This week, a 45-year-old immigrant in the U.S. illegally died in Border Patrol custody. His death follows the December deaths of 7-year-old Jakelin Caal and 8-year-old Felipe Alonzo-Gomez in United States immigration custody, both of which prompted demands for improving healthcare for immigrants in detention.
As a physician who has evaluated dozens of individuals in Immigration and Customs Enforcement detention for legal groups and human rights organizations, I know that high-profile deaths are only one small piece of the story of severely substandard healthcare in America’s immigration detention system.
For example, in one detention center I met and reviewed the medical records of a man who had been thriving and holding steady employment for years while on schizophrenia medications. Then he was picked up and detained by ICE. In detention, he told me, ICE personnel abruptly stopped his medications. After a nearly two-week delay, an alternative medication was prescribed, but it was not as effective. His mental health deteriorated, and he experienced worsening auditory hallucinations and suicidal thoughts. He attempted suicide four times.
Another individual I met with and whose medical records I reviewed had longstanding hypothyroidism, but ICE failed to provide her with thyroid medication in detention. When she was first hospitalized for worsening mental health, her thyroid hormone level was 60 times higher than normal. Despite the hospital medical team’s explicit instructions, ICE still failed to provide her thyroid medication when she returned to detention. It was not until a second hospitalization, again with a critically abnormal thyroid hormone level, that she finally received her medication.
I also met with a man who had developed a stomach ulcer and vomited blood after ICE medical personnel gave him ibuprofen repeatedly for back pain — even though he had reported symptoms of severe heartburn. Any physician applying the proper standard of care would know to minimize prescribing ibuprofen to an individual with severe heartburn.
The kinds of problems I saw are in keeping with the type repeatedly documented by immigrant advocates, filed in litigation and contained in the government’s own reports. According to Freedom for Immigrants, a national advocacy group seeking to end immigration detention, the top complaint they hear from detained immigrants is medical neglect.
In addition, multiple Department of Homeland Security inspector general reports have concluded that detention facilities repeatedly fail to comply with federal standards, including those requiring adequate healthcare. In 2017, a report noted delays in the provision of healthcare and a lack of adequate documentation. And the problems extend beyond healthcare.
A report in January 2019 cited more than 14,000 deficiencies found during inspections of 106 immigrant detention facilities nationwide between October 2015 and June 30, 2018.
Substandard conditions can significantly harm an individual’s health. Many of the individuals I met with said they experienced sleep deprivation from lights being kept on 24 hours a day. Some said they had to wear dirty prison uniforms that caused urinary and vaginal infections. Others complained of being served rotten or inadequate food, a violation of standards that has been repeatedly documented in inspection reports.
Some detainees also reported verbal and physical abuse by guards, which can significantly worsen the mental health of immigrant detainees. For example, during one of his acute mental health crises, the schizophrenic man I interviewed recalled banging his body against a wall as he wrestled with voices telling him to kill himself. He said a guard referred to his distress as a “tantrum” and told him to “get over it.”
Other detainees told me that staff used frequent racial epithets and also referred to them as “crazies,” or “Loony Tunes,” or “trash.” As one detainee put it: “They see us not like human but as animals here.”
Media reports of high-profile deaths capture only a sliver of the human rights violations occurring in detention. None of the patients I interviewed died from the dangerous neglect they experienced, and so their experiences didn’t garner headlines. But their experiences were dangerous — and not uncommon. We need to hold the U.S. government accountable not just for the deaths that occur of immigrants in their custody, but also for the neglect and abuse that can lead to or exacerbate serious health problems.
Altaf Saadi is a neurologist, clinical instructor of medicine and fellow at the National Clinician Scholars Program at UCLA. She has performed numerous evaluations for the Physicians for Human Rights Asylum Network.