Health Care in US Detention Centers:

Ethical Analysis from the Preferential

Option for the Poor

Abstract

The US has built the most extensive immigration detention system globally. Over the last three
administrations, several organizations have noted a systemic failure in the provision of health care
in detention centers, leading to the torture and death of immigrants. This essay develops the
principle of the preferential option for the poor to examine the causes of deficient access to health
care and solutions to overcome them. It analyzes the substandard health care in detention centers
from the notion of structural violence and systematizes solutions of grassroots immigrant
organizations from the idea of solidarity, understood here as a form of friendship with the poor
that moves toward relational justice. Its goal is to build bridges between people so that the
political will is generated to create policies to improve and enforce health care standards in
detention centers and address the unjust foundations of immigration detention.

In December 2019, the US government published new standards for health

care services in US detention centers. Such measures worsen the precarious
situation of health care within detention facilities. This situation compels those
interested in improving the lives of immigrants outside and inside detention to
engage in critical reflection. Furthermore, it is urgent to evaluate the proposals
that can enhance the situation of imprisoned immigrants and their
communities.

This paper argues that, according to the preferential option for the poor, the
US government must provide quality health care in detention centers, and even
more so, it should dismantle the unjust foundations on which the detention
system is based. Leadership by immigrant detainees and their advocates is
critical to achieving results that benefit undocumented immigrants. This thesis
is defended in four parts. First, this paper analyzes the reality of the
criminalization and detention of immigrants in the US. Part two studies the
situation of health care in US detention centers.

Miguel Cerón Becerra, SJ, is studying for his doctorate in philosophy at Loyola University
Chicago. He earned a master’s in philosophy at ITESO, Universidad Jesuita de Guadalajara
(Mexico) and a master’s in theology at Boston College.

JOURNAL OF CATHOLIC SOCIAL THOUGHT - 18:1, 2021, 35-63.

https://doi.org/10.5840/jcathsoc20211814
 36

Section three develops three critical concepts to map ethics from the
preferential option for the poor: vulnerability, structural violence, and
solidarity. Finally, part four examines the health care system in detention
facilities from the preferential option for the poor. This section analyzes the
reality of health care accessibility in detention facilities from the concept of
structural violence. Additionally, it examines diverse proposals to improve the
situation of substandard health care in detention centers and address its causes
from the notion of solidarity.

This article draws on recent scholarship about health care in detention

facilities, as well as the reality of the criminalization of immigrants. To frame
the principle of the preferential option for the poor, this essay delves into
studies of vulnerability, structural violence, and solidarity. For vulnerability,
this paper will pay particular attention to the work of James Keenan, Enda
McDonagh, Vincent Leclercq, Linda Hogan, and Judith Butler. Cynthia Moe-
Lobeda’s studies will provide the framework to analyze structural violence.
For solidarity, Paul Farmer’s and Gustavo Gutierrez’s developments will set
the tone of the discussion among the diverse scholars who contribute to this
topic. Finally, this essay analyzes proposals to improve health care in detention
centers from organizations such as Human Rights Watch, Detention Watch
Network (DWN), Freedom for Immigrants, Freedom to Thrive, and the
National Network for Immigrant and Refugee Rights, as well as scholars and
journalists committed to improving the lives of immigrant detainees.

The Reality of the Criminalization and Detention of Immigrants in the US

Too often in the present political climate, being an undocumented immigrant

in the US means being treated like a criminal. Thus, undocumented individuals
with no or minor criminal offenses are likely to face imprisonment in US
detention centers. This trend had a major upswing during the Obama
administration and gained momentum under the presidency of Donald Trump.
Indeed, at the end of Obama’s administration (September 2016), 55 percent of
the detainees had no conviction, and 20 percent had minor offenses (mainly
DUI, illegal entry, or traffic offenses). In April 2019, the number of
unconvicted detainees increased to 64 percent, which shows a clear policy of
criminalization of undocumented immigrants.1
In terms of totals, both administrations have similar trends. For example,
during the Obama administration (fiscal years 2009-16), on average, 397,733
people were detained every year. Comparatively, in the first three years of the
Trump administration (fiscal years 2017-19), the number increased to an

1See “Growth in ICE Detention Fueled by Immigrants with No Criminal Conviction,”

Transactional Records Access Clearinghouse (TRAC), Syracuse University, November 26, 2019,
https://trac.syr.edu/immigration/reports/583/.
 37

average of 402,076 detained people per year (1.1 percent increase). 2

Concerning demographic information, in FY 2015 (Obama), “individuals from
Mexico and Northern Triangle regions [Guatemala, El Salvador, Honduras]
added up to 89% of the detainee population.”3 Most of them were men (79
percent) between the ages of 18 and 30 (42 percent). 4 Furthermore, 62 percent
of the detainees were deported, 20 percent were temporarily released, and 12
percent continued in detention.5

The data show a continuity between the Obama and Trump administrations
regarding US immigration policies. Additionally, because they are detained
without criminal offense through civil proceedings, immigrants are treated like
criminals, yet they lack “many of the protections that are triggered when
someone is charged with a crime.”6 In this way, the US government is using
detention to criminalize and punish undocumented immigration. 7 Furthermore,
since the criminalization of immigrants is mainly directed at Mexico,
Honduras, El Salvador, and Guatemala, detention works as part of the
deterrence strategy of the US focused on these specific regions.8

Detention in the US is good business for some people, a tragedy for others,
and an unknown reality for most US citizens. Owners of private detention
centers, various US counties, and large corporations that invest in the
incarceration of immigrants benefit the most from immigration detention.
Regarding the owners, in FY 2015, the for-profit migrant prisons GEO and
CoreCivic received up to 18 percent and 24 percent, respectively, of their
revenue from ICE.9 Additionally, “with a payroll that includes nearly 5 percent
of the county’s workers,” ICE is “the biggest non-government employer.” 10
Moreover, “pension funds for Ohio public employees,” “New York teachers,”
2See Emilie Kassie, Detained: How the United States Created the Largest Immigrant
Detention System in the World, September 24,2019, https://www.themarshallproject.org/
2019/09/24/detained.
3Emily Ryo and Ian Peacock, “A National Study of Immigration Detention in the United
States,” Southern California Law Review 92, no. 1 (November 2018): 24.
4 After this age group, people between 31 and 40 account for 26 percent, while a
significant 17 percent represent people who are under the age of 18. See Ryo and Peacock, 23.
5 Ryo and Peacock, 31.
6American Civil Liberties Union Immigrants’ Rights Project, Issue Brief: Criminalizing
Undocumented Immigrants, February 2010, 2, https://www.aclu.org/other/issue- brief-
criminalizing-undocumented-immigrants.
7See Jessica T. Simes and Mary C. Waters, “The Politics of Immigration and Crime,” in The
Oxford Handbook of Ethnicity, Crime, and Immigration, ed. Sandra M. Bucerius and Michael H.
Tonry (Oxford: Oxford University Press, 2014), 472.
8See Emily Ryo, “Detention as Deterrence,” Stanford Law Review 71 (March 2019): 237-50,
https://review.law.stanford.edU/wp-content/uploads/sites/3/2019/03/71-Stan.-L.- Rev.-Ryo.pdf.
9 See César Cuauhtémoc García Hernández, “If Private Prisons Close Crimmigration.com,
September 1, 2016, http://crimmigration.com/2016/09/01/if-private- prisons-close/, quoted in
César Cuauhtémoc García Hernández, Migrating to Prison: America’s Obsession with Locking
Up Immigrants (New York: New Press, 2019), 178.
10 García Hernández, Migrating to Prison, 179.
 38

and “retirement accounts for public employees in California, New York,

Alabama, and several more states” held high shares of CoreCivic or GEO
Group.11 The data show how entrenched the detention system is in the US
welfare state.

Importantly, the most affected groups are the detainees, their families, and
the rest of the people without legal status in the US. The detainees face “a host
of due process violations and human rights abuses in immigration detention.”12
Among the abuses, numerous reports expose “the rising number of deaths and
suicides in detention, dangerous and substandard medical care, sexual and
physical abuse, exploitative labor practices, and lack of adequate access to
legal counsel.”13 These abuses are exacerbated in privately operated facilities
(with 67 percent of detainees in FY 2015) and those outside major urban areas
(with 64 percent of detainees in FY 2015).14 The data show that not only are
immigrants and asylum seekers treated as criminals by being detained but they
also receive inhumane treatment while they are in detention.

