Joint Statement of America’s Frontline Physicians Opposing Final Rule Rolling Back Protections in Flores Settlement Agreement

The Department of Homeland Security issued a final regulation that would roll back critical protections for immigrant families established under the Flores Settlement Agreement.

In response, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and American Psychiatric Association issued this statement:

Our organizations, which represent more than 452,100 physicians and medical students, are united in our strong opposition to the Department of Homeland Security’s (DHS) final rule rolling back protections for immigrant children and their families put in place by the Flores Settlement Agreement. Under the new rule, immigrant children and their parents could be held in federal detention facilities that may be unsafe for months, years, or even indefinitely. As physicians, we protect the health and well-being of our patients. We are compelled to speak out about this because of the harm it will do to the health of these patients and families.

Conditions in federal detention facilities too often fail to ensure access to health care that meets guideline-based standards, treatment that mitigates harm or traumatization, and services that support immigrants’ health and well-being.

Even short periods of detention can have long-lasting consequences for vulnerable populations such as pregnant women, children, and those with chronic or complex health conditions or mental illness. When children are detained, they experience physical and emotional stress, placing them at risk for serious short- and long-term health problems, such as developmental delays, poor psychological adjustment, anxiety, depression and suicidal ideation. Studies of adults in detention have also demonstrated negative physical and mental health effects, including musculoskeletal, gastrointestinal, respiratory, and neurologic symptoms, along with anxiety, depression, posttraumatic stress disorder, difficulty with relationships, and self-harming behavior. Detention itself undermines parents’ authority and capacity to respond to their children’s needs, and there is no evidence indicating that any time in detention is safe for children.

The lack of adequate sleep and added stress endured in detention also compromises individuals’ ability to fight off infection, increasing the likelihood of illness among those who are detained for long periods of time.

We urge this rule to be rescinded by DHS and rejected by the courts. Instead, we call on the federal government to advance policies that promote the health and well-being of immigrants in federal custody.


American Psychiatric Association

The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 38,500 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information please visit

About the American Academy of Family Physicians

Founded in 1947, the AAFP represents 134,600 physicians and medical students nationwide. It is the only medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care. To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website,

About the American Academy of Pediatrics

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds.

About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 154,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

About the American College of Obstetricians and Gynecologists

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion.

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