violations of human rights, including physical and sexual abuse, insufficient or denial of medical care, and substandard living conditions. health conditions and medical services have also received increasing attention in news coverage due to reports of premature deaths of those who had been held in detention. hygiene and sanitation a report from the office of inspector general at the department of homeland security found that, out of five officially inspected detention facilities, four failed to meet proper standards for medical care and sanitary conditions. inspectors noted that several detention center bathrooms had mold in the showers. multiple detention facilities in texas were similarly cited for poor hygienic conditions. specifically, children did not have regular opportunities to shower or use soap to wash their hands while distributed clothing was also inadequate or dirty, with some children having to wear only diapers. furthermore, detainees reported that some were not provided with hygiene supplies, such as soap, toothpaste, and toilet paper, and did not have access to hot water. an inspection of two detention centers in georgia indicated that food and water conditions were deemed unsanitary. specifically, detainees reported that provided food was often spoiled, under-cooked, rancid, or found to contain objects such as bugs, debris, hair, teeth, and mice. many detainees also observed malnutrition and rapid weight loss. as well, according to the 2011 performance-based national detention standards published by ice, detainees with diabetes or other health conditions are to be provided with an appropriately suited diet. however, multiple detainees received meals that were not adjusted to compensate for medical dietary restrictions. medical services investigative journalists and advocacy groups such as the american civil liberties union (aclu) have expressed concerns of systemic sub-standard and neglectful medical treatments in detention centers, reporting that detention facilities often deliver medical services with long wait times and delays. medical experts report that detainees with serious conditions such as pneumonia are similarly subjected to long wait times and do not receive proper care nor pain management. detainees often report receiving insufficient treatments and services, as well. patients in various detention centers stated that they were denied surgeries due to delays by ice or other forms of care such as physical exams and biopsies, receiving only pain killers instead. cnbc reported that, as of august 2019, detention facilities do not currently nor plan to administer vaccines to detained individuals. health professionals have criticized this policy, attributing it to outbreaks among detainees. in 2019, at least three detained children died from complications of contracting influenza while in detention. a study by aiden varan and his colleagues also found that ice detainees were particularly susceptible to contracting chicken pox due to increased exposure in facilities. a study in the center for disease control's morbidity and mortality weekly report indicated increasing outbreaks of mumps in facilities, as well. both studies concluded that health initiatives that incorporated targeted vaccination efforts could mitigate the frequency of outbreaks. the center for immigrants' rights clinic reported that medical units in detention facilities were also severely understaffed, requiring some patients to travel to off-site centers for their treatments. the human rights watch also reported that there had been cases where medical staff had treated patients in capacities outside of the scope of their training and licenses. additionally, many medical practitioners in detention facilities are not multi-lingual, which impedes effective communication by patients who do not speak english. various detention centers provide phone translation services for this purpose. laura redman, the director of the health justice program at new york lawyers for the public interest, reported that numerous detained clients were never instructed on how they could make sick calls if needed. in august 2019, a class action lawsuit was filed against ice and the u.s. district court for the central district of california. the suit alleged that ice and other federal officials were cognizant of the conditions and quality of medical care inside detention facilities yet took no action to remedy this. mental health a report from the office of inspector general has also indicated substandard treatment of detainees' mental health. unsafe or isolating conditions can exacerbate mental health conditions such as depression or trauma, yet distrust, due to being forcibly detained, also prevents many immigrants from seeking mental health services. studies reveal that children are particularly vulnerable to adverse impacts on mental health. a review by the american academy of pediatrics indicated that young detainees may demonstrate emotional problems and post-traumatic symptoms, which can negatively impact development. charles baily and his colleagues also found that negative experiences in detention centers, supplemented by difficulties encountered in migration, can increase children's risk for post-traumatic stress disorder (ptsd), anxiety, and depression. adults similarly report experiencing depression, self-harm, and post-traumatic symptoms. a review conducted by kristen ochoa found that detained immigrants with specific mental health needs were subjected to prolonged solitary confinement, restricted contact with family and friends, insufficient monitoring for detainees expressing suicidal ideation, and refusals to supply appropriately prescribed medications. in many reports, detainees with mental disabilities were observed as often physically restrained, shackled, or heavily medicated. the center for immigrants' rights clinic report indicated that most detainees were not informed of existing mental health services or how to file grievances. many also expressed fear of being held in solitary confinement and thus did not express mental health concerns. reproductive and sexual health a report by the southern poverty law center indicated that detainees at lasalle detention facility in louisiana received insufficient menstrual products, such as sanitary pads and tampons. media outlets such as the daily beast and rewire news report that miscarriages and stillbirths in ice custody have increased. pregnant detainees who suffered vaginal bleeding, breast pain, and ovarian cysts stated that they faced delays and neglect by medical personnel as well. the aclu, american immigration council, and other immigration advocacy groups compiled a report of complaints regarding the treatment of multiple pregnant detainees by ice. this included inaccurate pregnancy tests, stress-inducing conditions, vaginal bleeding, denied requests for parole, insufficient nutrition, and