and subnational sets of disability weights in mainland China: findings from the Chinese disability weight measurement study”

Lette

Impact of Forensic Medical Evaluations on Immigration Relief Grant Rates and Correlates of Outcomes in the United States.

The purpose of this study was to investigate the impact of forensic medical evaluations on grant rates for applicants seeking immigration relief in the United States (U.S.) and to identify significant correlates of grant success. We conducted a retrospective analysis of 2584 cases initiated by Physicians for Human Rights between 2008-2018 that included forensic medical evaluations, and found that 81.6% of applicants for various forms of immigration relief were granted relief, as compared to the national asylum grant rate of 42.4%. Among the study’s cohort, the majority (73.7%) of positive outcomes were grants of asylum. A multivariable regression analysis revealed that age, continent of origin, history of sexual or gender-based violence, gang violence, LGB sexual orientation, and being detained by the U.S. government at the time of evaluation request were statistically associated with case outcomes. Forensic physical evaluation was more strongly associated with a positive outcome than forensic psychological evaluation. Our findings strengthen and expand prior evidence that forensic medical evaluations can have a substantial positive impact on an applicant’s immigration relief claim. Given the growing applicant pool in the U.S., there is an urgent need for more trained clinicians to conduct forensic medical evaluations as well as to educate adjudicators, immigration lawyers, and policy makers about the nature of the life-altering events that applicants for immigration relief experience

A water cycle for the Anthropocene

International audienceHumor us for a minute and do an online image search of the water cycle. How many diagrams do you have to scroll through before seeing any sign of humans? What about water pollution or climate change—two of the main drivers of the global water crisis? In a recent analysis of more than 450 water cycle diagrams, we found that 85% showed no human interaction with the water cycle and 98% omitted any sign of climate change or waterpollution (Abbott et al., 2019). Additionally, 92% of diagrams depicted verdant, temperate ecosystems with abundant freshwater and 95% showed only a single river basin. It did not matter if the diagrams came from textbooks, scientific articles, or the internet, nor if they were old or new; most showed an undisturbed water cycle, free from human interference. These depictions contrast starkly with the state of the water cycle in the Anthropocene, when land conversion, human water use, and climate change affect nearly every water pool and flux (Wurtsbaugh et al., 2017; Falkenmark et al., 2019; Wine and Davison, 2019). The dimensions and scale of human interference with water are manifest in failing fossil aquifersin the world’s great agricultural regions (Famiglietti, 2014), accelerating ice discharge from the Arctic (Box et al., 2018), and instability in atmospheric rivers that support continental rainfall (Paul et al., 2016).We believe that incorrect water cycle diagrams are a symptom of a much deeper and widespread problem about how humanity relates to water on Earth. Society does not understand how the water cycle works nor how humans fit into it (Attari, 2014; Linton, 2014; Abbott et al., 2019). In response to this crisis of understanding, we call on researchers, educators, journalists, lawyers, and policy makers to change how we conceptualize and present the global water cycle. Specifically, we must teach where water comes from, what determines its availability, and how many individuals and ecosystems are in crisis because of water mismanagement, climate change, and land conversion. Because the drivers of the global water crisis are truly global, ensuring adequate water for humans and ecosystems will require coordinated efforts that extend beyond geopolitical borders and outlast the tenure of individual administrations (Keys et al., 2017; Adler, 2019). This level of coordination and holistic thinking requires widespread understanding of the water cycle and the global water crisis. Making the causes and consequences of the water crisis visible in our diagrams is atractable and important step towards the goal of a sustainable relationship with water that includes ecosystems and society

Human domination of the global water cycle absent from depictions and perceptions

International audienceHuman water use, climate change and land conversion have created a water crisis for billions of individuals and many ecosystems worldwide. Global water stocks and fluxes are estimated empirically and with computer models, but this information is conveyed to policymakers and researchers through water cycle diagrams. Here we compiled a synthesis of the global water cycle, which we compared with 464 water cycle diagrams from around the world. Although human freshwater appropriation now equals half of global river discharge, only 15% of the water cycle diagrams depicted human interaction with water. Only 2% of the diagrams showed climate change or water pollution—two of the central causes of the global water crisis—which effectively conveys a false sense of water security. A single catchment was depicted in 95% of the diagrams, which precludes the representation of teleconnections such as ocean–land interactions and continental moisture recycling. These inaccuracies correspond with specific dimensions of water mismanagement, which suggest that flaws in water diagrams reflect and reinforce the misunderstanding of global hydrology by policymakers, researchers and the public. Correct depictions of the water cycle will not solve the global water crisis, but reconceiving this symbol is an important step towards equitable water governance, sustainable development and planetary thinking in the Anthropocene