Health Care in US Detention Centers

The situation of health care in US detention centers is significantly

worrisome. Human Rights Watch shows that eight of the fifteen deaths that
occurred between 2015 and 2017 were related to medical lapses. 15 According
to its report, “Three failings stand out: (1) unreasonable delays in providing
care, (2) poor practitioner and nursing care, and (3) botched emergency
responses.”16 The report also mentions the dangerous use of isolation for
people with psychosocial disabilities while in detention.
According to the report, “ICE detainees with psychosocial disabilities have
often been subjected to prolonged and repeated solitary confinement.”17 This
practice is deemed “to be ‘cruel, inhuman or degrading treatment’” by the UN
Special Rapporteur on torture.18
11García Hernández, 182-83.
12 Ryo and Peacock, “Immigration Detention,” 4.
13 Ryo and Peacock, 4.
14 See Ryo and Peacock, 28, 47-^48.
15 See Human Rights Watch, Code Red: The Fatal Consequences of Dangerously
Substandard Medical Care in Immigration Detention (June 2018), https7/www.aclu.org/
sites/default/files/field_document/coderedreportdeathsicedetention.pdf.
16Human Rights Watch, 45.
17Human Rights Watch, 51. For a broader analysis of this topic, see Erika Voreh, “The United
States’ Convention against Torture RUDs: Allowing the Use of Solitary Confinement in Lieu of
Mental Health Treatment in US Immigration Detention Centers,” Emory International Law
Review 33, no. 2 (2019): 287-310.
18UN General Assembly, Interim Report of the Special Rapporteur of the Human Rights
Council on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,
A/66/268, August 5, 2011, as quoted in Human Rights Watch, Code Red, 51. See also Allyson
Zivec, “Don’t Give Us Your Sick: Inadequate Medical Care in Immigration Detention Centers
and How It Violates International Human Rights Law,” Phoenix Law Review 5 (2011): 257.
 39

This situation is not something new in ICE’s way of proceeding. Since 2007,
several complaints have alleged “failure to timely respond to sick call requests,
failure to monitor chronic conditions (such as hypertension, diabetes, or
asthma), failure to timely issue prescription refills, failure to timely refer
patients for specialized care, and failure to provide dental care, vision care, or
adequate mental health care.”19

Notably, various reports between FY 2007 and FY 2013 show that

inconsistent and discontinuous care in detention centers led people living with
HIV to fatal outcomes.20 Additionally, during the Obama presidency, reports of
deaths in custody from 2012 to 2015 identify evidence of substandard and
potentially dangerous care.21 In at least seven of the examined deaths, there is
evidence that “medical staff members failed to follow up on critical symptoms
and were slow to seek emergency treatment, providing ‘inadequate care’ that
was probably a factor in the deaths.”22
The situation of health care in detention centers will worsen due to ICE’s
2019 version of its National Detention Standards (NDS). In Eunice Cho’s
analysis,

ICE’s new NDS has removed even basic, minimal safeguards necessary for adequate
medical care. ICE no longer requires facilities governed by the NDS to maintain current
accreditation with the National Commission on Correctional Health Care (NCCHC). Also
gone is the requirement that health assessments of detainees be performed according to
national correctional standards. ... The new NDS no longer requires health care and medical
facilities at these jails to be under the direction of a licensed physician, but instead a
“Health Services Administrator.” ... The new NDS further weakens protections for
immigrant detainees against the use of force and solitary confinement by officers. ... The
new NDS broadens allowable reasons to place a detainee in solitary confinement and has
removed specific protections for detainees in disciplinary proceedings facing solitary
confinement. ... ICE has also eliminated standards that help to preserve detainees’ basic
dignity.23

19 Kelsey E. Papst, “Protecting the Voiceless: Ensuring ICE’s Compliance with Standards
That Protect Immigration Detainees,” McGeorge Law Review 40, no. 1 (2009): 277.
20See Carl Kenneth Lipscombe, “Tylenol and an Ice Pack: An Inadequate Prescription for
HIV/AIDS in Immigration Detention Centers,” Cardozo Public Law, Policy & Ethics Journal 11,
no. 3 (2013): 548. See also Human Rights Watch, Chronic Indifference: HTV/AIDS Services for
Immigrants Detained by the United States (December 5, 2007),
https://www.hrw.org/report/2007/12/05/chronic-indifference/hiv/aids-services-immigrants-
detained-united-states; Dana Priest and Amy Goldstein, “System of Neglect,” Washington
Post.com, May 11,2008, https://www.washingtonpost.com/wp-srv/nation/specials/immigration/
cwc_dayl_printer.html.
21 See Megan Jula and Julia Preston, “Delayed Care Faulted in Immigrants’ Deaths at
Detention Centers,” New York Times, July 7,2016, https://www.nytimes.com/2016/07/08/
us/delayed-care-faulted-in-immigrants-deaths-at-detention-centers.html.
22 Jula and Preston.
23 Eunice Cho, “The Trump Administration Weakens Standards for ICE Detention
Facilities,” ACLU, January 14, 2020, https://www.aclu.org/news/immigrants-rights/the- trump-
administration-weakens-standards-for-ice-detention-facilities/.
 40

The new standards decrease the possibility of transparency and accountability

within detention centers. Before these new standards, the problem was that the
previous ones were not being enforced.24 Now, given the steps backward in the
promotion of human rights, the US detention system eliminates the possibility
of enforcing rules that could provide the detainees with health care and
security.

Diverse researchers, finally, point to the following systemic failures

regarding medical care in US detention centers:

1. Overcrowding in detention centers due to stricter immigration policies.

Since its creation in 2003, ICE has considered immigration a threat to
national security, leading to “stringent immigration policies and en-
forcement,” which “have led to a greater number of immigrants being
held in detention centers.”25 The result of such policies has been
overcrowded detention centers and a lack of medical personnel.26
2. Limited access to attorneys and grievance systems. According to Allyson
Zivec, “Detainees do not have access to government-funded legal aid for
representation in immigration removal proceedings. ... [They] are often
not even informed about their right to access a grievance system, [or, if
they are informed], the filed grievances are frequently not responded to
in a timely manner, if at all. Additionally, detainees ... do not file
complaints due to fear of reprisal by the detention center staff.” 27 In
addition to this reality, under the 2019 standards, immigrant detainees
will face even greater hurdles in accessing lawyers.28
3. Lack of transparency. ICE has systematically violated “the standard
requiring NGO and media access, along with the refusal to make
assessment reports publicly available, [creating] the perception that ICE
hides abusive practices in its detention centers.” 29 Now, under the 2019
standards, “NDS no longer requires facilities to guarantee non-
governmental organizations access to detention facilities, and removes
specific requirements for non-profits to provide legal education,
monitoring, and visitation.”30 Additionally, ICE’s 2019 standards have
“now weakened reporting and record-keeping requirements in the event

24 See Zivec, “Don’t Give Us Your Sick,” 254-57.

25 Zivec, 242.
26 Zivec, 242-^43. See also Lipscombe, “Tylenol and an Ice Pack,” 549; Papst, “Protecting
the Voiceless,” 276. For a recent report on overcrowding, see Overcrowding and Prolonged De-
tention at CBP Facilities: Hearing Before the Subcommittee on Immigration and Citizenship of
the Committee on the Judiciary, House of Representatives, 106th Cong., First Session (2019),
https://www.govinfo.gov/content/pkg/CHRG-116hhrg37445/pdfiCHRG-116hhrg37445.pdf.
27 Zivec, 244-45.
28 See Cho, “Trump Administration Weakens Standards.”
29 Zivec, “Don’t Give Us Your Sick,” 246.
30 Cho, “Trump Administration Weakens Standards.”
 41

of a detainee’s death at these facilities.”31

The above analysis comprises specific institutional policies that foster systemic
violence against detained immigrants. This situation is likely to continue, given
the trends in human rights violations within US detention centers in the last
administrations. This system is designed to harm immigrant communities by
compromising the provision of health services in detention centers, separating
families and creating an atmosphere of fear within immigrant communities.

Ethics from the Preferential Option for the Poor

Liberation theology stresses the need for starting the debate on access to
health care from the standpoint of the poor. Otherwise, such discussions will
focus “on protecting the interests of medical providers, including both
physicians and institutions.”32 Moreover, to improve health care for the poor,
medical institutions need to “create a dialogical process that empowers the
excluded to participate in the social and political arena.” 33 The Christian ethic
provides critical concepts to address this task: structural violence and
solidarity. The notion of structural violence makes it clear that “medicine is an
institution and thus is embedded in social structures and social determinants of
health.”34 Solidarity prioritizes “meeting the health needs of all.” 35 In what
follows, these concepts will be further developed.

