The following are Human Rights Watch’s comments in response to the U.S. Department of Homeland Security (DHS) and the Department of Health and Human Services (HHS) proposed rule, “Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children,” published September 7, 2018 (DHS Docket No. ICEB-2018-0002). Human Rights Watch expresses strong opposition to the proposed rule to amend regulations relating to the apprehension, processing, care, custody, and release of alien juveniles published in the Federal Register on September 7, 2018.
Human Rights Watch has monitored rights conditions for migrant youth in US custody for over two decades, including in the lead up to the finalization of Flores Settlement Agreement in 1997. For the reasons detailed in the comments that follow, DHS and the Department of Health and Human Services (HHS) should immediately withdraw their current proposal, and dedicate their efforts to advancing policies that safeguard the health, safety, and best interests of children and their families, not least through robust, good-faith compliance with the Flores Settlement Agreement.
DETAILED COMMENTS in opposition to DHS Docket No. ICEB-2018-0002, RIN 0970-AC42 1653-AA75, Proposed Rulemaking: Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children
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b) Department of Homeland Security has a poor track record of accountability and transparency with respect to immigration detention facilities and yet proposes to create its own child care licensing mechanism for family detention centers. 21
The Department of Homeland Security (DHS) and Health and Human Services (HHS) have proposed regulations governing their agencies’ treatment of migrant children that do not comply with international standards regarding the treatment of child migrants.
The right to liberty and security of person is a fundamental norm of international human rights law. While the right to liberty is not absolute, it contains certain prohibitions that are non-derogable norms of customary international law, including the strict prohibition of arbitrary detention.
For adults, immigration detention should only be used on an exceptional basis, as a matter of last resort. For immigration detention of adults to be justified and not arbitrary, it must be lawful (that is, prescribed in law and based on allowed grounds); reasonable, necessary and proportionate in light of the circumstances; and respectful of procedural safeguards. The detention of asylum seekers is subject to further safeguards. Mandatory detention exceeds the requirements of necessity and proportionality and constitutes arbitrary detention, as does excessive detention and indefinite detention.
In a joint general comment, the UN Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families (CMW) and the UN Committee on the Rights of the Child (CRC) concluded that the criminalization of irregular entry or stay “exceeds the legitimate interest of States parties to control and regulate migration, and leads to arbitrary detention.” The US is not a party to either the Convention on the Rights of the Child (CRC) or the International Convention on the Rights of Migrant Workers (ICRMW), and as such is not legally bound by their provisions. However, the treaties and the work of their respective treaty bodies represent a useful and authoritative guide to the steps necessary to safeguard the rights of immigrants, including children.
The Committee on Migrant Workers and the Committee on the Rights of the Child have determined that the general principle that children may be deprived of liberty if done “as a last resort and for the shortest appropriate period of time” does not apply to immigration detention. “[O]ffences concerning irregular entry or stay cannot under any circumstances have consequences similar to those derived from the commission of a crime,” the committees have found.
Immigration detention has serious adverse consequences for children’s health, well-being, and safety. As a result, it is never in the best interests of the child and amounts to a violation of children’s rights.
The UN special rapporteur on torture has noted that immigration detention of children puts them at risk of cruel, inhuman, or degrading treatment or punishment. Similarly, the Inter-American Commission on Human Rights concluded after its 2015 visits to Colombia and Venezuela that even short-term immigration detention of children rises to the level of cruel, inhuman, and degrading treatment, and the European Court of Human Rights has held that detention of migrant children violates the prohibition on torture and other ill-treatment.
The Committee on the Rights of the Child has found that “[t]he detention of a child because of their or their parent’s migration status . . . always contravenes the principle of the best interests of the child.” Similarly, the UN special rapporteur on torture has stated that “the deprivation of liberty of children based on their or their parents’ migration status is never in the best interests of the child . . . .” The Parliamentary Assembly of the Council of Europe has called on states to “acknowledge that it is never in the best interests of a child to be detained on the basis of their or their parents’ immigration status.” The Inter-American Court of Human Rights has found that the detention of children solely on the basis of their migration status exceeds the requirement of necessity, is contrary to children’s best interests, and is therefore incompatible with regional human rights treaties.
The detention of migrant children together with their parents because the parents are in (or are thought to be in) an irregular situation is sometimes purportedly justified as a means of maintaining family unity. As international authorities make clear, subjecting children to immigration detention because of their parents’ status is not in children’s best interests. For instance, the Working Group on Arbitrary Detention has explicitly observed that the detention of children because of their parents’ migration status is contrary to children’s best interests. The UN special rapporteur on the human rights of migrants has clarified, “This does not mean that the best interests of the child are served through splitting up the family by detaining the parents and transferring their children to the alternative-care system.” To the contrary, respect for the best interests of the child, together with their rights to liberty and family unity, will in most cases require solutions that “allow children to remain with their family members and/or guardians in non-custodial, community-based contexts while their immigration status is being resolved and the children’s best interests are assessed,” as the Committee on Migrant Workers and the Committee on the Rights of the Child have recommended.
Taking all these factors into account, the Committee on the Rights of the Child observed in 2012, “The detention of a child because of their or their parent’s migration status constitutes a child rights violation. . . .” Echoing this conclusion, the UN secretary-general stated in 2013, “Detention of migrant children constitutes a violation of child rights.”
In consequence, international and regional bodies have called on states to end immigration detention of children, both those detained alone and those with their parents.
The Committee on the Rights of the Child stated in 2005 that “detention cannot be justified solely on the basis of the child being unaccompanied or separated, or on their migratory or residence status, or lack thereof.” In 2012, the Committee urged states to “expeditiously and completely cease the detention of children on the basis of their immigration status.” In 2017, both the Committee on the Rights of the Child and the Committee on Migrant Workers reaffirmed that “children should never be detained for reasons related to their or their parents’ migration status” and called on states to “eradicate the immigration detention of children,” adding that “[a]ny kind of child immigration detention should be forbidden by law and such prohibition should be fully implemented in practice.”
In similar terms, the Working Group on Arbitrary Detention concluded in 2018: “The deprivation of liberty of an asylum-seeking, refugee, stateless or migrant child, including unaccompanied or separated children, is prohibited.” The Parliamentary Assembly of the Council of Europe concluded in 2011 that “no detention of unaccompanied children on migration grounds should be allowed” and has called on states to “introduce legislation prohibiting the detention of children for immigration reasons.” UNHCR guidance notes that children “should in principle not be detained at all.” And 11 UN human rights experts stated in June 2018 that “children should never be detained for reasons related to their own or their parents’ migration status.”
