Raúl Ernesto Morales-Ramos, detained in California and ravaged by cancer, begged for treatment. He was given ibuprofen.



Tiombe Kimana Carlos, detained in New York with chronic schizophrenia, was held in solitary confinement. She made a noose from a sheet.

Manuel Cota-Domingo, detained in Arizona with untreated diabetes and pneumonia, began to have trouble breathing. Staff dithered over who should call 911.

All three died, victims – according to a report published on Monday – of dangerously inadequate medical care in immigrant detention facilities across the US.

The joint study by Human Rights Watch (HRW) and Community Initiatives for Visiting Immigrants in Confinement (Civic) details “systemic failure” which results in suffering and preventable deaths.

“The data reveals that people in immigration detention died needlessly under the Obama administration, even with its attempts at reform,” said Grace Meng, a senior HRW researcher. “The Trump administration has already announced its intent to roll back key reforms while detaining even more immigrants, which would likely mean more people will die needless and preventable deaths.”

The 104-page report, Systemic Indifference: Dangerous & Substandard Medical Care in Immigration Detention, details delays, mistakes and unaccountability in a network of facilities which detain about 40,000 people daily and 400,000 a year.

The Trump administration is seeking $1.2bn additional funding to expand detention capacity, raising alarm that inadequate medical care will worsen. More than two-thirds of detainees are held in facilities operated by private prison companies.

The report is based on independent medical experts’ analyses of records from US Immigration and Customs Enforcement’s (Ice) own investigations into 18 deaths in detention from 2012 to 2015 and the medical records of 12 additional detainees, plus interviews with more than 90 other people, including relatives, attorneys and correctional health experts.

“The medical experts found numerous incidents of substandard and dangerous medical care, including failure to follow up on symptoms that required attention; medical personnel apparently practicing beyond the scope of their licenses and expertise; severely inadequate mental health care; the misuse of solitary confinement for people with mental health conditions; and sluggish emergency responses,” said the report.

The experts concluded that subpar care contributed to seven of the 18 deaths.

Among them was Morales Ramos, a Salvadorean held in Adelanto, California. He showed symptoms of cancer in 2013 but his appeals for treatment were largely ignored, according to the report.

In a grievance submitted in February 2015, he wrote: “To who receives this. I am letting you know that I am very sick and they don’t want to care for me. The nurse only gave me ibuprofen and that only alleviates me for a few hours. Let me know if you can help me.” He died two months later.

Kimana Carlos, originally from Antigua and Barbuda, was diagnosed with schizophrenia as a teenager. Staff at the detention facility in York, New York, knew her condition but gave “woefully inadequate” mental health treatment, according to doctor cited in the report. She hanged herself in October 2013.

A restriction on which staff members can call 911 at the Eloy detention centre in Arizona contributed to an eight-hour delay in treatment for Cota-Domingo, a 34-year-old Guatemalan, who suffered breathing problems related to diabetes and pneumonia.

The report also alleged non-fatal delays and inadequacies in treatment for detainees with other conditions, including a torn ligament and vision problems.



Such a critique is not new. This is the third report HRW has released on medical care in immigrant detention since 2007. Last week, Penn State Law’s Center for Immigrants’ Rights Clinic and Project South published a study detailing complains and alleged abuses at two Georgia detention centres.



The Guardian last year reported on the case of Jose Jamarillo, who died after inadequate care at a facility in New Mexico. A facility in Pennsylvania allegedly left a five-year-old’s highly contagious disease untreated for weeks.

There is evidence that Ice knows about deficiencies in medical care but lacks procedures to take swift, appropriate action, said Christina Fialho, an attorney and the co-executive director of Civic.



“The sheer number and consistency of cases involving inadequate medical care point to a crisis that warrants immediate action. The medical experts’ analyses confirm what we have been hearing from detained immigrants for years. It’s past time to put an end to the substandard medical practices that harm many people in immigration detention each year,” she said.

Ice will review the HRW/Civic report to determine what changes, if any, should be made based on its recommendations, a spokesperson, Jennifer Elzea, said in a statement to the Guardian.

The agency was committed to ensuring the welfare of all those in its custody, she said.

“Staffing for detainees includes registered nurses and licensed practical nurses, licensed mental health providers, mid-level providers that include a physician’s assistant and nurse practitioner, a physician, dental care, and access to 24-hour emergency care.”



A detainee with a medical condition requiring follow-up treatment will be scheduled for as many appointments as needed, she added. “At no time during detention will a detainee be denied emergent care.” The agency said it spent more than $180m annually on detainee medical care.