shackling. in interviews conducted by the human rights watch, participating detainees stated that they had been denied forms of gynecological care such as pap smears, hormonal contraceptives, and mammograms. additionally, immigrants with hiv reported that they had been denied proper and timely medication, which can allow the virus to develop resistance to drug treatments. due to weakened immunity, detainees with hiv are highly susceptible to further infections in unsanitary conditions without sufficient care. studies also find that detention facilities typically do not provide adequate screenings for hiv. demonstrations and protests the barriers that immigrants face in health care settings are similar to the barriers that they face in communicating their health circumstances when detained in detention facilities. an article from the new york times magazine, describes the story of how detained immigrants located in a south georgia detention center were able to devise and communicate a plan to protest against the facility and their officials during the covid-19 pandemic. although the women and men in this detention center were separated into different units, a collection of women wrote a letter that was then placed into an article of clothing that was being moved to the men's section of the facility. they wanted to stage this protest in order to demand safer protective measures against the virus and request that ice "release the sick, elderly and high-risk among them." not only were these individuals able to find ways to communicate with one another within the detention facility, but they also had a means of communicating with an investigative reporter who then wrote about their efforts to mobilize a protest and try to fulfill their requests. this particular detention center had a video visitation system which detainees utilized to speak with the investigative reporter who was then able to witness the unhealthy conditions that these people were forced to live in (such that these individuals were creating their own face masks because they were not granted any, as well as the ways guards would not wear masks when moving through the facility). whistleblowers whistleblowers are individuals who have played a significant role in communicating the unjust and illicit treatment of immigrants held within detention centers. an example includes a news article from the guardian, which depicts the story of an immigrant woman who underwent a dilation and curettage (d&c) procedure after expressing to the doctor at the center her concerns about her menstrual health. after her procedure, the doctor explained how one of her tubes were tied and how she may not be able to have children in the future. the woman was emotionally distraught and expressed how she had not given consent for the procedure to be done. a nurse by the name of dawn wooten filed a whistleblower report that claimed the doctor at the center was performing "an alarmingly high-rates of hysterectomies... on spanish-speaking women" which herself and others nurses felt did not fully understand the procedures were being done to them. it is through the efforts of whistleblowers that these kinds of injustices are brought to the attention of the public and because of their reports, the general masses are able to become more informed on the living conditions and health matters of immigrants within these detention centers which they do not have direct access to. public opinion support for immigrant health care benefits proponents of immigrant health care reform contend that children of immigrant families are like native-born children in their need for security in health and nutrition; as such, they argue that the current state of health care access does not appropriately reflect national interest. proponents also argue that, because immigrants can also join the health sector's work force, their inclusion in receiving benefits is necessary in servicing the expanding population. additionally, other arguments of support note that limited accessibility of care requires immigrants to seek care through emergency services, which ultimately results in delays in major diagnoses until the later stages of an affliction, thereby increasing a community's level of disease. a fact report published by the immigration policy center in 2009 also suggests that increased immigrant participation in the united states' health care system yields monetary benefits. proponents argue that expanding eligibility to include immigrants in the health care system would spread the costs of sustaining public benefits, creating more available tax dollars to alleviate the financial costs of social security and medicare. opposition to immigrant health care benefits opponents argue that immigrants to the united states intend to take advantage of public benefits and therefore favor legislation that implements more restrictions. alternatively, others statethat health care benefits should be limited given their burden on the federal budget. there is some concern that legislative acts like emtala, in ensuring emergency medical care to all, lack clarity in defining what constitutes an "emergency". as such, minor health issues such as migraines—as opposed to emergencies like gunshot wounds and cardiac arrest—are included and hurt hospitals due to the lack of additional government compensation. healthy migrant theory although immigrant populations have increasingly become the foci for analyzing health disparities, the issue of providing care within the context of the patient's cultural background was contested by studies that completely denied the presence of rising health issues in immigrants due to inadequate health services. in 1986, theorists kyriakos markides and jeannine coreil developed the idea of the healthy migrant theory that thought of migration to include an inherent selection process due to the physical and psychological demands of travel, searching for employment, and adjusting to new cultural norm. this paradox theorized that despite the social disadvantages of transitioning into a new country especially for ethnic minority groups, there is an inherent physical and psychological robustness in immigrants compared to populations in both their home country and the united states. although the data that supported the healthy migrant theory converged on the idea that general immigrants arrived to the united states healthier than native-born americans, the theory does not take into consideration the populations that immigrate to the united states for necessity, such as refugees, undocumented immigrants, or families looking for academic or financial opportunity. the healthy migrant theory assumes that immigrants are able to successfully transition their lives in america, become fluent in english, or retain their health status. consequently, continuous studies have found evidence of the uniform decline of immigrants’