The proposed regulations fall short of these standards in at least the following ways: using deterrence as a justification for detention, sanctioning prolonged and indefinite detention, and allowing inadequate and abusive conditions of detention for children.
A central part of the administration’s argument for the proposed regulations pertains to the supposed deterrent effect of widespread incarceration in Family Residential Centers of children and families arriving at the southern border. In the proposed rule, the administration argues that the July 2015 court ruling—which held that the Flores settlement protections, including the prohibition on holding children in secure, unlicensed facilities for more than 20 days, applied to accompanied as well as unaccompanied children—led to an increase in families arriving at the southern border. In particular the proposed rule argues that “although it is difficult to definitively prove the causal link, DHS’s assessment is that the link is real, as those limitations” i.e. the 20-day limit “correlated with a sharp increase in family migration.”
Detention policies aimed at deterrence are generally unlawful under international human rights law as they are not based on an individual assessment as to the necessity to detain. As a result, the UNHCR Detention Guidelines stipulate that the “detention of asylum seekers should normally be avoided and be a measure of last resort.”
Experts generally agree that restrictive border control measures focused on deterrence do not have a lasting impact on the number of arrivals but rather result in changes to the ways in which migration occurs. This is because migration is a complex social process that extends well beyond the reach of domestic border control policies, which are generally understood to have a “relatively small” impact compared to other social, economic, and political determinants.
Historically, at the US-Mexico border, border enforcement has resulted in rechanneling flows of unauthorized migrants to more hazardous areas, raising fees charged by people-smugglers, and discouraging unauthorized migrants already in the US from returning to their places of origin. However, there is no evidence that the strategy is deterring or preventing significant numbers of new illegal entries.
DHS does not provide any of the data or methods used to make its assessment. But looking at the data on apprehensions before and after the July 2015 federal court ruling, Professor Tom K. Wong of the University of California, San Diego, finds no statistically significant increase in—nor any statistically significant relationship between—apprehensions of families at the southern border and the July 2015 ruling. Professor Wong used two methodologies, interrupted time series analysis (ITSA) and autoregressive integrated moving average (ARIMA) ITSA to find that the 2015 Flores ruling had no statistically significant effect on apprehensions. This analysis is consistent with other work by Professor Wong which shows that family incarceration as well as family separation has not had a statistically significant impact on family arrivals, and as such, is unlikely to be a deterrent in the future.
Indeed, numerous studies and data have shown that detention and other punitive measures will not deter families from coming to the United States to seek protection. Genuine refugees, like the many families fleeing the Northern Triangle region of Central America, will continue to flee violence to save their lives and those of their children. This was shown after the previous administration attempted to implement the same flawed policy, which resulted in a finding by a federal district court that the policy was unlawful. Moreover, the architect of said policy shift in 2014, former Secretary of Homeland Security Jeh Johnson, recently admitted that this policy failed to achieve its stated goal of halting the numbers of families coming to our borders to seek asylum. Importantly, “[e]xperience teaches that widely publicized changes in immigration-enforcement policy may cause sharp downturns in the level of illegal migration in the short term, but migration patterns then revert to their higher, traditional levels in the long term so long as underlying conditions persist.”
The government’s arguments regarding deterrence also serve to obfuscate the exorbitant financial cost associated with the rule while failing to engage with the efficacy of less expensive alternatives to detention (ATDs). In the fiscal year 2019 Congressional Budget Justification, ICE estimated the cost of one family detention bed at $318.79, which contrasts to the average daily cost of alternative to detention programming, which costs as little as $4 or $5 per day.
The proposed regulations would cause serious harm by allowing for the prolonged and indefinite detention of children and families.
The core principle and requirement of the Flores Settlement Agreement (FSA) is that migrant children taken into detention should be released from detention as “expeditiously” as possible. The Section of the FSA entitled “General Policy Favoring Release,” provides clearly and unambiguously that absent certain limited circumstances, “the INS shall release a minor from its custody without unnecessary delay.”  Moreover, while a child is detained, the FSA requires that “the INS, or the licensed program in which the minor is placed, shall make and record the prompt and continuous efforts on its part toward family reunification and the release of the minor...,” and requires that such efforts “shall continue so long as the minor is in INS custody.”
The FSA requires that, within three (or, under certain circumstances, five) days of a child being in federal immigration detention, the child must be released to a parent or relative, or if that is not possible then placed into a program licensed by a State child welfare agency (a “licensed program”). The FSA provides that a child cannot be held in detention in an “unlicensed program” for longer than three days (or, under some circumstances, five) days. If the Government faces an “emergency” or a major “influx” of minor children at the border, then the three or five-day timeframe does not apply and the release must be effected “as expeditiously as possible.” In 2014, a court acceded to the Government’s request that a time period of up to 20 days be considered “expeditious” in these circumstances. The 20-day period was set based on the government’s representation to the court that that is the amount of time required for the Government, “in good faith and in the exercise of due diligence,” to screen family members or others to whom a child could be released.
Further, under the FSA, the child’s release must be to the “least restrictive setting” possible--with priority given, first, to release to a parent or other family member and then to a “licensed program” or, “when it appears that there is no other likely alternative to long term detention and family reunification does not appear to be a reasonable possibility,” then to another suitable adult or entity seeking custody of the child. These provisions reflect the two basic premises of the FSA. First, pending a child’s further immigration proceedings, the child should be released almost immediately to family members or other acceptable sponsors rather than held in detention. Second, if a child will remain in detention longer term (as contemplated by the FSA, because there are no family members or acceptable sponsors to whom the child can be released), then the child should not be in a federal immigration facility (i.e., a facility such as an FRC--which, we note, is similar to a prison setting), but, rather, should be in a setting that is licensed by a State child welfare agency for the longer-term housing and care of children (such as a group home, foster home or juvenile delinquent facility).
By contrast, the Proposed Regulations provide for indefinite detention of accompanied children in federal immigration facilities pending resolution of the long process of their and their parents’ immigration proceedings. The Proposed Regulations provide that Accompanied Children can be kept in detention indefinitely during the pendency of their and their parents’ immigration proceedings. These regulations mirror the Government’s request in [July 2017] to the Flores court to modify the FSA to permit detention of children for up to the entire pendency of their and their parents’ immigration proceedings. We note that these proceedings typically take many months and can take years. The court rejected that request. Judge Gee noted that in July 2017, the government, “now seek[s] to hold minors in indefinite detention in unlicensed facilities, which would constitute a fundamental and material breach of the parties’ Agreement.” The Government now seeks, through the Proposed Regulations that it contends materially implement the FSA, to accomplish the material modification of the FSA that the Government sought from the court and the court rejected.
