Public Health Experts Issue Recommendations To Protect Public Health and Lives of Asylum Seekers

Leading epidemiologists and public health experts issued recommendations today for protecting public health and the lives of people seeking asylum at the U.S. southern border. The recommendations—released in the wake of the Trump administration’s misuse of public health authority to expel people seeking protection and the Biden campaign’s commitment to review the policy and make appropriate changes—were issued by experts at the Columbia University Mailman School of Public Health, the Johns Hopkins Center for Humanitarian Health, the George Washington University Milken Institute School of Public Health, Physicians for Human Rights, Human Rights First and Doctors of the World, with input from numerous epidemiologists and other public health experts.

Earlier this year, senior experts within the Centers for Disease Control and Prevention (CDC) objected to the Trump administration’s plan to ban and expel asylum seekers and unaccompanied children as lacking a public health basis and not motivated by public health concerns. Leading public health experts concluded that the March 20 CDC order, subsequently extended indefinitely in May and re-issued in October, was specious from a public health perspective, undermined health and endangered the lives of people seeking refugee protection.

“Instead of bans, expulsions and asylum denials, the Biden administration should employ science-based public health measures at borders to protect the health of the American public, U.S. border officers, communities on both sides of the border and the lives of those seeking refuge, safety and freedom,” read the recommendations. “We recommend effective, evidence-based public health measures, many of which are currently used in the United States and in connection to travel, to mitigate COVID-19 risks.”

These measures outlined in the public health recommendations include:

• Strengthen public health decision-making, contingency planning for increases or shifts in arrivals, and funding and support for public health and humanitarian entities on both sides of the border;

• Use masks, social distancing, hand hygiene, distancing demarcations, and barriers; adapt processing to minimize delays; avoid congregate and high-density situations; and maximize ventilation and use of outdoor areas at processing and shelters/other reception locations, using areas appropriate for non-congregate processing; 

• Ramp up testing capacity, deploying mobile units, and scale-up quarantine and isolation capacities – public health measures that should be directed and conducted by CDC, HHS, and/or other health professionals independent of CBP or ICE; and  

• Do not hold families, adults or children in congregate detention which presents health risks, and instead families and adults can shelter in place with their families or other U.S. community contacts using proven case management alternatives to detention, while ensuring immediate transfer of unaccompanied children to HHS/ORR custody.

“The Trump administration has misused public health authority as a ploy to attempt to justify expulsions that endanger human lives,” said Monette Zard, associate professor and director of the Program on Forced Migration and Health at Columbia University Mailman School of Public Health. “The Biden administration should end this abuse of public health authority, ensure public health decisions are made by public health officials without pressure to advance migration policy or other political objectives and use public health measures to safely process the cases of families, adults and children seeking protection at our borders.” 

“The United States has the ability to protect public health and safeguard the lives of children, families, and adults seeking asylum and other humanitarian protection,” said Paul Spiegel, professor and director of the Center for Humanitarian Health at Johns Hopkins Bloomberg School of Public Health. “These recommendations provide a road map of evidence-based public health measures for achieving these objectives in ways that uphold this country’s values, laws, and refugee treaty obligations.” 

“Instead of turning people seeking refuge back to danger or sending them to immigration jails, the Biden administration should use public health measures to process cases and scale-up case management so that people can shelter in place with family in the United States as their asylum requests are adjudicated,” said Michele Heisler, medical director of Physicians for Human Rights and professor at the University of Michigan Medical School and School of Public Health. “Asylum seekers stranded by the Trump administration’s chaotic and dangerous Remain in Mexico policy should be safely and swiftly paroled into the country.”

“The misuse of public health authority to turn people fleeing violence back to danger must end,” Ron Waldman, president of Doctors of the World and professor at the Milken Institute School of Public Health, George Washington University. “Instead, a Biden administration should uphold U.S. values and laws using evidence-based public health measures – like social distancing, masks, ventilation and use of outdoor areas, testing and other measures - which are used in travel and other contexts in these challenging times.”  

“As the Biden administration ends the Trump administration’s chaos and instead implements policies that uphold U.S. values and laws, these recommendations confirm that U.S. agencies can use public health measures to bring into safety people seeking protection from persecution, including asylum seekers stranded in danger in Mexico,” said Eleanor Acer, senior director for refugee protection at Human Rights First. “In addition to implementing fair, orderly and safe processes, the incoming administration should sharply ramp up U.S. efforts to address factors pushing people to flee their countries and enhance refugee protection across the region.”   

Asylum seekers from Burundi, Cameroon, Cuba, the Democratic Republic of the Congo, El Salvador, Guatemala, Haiti, Honduras, Mexico, and Venezuela have been blocked from leaving Mexico due to the CDC order, and others have been expelled to danger including dissidents flown back to Nicaragua, a transgender Honduran asylum seeker expelled to Mexico, and a pregnant Honduran asylum seeker expelled to Mexico while experiencing contractions, even though she had been repeatedly raped there. Human Rights First has tracked more than 1,300 public reports of violent attacks on asylum seekers forced to wait in danger under MPP.

Leading public health experts wrote to the CDC in May 2020 to urge the order be rescinded and identify public health measures that can be used in processing asylum cases, and wrote to DHS and DOJ in August to urge withdrawal of a proposed rule that would also use public health as a pretext to deny asylum and other protection to refugees. In November 2020, the UN Refugee Agency (UNHCR) warned that “measures restricting access to asylum must not be allowed to become entrenched under the guise of public health.” 

In November, the Biden campaign said that a Biden Administration would “direct the CDC and [the Department of Homeland Security (DHS)] to review this policy and make the appropriate changes to ensure that people have the ability to submit their asylum claims while ensuring that we are taking the appropriate COVID-19 safety precautions, as guided by the science and public health experts.” A federal court, late in November, issued a preliminary injunction blocking DHS from expelling unaccompanied children under the CDC order and finding that the government was not likely to prevail on its assertion that the U.S. public health laws cited as authority for the CDC order authorize expulsions.

In their recommendations, which update recommendations shared earlier this year, the health experts explained that measures should be reviewed, scaled up or adjusted as the COVID-19 transmission context, arrival locations/levels, health guidance, testing technology/capacity, vaccine availability, and understanding of the disease change.  

To learn more about the impact of the expulsion policy on asylum seekers and children expelled to danger, read Human Rights First’s new report “Humanitarian Disgrace: U.S. Continues to Illegally Block, Expel Refugees to Danger.” Human Rights First has also made in-depth policy recommendations to the next administration to address U.S. refugee protection challenges.