When images emerged of Syrian refugee Alan Kurdi drowned in the Mediterranean Ocean en route to seeking asylum in 2015, many new coalitions shifted their attention to the refugee crisis. Emotional images and stories do have the power to shift policy (Protess D, McCombs ME. Agenda Setting: Readings on Media, Public Opinion, and Policymaking. London, England: Routledge; 2016); however, the concern over the event may fade from the issue attention cycle (Moeller SD. Compassion fatigue. In: Bleiker R, ed. Visual Global Polities. London, England: Routledge; 2018). When an event maintains the interest of key groups and policymakers, efforts to reduce future harms through policy change mean that the event can be categorized as a focusing event (http://bit.ly/2RPhldL). The caveat is that, by definition, these focusing events have the potential to change policy—but do not necessarily result in policy change.
Jackeline Caal, an asylum-seeker from Guatemala, was seven years old when she died in December of 2018 in US Department of Homeland Security (DHS) custody. Jackeline had had a fever of nearly 106°F before she died of dehydration and sepsis. Just as activists began reporting on details of Jackeline’s memorial service in Guatemala, new information emerged about another child’s death. On December 24, Felipe Gómez Alonzo also died of illness in Border Patrol custody. Immigrants in the United States face barriers to accessing health care (Philbrick AM. Immigrant health care in the context of an incredibly complicated health care system. Am J Public Health. 2018;108[7]:843–844), and in detention centers, the lack of adequate care is deadly.
As a researcher who studies vulnerable populations and also as a parent, I find these events to be jarring. However, the contingency to care about Jackeline’s death should not rest on empathy through relatability. Everyone should be alarmed that Jackeline and Felipe did not receive adequate health care while being held in detention because it displays poor planning and coordination of health services and a lack of concern for human rights.
Reporters such as Aura Bogado who have been following the conditions in immigration detention centers have been detailing the prison-like conditions (http://bit.ly/2MWRq35). The immigration detention centers are referred to as hieleras, or ice boxes. The centers are essentially prisons, and they are not designed for children.
In June, humanitarian and advocate Heather Blanchard (http://bit.ly/2SVTSsI) made the excellent point that the Emergency Support Sheltering Function 6 (ESF-6—Mass Sheltering) was not being activated for asylum seekers. ESF-6 is designed for civilian sheltering under the US National Response Framework. Sheltering and mass care is also designated to be managed by the local officials and groups who are responding to a disaster. Sheltering a mass population takes a lot of work, coordination, and expertise. As Blanchard pointed out, by avoiding activating ESF-6, DHS is not coordinating with groups that specialize in humanitarian sheltering, medical and psychosocial care, and nutrition—such as Save the Children, World Vision, and the International Medical Corps.
It is clear that the DHS’s current detention operating structure—the absence of humanitarian organizations in detention centers—caused irrevocable harm and will continue to cause harm unless new policies ensure the delivery of adequate health services. New reports from DHS suggest that it will consider cooperating with expert agencies such as the Centers for Disease Control and Prevention. Health expertise and coordination with outside groups is essential, especially for pediatric care.
There are health care coalitions, faith-based groups, and other groups who have been working in El Paso, Texas, and surrounding areas for decades. After the world saw Jackeline’s photo and heard Felipe’s story, it is likely that new fundraisers and advocacy efforts will be evident in the weeks and months to come. However, it is unlikely the DHS will utilize ESF-6 activation. It is urgent that health care advocates, medical doctors, immigration lawyers, social scientists, and policymakers mobilize and work together to demand accountability for immigration health care services and to ensure that immigrant rights remain central in the public policy agenda.
17 Years Ago
Attacks on Science and the Risks to Evidence-Based Policy
As government agencies, academic centers, and their researchers increasingly provide the science base for policy decisions, they are also subject to forces that seek to politicize or silence objective scientific research. We refer . . . to the vulnerability of science to attacks by vested interests. . . . Consider, for example, the 1998 White House decision not to fund needle exchange programs . . . . [A]lthough emotional and ideological vested interests had worked successfully to undermine the scientific database, the cumulative evidence was clear in finding that such programs do not increase drug use and do reduce cases of HIV. The administration recognized the science but nonetheless refused to lift a ban on federal funding of needle exchange programs.
From AJPH, January 2002, pp. 14, 17
92 Years Ago
The Hod Carriers of Science
We are apt to think of science as concerned only with the microscope, the test tube and the chemical balance. . . . [Yet] some of the most valuable truths of sanitary science have been discovered in the field, at the bedside, or at the desk of the statistician. . . . Austin Flint . . . with no knowledge of germs, showed that typhoid fever is spread by drinking water. . . . It was Finlay’s observations on the surroundings of his yellow fever patients in Cuba which led to his suspicion that a certain species of mosquito transmits this disease. . . . We have received a great heritage of knowledge from those who have gone before, both from the masters and from those who have been called the “hod carriers of science.” . . . [L]et us carry our hod well and try to place at least one stone on the ever growing edifice of science.”
From AJPH, November 1927, pp. 1115–1116
Biography