From a medical and mental health perspective, the changes proposed by DHS and DHHS to replace the standards of the Flores settlement agreement are neither safe nor humane. Legalizing prolonged and indefinite detention of families, eliminating the state licensing requirement, institutionalizing a permanent state of “emergency” to justify failure to meet standards of care, and increasing resort to inaccurate and unethical age determination procedures will further compromise the treatment of migrant families. Under these proposed changes, inadequate conditions of confinement are inevitable, heightening the risk of foreseeable health harms to the detained population.
The main purpose of the proposed change, that of legalizing indefinite detention of children with their families which is prohibited under the Flores settlement, is harmful in and of itself. Numerous clinical studies have demonstrated that the mitigating factor of parental presence does not negate the damaging impact of detention on the physical and mental health of children. In a retrospective analysis, detained children were reported to have tenfold increase in developing psychiatric disorders. Studies of health difficulties of detained children found that most children since being detained reported symptoms of depression, sleep problems, loss of appetite, and somatic complaints such as headaches and abdominal pains; specific concerns include inadequate nutritional provisions, restricted meal times, and child weight loss. DHS’ own medical experts recorded a case in which a 16-month-old baby lost a third of his body weight over 10 days because of untreated diarrheal disease, yet was never given IV fluids.
Policymakers are advised to give due weight to public health studies which have found that many migrants are fleeing epidemic levels of violence, including homicide and physical and sexual assault, and are in need of international protection and services which address their specific medical and mental health needs.
There is no evidence that any amount of time in detention is safe for children. In fact, even short periods of detention can cause psychological trauma and long-term mental health risks for children. Studies of detained immigrants have shown that children and parents may suffer negative physical and emotional symptoms from detention, including anxiety, depression and posttraumatic stress disorder. Detention itself undermines parental authority and capacity to respond to their children’s needs; this difficulty is complicated by parental mental health problems. Parents in detention centers have described regressive behavioral changes in their children, including decreased eating, sleep disturbances, clinginess, withdrawal, self-injurious behavior, and aggression.
Evaluations of children placed in immigration detention with their families have found them to experience serious trauma. Studies of detained immigrant children have found high rates of posttraumatic stress disorder, depression, and anxiety, and psychologists agree that “even brief detention can cause psychological trauma and induce long-term mental health risks for children.” In 2015, Human Rights Watch spoke with families who had been detained for the US for periods approaching a year. These families reported trauma, depression, and suicidal thoughts in detention. Dr. Luis Zayas, Dean of the School of Social Work at the University of Texas at Austin and an expert on child and adolescent mental health, interviewed families in immigration detention facilities and found “regressions in children’s behavior; suicidal ideation in teenagers; nightmares and night terrors; and pathological levels of depression, anxiety, hopelessness, and despair.” The Department of Homeland Security’s own Advisory Committee on Family Residential Centers concluded that “detention is generally neither appropriate nor necessary for families—and that detention or the separation of families for purposes of immigration enforcement or management are never in the best interest of children.” Troublingly, if unsurprisingly, in setting out proposed regulations codifying the family reunification process in the NPRM, HHS fails to consider the ample and readily available evidence demonstrating the harms of prolonged detention and family separation government.
The proposed regulations create needless barriers to release which will have the effect of prolonging the detention of unaccompanied children.
The Flores settlement establishes a “general policy favoring release.” If detention is not required to ensure a minor’s safety or compliance with immigration proceedings, ORR must release a UAC to an approved sponsor without “unnecessary delay.” This requirement is grounded in the recognition that children need a close and supportive relationship with a caregiver in order to thrive. It is also grounded in the recognition that congregate care facilities, where most unaccompanied children are sent before they are released to a sponsor, are harmful to children’s health and well-being.
Section 410.201(f) of the proposed regulation omits critical language in the FSA requiring the government to document and make continuous efforts toward the release of children from custody. Among the considerations to be applied generally to ORR’s placement of unaccompanied alien children, the proposed regulation states that “ORR makes and records the prompt and continuous efforts on its part toward family reunification. ORR continues such efforts at family reunification for as long as the minor is in ORR custody.” This provision reflects in part language from paragraph 18 of the FSA, but with a critical omission.
FSA paragraph 18 reads “Upon taking into custody, the INS, or the licensed program in which the minor is placed, shall make and record the prompt and continuous efforts on its part toward family reunification and the release of the minor pursuant to Paragraph 14 above. Such efforts at family reunification shall continue so long as the minor is in INS custody.” (emphasis added).
The omission of language directing ORR’s continued efforts toward the release of children from custody is not insignificant. The FSA, by its own terms, “sets out a nationwide policy for the detention, release, and treatment of minors. . . .” Indeed, the provision from which the proposed regulation draws is part of a larger section of the settlement titled “General Policy Favoring Release,” which sets forth the process by which the government is to release minors from custody “without unnecessary delay” whenever “detention of the minor is not required either to secure his or timely appearance before the INS or the immigration court, or to ensure the minor’s safety or that of others.” The removal of reference to continued efforts toward release is particularly troubling when read in tandem with other provisions in the proposed regulations expanding the government’s ability to detain children in family detention and unlicensed programs for potentially indefinite periods.
Importantly, ORR’s overarching purpose with respect to unaccompanied alien children is to provide care and custody for them only until they can be released to safe sponsors in the community. As such, ORR custody serves a distinct role from ICE custody more generally, as ORR’s primary purpose is not to detain children throughout their removal proceedings but to enable reunification and release of children in a manner that minimizes children’s time in federal custody. This accords with basic child welfare principles, domestically and internationally, advising that the detention of children should be used only as a last resort and for the shortest duration appropriate. The proposed regulation’s omission of references to release overlooks this critical responsibility.
The proposed regulation similarly fails to ensure ORR’s prompt and continuous efforts toward the reunification and release of children by weakening the FSA’s language to merely reference agency practice, rather than a requirement. While the FSA states that the government “shall” make prompt and continuous efforts to these ends, the proposed regulation states only that “ORR makes and records” such efforts.
