Human Rights Watch Submission to the UN Special Rapporteur on the Rights of Persons with Disabilities

Human Rights Watch welcomes the opportunity to contribute inputs to inform the Special Rapporteur's upcoming thematic report to the 64th session of the UN Human Rights Council.[1] This submission draws on our research on migrants, asylum seekers, and refugees with disabilities, particularly in Canada, Mexico, and the United States.[2]

This submission addresses the following questions raised by the Special Rapporteur: key barriers and protection gaps for migrants with disabilities in migration laws, policies, practices, and migration and asylum governance systems (1); how disability shapes experiences at different stages of migration (2); how migration governance systems are influenced by ableism and medical approaches to disability (3); intersectional dimensions of discrimination and exclusion, particularly concerning children with disabilities (4); and how migration legislation, policies, practices, and governance can be made disability-inclusive and compliant with the Convention on the Rights of Persons with Disabilities (5).

1. Key barriers and protection gaps for migrants with disabilities

Immigration detention

In Canada, Human Rights Watch documented how immigration detention can disproportionately affect people with disabilities, particularly people with psychosocial, intellectual, cognitive, and developmental disabilities. Disability can affect authorities' decisions concerning detention, the ability to participate in detention review proceedings, and release conditions.[3] Detention itself can also cause or exacerbate mental health conditions, particularly where detention becomes indefinite in duration.

Solitary confinement and responses to mental health crises

Human Rights Watch has documented the use of solitary confinement and other restrictive measures used against people experiencing mental health crises in immigration detention.

In Canada, Human Rights Watch found that people with mental health conditions were subjected to prolonged solitary confinement and that deteriorating mental health could contribute to continued detention rather than release and community-based support.[4]

In a particularly illustrative case in Canada, Prosper Niyonzima spent nearly five years in immigration detention, including about two years in solitary confinement. After 19 months, he experienced a severe mental health crisis and became catatonic. Instead of receiving adequate support, he was placed in prolonged isolation with inadequate medical care and poor conditions. He recalled, "I just remember looking at walls."[5]

In the United States, Human Rights Watch found that people seeking mental health support in immigration detention risked solitary confinement, discouraging others from seeking care and support.[6]

Failure to provide reasonable accommodations and disability-related support

Human Rights Watch has called on US immigration authorities to provide detained people with disabilities with reasonable accommodations and auxiliary aids and services, including wheelchairs, walkers, hearing aids, other assistive devices, and professional personal assistance for people who require support with activities of daily living.[7] These needs extend not just for the duration of detention, deportation, and return but also upon release into the community until they can access their own assistive devices.

Inadequate medical and mental health care and support

Human Rights Watch research in US immigration detention facilities has documented delays and failures in medical care, lack of access to prescribed medication, inadequate responses to serious health conditions, and barriers to mental health services.

These failures can have particularly serious consequences for people with disabilities and people with chronic health or mental health conditions who require continuity of treatment, medication, assistive devices, or other disability-related support.[8]

In its 2025 research at three immigration detention facilities in Florida, Human Rights Watch found that all 11 people interviewed who had been detained at the Krome North Service Processing Center reported not having access to needed medication during their time there.[9] People with diabetes, hypertension, HIV, severe migraines, and other chronic health conditions described interruptions in essential treatment. One man living with HIV reported being denied his medication for 13 days, causing his previously undetectable viral load to become detectable. Another man with diabetes, pancreatitis, asthma, and heart disease was deprived of insulin and other medications despite his family having delivered a three-month supply to the facility; after being denied insulin for nearly a week at another detention facility, he collapsed and was hospitalized with signs of cardiac distress. A woman with gallstones repeatedly sought medical assistance but began vomiting and lost consciousness after several days without adequate care; after emergency surgery to remove her gallbladder, she was returned to detention and was again denied medication prescribed by the hospital.[10]

Our research also found serious barriers to mental health support. One detained man received psychological assistance only after saying he was suicidal, and thereafter for just five to ten minutes a month. Another man with post-traumatic stress condition received approximately 15 minutes twice a month. At the Broward Transitional Center, detained people feared seeking psychological support because emotional distress could lead to solitary confinement. One woman said: "If you ask for help, they isolate you. If you cry, they might take you away for two weeks. So, people stay silent."[11]

In Human Rights Watch's research on third-country nationals deported from the United States to various countries in Africa, people provided similar accounts of failure to provide adequate medical care during their time in detention in other locations as well. For example, a 26-year-old woman who was deported to Cameroon, said that she was detained for ten days in January 2025 in what she thought was a Custom and Border Protection (CPB) holding cell, during which time, "We slept on the floor. It was very cold." She was transferred to the Bluebonnet Detention Center in Anson, Texas, where she said conditions were deplorable. "I had arrived with a chronic illness, hypothyroidism, and I never received treatment for that in detention. . . I was always cold, my eyes hurt, and [parts of her body] wouldn't stop swelling."[12]

