Recent reports of dangerous and unsanitary conditions at migrant detention facilities in the US have generated national outcry. Over the last 8 months, 6 children have died while in US custody or soon after being released. The deaths were linked to a number of infections including influenza, pneumonia, and Staphylococcus. While some of the children had preexisting conditions, multiple parties point to overcrowding and unsanitary conditions in US Customs and Border Patrol (CBP) facilities as the major culprit. Outbreak Thursday has previously addressed infectious disease outbreaks in similar settings. This week, we will discuss what is known about infectious disease outbreaks in migrant detention facilities in the US and the factors that may be contributing to the spread of infectious diseases in these and similar settings.

 

Dangerous Conditions in Detention Facilities

CBP is responsible for short-term detention of migrants—including single adults, families, and children—arriving in the United States without valid travel documents. According to CBP’s National Standards on Transport, Escort, Detention and Search, “detainees should generally not be held for longer than 72 hours…[and] every effort must be made to hold detainees for the least amount of time required for their processing, transfer, release or repatriation as appropriate and as operationally feasible.” After this period, detainees are supposed to be transferred to long-term facilities run by other agencies. Officially, unaccompanied minors are supposed to be transferred to the Department of Health and Human Services (HHS), while single adults and families are to be transferred to Immigration and Customs Enforcement (ICE); however, there have been reports of families being separated and sent to different facilities, even after an executive order was declared in June to end family separations at the border.

According to the Department of Homeland Security (DHS) Office of Inspector General, ICE and HHS facilities are currently operating at or above capacity, resulting in detained migrants spending extended periods of time in CBP custody. Overtaxed CBP facilities, particularly in Texas, have been cited with “dangerous overcrowding” and inadequate access to food, healthcare or sanitation. These reports come from a wide range of sources, including the New York Times, the President of the National Border Patrol Council, Representatives of Congress, the Acting Inspector General for the Department of Homeland Security, Vice President Mike Pence, and the United Nations High Commissioner for Human Rights.

 

Outbreaks in Detention Centers & Contributing Factors

According to the WHO, overcrowding is a major contributor to the transmission of diseases with epidemic potential—including acute respiratory diseases like measles, mumps, chickenpox, and influenza—as well as other diseases that flourish in close contact settings (eg, scabies, Staphylococcus infections). According to the US CDC and the WHO, poor sanitation and hygiene is also linked to the spread of disease, particularly for conditions such as lice infestations, diarrhea, and scabies. Physicians and peer-reviewed studies have noted that outbreaks often continue unchecked when patients have a lack of access to health services. Additionally, the improper use of isolation and quarantine can be detrimental to outbreak response. Reports from news organizations and DHS’s Office of Inspector General have documented infectious disease outbreaks and the presence of these factors in CBP and ICE facilities as described below. 

CBP and ICE facilities have had multiple infectious disease outbreaks in 2018 and 2019. In one example, a CBP facility in Clint, Texas, holding children has experienced outbreaks of scabies, shingles, and chickenpox so far in 2019. In May, 32 migrants tested positive for influenza in a CBP facility in McAllen, Texas, after a 16-year-old Guatemalan migrant detained at the facility died of the disease. Visitors to CBP facilities in Texas have also reported lice infestations. Beyond infectious disease outbreaks, the CBP facilities in McAllen and Clint have also been specifically cited by entities including the New York Times, members of Congress, expert witnesses, and the Office of Inspector General as having some of the worst CBP facility conditions with respect to overcrowding, poor access to healthcare or sanitation, and improper use of isolation and quarantine.

Similarly, ICE facilities reported a total of 423 cases of influenza and 461 cases of chickenpox in 2018. Notably, ICE reported 236 confirmed or probable cases of mumps among detainees across 51 facilities between March 2018 and March 2019, compared to zero cases from January 2016 to February 2018. As of June 14, 2019, ICE has placed 5,200 adult detained migrants in quarantine due to mumps and/or chickenpox exposure. In March 2019, CBP and ICE officials announced that ICE detention centers had reached maximum capacity, and the Office of Inspector General also has cited multiple ICE facilities for poor access to healthcare and sanitation as well as food safety issues.

Outbreaks & Contributing Factors in Similar Settings

These associations between various factors such as overcrowding and infectious disease transmission are not limited to migrant detention facilities; these associations are commonly found in similar settings such as refugee camps as well. Examples of outbreaks in settings worsened by overcrowding, poor sanitation and other factors include outbreaks in refugee camps, post-disaster settings, and even the 2014-16 West Africa Ebola epidemic. A systematic review of examples of camps facing outbreaks due to the associations we have described as well as additional risk factors for disease spread can be found here

Conclusions

The infectious disease outbreaks present in migrant detention facilities must be addressed. It has been clearly defined in the literature that factors such as overcrowding, improper use of quarantine, poor sanitation, and poor access to health care contribute to disease spread. It is imperative that any solution pursued to improve conditions at detention facilities also includes plans to address contributing factors to infectious disease outbreaks. Otherwise, diseases will continue to rapidly spread in these facilities.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.

 

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