Vulnerability is another essential concept to develop ethics from the

preferential option for the poor. However, this term has received limited
attention from liberation theology. It is common to find the formulation
“preferential option for the poor and vulnerable,” in which it is assumed that
vulnerability is a form of weakness, the understanding of which does not need
further examination.36 Nonetheless, the developments of vulnerability from
recent scholarship in theology and philosophy show that this concept can
provide a positive description of the human being. Furthermore, this concept
31Cho. See also Kate Oh and Eunice Cho, “ICE’s Destruction of Records Must Be Stopped,”
ACLU, February 18, 2020, https://www.aclu.org/news/immigrants-rights/ices- destruction-of-
records-must-be-stopped/.
32Alexandre A. Martins, “Healthy Justice: A Liberation Approach to Justice in Health Care,”
Theology and Ethics Colloquium of CHA (March 20, 2014): 1, https://www.chausa.org/
docs/default-source/hceusa/healthy-justice-a-liberation-approach-to-justice-in-health-care.pdf?
sfVrsn=2, quoted in M. Therese Lysaught and Michael McCarthy, “A Social Praxis for US Health
Care: Revisioning Catholic Bioethics via Catholic Social Thought,” Journal of the Society of
Christian Ethics 38 (2018): 121.
33 Martins, 2, quoted in Lysaught and McCarthy, 121.
34 Lysaught and McCarthy, 124.
35 Lysaught and McCarthy, 116.
36 For example, Martins uses the word “vulnerable” once in the chapter “Liberation Ethics”
to talk about someone who needs protection. Alexandre A. Martins, The Cry of the Poor:
Liberation Ethics and Justice in Health Care (Lanham, MD: Lexington Books, 2020), 114.
 42

gives the anthropological and ethical basis for reflection on structural violence
and solidarity.37

Vulnerability

Vulnerability is both an anthropological reality and an ethical task. It is

anthropological because being human means being vulnerable, able to be
wounded, and exposed to the other. 38 Vincent Leclercq talks about a universal
dimension of vulnerability, which refers to physical vulnerability. He states
that “one cannot ever forget that the specific vulnerability to parasitic agents or
infectious diseases constitutes a common characteristic of the human
condition.”39 The human being is receptive by nature.40
Alternatively, being vulnerable means being capable of responding to the
needs of another person. Every human being is called to be a responsive agent
—that is, a person who uses one’s power on behalf of another. 41 Vulnerability,
in this sense, means “breach or openness in a person’s or a society’s
defenses,”42 and it provides the foundation for understanding how humans are
capable of letting other people’s experiences affect them.

Further, vulnerability is the basis of the human being’s ability to listen to

one’s conscience and respond in consciousness. 43 Certain individuals and
communities can act by appealing to their conscience or by anesthetizing it.44
Here, appealing to conscience becomes an ethical task. How people respond to
this challenge will form the foundation of their relationality. 45 It will define

37 For a detailed analysis of the theological and philosophical reflection on vulnerability,

see James F. Keenan, “The World at Risk: Vulnerability, Precarity, and Connectedness,”
Theological Studies 81, no. 1 (March 2020): 132-49, https://doi.org/10.1177%
2F0040563920907633.
38 See Keenan, 138.
39 Vincent Leclercq, Blessed Are the Vulnerable: Reaching Out to Those with AIDS (New
London, CT: Twenty-Third, 2010), 17.
40See Judith Butler, “Precarious Life, Vulnerability, and the Ethics of Cohabitation,” Journal
of Speculative Philosophy 26, no. 2 (2012): 134-51, https://doi.org/10.5325/ jspecphil.26.2.0134,
quoted in Keenan, “World at Risk,” 139.
41 See Keenan, 138.
42 James F. Keenan and Enda McDonagh, “Instability, Structural Violence and
Vulnerability: A Christian Response to the HIV Pandemic,” Progressio (2009): 8, https://
www.progressio.org.uk/sites/default/files/HIV+instability_2009_0.pdf.
43See Daniel J. Fleming, Attentiveness to Vulnerability: A Dialogue between Emmanuel
Levinas, Jean Porter, and the Virtue of Solidarity (Eugene, OR: Pickwick, 2019).
44Francis, in this sense, has talked about the danger of anesthetizing the consciousness. See
Radio Vaticano, “Papa Francisco: Discernid y vigilad para no anestesiar la conciencia.” Aleteia,
October 9, 2015, https://es.aleteia.org/2015/10/09/papa-francisco- discernid-y-vigilad-para-no-
anestesiar-la-conciencia/.
45 See Linda Hogan, “Vulnerability: An Ethic for a Divided World,” in Building Bridges in
Sarajevo: The Plenary Papers from CTEWC 2018, ed. Kristin E. Heyer (Maryknoll, NY: Orbis
Books, 2019), 216, quoted in Keenan, “World at Risk,” 136.
 43

whether people build relationships of mutual dependence or dominance. The

first leads people to act under the principle of the preferential option for the
poor, while the second leads them to participate in structures of violence.

Structural Violence

By anesthetizing their consciousness, people become indifferent to the

precariousness of the other, thinking of vulnerability as weakness and
powerlessness.46 In this sense, the vulnerable person becomes an object of
concern.47 Subsequently, society starts building strategies, institutions, and
ideologies that prevent a limited group of people from being vulnerable.
Meanwhile, those who live in unstable environments are deemed to get what
they deserve. This personal and communal form of relationality leads people to
condone structural violence.
Structural violence, in the words of Cynthia Moe-Lobeda, is “the physical,
psychological, and spiritual harm that certain groups of people are
experiencing as a result of the unequal distribution of power and privilege.” 48
This inequality refers to the social dimension of vulnerability, which points to
disparities in access to material resources among peoples and individuals. 49
Importantly, structural violence works according to “‘interlocking forms of
oppression’ by which those who benefit from one form, may be victimized by
another.”50 The Western world has created certain standards of normality that
grant some people access to the welfare state and deny it to others, according
to parameters of class, gender, race, and nationality. 51 Moreover, “whereas
structural violence does express itself by way of direct, person to person
violence, it typically does not have one perpetrator but is built into the
structures of society.”52 Specifically, Moe-Lobeda points to the creation of
“ideologies, institutional policies and practices embedded in society’ that
reproduce structural violence.53 The practice of racial profiling by law
enforcement officials is an example of structural violence directed against
46 See Keenan, 141.
474' See Keenan, 138.
48 Cynthia Moe-Lobeda, Resisting Structural Evil: Love as Ecological-Economic Vocation
(Minneapolis: Fortress, 2013), 72, quoted in Hilda P. Roster, “Trafficked Lands: Sexual Violence,
Oil, and Structural Evil in the Dakotas,” in Planetary Solidarity: Global Women’s Voices on
Christian Doctrine and Climate Justice, ed. Grace Ji-Sun Kim and Hilda P. Roster (Minneapolis:
Fortress, 2017), 173.
49 See Leclercq, Blessed Are the Vulnerable, 21.
50o0 Moe-Lobeda, Resisting Structural Evil, 77, quoted in Roster, “Trafficked Lands,” 173.
51 See Paul Farmer, “An Anthropology of Structural Violence,” Current Anthropology 45,
no. 3 (2004): 323, https://doi.org/10.1086/382250, quoted in Keenan and McDonagh, “Instability,
Structural Violence and Vulnerability,” 7. For an analysis of nationality as a factor of
discrimination, see Jose Jorge Mendoza, “Illegal: White Supremacy and Immigration Status,” in
The Ethics and Politics of Immigration: Core Issues and Emerging Trends, ed. Alex Sager
(London: Rowman & Littlefield, 2016), 201-20.
52 Roster, “Trafficked Lands,” 173.
5303 Moe-Lobeda, Resisting Structural Evil, 77, quoted in Roster, 174.
 44

impoverished Black people in the US. The problem with this level of violence
is that, because such ideologies, institutional policies, and practices form the
basis of society, they “appear natural, normal, inevitable, or divinely
mandated,” and therefore, it is difficult to recognize the structural nature of
these forms of violence.54 From this framework, those who hold power and
privilege can stigmatize the underserved by creating “manipulative narratives
that perpetuate myths” that portray the impoverished as getting what they
deserve, “focusing on symptoms rather than causes.” 55 In this way, structural
violence allows people and institutions that have power and privilege to
commit crimes against the socially vulnerable with impunity, abetting the
“complicity in injustice and apathy” of people who are not directly affected by
the violence committed against the neglected.56

Two consequences follow from the above analysis. First, structural violence
constrains the agency of people affected by structural violence when it comes
to defending their rights.57 Karma R. Chavez contends that “subversive
possibilities always remain tied to the conditions of power.” 58 Power dynamics
constrain people’s ability to move and act. From this view, even performing
subversive acts requires some degree of privilege. Thus, “human rights
abuses ... [work as a] punishment for efforts to escape structural violence,”
limiting people’s ability to act and punishing their attempts to change the
situations in which they live.59

