[Teaches in Department of Social Work, Loyola College, Chennai]
Almost 30,000 people in the USA are currently held in administrative detention for alleged violations of immigration law. The detainees are accommodated across more than 500 facilities, mostly state and county jails, often for periods of months or years.
The health of women in custodial facilities raises specific challenges. The USA has the highest rate of immigration in the developed world. Many migrants entering the country are extremely vulnerable, face poor working and living conditions, and have limited, if any, entitlement to health care even after their status has been declared legal. Obama announced a welcome law change: that legal immigrant pregnant women and children who have been in the country fewer than 5 years will be able to receive health benefits through the State Children's Health Insurance Program and Medicaid.
One of the major barriers to adequate health care for migrants to the USA is a lack of understanding of their specific health needs. Data for disease prevalence are rarely disaggregated by country of birth or length of residence in the USA, so American-born ethnic minorities are not distinguished from foreign-born migrants. This knowledge is crucial for targeting vulnerable communities with tailored disease-prevention programmes and treatment strategies.
The Lancet has previously praised the USA on its contribution to global health. The country's efforts to improve the health of vulnerable people in resource-poor countries around the world is immensely important, but the fact that the USA largely ignores the needs of migrants on its own doorstep is shameful. Issuing guidelines is not enough—they must be enforced through data transparency, staff training, and continuous monitoring of standards. America's failure to provide adequate health care for its migrant population risks seriously undermining President Obama's commitment to improve global health.
Full text of this editorial in the latest Lancet (Volume 373, Issue 9669, 28 March 2009-3 April 2009, Page 1053 )