Disturbingly, the proposed regulations eliminate the requirement that DHS evaluate simultaneous release of a parent, legal guardian, or adult relative who is also detained when releasing juveniles from DHS custody. Currently, 8 C.F.R. § 236.3(b)(2) provides that, when a minor in DHS custody is authorized for release on bond, parole, or recognizance, and there is no suitable sponsor available, DHS shall evaluate, on a “discretionary case-by-case basis,” the simultaneous release of a “parent, legal guardian, or adult relative in Service detention.” The proposed regulations eliminate this provision entirely. Without the requirement to consider simultaneous release for parents along with their children, more children may be denied liberty as they are left in family detention for longer, or separated from their parents and placed in ORR custody.
The proposed regulations would implement unnecessary restrictions on sponsors that would likely to keep more children in custody. HHS seeks, without justification, to define an adult relative who can sponsor a child narrowly, as only a “brother, sister, aunt, uncle, or grandparent.” At times it may be most appropriate to place a child with more distant relatives over closer biological relatives in recognition of established family ties. In state child welfare systems, all relatives typically fall into the same category, and are evaluated based on the actual individual relationship to the child rather than the biological level of relationship to the child.
Family members should also be involved in decision making about who will be the best caregiver and sponsor for a child. For example, a second cousin and a grandparent may decide together that the second cousin is better able to care for the child, because of the cousin’s financial resources and other supports. Limiting who counts as a family member by biological relationship is both inappropriate because it lacks any basis in child welfare evidence or best practice, and it is likely to impede the reunification process by introducing artificial barriers for relative sponsors who do not meet ORR’s overly narrow and unexplained definition. It is inappropriate to place a child in what is likely to be an institutionalized setting solely because they have already suffered the loss of a parent, or are fleeing a parent’s abuse or abandonment. For children without a parent available to provide a designation, detention will be significantly prolonged as ORR searches for a licensed facility to accept them regardless of whether a loving adult is available and willing to be a sponsor.
The FSA’s influx and emergency provisions were intended to account for unexpected and significant increases in children in custody, and not to serve as a baseline standard for the agency’s ongoing and routine care and placement of unaccompanied alien children. Flexibility of this kind is inappropriate as a “consideration generally applicable to the placement of children,” as such a reading would render hollow the protections and provisions of Flores, the TVPRA, and HSA. However, the proposed regulations provide for broad exemptions to existing child protections by expansively defining the terms “emergency” and “influx.” These broad definitions provide massive leeway to DHS and HHS to selectively ignore the important children's rights provisions, essentially leaving immigration enforcement operations impacting migrant children unregulated.
The term emergency, under the proposed regulations, "means an act or event...that prevents timely transport or placement of minors or impacts other conditions" touching on the basic needs of children including the very provision of snacks and meals or prolonged detention of children in border jails. The regulations propose natural disaster, facility fire, civil disturbance, medical or public health concerns in the list of examples of such events but indicate that other kinds of events might also qualify, leaving significant room for interpretation.
DHS and HHS also propose to adopt an antiquated definition of influx, a situation, according to the proposed regulations, in which there are, "at any given time, more than 130 minors or UACs eligible for placement in a licensed facility". This original numerical cut off of 130 was set by the children's lawyers' and the government in the late 1990s when the then INS apprehended 1.4 million people a year. Divided equally each of the almost 7,000 border agents apprehended an average of 17 people a month. In fiscal year 2017, by comparison, Border Patrol arrested a much smaller number of 310,531 people at the U.S. border, and each of the almost 20,000 agents made an average of only 1.3 arrests a month. DHS and HHS disingenuously argue that they exist within a "constant state of influx" even while overall border crossings are 20 percent of what they were in the moment that term was defined in the FSA while staffing has increased by almost three times. The border is not in crisis -- except in terms of protection of vulnerable people's rights -- and DHS suffers from no shortage of resources to respond to historically low migratory flows.
Border arrests and staffing 1997, 2017
Total border arrests
Number of border agents
Instead DHS and HHS appear to be using these proposed regulations as a means of quietly erasing the FSA’s time limitations on transferring children out of DHS custody, admitting that the impact of the definitions of emergency and influx is to make ignoring limitations on transfer the "default." This would continue to expose children to dangerous conditions documented repeatedly by government inspectors and outside researchers including inadequate and inappropriate food, severely cold temperatures, bullying and abuse and lack of medical care. Codifying this “default,” would allow the government to continue to ignore the intent of the Flores Settlement agreement, which is to protect children's rights.
Most worryingly, the language of the proposed rule also allows the government to routinely ignore standards of care included in the FSA such as the requirement that the government provide a meal or snack to a child at a certain periodicity and of certain quality while that child is detained, or the requirement to keep unaccompanied children held for periods of over a day separate from unrelated adults. This expansion of the weakening of protections triggered by an emergency or influx is new and is especially worrying given the agencies' current record of failure to adhere to basic standards of child protection. Constant exemption not just of the requirements to transfer children to child care facilities but to provide for their basic care while in border jails makes a mockery of the FSA’s scheme.
Department of Homeland Security has a poor track record of accountability and transparency with respect to immigration detention facilities and yet proposes to create its own child care licensing mechanism for family detention centers
The Flores v. Reno settlement agreement and the court decisions implementing it require that immigration detention facilities that hold children for more than twenty days be licensed by “an appropriate State agency” to meet certain standards of care. Because most states have not licensed facilities to detain parents with their children, the Department of Homeland Security (DHS) has had difficulty obtaining licenses for family detention centers, limiting the length of family detention.
Under the proposed regulation, DHS would be able to “employ an entity outside of DHS that has relevant audit experience to ensure compliance with the family residential standards established by ICE [Immigration and Customs Enforcement].” DHS claims that this would provide “materially identical assurances about the conditions” of family detention centers while allowing for longer periods of detention.
However, DHS’s record of oversight, transparency, and accountability with regard to immigration detention facilities is abysmal. This record demonstrates just how dangerous it would be to allow DHS to bypass state certification standards for facilities that detain children. Since 2010, Human Rights Watch has found that 23 or 52 deaths in immigration detention analyzed by outside experts were linked to substandard medical care. Our analysis of these deaths found that the same defects in oversight are leading to the same deadly failures. Three failings stand out: (1) unreasonable delays in providing care, (2) poor practitioner and nusing care, and (3) botched emergency responses. There is also a troubling pattern of suicides by people with psychosocial disabilities who have been held in isolation.