Second, structural violence guarantees unequal life chances for people

enduring structural violence, diminishing the life expectancy of peoples and
communities.60 Paul Farmer identifies the “root causes of disease as being
more connected to economics than to biology.” 61 Indeed, structural violence
creates a vicious cycle in which impaired health precludes people from
experiencing economic development, and financial hardship prevents people
from attaining good health.62 Structural violence thus threatens the existence of
neglected individuals and communities, perpetuating unjust relations in

54 Roster, 172.
55 Kristin E. Heyer, “Internalized Borders: Immigration Ethics in the Age of Trump,”
Theological Studies 79, no. 1 (2018): 146, https://doi.org/10.1177/0040563917744396.
56 Heyer, 161.
5707 See Paul Farmer, Pathologies of Power': Health, Human Rights, and the New War on the
Poor (Berkeley: University of California Press, 2003), 40, quoted in Keenan and McDonagh,
“Instability, Structural Violence and Vulnerability,” 7.
58Karma R. Chavez, “Spatializing Gender Performativity: Ecstasy and Possibilities for Livable
Life in the Tragic Case of Victoria Arellano,” Women’s Studies in Communication 33, no. 1
(2010): 11, https://doi.org/10.1080/07491401003669729.
59 Keenan and McDonagh, “Instability, Structural Violence and Vulnerability,” 7.
60See Johan Galtung, “Violence, Peace and Peace Research,” Journal of Peace Research 3
(1969): 171, http://search.proquest.com/docview/37961669/, quoted in Keenan and McDonagh, 7.
61 Keenan and McDonagh, 6.
62 See Martins, Cry of the Poor, 207-9.
 45

society.

Solidarity

In addition to the universal and social aspects of vulnerability, Leclercq

develops a personal dimension, which refers to a person’s vulnerability to the
needs of those in danger.63 This kind of vulnerability entails risk: “to enjoy the
company of the most vulnerable and to accept to be transformed by them. In
that perspective, we must accept to be more vulnerable ourselves.” 64 In a
similar vein, Paul Farmer talks about the importance of getting close to the
poor and their sufferings.65 Through such closeness, solidarity relationships
with those who are socially more vulnerable can be established. Solidarity,
then, is a gift founded on love and a duty based on relational justice.66

As a gift founded on love, solidarity entails becoming friends with the poor,
which is the result of a conversion process elicited by fostering an encounter
with the poor and becoming close to them. 67 Such proximity entails being
receptive to their lives and understanding their reality beyond the narratives
that exclude and marginalize them. In terms of liberation theology, conversion
comprises three elements, two related to intellect and one to will.

1. It involves understanding global poverty, acknowledging that the causes

of poverty are “the result of historically given and economically driven
forces.”68
2. It entails recognizing that “as science and technology advance, our
structural sin deepens.”69 This statement is related to the previous point
and to understanding the “globalization of the technocratic paradigm,”
analyzed by Pope Francis in the encyclical Laudato si’.70 71

63 See Leclercq, Blessed Are the Vulnerable, 22.

64 Leclercq, 31.
65See Paul Farmer, “Conversion in the Time of Cholera: A Reflection on Structural Violence
and Social Change,” in In the Company of the Poor: Conversations with Dr. Paul Farmer and
Fr. Gustavo Gutierrez, ed. Michael Griffin and Jennie Weiss Block (Maryknoll, NY: Orbis
Books, 2013), 112-16, Kindle.
66See Lisa Sowle Cahill, “AIDS, Justice, and the Common Good,” in Catholic Ethicists on
HIV/AIDS Prevention, ed. James F. Keenan, Jon Fuller, Lisa Sowle Cahill, and Kevin T. Kelly
(New York: Continuum, 2000), 289.
676 7 See Gustavo Gutierrez, “Conversion: A Requirement for Solidarity,” in Griffin and Block,
Company of the Poor, 72.
68 Farmer, “Reimagining Accompaniment: A Doctor’s Tribute to Gustavo Gutierrez,” in
Griffin and Block, Company of the Poor, 7.
69 Farmer, 9.
70 Francis, Laudato si’, encyclical, Vatican, May 25, 2015, §§ 106-14, http://
www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_
enciclica-laudato-si .html.
71 See Farmer, “Reimagining Accompaniment,” 8.
 46

3. An understanding of poverty must be linked to efforts to end it. 71 This

implication is related to understanding solidarity as a virtue, which,
according to John Paul II, is “a firm and persevering determination to
commit oneself to the common good.”72
The notion of the common good within a framework of friendship with the
poor means that “relationships with others are intrinsically valuable.” 73 From
this perspective, the common good takes place by building it with others. Thus,
the processes that are undertaken and the relationships that are nurtured in
building the common good are goods in themselves.74 Solidarity, in this sense,
starts with the recognition of human limitations in pursuing the common good.
When one recognizes one’s limitations, others are allowed to challenge and
nurture personal conceptions of what is valuable, leading to a collective
construction of what is good.75 David Hollenbach writes that “the solidarity of
shared freedom is an essentially dynamic standard. It sets us on a
transformative path rather than leading to an all-or-nothing call for utopia.” 76 77
Therefore, the virtue of solidarity is a quest from which the human being sets
out to build the greater good with others, based on imperfect but real
developments.7 7

Furthermore, friendship involves solidarity with the God of the poor, which
is a “serious engagement with the religious and theological worldview that
shapes the beliefs and experiences of poor people.”78 Only by engaging with
the poor’s struggles from their worldview can a person act with authentic
solidarity. From this perspective, the Latin American bishops in Aparecida
wrote that ‘“only the closeness that makes us friends allows us to profoundly
appreciate the values of the poor today, their legitimate desires, and their own
way of living the faith. The option for the poor should lead us to friendship
with the poor.’”79
As a duty based on relational justice, solidarity implies acknowledging the

72 John Paul II, Sollicitudo rei socialis, § 38, quoted in Meghan J. Clark, The Vision of
Catholic Social Thought (Augsburg: Fortress, 2014), 110.
7313 David Hollenbach, The Common Good and Christian Ethics (Cambridge, UK: Cambridge
University Press, 2002), 79.
74See David Cloutier, “What Can Social Science Teach Catholic Social Thought about the
Common Good?,” in Empirical Foundations of the Common Good: What Theology Can Learn
from Social Science, ed. Daniel K. Finn (New York: Oxford University Press, 2017), 176-77.
75 On the positive contribution of contention and conflict to the common good, see Cloutier,
179-84.
76 Hollenbach, Common Good and Christian Ethics, 85.
7717 Similarly, MacIntyre defines virtue (in general) as a “quest for the good.” Alasdair
MacIntyre, After Virtue (Notre Dame, IN: University of Notre Dame Press, 1984), 219.
78Roberto S. Goizueta, Christ Our Companion: Toward a Theological Aesthetics of
Liberation (Maryknoll, NY: Orbis Books, 2009), 371.
79 Consejo Episcopal Latinoamericano, “V Conferencia General del Episcopado Lat-
inoamericano y del Caribe: Documento Conclusivo,” CELAM, July 2007, § 398, https://
www.celam.org/aparecida/Espanol.pdf, quoted in Gustavo Gutierrez, “The Option for the Poor
Arises from Faith in Christ,” in Griffin and Block, Company of the Poor, 140.
 47

exploitative relationships that began in the past and continue today.80 This
concept of justice emphasizes the demands involved in the relationships with
the poor. This understanding of justice is based on “the fundamental truth of
the equality of all human beings.”81 From the theoretical truth of people’s
equality, and a practical closeness and friendship with the poor, individuals are
enabled to promote social equity and eliminate factors that increase social
vulnerability. In this way, solidarity entails safeguarding the social conditions
that favor the poor’s flourishing. This understanding of solidarity refers to a
practical conception of the common good, from which the common good
“embraces the sum total of those conditions of social living whereby men [and
women! are enabled to achieve their own integral perfection more fully and
more easily.”82 Significantly, the common good is reached by promoting “eq-
uitable distribution of available resources ... necessary to equal opportunity for
full participation in society.”83 In this sense, the preferential option for the poor
means that “those who have in the past most greatly suffered from exclusion
have a right to preferential compensation in access to social goods.” 84 From
this notion of solidarity, the preferential option for the poor comprises the duty
to defend the rights of the poor.85