Research on third-country nationals deported from the United States to Mexico found that people with disabilities and chronic health conditions faced barriers to health care and medication after deportation. At least 20 men interviewed by Human Rights Watch deported from the United States to Mexico reported a health condition, 14 of them chronic, most commonly diabetes and hypertension. At least 20 of them were 60 or older. Some arrived with little or no medication, and lost access to treatment they had received in the United States. Without legal status, employment, or identity documents, they could not afford or obtain medication or treatment in Mexico.[13]

Human Rights Watch's joint research with Physicians for Human Rights on deaths in detention facilities in the United States found evidence that several of the 39 people who died in immigration detention during the first year of the current administration received inadequate or delayed health care, raising serious concerns that the deaths may have been preventable.[14]

These failures have had particularly serious consequences for older people, people with disabilities and people with chronic health or mental health conditions who require continuity of treatment, medication, assistive devices, reasonable accommodations, or other disability-related support.

Disability-related barriers to release

In Canada, people with psychosocial disabilities faced additional barriers to release.[15] Human Rights Watch documented the case of a man who remained in detention despite being ordered released because a government-contracted community organization refused to supervise him in light of his disability. Border officials said people in detention needed to be sufficiently "stable" for community supervision. Lawyers reported that authorities also used a lack of accessible medication in the community as a reason to prolong detention.[16]

Release from detention in Canada can also depend on securing a place in a residential treatment program.[17] Human Rights Watch found that such programs had limited availability and could require eligibility assessments that could not be completed while a person remained in detention, which further delayed release. These practices can create a discriminatory cycle in which a person's disability, or the absence of appropriate community-based health and disability support, becomes a reason for continued deprivation of liberty.[18]

2. How disability shapes experiences at different stages of migration

Human Rights Watch research indicates that disability can affect migrants not only during detention but throughout immigration enforcement and proceedings.

People with disabilities may require accessible information, communication support, assistive technology, reasonable accommodations, or personal assistance to understand and participate effectively in immigration procedures. Failure to provide these accommodations can prevent people with disabilities from exercising their rights on an equal basis with others.

In Canada, disability can impact effective participation in detention proceedings.[19] The Immigration and Refugee Board may appoint a "designated representative" when an adjudicator considers a person unable to appreciate the nature of the proceedings. Human Rights Watch found these assessments are routinely informal and inconsistent; lawyers described them as "superficial and cursory" and "extraordinarily variable," sometimes lasting only minutes and failing to assess accommodations or decision-making support that could enable participation.[20]

Prosper Niyonzima's case illustrates the consequences of the "designated representative" system. After a severe mental health crisis left him catatonic and unable to communicate, his monthly detention reviews continued for about two years through a designated representative who, according to an external audit, never communicated with him. Hearings sometimes lasted less than five minutes. When Prosper appeared at one hearing, he seemed unaware of his surroundings and put his head on the table. Rather than providing accommodations, authorities characterized him as "non-cooperative" and accused him of obstructing his removal.[21]

Disability-related barriers can continue after deportation procedures. Javier, a 66-year-old Cuban man deported from the United States to Mexico, had lost vision in one eye due to diabetes and frequently became disoriented. His asylum case was closed twice after he missed required in-person check-ins. Even after authorities acknowledged his age and health condition and reopened his case, they continued requiring him to report in person. Similar requirements created barriers for other older people with physical disabilities and chronic health conditions.[22]

3. Ableism and medical approaches to disability in migration governance systems

In Canada, rather than identifying the support or accommodations a person needs to exercise legal capacity in immigration detention, the law allows for a shift in decision-making to another person - a "designated representative" - thus undermining equal recognition before the law and supported decision-making.[23]

As noted above, disability-related requirements can become barriers to release from immigration detention when community support is unavailable or where authorities require people with psychosocial disabilities to demonstrate "stability" before providing access to community programs. Such requirements risk failing to treat disability as something that requires appropriate support and accommodations.

Legal systems should not use disability, "perceived incapacity," need for treatment, or need for support as grounds for restricting liberty or participation. Disability-related support should facilitate the exercise of rights, rather than function as a condition for accessing them.

An example of how ableism and medicalization can shape broader migration systems is the new EU Pact on Migration and Asylum.[24] The CRPD has argued that its reliance on "vulnerability" and medical assessments may overlook disability-related support requirements and reasonable accommodations, limiting participation and increasing the risk of unlawful detention.[25]

4. Intersectional discrimination: children and older persons with disabilities

Human Rights Watch has identified particular risks for migrant children with disabilities.