The proposed regulations make clear that DHS does not intend to increase oversight of family detention centers as part of its new licensing authority. DHS asserts in its proposed regulation that “ICE currently meets the proposed licensing requirements” because it currently requires family detention facilities to comply with ICE’s detention standards and hires inspectors to monitor compliance, and therefore “DHS would not incur additional costs in fulfilling the requirements of the proposed alternative licensing scheme.”
Since May 2015, DHS has contracted with a company called Danya International to inspect family detention centers (which ICE calls family residential centers, or FRCs) for compliance with ICE’s internal standards. According to court documents, Danya has conducted unannounced monthly inspections of all three family residential centers since August 2015. Only three reports from those inspections—one from each facility, as selected by ICE—are publicly available. With respect to the others, the only information available to the public is an assertion by an ICE official in a court declaration that “Danya has generally found the FRCs to be compliant with a majority” of standards, and “[w]here Danya observed individual issues of non-compliance, the facilities took corrective action as appropriate and achieved compliance although this is a continuous process.” These vague descriptions provide very little information about what individual standards were violated, or how severe and prolonged those violations were.
ICE denied requests by DHS’s own Advisory Committee on Family Residential Centers for access to the other Danya International inspection reports. The three reviews that are available consist mainly of checklists of standards with limited further explanation of the findings, and no apparent input from detainees.
DHS’s Office of Civil Rights and Civil Liberties has conducted more in-depth inspections and investigations of family detention centers, but those documents and reports are likewise unavailable to the public. Two medical doctors who served as subject matter experts for the Office of Civil Rights and Civil Liberties on family detention centers, Dr. Pamela McPherson and Dr. Scott Allen, recently reported to Congress that their investigations “frequently revealed serious compliance issues resulting in harm to children.” Drs. McPherson and Allen stated that family detention centers “still have significant deficiencies that violate federal detention standards,” including repeated violations of the standards for medical staffing, clinic space, timely access to medical care, and language access, and gave detailed examples of cases when children have been harmed by inadequate medical care.
More information is publicly available regarding DHS’s record on inspections of adult ICE detention centers—but that record provides further evidence that the agency’s self-inspections are a poor substitute for state child welfare agencies or court supervision.
A DHS Office of Inspector General (OIG) investigation published in June found that because of the flaws in inspections of ICE detention facilities, deficiencies “remain uncorrected for years.” The most frequent inspections of ICE facilities are conducted by a private contractor called the Nakamoto Group. The OIG found that Nakamoto’s inspections were severely lacking. According to OIG, “typically, three to five inspectors have only 3 days to complete the inspection, interview 85 to 100 detainees, brief facility staff, and begin writing their inspection report for ICE.” An ICE employee told the OIG that this was not “enough time to see if the [facility] is actually implementing” required policies. Other ICE personnel described Nakamoto inspections as “very, very, very difficult to fail” and “useless.”
For the inspections that DHS OIG observed, Nakamoto reported having conducted 85 to 100 detainee interviews. But contrary to what Nakamoto’s contract required, the conversations with detainees that OIG saw were not conducted in private, were conducted only in English, and OIG wrote that it “would not characterize them as interviews.” (OIG found that inspections conducted by the Office of Detention Oversight were much more thorough, but occurred only once every three years on average, and ICE did not adequately follow up to ensure that problems were corrected.)
The proposed regulation fails to incorporate basic child protection obligations for children detained without adults
The proposed regulations fails to include obligations memorialized in the FSA aimed at protecting the rights of children including, listed proper physical care and maintenance including suitable living conditions, food, appropriate clothing and personal grooming items; appropriate routine medical and dental care, family planning services, and emergency health services, the administration of prescribed medication and special diets and appropriate mental health intervention; an individualized needs assessment; educational services appropriate to the child’s level of development; activities according to a recreation and leisure time plan; at least one individual counseling session per week conducted by trained social work staff; group counseling sessions at least twice a week; acculturation and adaptation services; a comprehensive orientation program; access to the religious services of the child’s choice; visitation and contact with family member that respect the child's privacy; a reasonable right to privacy; family reunification services designed to identify relatives in the United States as well as in foreign countries; and legal services information.
In the two decades since that agreement was signed, Flores counsel has repeatedly returned to federal court to seek enforcement of the agreement. The most recent motions to enforce were filed just in April 2018. That filing identified failures to comply with the Flores Agreement on issues ranging from the administration of medication to the conditions of care within residential treatment centers.
Because the proposed regulations fail to incorporate the clear language of the Flores Agreement on the appropriate care of children it invites the implementation of care standards that fall below the detailed requirements that have governed the care of vulnerable children in federal immigration custody for more than 20 years.
 Universal Declaration of Human Rights (UDHR), adopted December 10, 1949, G.A. Res. 217A(III), U.N. Doc. A/810 at 71 (1949), art. 9(1) (“No one shall be subjected to arbitrary arrest and detention.”). See also Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989), entered into force September 2, 1990, art. 37(b) (“No child shall be deprived of his or her liberty unlawfully or arbitrarily.”); International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (Migrant Workers Convention), adopted December 18, 1990, G.A. Res. 45/158, annex, 45 U.N. GAOR Supp. (No. 49A) at 262, U.N. Doc. A/45/49 (1990), entered into force July 1, 2003, art. 16(4) (“Migrant workers and members of their families shall not be subjected individually or collectively to arbitrary arrest or detention; they shall not be deprived of their liberty except on such grounds and in accordance with such procedures as are established by law.”).
 UN Commission on Human Rights (UNHCR), Working Group on Arbitrary Detention, Revised Deliberation No. 5, para. 8 (“The prohibition of arbitrary detention is absolute, meaning that it is a non-derogable norm of customary international law, or jus cogens.”).
 UN High Commissioner for Refugees (UNHCR) Detention Guidelines, para. 2. The Inter-American Commission on Human Rights has concluded that the American Convention on Human Rights requires that immigration detention be used only in exceptional circumstances; there should be a presumption in favor of liberty, not of detention. Comisión Interamericana de Derechos Humanos, Informe de Admisibilidad y Fondo No. 51/01, Caso 9903, Rafael Ferrer-Mazorra y otros (Los Cubanos del Mariel) (Estados Unidos de América), April 4, 2001, paras. 216-219. See also Committee on Migrant Workers, General Comment No. 2, para. 26.