Coming from the analysis above, the preferential option for the poor leads to
a double task. Solidarity “must involve both accompaniment of the locally
poor and advocacy of the globally powerful.” 86 Here it is essential to
acknowledge how accompaniment and advocacy take place in a framework
based on friendship with the poor. According to Farmer, “Liberation theology,
in contrast to officialdom, argues that genuine change will be most often
rooted in small communities of poor people.”87 This view acknowledges that

80 Tisha M. Rajendra, “The Rational Agent or the Relational Agent: Moving from Freedom
to Justice in Migration Systems Ethics,” Ethical Theory and Moral Practice 18, no. 2 (2015):
367, https://doi.org/10.1007/sl0677-014-9522-z. See also Heyer, “Internalized Borders,” 155-58.
81 Congregation for the Doctrine of the Faith, Dignitas personae, December 8,2008, § 27,
https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_
20081208_dignitas-personae_en.html.
82 John XXIII, Pacem in terris, § 58, quoted in Cahill, “AIDS, Justice, and the Common
Good,” 288.
83Courtney Campbell, James F. Keenan, David R. Loy, Kathleen Matthews, Terry Winograd,
and Laurie Zoloth, “The Machine in the Body: Ethical and Religious Issues in the Bodily
Incorporation of Mechanical Devices,” in Altering Nature, Vol. 2: Religion, Biotechnology, and
Public Policy, ed. B. Andrew Lustig, Baruch A. Brody, and Gerald P. McKenny (Berlin:
Springer, 2008), 248.
84 Cahill, “AIDS, Justice, and the Common Good,” 289.
85 See Mark Engler, “Toward the ‘Rights of the Poor’: Human Rights in Liberation
Theology,” Journal of Religious Ethics 28, no. 3 (2000): 352-53, https://doi.org/10.llll/ 0384-
9694.00053.
86 Gustavo Gutierrez, “Saying and Showing to the Poor: ‘God Loves You,’” in Griffin and
Block, Company of the Poor, 18.
87Paul Farmer, “Health, Healing, and Social Justice: Insights from Liberation Theology,” in
Griffin and Block, Company of the Poor, 24.
 48

the oppressed should have the first word concerning their struggles. 88 In this
vein, Leclercq points to the poor’s desire for healing and their urgent need “to
overturn situations of vulnerability.”89 Indeed, by personal experience, the
oppressed can understand certain forms of violence invisible to those who,
directly or indirectly, benefit from it. Accordingly, vulnerability is more than
the capacity to be wounded; it is “a hurt that leads us to a new potential.” 90 The
poor have the potential to understand the causes of poverty in a particularly
acute way, as they live poverty in their own flesh, and to act more quickly and
forcefully to overcome its causes. From this reality, liberation theology claims
that “truth ... is to be found in the perspective of those who suffer unjust
privation.”91

All in all, the preferential option for the poor indicates that those who do not
suffer directly from structural violence should acknowledge the agency of the
poor and foster their leadership. Clearly, only the poor can “teach us how to
respond to the threats” they endure. 92 In this vein, Leclercq avers that those
affected by structural violence are “valuable experts” on dealing with the
challenges they face.93 Following this path, society at large can rely on the
capability of the oppressed to train the rest of the people who fail to notice
certain forms of violence.94 An essential task within this framework is to
facilitate the telling of the stories of those experiencing structural violence. 95
Theology should work “to elicit the experiences and views of poor people and
to incorporate these views into all observations, judgments, and actions.” 96
Consequently, these experiences must permeate practices, institutions, and
ideologies if equitable social structures are to be created.

Ethical Analysis of the Health Care System in Detention Facilities

In what follows, this paper will offer an analysis of the health care system in
US detention facilities. The substandard health care in detention centers will be
depicted as structural violence. Thus, the detention system constrains the
immigrants’ agency through substandard health care. Subsequently, this article
will provide proposals for dismantling the structures of violence against
detained immigrants from the preferential option for the poor. This part
presents two types of proposals that come from grassroots immigrant

88 See Francis, Laudato si’, § 146.

89 Leclercq, Blessed Are the Vulnerable, 36.
90 Leclercq, 13.
91 Farmer, “Health, Healing, and Social Justice,” 41.
92 Leclercq, Blessed Are the Vulnerable, 30.
93 Leclercq, 30.
94See Keenan’s reflection on meekness and the necessity of allowing “oneself to be trained
precisely by the precarious one.” Keenan, “The World at Risk,” 141.
95 See Leclercq, Blessed Are the Vulnerable, 35.
96 Farmer, “Health, Healing, and Social Justice,” 32.
 49

organizations and that seek to address the causes of poor health care in
detention facilities: storytelling strategies and campaigns advocating for prison
divestment and abolition.

Substandard Health Care in US Detention Centers as Structural Violence

For an analysis of the health care system in US detention centers according

to structural violence theory, it is important to note the interplay between the
universal and social dimensions of vulnerability. The universal dimension
points to the physical harm people suffer due to substandard medical care in
US detention facilities, in which immigrants are getting sick and dying due to
unreasonable delays in providing care, poor practitioner and nursing care,
botched emergency responses, and dangerous use of isolation for people with
psychosocial disabilities. Concerning the social dimension of vulnerability,
structural violence stresses the disparities between the medical care received
by detainees and that provided to people outside detention. Moreover,
disparities in access to health care widen when comparing undocumented
immigrant communities’ access to care with that of US citizens. Furthermore,
social disparities are aggravated by the limited access to attorneys and
grievance systems, and the lack of transparency in these processes.

Substandard medical care in detention centers is a systemic failure caused by

specific ideologies, institutional policies, and practices that harm the well-
being of the detainees, their families, and communities. These systemic
failures are constantly promoted by the US government. Neil Sampson, the
former director of Division of Immigration Health Services, “said in an
interview that ICE treated detainee health care ‘as an afterthought,’ reflecting
what he called a failure of leadership and management at the Homeland
Security Department. ‘They do not have a clear idea or philosophy of their
approach to health care [for detainees]/ he said. ‘It’s a system failure, not a
failure of individuals.’”97

Sampson’s words, it is important to note, acknowledge the systemic scope of

the substandard health care accessibility in detention centers. Moreover, it is
important to acknowledge that this state of affairs is the result of the national
strategy of immigration deterrence that has been in place since the Clinton
administration. While it is true that the Trump administration has significantly
worsened the access to health care in US detention centers, the persistent
human rights violations within detention centers are the result of a system that
has been built with the complicity of previous administrations. Canadian
journalist Emily Kassie writes that “the United States’ reliance on immigrant
detention is not a new phenomenon, nor did it emerge with President Donald
Trump (though its growth under his administration is staggering). Over the last

97 Priest and Goldstein, “System of Neglect.”

 50

four decades, a series of emergency stopgaps and bipartisan deals has created a
new multi-billion dollar industry built on the incarceration of immigrants.”98

Kassie’s reflection shows that the troubling situation of detention centers is a

product of US immigration policies in recent decades. Furthermore, it is clear
that the restrictions on health care are not due to a low budget but to the fact
that these detention centers operate like businesses that are part of a national
strategy to deter immigration. In this sense, the US government deliberately
violates the rule of law, making immigration detention a matter of economic
gain while failing to provide the detainees with access to health care. 99

Concerning structural violence’s interlocked forms of oppression, it is clear

that racial discrimination is a critical cause of the detention and deportation of
immigrants, as well as substandard medical care in detention facilities.100 This
social dynamic leads US citizens to the impression that “immigrants are more
likely to be criminals than are natives.” 101 This belief, however, proves false
when it is compared to actual research. 102 Additionally, racial discrimination in
the US nourishes nativism, which is “zealous opposition to minorities because
of perceived un-American characteristics.”103 In addition to the expectation to
culturally assimilate, undocumented immigrants continue to experience more
difficult access to jobs, education, and health care. 104 Moreover, due to the
criminalization of undocumented immigration, they are portrayed as “willful
lawbreakers, posing national security threats.”105 In this context, racism and
nativism lead US citizens and representatives to the aforementioned
“complicity in injustice and apathy” regarding human rights violations
committed against undocumented immigrants.106 Ultimately, the
criminalization of immigrants generates a lack of political will on the part of
constituents and representatives to create and implement adequate health
standards in detention centers.107
98 Kassie, Detained.
99 See Michael Flynn, “Who Must Be Detained? Proportionality as a Tool for Critiquing
Immigration Detention Policy,” Refugee Survey Quarterly 31, no. 3 (September 2012): 40-68,
https://doi.org/10.1093/rsq/hds008.
100See UN Committee on the Elimination of Racial Discrimination, Concluding
Observations on the Combined Seventh to Ninth Periodic Reports of the United States of
America, CERD/C/USA/CO/7-9, September 25, 2014, 17-19.
101Simes and Waters, “Politics of Immigration and Crime,” 459.
102See Simes and Waters, 470-72.
103 Mehdi Bozorgmehr, Anny Bakalian, and Sara Salman, “Host Hostility and Nativism,” in
Routledge Intel-national Handbook of Migration Studies, ed. Steven J. Gold and Stephanie J.
Nawyn (New York: Routledge, 2012), 190.
104See Bozorgmehr, Bakalian, and Salman, 194-97.
105 Heyer, “Internalized Borders,” 150. For a broader analysis of the “narratives of
misdirection and exclusion” in the Trump era, see Heyer, 150-55.
106Heyer, 161.
107 Pope Francis has pointed to “the lack of political will” to reach “meaningful and effective
global agreements on the environment.” Laudato si’, §166. This problem, however, is present in
 51

