In an El Paso federal courtroom on Friday, a doctor working for Immigration and Customs Enforcement calmly described the mechanics of force-feeding migrants who are hunger-striking at an El Paso detention center, a process that the United Nations has called “cruel, inhuman, and degrading” and she called “uncomfortable.”

Under questioning from a government lawyer, Dr. Michelle Iglesias said that it takes at least ten medical and correctional personnel to conduct the procedure, which involves inserting a long flexible tube through the detainee’s nose, down the throat, and into the stomach. “It looks like a plastic straw, the same diameter,” Iglesias, 37, told U.S. District Judge David Guaderrama. An X-ray technician checks to make sure the tube was inserted correctly. Six guards surround the detainee—one for each arm and leg, and one at each end of the bed—to respond to any resistance. As many as five other detainees, including fellow hunger-strikers, are in the same room as the sometimes-bloody procedure unfolds.

At the hearing, attorneys for ICE sought permission to force-feed two men from India who have gone without food for 39 days in a bid to be released on bond while courts decide their immigration cases. The men have said they will die in jail rather than be returned to certain political persecution in India.

Iglesias referred to the men several times as “my hunger strikers.” “It’s difficult to watch a very young individual do self-harm to himself. It’s very difficult to see someone slowly dying,” she said on the stand.

Their health situation has become dire. Both men, whose names are being withheld because they have said they could be killed if returned home, now weigh a hundred pounds or less. One of the hunger strikers was in court Friday, dressed in an orange jumpsuit and shackled in a wheelchair. His cheeks were sunken and he struggled to raise a water bottle to his mouth. He showed little emotion and didn’t speak during the hearing, but previously told Texas Monthly he desperately wanted out of detention. “I want to go outside. I want to watch freedom,” he said in a July interview.

Though Guaderrama seemed sympathetic to the men’s argument that they have a First Amendment right to stage a hunger strike as a form of protest, he said previous judicial rulings have made it clear that the government can take measures to prevent someone in custody from starving themselves. The judge said he would issue an order on Friday to begin force-feeding as soon as possible.

Iglesias, an ICE contract physician who also has a family practice in El Paso, has overseen two large-scale force-feedings this year at the El Paso Processing Center. Nine Indian men were force-fed for up to two weeks in January and December. Most were eventually deported, but two of the men resumed hunger strikes after the force-feeding ended and were later released on bond while courts decided their immigration and asylum cases.

Then, on July 8, four Indian men, including the two whose cases were heard on Friday, began a hunger strike to protest their detainment at the Otero County Processing Center in New Mexico. They were later transferred to El Paso, which has medical facilities for hunger strikers.

Until Friday, the court cases had been shrouded in secrecy because ICE had cited medical privacy laws to prevent public access to case records. But the two Indian men in court Friday waived their rights, so the courtroom could be open to the public.

The other hunger-striker at issue in Friday’s hearing was not in court; he was taken to a hospital on Thursday night with severe abdominal pain and diagnosed with ileus, a lack of movement in the intestines that can lead to a life-threatening blockage, Iglesias said. He will likely be discharged from the hospital Friday night if he refuses food, then sent back to the ICE detention facility, she said.

Iglesias testified on Friday that she began force-feeding one hunger striker under court order earlier this week, saying the procedure produced minimal bleeding. She testified that the three other hunger strikers were present for the force-feeding, but denied under cross-examination that having them present was an attempt to intimidate them. Some of the men who went on hunger strike earlier this year told Texas Monthly in March that they had been forced to witness the force-feeding of other detainees.

The doctor said several times during the hearing that force-feeding hunger strikers is widely viewed as medically unethical. “There wouldn’t be anyone in a hospital who would do it,” Iglesias said. But she said ICE regulations required force-feeding if necessary to prevent hunger strikers from starving themselves to death.

But representatives of human rights groups at the hearing said ICE could end the abusive practice by releasing the men. “Force-feeding these men is particularly cruel considering their doctor’s testimony today that they are competent and making an informed choice and considering ICE has the authority to release them, in which case the hunger strikers have said they would willingly resume eating. ICE can and should release these men immediately,” said Ariana Sawyer of Human Rights Watch, which monitors human rights abuses around the world.