Human Rights Watch documented that funding cuts led to the closure of specialized support programs for refugee children with disabilities in Cox's Bazar, Bangladesh. Such programs are no longer available in either Cox's Bazar or on Bhasan Char island.[26] Refugee children with disabilities have the right to access a system of inclusive, quality education on an equal basis with other children, including reasonable accommodations and individualized support.[27] The closure of these programs underscores the importance of ensuring that humanitarian education responses are inclusive and provide the support required for children with disabilities to fully participate in and benefit from education.

Immigration authorities should take into account both the rights of children and the disability-related requirements of individual children.

Human Rights Watch research also shows how disability can intersect with age following deportation.[28] As discussed in Section 2, older people with disabilities deported from the United States to Mexico faced particular barriers in accessing immigration procedures, health care, and other essential services.[29] Some told Human Rights Watch that they felt it was harder for them to find a job than for younger deportees due to their age and health conditions. Felipe, a 70-year-old man with diabetes and diabetes-related complications that affect his ability to walk, described being unable to find a job in Villahermosa: "Who do you think is going to want to employ [me] given all the problems I have with my legs?".[30]

5. Making migration legislation, policies, practices, and governance disability-inclusive

Human Rights Watch encourages the Special Rapporteur to recommend that states:

1. Stop holding people with physical and psychosocial disabilities in immigration detention, in line with the guidance of the UN Working Group on Arbitrary Detention, and work toward ending immigration detention. Persons' disabilities should be taken into account when determining the legality, necessity, and proportionality of any custodial or non-custodial migration enforcement measure, including the impact of these measures on mental health.
2. Guarantee equal recognition before the law and supported decision-making. Immigration and asylum systems should recognize the legal capacity of people with disabilities on an equal basis with others. Substitute decision-making arrangements should be replaced with systems of support that enable people with disabilities to make their own decisions in accordance with their will and preferences.
3. Provide procedural accommodations throughout immigration and asylum proceedings. States should ensure that people with disabilities can participate effectively in immigration, asylum, detention review, and return proceedings. Necessary accommodations and support should be identified individually and provided without requiring proof that a person is incapable of participating without them. Reporting, check-in, and other procedural requirements should be suspended or adapted when they are impossible or unduly burdensome because of disability or related circumstances, and failure to comply with inaccessible requirements should not automatically result in case closure or detention.
4. Ensure accessibility throughout the migration process. Accessibility obligations should apply from a person's first interaction with immigration authorities through registration, screening, immigration or asylum proceedings, detention or alternatives to detention, transfers, and return, deportation and release. Measures should include sign language interpretation, accessible information and alternative communication formats, assistive technologies, and individualized accommodations.
5. Guarantee reasonable accommodations and disability-related support. Immigration authorities should make reasonable accommodations, auxiliary aids and services, assistive devices, and personal assistance where required, including wheelchairs, walkers, hearing aids, communication support, and assistance with activities of daily living.
6. Prohibit solitary confinement for people with intellectual, developmental, or psychosocial disabilities, and all punitive responses to disability or mental health crises. People experiencing mental health crises should receive appropriate support and care rather than isolation, punishment, or increased restrictions.
7. Ensure timely and appropriate health and mental health services and continuity of care. Migrants, refugees, and asylum seekers with disabilities should have access to quality health and mental health services, continuity of medication and treatment, rehabilitation where required, and disability-related support. Mental health services should be accessible, voluntary, culturally appropriate, and non-punitive. When a person is transferred or deported to another country, authorities should take appropriate measures, with the person's consent, to facilitate continuity of care, including access to necessary medication, health and mental health services, and disability-related support following arrival.
8. Ensure that disability-related support requirements never become barriers to release. A lack of accessible housing, personal assistance, mental health services, or other community support should not justify continued immigration detention. States should ensure that community-based alternatives include the individualized disability-related supports necessary for people to live in the community.
9. Consider disability and related support requirements before removal to a third country. Before enforcing a removal order that would transfer a person to a third country, authorities should consider the person's age, disability, mental and physical health, and other humanitarian factors, including whether necessary health care and disability-related support will be available following removal. Receiving states should ensure access to emergency shelter, health care, essential medication, psychosocial and mental health services, and disability-related support following arrival.
10. Ensure heightened protection for children with disabilities, including access to inclusive, quality education in humanitarian emergencies. Children should not be deprived of liberty for immigration-related reasons, and their best interests should be a primary consideration in all decisions affecting them. Children with disabilities should have uninterrupted access to assistive devices, accessible communication, health care, education, and other disability-related supports. Governments and humanitarian agencies should guarantee the right to inclusive, quality education for children with disabilities in humanitarian emergencies, particularly refugee children with disabilities, by providing accessible learning environments, reasonable accommodations, accessible educational materials and communication, assistive devices, trained teachers, and individualized support services. Adequate and sustained funding should be allocated to ensure the availability and continuity of these services, including during humanitarian funding cuts, so that children with disabilities can access, participate in, and benefit from education on an equal basis with other children.