Furthermore, sexist discrimination and queerphobia within detention centers

are prevalent, as Victoria Arellano’s case illustrates. Arellano was a 23-year-
old, HIV-positive, transgender Mexican woman who died in San Pedro’s
detention facility in 2007 for neglect of medical care. 108 During detention,
Arellano was placed “in a large men’s detention cell with only a handful of
other transgender or gay detainees.”109 In her analysis of Arellano’s case,
Karma R. Chavez reflects that “in the space of detention, which relies on rigid
gender-sex norms to recognize and name people, Arellano’s embodiment was
stripped of its historicity: authorities regarded her as unreal.” 110 In addition to
the human rights violations that she endured due to her medical condition,
Arellano’s transgender identity was not recognized or respected.
Additionally, the human rights abuses that undocumented immigrants suffer
in detention constrain their agency. Specifically, the limited access to attorneys
and grievance systems, and the lack of transparency in their legal processes
prevent detainees from having access to justice. Such human rights abuses are
likely to continue to occur with impunity.111 Moreover, immigrants who
attempt to defend their rights are severely punished within the detention
system. In the case of Victoria Arellano, for instance, many of the detainees
who held the protests112 on Arellano’s behalf were punished by immediately
being transferred from the San Pedro detention facility without their families’
knowledge or their immigration records.113

Systemic human right abuses ultimately leave detainees with unequal life
chances. In this vein, Raka Shome says that “spatialities of power can render
people immobile and incapable of a sustainable existence.”114 Analyzing the
case of Victoria Arellano, Chavez writes that “had she not found herself in that
space as a queer (HIV-positive, undocumented, transgender) person, Arellano
would most likely be alive today.”115 Structural violence decreases the life
expectancy of people who are systemically marginalized, such as those in
detention centers.

Proposals to Improve Substandard Health Care in US Detention Facilities and

almost all issues of global social justice.

108 For a broader treatment of Arellano’s case, See Papst, “Protecting the Voiceless,” 261-
63.
109Chavez, “Spatializing Gender Performativity,” 7.
110Chavez, 7.
111See Chavez, 8.
112 Some protests included signed petitions, the refusal to line up for an evening’s head
count, and the outpouring of repeated chants of “Hospital! Hospital!” See Leslie Feinberg, “Death
of Trans Immigrant in Detention Forges United Protests,” Workers World, September 8, 2007,
https://www.workers.org/2007/us/trans-0913/, quoted in Chavez, 10.
113See Chavez, 11.
114 Raka Shome, “Space Matters: The Power and Practice of Space,” Communication
Theory 13, no. 1 (2003): 39-56, quoted in Chavez, 7.
115Chavez, 7.
 52

Confront Its Causes

The preferential option for the poor proposes an understanding of solidarity

based on friendship with the poor that moves toward relational justice. This
type of solidarity aims to reduce the social vulnerability of those who endure
structures of violence. In the context of US detention centers, a basic level of
fairness requires establishing and enforcing standards of quality health care.
There are significant resources from constitutional law, international human
rights law, and tort law that can guide efforts to improve health care in
detention facilities. For instance, Human Rights Watch stresses the need for
the US to adhere to international standards that protect the “right to reasonable
medical care and health.”116 Different international documents agree “that in-
dividuals in detention are entitled to a standard of medical care equivalent to
that available in the general community, without discrimination based on their
legal status.”117 The US should also ratify the International Covenant on
Economic, Social, and Cultural Rights, adopted in December 16,1966. It states
that “every person has a ‘right to the highest attainable standard of health.’” 118
The US should also follow the directives of the UN’s Special Rapporteur on
torture; these maintain “that the placement of individuals with psychosocial
disabilities into solitary confinement is prohibited.”119 Additionally, ‘“decisions
regarding the detention of migrants must take into account the effect of the
detention on their physical or mental health,”’120 and respect the “rights of
persons with psychosocial disabilities.”121 The US should ratify the Convention
on the Rights of Persons with Disabilities (CRPD), which seeks to “promote,
protect, and ensure the full and equal enjoyment of all human rights and
fundamental freedoms by all persons with disabilities.”122 These are basic
measures that are currently not applied in US detention centers.

It is important to consider that constitutional law, international human rights

laws, and tort law do not “provide specific guidance to detention staff
regarding the steps necessary to maintain detainee health and safety.” 123 After
acknowledging this situation, Stacey A. Tovino provides eight
recommendations based on “state laws governing involuntary commitment,

116 Human Rights Watch, Code Red, 58.

117 Human Rights Watch, 61.
118 International Covenant on Economic, Social, and Cultural Rights (ICESCR), December
16, 1966, 993 U.N.T.S. 3, art. 12, quoted in Human Rights Watch, Code Red, 62.
119 UN General Assembly, Interim Report, quoted in Human Rights Watch, Code Red, 60.
120 UN Human Rights Committee, General Comment no. 35, art. 9 (Liberty and
Security of Person), CCPR/C/GC/35 (2014), 18, quoted in Human Rights Watch, Code
Red, 63.
121 Human Rights Watch, Code Red, 62-63.
122 UN Human Rights Committee.
123 Stacey A. Tovino, ‘The Grapes of Wrath: On the Health of Immigration Detainees,”
Boston College Law Review 57, no. 1 (2016): 194,
http://search.proquest.com/docview/1783691878/.
 53

federal laws applicable to long-term care facilities, including Medicare-

participating skilled nursing facilities and Medicaid-participating nursing
facilities, and federal and state behavioral health laws,” which “contain
detailed health and safety requirements that are designed to protect vulnerable
patients in a variety of institutional contexts.”124

Those recommendations are (1) the promotion of health examinations; (2)

individualized plans of care; (3) treatment under medically accepted standards;
(4) minimum medical, nursing, and other health professional staffing ratios; (5)
the implementation of active programs for the prevention, intervention, and
control of infections and (6) suicide; (7) the promulgation of a legally
enforceable regulation establishing a formal complaint and investigation
process; and (8) penalties for detention centers that fail to comply with the
regulations proposed above.125 These suggestions point to reforming the health
care system within US detention centers. They are based on the best
knowledge of applicable laws to protect vulnerable populations within the
detention system. These proposals align with the preferential option for the
poor insofar as they imply that “health care must be understood as a shared
good, a common good, rather than a private commodity whose distribution is
stratified according to financial resources.” 126 Ultimately, these
recommendations aim to diminish the detainees’ social vulnerability.

In addition to stressing the legal framework to secure the detainees’ access

to health care, the preferential option for the poor provides the theological
framework for grassroots immigrant organizations and other advocates to build
and strengthen alliances with the general public, particularly those who want to
respond to the plight of immigrants but do not know how. The preferential
option for the poor also provides pedagogical elements that can serve as a
guide to educate the public, which has misconceptions and misinformation
about undocumented immigration. Its goal is to build bridges between people
so that the political will is generated to create policies that will help not only
improve and enforce health care standards in detention centers but also address
the unjust foundations on which immigration detention is based.

It is essential to promote proximity between people outside detention and

immigrant detainees. This endeavor will allow citizens and noncitizens not in
detention to be vulnerable to the reality of detained immigrants. Immigrant
advocates work to bridge the gap between society and immigrant detainees by
promoting institutional efforts such as immersion trips, volunteer experiences,
and other education projects in which individuals are invited to take the risk to
engage the detainees’ worldview by becoming immersed in their struggles.
From this type of projects, communication channels can be established that, in
124 Tovino, 194.
125 See Tovino, 215-25.
126Campbell et al., “Machine in the Body,” 241.
 54

turn, will trigger conversion processes that, as already mentioned, will increase
understanding of the causes of the immigrants’ sufferings and strengthen the
desire to confront those causes. The ultimate goal of this process is to foster a
friendship with the detainees from which relational justice can be reached.
Importantly, the preferential option for the poor clarifies that the struggles to
overcome poverty and structural violence should be led by those who endure
it. Thus, in the process of reaching out to the detainees, it is critical to
acknowledge their agency and promote their leadership. In doing so,
immigrant detainees, their advocates, and their allies will be able to challenge
ideologies, institutional policies, and practices that keep immigrant detainees
in a situation of systemic social vulnerability.