 UN Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families (Committee on Migrant Workers), General Comment No. 2, Rights of Migrant Workers, U.N. Doc. CMW/C/GC/2 (2013), para. 23. See also UN Human Rights Committee, General Comment No. 35, Liberty and Security of Person, U.N. Doc. CCPR/C/GC/35 (2014), para. 12.
 UNHCR Detention Guidelines: Guidelines on the Applicable Criteria and Standards Relating to the Detention of Asylum-Seekers and Alternatives to Detention, 2012.
 See Human Rights Committee, General Comment No. 35, para. 18 (“The decision must consider relevant factors case by case and not be based on a mandatory rule for a broad category”). See also Committee on Migrant Workers, General Comment No. 2, para. 26 (noting that “any custodial or non-custodial measure restricting the right to liberty must be exceptional and always be based on a detailed and individualized assessment”);.
 Working Group on Arbitrary Detention, Revised Deliberation No. 5, para. 25.
 Ibid., para. 26.
 Committee on Migrant Workers and Committee on the Rights of the Child, Joint General Comment No. 4/23, U.N. Doc. CMW/C/GC/4-CRC/C/GC/23 (2017), para. 7. See also Committee on Migrant Workers, General Comment No. 2, para. 24; Cyprus. (2014). CAT/C/CYP/CO/4; Belize. (2014). CMW/C/BLZ/CO/1.
 As a signatory to the CRC, the US is obligated to refrain from actions that would “defeat the object and purpose” of the treaty. Vienna Convention Art. 18. The US has neither signed nor ratified the ICRMW.
 Convention on the Rights of the Child, art. 37.
 Committee on Migrant Workers and Committee on the Rights of the Child, Joint General Comment No. 4/23, para. 10. Well before the publication of the joint general comment, other international authorities had observed that immigration detention of children could not satisfy the requirements of necessity and proportionality, and accordingly amounted to arbitrary detention. See, for example, UN General Assembly, Human Rights Council, Report of the Working Group on Arbitrary Detention, U.N. Doc. A/HRC/13/30 (18 January 2010), para. 60 (“Given the availability of alternatives to detention, it is difficult to conceive of a situation in which the detention of an unaccompanied minor would comply with the requirements stipulated in article 37 (b), clause 2, of the Convention on the Rights of the Child, according to which detention can be used only as a measure of last resort.”); UN General Assembly, Human Rights Council, Report of the Special Rapporteur on the Human Rights of Migrants, François Crépeau, U.N. Doc. A/HRC/20/24 (2 April 2012), para. 41 (concluding that the detention of children “cannot be justified solely on the basis of their migratory or residence status, or lack thereof”).
 UN General Assembly, Human Rights Council, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan Ernesto Mendez, Treatment of Children Deprived of Their Liberty, UN Doc. A/HRC/28/68, March 5, 2015, para. 80.
 Inter-American Commission on Human Rights, “IACHR Concludes Visit to Colombia’s Border with Venezuela,” September 28, 2015, http://www.oas.org/en/iachr/media_center/PReleases/2015/109A.asp (accessed September 11, 2018).
 Popov v. France, App. Nos. 39472/07 and 39474/07 (Eur. Ct. H.R. January 19, 2012); Rahimi v. Greece, App. No. 8687/08 (Eur. Ct. H.R. April 5, 2011); Mubilanzila Mayeka and Kaniki Mitunga v. Belgium, App. No. 13178/03 (Eur. Ct. H.R. October 12, 2006).
 Committee on the Rights of the Child, Report of the 2012 Day of General Discussion: The Rights of All Children in the Context of International Migration (2012), para. 78.
 A/HRC/28/68, para. 80.
 Parliamentary Assembly, Council of Europe, The Alternatives to Immigration Detention of Children, Resolution 2020 (2014), para. 9.1, http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=21295&lang=en (accessed September 11, 2018).
 Rights and Guarantees of Children in the Context of Migration and/or in Need of International Protection, Advisory Opinion OC-21/14 of August 19, 2014 (Inter-Am. Ct. H.R.), paras. 154-160.
 See Working Group on Arbitrary Detention, Revised Deliberation No. 5, para. 40 (“Detaining children because of their parents’ migration status will always violate the principle of the best interests of the child.”); Basic Principles and Guidelines on Remedies and Procedures on the Right of Persons Deprived of Their Liberty to Bring Proceedings Before a Court, princ. 21, para. 46 (same).
 A/HRC/20/24, para. 40.
 Joint General Comment No. 4/23, para. 11.
 Committee on the Rights of the Child, Report of the 2012 Day of General Discussion: The Rights of All Children in the Context of International Migration (2012), para. 78.
 UN General Assembly, International Migration and Development: Report of the Secretary General, UN Doc. A/68/190 (July 25, 2014), para. 75.
 Committee on the Rights of the Child, General Comment No. 6, para. 61.
 Committee on the Rights of the Child, Report of the 2012 Day of General Discussion: The Rights of All Children in the Context of International Migration (2012), para. 78.
 Joint General Comment No. 4/23, para. 5.
 Revised Deliberation No. 5, para. 11.
 Parliamentary Assembly, Council of Europe, Unaccompanied Children in Europe: Issues of Arrival, Stay and Return, Resolution 1810 (2011), para. 5.9.
 Parliamentary Assembly, The Alternatives to Immigration Detention of Children, Resolution 2020 (2014), para. 9.2.
 UNHCR Detention Guidelines, para. 51.
 “UN experts to US: ‘Release migrant children from detention and stop using them to deter irregular migration,’” 22 June 2018, https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=23245&LangID=E (accessed 12 September 2018).
 Flores v. Lynch, 212 F. Supp. 3d 907, 909 (C.D. Cal. 2015).
 Notice of Proposed Rulemaking, “Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children,” Federal Register, Vol. 83, No. 174, September 7, 2018, pgs. 45493-45494,
 UNHCR, Detention Guidelines: Guidelines on the Applicable Criteria and Standards relating to the Detention of Asylum-Seekers and Alternatives to Detention, available at http://www.refworld.org/pdfid/503489533b8.pdf
 Mathias Czaika and Hein De Haas, “The Effectiveness of Immigration Policies,” Population and Development Review, vol. 39(3) (2013), p. 503.
