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

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By PHR staff members Kathryn Hampton, MSt, MA, senior officer, Asylum Program; Michele Heisler, MD, MPA, medical director; and Cynthia Pompa, Asylum Program officer; and Alana Slavin, medical student at the University of Michigan Medical School.

Executive Summary

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.[1] 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,[2] 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. A letter from public health experts in July 2021 reiterated that the latest scientific knowledge regarding transmission of the virus that causes COVID-19 did not support expulsion as a public health measure, and thus that the order undermined trust in the CDC itself as a scientific body.[3]

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. PHR researchers used validated Spanish-language screening tools to screen participants for mental health symptoms, including the PCL-5 Civilian scale for post-traumatic stress disorder (PTSD) symptoms, and the Hopkins Symptom Checklist (HSCL25) for anxiety and depression symptoms.

"I cannot go back to my country. I cannot live there due to the violence. I cannot live in Mexico due to the violence. Where am I supposed to go?" 36-year-old woman from Honduras

Almost all the people interviewed came to the border to seek asylum in the United States due to gang violence or domestic violence in their home countries. Families reported repeated crossings, often in dangerous conditions -- in flimsy rafts, wet and cold, carrying their children, sometimes injured, sometimes with smugglers who abused, robbed, or extorted them -- in their desperation to find refuge in the United States. When asked if they feel safe in Mexico, all but one of the asylum seekers interviewed said that they did not feel safe. People told PHR researchers that they had been assaulted, kidnapped, extorted, and subjected to physical and sexual violence in Mexico. Interviewees reported that they did not have access to state protection from Mexican authorities, and several were even robbed or extorted by Mexican authorities after they were expelled from the United States.

Interviewees reported that U.S. officials rebuffed all their attempts to seek asylum in the United States. Furthermore, all the asylum seekers interviewed described gratuitously cruel and inhumane treatment at the hands of the U.S. government, including physical and verbal abuse by U.S. officials, inhumane detention conditions, active deception about their expulsion and the whereabouts of their family members, and unsafe returns that put people at heightened risk of harm.

Although the Title 42 order is characterized by the Biden administration as a public health policy, every aspect of the expulsion process, such as holding people in crowded conditions for days without testing and then transporting them in crowded vehicles, increases the risk of spreading and being exposed to COVID-19.

"I begged them over and over not to separate me from my family. I thought they would not separate us because Biden said he would not separate families, but they separated me from my partner and child." 32-year-old man from El Salvador

The psychological effects of expulsions and family separation were also profound. Of the 26 participants who were administered validated screening tools, 25 (96 percent) screened positive for at least one mental health diagnosis; 25 (96 percent) screened positive for at least two disorders; and 23 (88 percent) screened positive for PTSD, anxiety, and depression. Of the 26 who were administered the survey, 23 people (88 percent) screened positive for PTSD related to the events leading to family separation, 25 (96 percent) screened positive for depression, and 24 (92 percent) screened positive for anxiety.

U.S. border officials not only refused to provide basic information to those they detained and expelled, they also frequently deceived and actively provided false information to asylum seekers. Sixteen interviewees reported not receiving information related to their expulsion. Ten interviewees reported being intentionally deceived by immigration officials, particularly during the expulsion process. Even more cruelly, U.S. officials deceived people about being reunited with family members, while, in reality, they were separating them.

Under the Biden administration, families continue to be separated, as some family members are permitted to enter the United States, while others are expelled. Of those we interviewed, 11 people were forcibly separated from family members by border officials. A further eight people were separated from family members they traveled with who were not their biological children, but for whom they were the primary guardian, such as younger minor siblings or nieces and nephews. These separations took place without any consideration of the needs or vulnerabilities of family members, or the age of the children.

The interviewees described the profound impact that family separation has had upon children in their family. A wide array of symptoms was described, including excessive crying, disturbed sleep, and loss of developmental milestones such as resuming bed wetting. Eleven interviewees stated that their children were not eating and had lost significant weight due to the stress of 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. Public health experts have already outlined detailed recommendations on effective and evidence-based public health measures for the U.S. government to safely process families, children, and adults at the border, such as COVID-19 testing, masking, social distancing, and quarantining.[4] These measures must be implemented urgently. 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.