In what follows, two kinds of proposals that stem from grassroots immigrant
organizations’ work and experience will be analyzed. They illuminate the
principle of the preferential option for the poor in concrete ways. Specifically,
these proposals show a broad understanding of the root causes of poor health
care in detention centers and the urgency of addressing them. They come from
immigrant organizations that seek to build the political will that will ultimately
benefit immigrant detainees and their communities.

The first group of proposals uses storytelling as a way to heal and empower
immigrants and their communities, and to foster society’s empathy for the
reality of detained immigrants in the US. Grassroots immigrant organizations
and theologians recommend the storytelling strategy to build a “justice ethic of
collective community healing and accountability.”127 Accordingly, the
theologian Peter C. Phan talks about the need for immigrants to remember and
share their experiences to heal intergenerational wounds. 128 The theologian
Tisha Rajendra stresses the critical role that immigrant narratives play in
establishing new bases of citizen responsibility toward immigrants. 129 In this
vein, Freedom for Immigrants offers storytelling projects consisting of videos,
audios, and poetry that expose the testimonies of children, youth, and adults
detained in recent years.130 According to Christina Fialho, the founder of

127 César Cuauhtémoc García Hernández, “Abolishing Immigration Prisons,” Boston

University Law Review 97, no. 1 (2017): 298.
128 In this respect, Phan affirms that an effective ethics of migration “must not only be based
on the abstract principles of human rights and justice but also bathed in the blood and tears; the
hunger and thirst; the grief and pain; the torture; and, yes, the deaths of so many migrants on their
way to freedom.” Peter C. Phan, “‘Always Remember Where You Came From’: An Ethics of
Migrant Memory,” in Living with(out) Borders: Catholic Theological Ethics on the Migrations of
Peoples, ed. Agnes M. Brazal and Maria Teresa Davila (Maryknoll, NY: Orbis Books, 2016),
138.
129 See Tisha M. Rajendra, Migrants and Citizens: Justice and Responsibility in the Ethics
of Immigration (Grand Rapids, MI: Eerdmans, 2017), 341.
130 “Storytelling Projects,” Freedom for Immigrants (website), accessed May 7, 2020,
http://www.endisolation.org/storytelling. Other online sources that tell the stories of detained
immigrants include the project “Wavering Stripes,” by Naily Nevares, accessed September 18,
 55

Freedom for Immigrants and editor of the book Call Me Libertad: Poems
between Borders, these materials “give unprecedented insight into immigration
detention,” as they bring a first-person perspective to the suffering and hopes
of detainees.131 Storytelling, according to the Freedom for Immigrants website,
accomplishes three goals: “[It] allows us to experience the similarities between
ourselves and others. It allows us to link present struggles for justice to similar
struggles of the past. And it allows us to create an archive of the present for
future generations to learn about subaltern histories that are often forgotten.”132
By achieving these goals, storytelling can help communities directly affected
by structural violence to initiate healing processes. It can help them to build a
shared horizon with people who have passed or are passing through similar
struggles. In this regard, Freedom for Immigrants frames immigrants’ struggles
as part of the fight against the mass-incarceration system, the effects of which
fall disproportionately on Black US citizens and noncitizens. 133 Storytelling
also aims to share immigrants’ experiences with future generations to pass on
knowledge that will enable them to fight structures of oppression. Notably, it is
recognized in trauma studies that by “reconnecting past, present and future,”
victims of violence “can reclaim their history and self and move forward again
in hope.”134 Indeed, by narrating their struggles from their perspective,
communities wounded by structural violence can rebuild the agency and hope
that the detention system denies them.

Storytelling also fosters empathy between those directly affected by

structural violence and those who are not. According to Garcia Hernandez,
“Sharing stories of one’s life helps humanize the storyteller and identify
common bonds between speaker and listener.” 135 Storytelling can break false
and shared assumptions about immigrants, such as those that, in a
dehumanizing way, portray them as criminals. In Maya Schenwar’s view,
projects like these will develop a common foundation that will ultimately
allow detainees and their allies to “identify ‘[n]ew ways of thinking ...

2020, https://www.nailynevarez.com/wavering-stripes; the documentary “Lost in Detention,”

Frontline, aired October 18, 2011, on PBS, https://www.pbs.org/wgbh/frontline/film/lost-in-
detention/; the 2019 documentary ‘The Infiltrators,” directed by Cristina Ibarra and Alex Rivera;
the 2020 docuseries “Immigration Nation,” directed by Christina Clusiau and Shaul Schwarz; the
podcast Endisolation, by Community Initiatives for Visiting Immigrants in Confinement,
accessed October 2, 2020, https://soundcloud.com/endisolation. These are essential resources for
educators and immigrant advocates who want to advance the cause of immigrant detainees.
131 Alicia Partnoy, Christina Fialho, and Kristina Shull, eds., Call Me Libertad: Poems
between Borders (San Francisco: CIVIC, 2016), 6, https://staticl.squarespace.com/static/
5a33042eb078691c386e7bce/t/5bc916dae5e5f05d2c07b6b8/1539905249484/Call_Me_
Libertad_Poems_Between_Borders_Final.pdf.
132 “Storytelling Projects.”
133See “Storytelling Projects.”
134 Elizabeth Phillips, “Narrating Catastrophe, Cultivating Hope: Apocalyptic Practices and
Theological Virtue,” Studies in Christian Ethics 31, no. 1 (2018): 25, https://
doi.org/10.1177/0953946817737.
135García Hernández, “Abolishing Immigration Prisons,” 299.
 56

transforming our perceptions, our definitions, our experiences of justice, and

our understandings of how to live together in the world.’” 136 Storytelling can
help immigrant advocates and their allies to create strategies that acknowledge
the magnitude and urgency of the detainees’ demands.

Storytelling can also trigger other avenues of communication with

immigrant detainees. Thus, in addition to storytelling projects, various
grassroots immigrant organizations arrange regular visits to detention centers
or establish other channels of communication through letters and phone
calls.137 These opportunities, in turn, can form new, friendly relationships from
which further strategies can be envisioned to respond to the needs of
immigrant detainees. From the framework of the preferential option for the
poor, the objective of these strategies is that they emerge from the detainees,
building processes of relational justice. Some examples of these types of
strategies are systematized by the DWN project “Voices from Detention.” 138 It
shows an interactive map of the protests by people in ICE detention and
provides links to the websites of local immigrant advocates who are supporting
immigrant detainees from outside. Some of these forms of support are
exposing conditions of detention, promoting the release of immigrant
detainees, and providing legal and financial aid.

The second set of proposals confronts the causes of institutional violence

against immigrants in detention. These proposals comprise strategies that echo
the UN’s Working Group on Arbitrary Detention’s report, which stresses that
“‘immigration detention should gradually be abolished.’” 139 Specifically, the
US government needs to focus on ‘“crowd[ing] out prisons’” and “bringing]
communities together rather than destroying them.”140 These strategies can be
organized into two categories: prison divestment and abolition.

The campaign “Defund Hate” is a national strategy for divestment. It was

launched by DWN in 2017 with two goals:

136 Maya Schenwar, Locked Down, Locked Out: Why Prison Doesn’t Work and How We
Can Do Better (Oakland, CA: Berrett-Koehler, 2014), 157, quoted in Garcia Hernandez,
“Abolishing Immigration Prisons,” 299.
137 See, for instance, the National Visitation Network and the National Detention & Abuse
Reporting Hotline by Freedom for Immigrants, or the project “Connect with a Pen Pal in
Detention” by the Lutheran Immigration and Refugee Service, https:// www.lirs.org/connect-
with-a-pen-pal-in-detention/.
138 “Voices from Detention,” Detention Watch Network, accessed September 18, 2020,
https://www.detentionwatchnetwork. org/pressroom/voices.
139 UN Commission on Human Rights, Report of the Working Group on Arbitrary
Detention, A/HRC/13/30, January 18, 2010, 59, quoted in Human Rights Watch, Code
Red, 63.
140 Schenwar, Locked Down, Locked Out, 159, quoted in Garcia Hernandez, “Abolishing
Immigration Prisons,” 298.
 57

1. Get a critical mass of members of Congress on the record demanding

cuts in funding to ICE and Customs and Border Protection (CBP).
2. Reduce the federal funding that these agencies receive to detain and
deport immigrant communities.141

This campaign aims to involve immigrants and their allies in the struggle for
prison divestment. DWN provides education resources for immigrants and
allies to reach out to representatives and promote the prison divestment
agenda. Specifically, they provide the public with strategies for conducting
telephone or in-person meetings with public representatives. DWN also
provides trainings on immigration policy, budget issues, and the use of
storytelling strategies. In the words of Gaby Viera, a DWN advocacy associate,
the vision guiding their divestment campaign is that “the [government] budget
should reflect the values of our communities.” 142 This campaign succeeds in
educating the public, involving them with public representatives and
supporting policies in favor of immigrant communities.