 Wayne A. Cornelius, “Death at the Border: Efficacy and Unintended Consequences of US immigration Control Policy,” Population and Development Review, vol. 27 (2001), p. 661-685; Wayne A. Cornelius, (2005) “Controlling 'Unwanted' Immigration: Lessons from the United States 1993-2004,” Journal of Ethnic and Migration Studies, vol. 31(4), (2005), p. 775-794; Derek Lutterbeck, “Policing Migration in the Mediterranean,” Mediterranean Politics, vol. 11(1), (2006), p. 59-82; Thomas Spijkerboer, “The Human Costs of Border Control,” European Journal of Migration and Law, vol. 9, (2007), p. 127-139.
 Tom K. Wong, “Did a 2015 Flores Court Ruling Increase the Number of Families Arriving at the Southwest Border?” Center for American Progress, October 16, 2018, https://www.americanprogress.org/issues/immigration/news/2018/10/16/459358/2015-flores-court-ruling-increase-number-families-arriving-southwest-border/ (accessed November 6, 2018).
 Tom K. Wong, “Do Family Separation and Detention Deter Immigration?” Center for American Progress, July 24, 2018, https://www.americanprogress.org/issues/immigration/reports/2018/07/24/453660/family-separation-detention-deter-immigration/ (accessed November 6, 2018).
 See, e.g., Medecins sans Frontieres, “Forced to Flee Central America’s Northern Triangle: A Neglected Humanitarian Crisis,” June 2017, https://www.msf.org/sites/msf.org/files/msf_forced-to-flee-central-americas-northern-triangle_e.pdf (accessed November 6, 2018).
 Jeh Charles Johnson, “Trump’s ‘Zero-Tolerance’ Border Policy is Immoral, Un-American, and Ineffective,” Washington Post, June 18, 2018, https://www.washingtonpost.com/opinions/trumps-zero-tolerance-border-policy-is-immoral-un-american--and-ineffective/2018/06/18/efc4c514-732d-11e8-b4b7-308400242c2e_story.html?noredirect=on&utm_term=.a547532ad070 (accessed November 6, 2018).
 See U.S. Immigration and Customs Enforcement, “Congressional Budget Justification for FY 2019”; see also American Immigration Lawyers Association et al., “The Real Alternatives to Detention,” June 2017, https://www.immigrantjustice.org/sites/default/files/content-type/research-item/documents/2018-06/The%20Real%20Alternatives%20to%20Detention%20FINAL%2006.17.pdf (accessed November 6, 2018).
 FSA, ¶ 14. The only exceptions to expeditious release are the unusual circumstances where there is a particular reason that detention is “required either to secure [the child’s] timely appearance before the INS or immigration court, or to ensure the minor’s safety or that of others.” FSA, ¶ 14.
 FSA, ¶ 18.
 FSA, ¶ 6A “licensed program” is defined in the SFA as “any program, agency of organization that is licensed by an appropriate State agency to provide residential, group, or foster care services for dependent children, including a program operating group homes, foster homes, or facilities for special needs minors…and that] meets those standards for licensed programs set forth in Exhibit I [to the FSA].”
 FSA, ¶ 12.
 FSA, ¶ 12A(3). The term “emergency” is defined as follows: “[A]ny act or event that prevents the [transfer] within the time frame provided.” The FSA provides that “such emergencies include natural disasters (e.g., earthquakes, hurricanes, etc.), facility fires, civil disturbances, and medical emergencies (e.g., a chicken pox epidemic among a group of minors).” The phrase “influx of minors into the United States” is defined as follows: “[T]hose circumstances where the INS has, at any given time, more than 130 minors eligible for placement in a licensed program…, including those who have been so placed or are awaiting such placement.” The FSA requires that, “[i]n preparation for an ‘emergency’ or ‘influx,’…the INS shall have a written plan that describes the reasonable efforts that it will take to place all minors as expeditiously as possible” (including the identification of potentially available “licensed programs”). Id.
 FSA, ¶ 14.
 83 FR 45493. We note that, under the FSA, the Government’s policy with respect to Unaccompanied Children (i.e., children who cross the border without a parent or legal guardian) has been to place them in a licensed program pending resolution of their immigration claims--at which time they would then, depending on the resolution, either be removed from the country or returned to a licensed program until they reached the age of majority and could be released. The Proposed Regulations would not change this policy relating to Unaccompanied Children. The change that the Proposed Regulations would effect is that Accompanied Children (i.e., children who cross the border with a parent or legal guardian) would be detained indefinitely in federal immigration facilities (FRCs) pending resolution of their and their parents’ immigration claims--rather than, as was the case before 2014, being released with their parents (subject to ankle monitoring, bond, or other compliance programs), or, as was the case under the family separation policy in April-June 2018, forcibly separated from their parents to be housed alone in a licensed program.
 Flores v. Sessions, Case No. CV 85-4544-DMG (C.D. Cal., July 9, 2018).
 Id. at 4.
 Michael Dudley et al., “Children and Young People in Immigration Detention,” Current Opinion Psychiatry vol. 25 (2012), p. 285-292; Kim Ehntholt et al., “Mental Health of Unaccompanied Asylum-Seeking Adolescents Previously Held in British Detention Centres,” Clinical Child Psychology and Psychiatry, vol. 23(2), (2018) p. 238–257; Rachel Kronick et al., “Asylum-Seeking Children’s Experiences of Detention in Canada: A Qualitative Study,” American Journal of Orthopsychiatry, vol. 85(3) (2015), p. 287.
 Zachary Steel et al., “Psychiatric Status of Asylum Seeker Families Held for a Protracted Period in a Remote Detention Centre in Australia,” Australian and New Zealand Journal of Public Health, vol. 28 (2004), p. 527-536.
 Ann Lorek et al., “The Mental and Physical Health Difficulties of Children Held within a British Immigration Detention Center: A Pilot Study,” Child Abuse & Neglect, vol. 33 (2009), p. 573-585.
 Letter from Dr. Scott Allen and Dr. Pamela McPherson to the Senate Whistleblowing Caucus, “Psychological Impact of Detention on Children,” July 17, 2018, https://www.whistleblower.org/sites/default/files/Original%20Docs%20Letter.pdf.
 Allen Keller et al., “Pre-Migration Trauma Exposure and Mental Health Functioning among Central American Migrants Arriving at the US Border,” PLOS ONE, vol. 12(1) (2017).
 Julie M. Linton, Marsha Griffin, and Alan Shapiro, American Academy of Pediatrics, “Policy Statement: Detention of Immigrant Children,” April 2017, http://pediatrics.aappublications.org/content/early/2017/03/09/peds.2017-0483 (accessed November 6, 2018).