In a similar vein, the National Network for Immigrant and Refugee Rights,
Freedom to Thrive (formerly ENLACE), and Families for Freedom launched
the “Private Prison Divestment Campaign” to promote pension divestment
from the for-profit, private prison industry in 2011.143 According to its website,
Freedom to Thrive has been able to divest $4.8 billion from the prison-
industrial complex in the last five years, involving more than 487
participants.144 One remarkable case is the University of California divestment
of $30 million in prison holdings amid student pressure in 2015. 145 This
campaign’s vision is based on understanding community safety through access
to health, housing, education, and wellbeing in immigrant communities.146

Diverse grassroots immigrant organizations also advocate for prison

abolition. DWN launched the campaign “Communities Not Cages” to halt

141 See Detention Watch Network, 2018 Annual Report, 6,

https://www.detentionwatchnetwork.org/sites/default/files/DWN%20Annual%20Report
%202018_English.pdf.
142 Organized Communities against Deportations, “Divesting from ICE/CBP to Invest in
Our Communities,” accessed September 18, 2020, https://www.facebook.com/OCADCHI/
videos/3430521823682358.
143See Families for Freedom, “Private Prison Divestment Campaign,” accessed
September 18, 2020, https://familiesforfreedom.org/organizing/campaigns/private-
prison-divestment-campaign; National Network for Immigrant and Refugee Rights, “National
Prison Divestment Campaign,” accessed September 18, 2020, https://
www.nnirr.org/drupal/prisondivestment; Freedom to Thrive, “Prison Industry Divestment
Movement,” accessed September 18, 2020, https://prisondivest.com.
144 Freedom to Thrive, “Prison Industry Divestment Movement.”
145 Jason Song, “UC System Divests $30 Million in Prison Holdings amid Student
Pressure,” Los Angeles Times, December 26, 2015, https://www.latimes.com/local/ education/la-
me-uc-divestment-prisons-20151226-story.html.
146 Freedom to Thrive, “Prison Industry Divestment Movement.”
 58

detention expansion locally, shutting down existing facilities, and preventing

the metastasizing of detention into other federal agencies. 147 Alternatively,
DWN and Freedom for Immigrants propose alternatives to detention. It is
important to distinguish between alternatives to detention and alternative forms
of detention.148 As an example of the latter, ICE proposes the Intensive
Supervision Appearance Program and the Electronic Monitoring Device
Program. Both programs use monitoring systems such as telephonic reporting,
radio frequency (electronic bracelet), and other types of electronic tracking to
keep vigilance on undocumented immigrants. 149 On this matter, Freedom to
Thrive has pointed out the harmful effects of using all forms of “e-carceration”
on immigrant communities, such as impediments to finding work or housing,
health deterioration, and stigmatization.150

Conversely, Freedom For Immigrants suggests a “community-initiated

alternative to detention programs run by community groups or nonprofits in a
similar manner to the federal Refugee Resettlement Program,” which is carried
out by the US Department of Health and Human Services. 151 Additionally,
DWN proposes the use of parole, as well as “ensuring that someone has legal
representation and providing community-based support by organizations with
proven experience delivering social services for immigrant communities.” 152
These services are vital to the prosperity of immigrant communities and their
integration into US society. Additionally, these measures reduce the inhumane
practice of detention while the government deals with the immigrants’
administrative issues.

The proposals presented in this section (storytelling, prison divestment, and

abolition) address demands for immigrants in detention in the short and long
term. They seek both to ensure the immediate attention needed by immigrant
detainees and to reverse the unjust foundations of the detention system.
Immigration issues are addressed from the need to defend individuals’ human
rights, regardless of their immigration status, and not from understanding
migration as a threat to national security. Ending the criminalization of
immigrants is a critical step to overcome a dehumanizing immigration system.
Notably, an immigration system that works for the common good (in both its

147 See Detention Watch Network, 2018 Annual Report, 8.

148 See Freedom for Immigrants, “Alternatives to Detention,” accessed May 7, 2020,
https://www.freedomfor immigrants.org/alternatives -to-detention.
149 BI, “Immigration Services,” accessed September 18, 2020, https://bi.com/ immigration-
services/; HomelandSecurityEDU.org, “A Career as a Homeland Security Electronic Monitoring
Specialist,” accessed September 18, 2020, https://www. homelandsecurityedu.org/electronic-
monitoring-specialist/.
150 “Not on Our Watch! / jAlto a la Vigilancia!,” Center for Urban Pedagogy (2020),
http://welcometocup.org/file_colunms/0000/2366/cup.mpp.ftt-web-spreads-layout.pdf.
151 “Not on Our Watch!”
152 Detention Watch Network, “Government Alternatives to Detention,” accessed May 7,
2020, https://www.detentionwatchnetwork.org/issues/alternatives.
 59

relational and its practical sense) will be achieved when US society starts
paying attention to the immigrant detainees’ voices and their advocates. The
framework of the preferential option for the poor gives grassroots immigrant
organizations and their allies the doctrinal basis and pedagogical elements to
continue promoting this agenda.

Conclusion

This essay defines the preferential option for the poor as a commitment to
defend their rights. While this understanding of the principle of the preferential
option for the poor is not new, this paper deepens its meaning by analyzing
critical concepts such as structural violence and solidarity from the notion of
vulnerability, which was presented in its universal, social, and personal
dimensions. From its universal dimension, vulnerability highlights the capacity
of humans to be receptive to the sufferings of others and to be responsive to
their distress. Social vulnerability opens the path to reflect on structural
violence, which in turn illuminates how ideologies, institutional policies, and
practices create structures that render some people more vulnerable than
others. It also provides critical insights into the complex causes of precarious
health care accessibility in US detention facilities. Such causes relate to the
discrimination and criminalization of immigrants, which provide the basis for
violating human rights in detention facilities with impunity by fostering, as
noted above, what Heyer calls “complicity in injustice and apathy” on the part
of US citizens and representatives.

Personal vulnerability refers to the risk that people run when they come into
contact with another person’s suffering. This concept is the basis of the notion
of solidarity, which involves proximity between people with some degree of
privilege and those who bear the brunt of structural violence. In the context of
immigration detention, closeness with detained immigrants and their families
is the first step in a conversion process that aims to build friendly relationships
capable of creating processes of relational justice. Further, solidarity requires
acquiring the knowledge about the causes of detention and the determination to
address those causes. Solidarity also demands acknowledging the detainees’
agency and fostering their leadership.

Finally, this paper presented proposals from grassroots immigrant

organizations that align with this article’s understanding of the preferential
option for the poor. In particular, this article presented storytelling as a strategy
to heal the negative effects of immigration detention on detainees and foster
empathy for their plight in US society. In turn, storytelling can trigger other
forms of communication that foster friendly relationships between detainees
and non-detainees, deepening conversion processes. From these relationships,
resources can be provided to support the demands of detainees from outside,
 60

creating developments of relational justice. This article also explored

campaigns that promote prison divestment and abolition and that aim to
address the root causes of the lack of access to health care in US detention
facilities. These campaigns are based on visions of society that ultimately seek
to end the inhumane machinery of immigration detention.
Other avenues of research should pay attention to the implementation and
changes in health care standards in detention facilities during the COVID-19
pandemic. They should also monitor the various strategies being developed by
grassroots movements to respond to the health crisis in detention centers, along
with the strategies being adopted by immigrant detainees to overcome unjust
treatments. On the theoretical side, trauma studies can shed light on the
consequences that structures of violence have on detainees, as well as the
possibilities that storytelling strategies can produce in their healing processes.
Theologically, the Catholic understanding of friendship with the poor
developed in this essay can be enriched by the notion of civic friendship. 153 In
this way, the concept of friendship can be translated into the political realm,
leaving aside the idealizations that the common notion of friendship might
bring.

153 See Heyer, “Internalized Borders”; Sibyl A. Schwarzenbach, On Civic Friendship:

Including Women in the State (New York: Columbia University Press, 2009).