 Wendy Cervantes, “Baby Jails are Not Child Care,” CLASP, February 2018, https://www.clasp.org/sites/default/files/publications/2018/02/Baby%20Jails%20are%20not%20Child%20Care.pdf(accessed November 6, 2018); Lutheran Immigration and Refugee Service and the Women’s Refugee Commission, “Locking Up Family Values, Again” October 2014, https://innovationlawlab.org/wp-content/uploads/2015/01/Fam-Detention-Again-Full-Report.pdf (accessed November 6, 2018).
 Julie M. Linton, Marsha Griffin, and Alan Shapiro, American Academy of Pediatrics, “Policy Statement: Detention of Immigrant Children,” April 2017, http://pediatrics.aappublications.org/content/early/2017/03/09/peds.2017-0483 (accessed November 6, 2018).
 \ “US: Trauma in Family Immigration Detention,” Human Rights Watch news release, May 15, 2015, https://www.hrw.org/news/2015/05/15/us-trauma-family-immigration-detention-0.
 Claire Hutkins Seda, “Dr. Luis Zayas Provides Testimony on Family Detention,” Migrant Clinicians Network, July 29, 2015, https://www.migrantclinician.org/blog/2015/jul/dr.-luis-zayas-provides-testimony-family-detention.html (accessed November 6, 2018).
 Advisory Committee on Family Residential Centers, “Report of the ICE Advisory Committee on Family Residential Centers,” October 7, 2016, https://www.ice.gov/sites/default/files/documents/Report/2016/acfrc-report-final-102016.pdf (accessed November 6, 2018).
 Para. 14, Flores v. Reno, case no. CV 85-4544-RJK(Px), Stipulated Settlement Agreement.
 FSA para. 9 (emphasis added).
 FSA para. 14.
 See Office of Refugee Resettlement, “Unaccompanied Alien Children: Frequently Asked Questions,” https://www.acf.hhs.gov/orr/resource/unaccompanied-alien-children-frequently-asked-questions (“HHS is legally required to provide care for all children until they are released to a suitable sponsor, almost always a parent or close relative, while they await immigration proceedings.”); see generally FSA, para. 14.
 See Art. 37, United Nations General Assembly, Convention on the Rights of the Child, https://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf (“The arrest, detention or imprisonment of a child shall be in conformity with the law and shall be used only as a measure of last resort and for the shortest appropriate period of time”).
 See, e.g. Va. Code §63.2-100 (“‘Kinship care’ means the full-time care, nurturing, and protection of children by relatives.”); Va. Code § 63.2-1305 (evaluating a kinship placement in part based on the child’s attachment to the relative).
 83 FR 45496
 83 FR 45525
 In fiscal year 1997, INS apprehended 1,412,953 at the US border. United States Border Patrol, “Nationwide Illegal Alien Apprehensions Fiscal Years 1925-2017,” https://www.cbp.gov/sites/default/files/assets/documents/2017-Dec/BP%20Total%20Apps%20FY1925-FY2017.pdf.
 United States Border Patrol, “Nationwide Illegal Alien Apprehensions Fiscal Years 1925-2017,” https://www.cbp.gov/sites/default/files/assets/documents/2017-Dec/BP%20Total%20Apps%20FY1925-FY2017.pdf.
 United States Border Patrol, “Border Patrol Agent Staffing by Fiscal Year,” https://www.cbp.gov/sites/default/files/assets/documents/2017-Dec/BP%20Staffing%20FY1992-FY2017.pdf.
 See 83 FR 45498.
 See Human Rights Watch, In the Freezer: Abusive Conditions for Women and Children in US Immigration Holding Cells (New York: Human Rights Watch, 2018) https://www.hrw.org/report/2018/02/28/freezer/abusive-conditions-women-and-children-us-immigration-holding-cells.
 83 FR 45496, 45526.
 See Human Rights Watch, In the Freezer.
 Flores v. Reno, Stipulated Settlement Agreement, Aug. 12, 1996, p. 4. https://www.aclu.org/sites/default/files/assets/flores_settlement_final_plus_extension_of_settlement011797.pdf (accessed November 6, 2018).
 Department of Homeland Security and Department of Health and Human Services, “Apprehension, Processing, Care, and Custody of Alien Minors and Unaccompanied Alien Children,” Federal Register, Vol. 83, No. 174, September 7, 2018, https://www.gpo.gov/fdsys/pkg/FR-2018-09-07/pdf/2018-19052.pdf. p. 45525.
 Id., p. 45488.
 Id., p. 45518.
 Declaration of Jon Gurule, ¶6, Flores v. Holder, No. CV 85-4544-DMG (C.D. Cal June 3, 2016) https://www.clearinghouse.net/chDocs/public/IM-CA-0002-0030.pdf (accessed November 6, 2018).
 Id., exhibits 1, 2 and 3.
 Id. ¶6.
 Human Rights First, “Report of the DHS Advisory Committee on Family Residential Centers,” October 7, 2016, p. 93, https://www.humanrightsfirst.org/sites/default/files/dhs-advisory-committee-on-family-residential-centers.pdf (accessed November 6, 2018).
 Letter from Dr. Scott Allen and Dr. Pamela McPherson of the Department of Homeland Security Office of Civil Rights and Civil Liberties, to Sens. Charles E. Grassley and Ron Wyden, Senate Whistleblowing Caucus, July 17, 2018 https://www.wyden.senate.gov/imo/media/doc/Doctors%20Congressional%20Disclosure%20SWC.pdf (accessed November 6, 2018).
 Department of Homeland Security Office of Inspector General, “ICE’s Inspections and Monitoring of Detention Facilities Do Not Lead to Sustained Compliance or Systemic Improvements: DHS OIG Highlights (OIG-18-67),” June 26, 2018, https://www.oig.dhs.gov/sites/default/files/assets/2018-06/OIG-18-67-Jun18.pdf (accessed November 6, 2018).
 These care obligations are described in much greater detail in Exhibit 1 of the Flores Settlement Agreement.
 Flores v. Sessions, Document 402-2 (N.D. Cal., Apr. 28, 2018); see also Molly Hennessy-Fiske, “Lawsuit Alleges Improper Medication of Migrant Children in Federal Shelters,” Los Angeles Times, June 21, 2018, http://www.latimes.com/nation/la-na-immigrant-shelters-medicated-20180620-story.html (accessed November 6, 2018).