The child and the man were locked up at the infamous Border Patrol detention center in McAllen, Texas, where immigrants are kept for a few days before they are transported to long-term detention centers run by Immigration and Customs Enforcement. The McAllen center is notorious for putting detainees in cage-like rooms and, during the recent “zero tolerance” period, for separating parents from their children. Immigrants know it as “the icebox” and “the dog pound.”

At a different South Texas detention center, another young Guatemalan child recently came down with a common illness that is easy to identify in its early stages but which can kill if not diagnosed and treated. Treatment was delayed for days, however, and the delay put the little girl’s life at risk. And less than three months before that little girl became sick, a Honduran man who spent time at the same facility died from a life-threatening illness that was not diagnosed.

The death of a Guatemalan child soon after leaving immigration detention made national news this week amid speculation that conditions in detention were responsible for her demise. It is not clear why 19-month-old Mariee Juárez became fatally ill, or if she suffered medical neglect at the South Texas Residential Center, the family detention center better known as “Dilley.” Her family alleges that Mariee became ill due to unsafe conditions and died as a result of medical neglect.

A one-page transport request form in the child’s case was generated by the government and sent to a hospital that later treated her, so the document ended up in her hospital records. It indicates that medical care at the McAllen facility is provided by the Division of Immigration Health Services, which is part of the U.S. Public Health Service. DIHS supplies medical staff to many long-term immigration detention facilities, including Dilley. Many ICE detention centers have been investigated for medical negligence over the past decade. But there has been little discussion of similar problems in short-term detention centers such as the one where the Honduran man died and the little girl was put at risk of death.

The Intercept attempted to obtain records of the child’s medical history while she was held at the McAllen detention facility, but was told by Customs and Border Protection and ICE that the records are obtainable only through a Freedom of Information Act request. The following account of the little girl’s medical ordeal was provided by her mother.

The Intercept will refer to the mother as Ingrid and to the child as Paulina, in order to protect the family from U.S. government reprisals and from people in Guatemala who want to hurt them.

A Determined Mother

Ingrid has three children who were 3, 5, and 8 years old when they left Guatemala in July to escape attacks against Ingrid by her severely abusive husband. She had money for only two bus tickets, so the family took turns sleeping in bus seats and on the floor. The arduous trip took almost three weeks. Even so, when they arrived in Texas in early August, everyone seemed healthy, including 5-year-old Paulina.

After they were arrested near the Rio Grande by the Border Patrol, the family was transported to the “icebox” in McAllen. It was Saturday, around noon, Ingrid remembered. They were fed half-frozen ham sandwiches on white bread, which the children found distasteful. Paulina took a bite and refused to eat more. A few hours later, she said she felt nauseous. Ingrid chalked it up to the sandwich.

But the next morning, on Sunday, Paulina’s cheeks were flushed. She had a fever, was crying, and said her whole body hurt. Ingrid asked for medical attention, and someone dressed like a doctor gave Paulina a liquid medicine and said that she felt ill simply because she was acclimating to the cold temperature inside the facility. Ingrid was told that Paulina should eat and drink water.

Two hours later, Paulina began complaining of pain in her lower right abdomen and below her belly button. By evening, Ingrid was concerned and again took Paulina for medical attention. The little girl still had abdominal pain and a fever, but the medical staffer did not lay her down on an examining table or palpate the site of the pain. Instead, Paulina got a visual evaluation while she was sitting up and clothed. Ingrid was again advised to have her daughter “drink liquids.” Paulina went back to her cell and fell asleep.

By Monday morning, she had been sick for over 40 hours and was getting worse. She was crying and saying that she needed to pee but couldn’t get to the bathroom because moving her body was too painful. Ingrid carried her, but sitting on the toilet proved so painful that the little girl could not position herself. She urinated on her clothes.

Horrified, Ingrid took Paulina once again to the medical office. Again, the staff failed to lay her down and check her abdomen. They merely took her temperature and gave her medication for fever.

For the next 23 hours, Paulina mostly slept. On Tuesday morning, she awoke and said the pain was so bad that she couldn’t breathe. Ingrid approached the guards and once again requested medical attention. In seeming disgust, a guard asked, “Now what?” Again, Paulina was not given an abdominal exam.

On Tuesday afternoon, Ingrid was told that the family was being released and would be taking a days-long bus trip to the East Coast to join a friend whom Ingrid had designated as the family’s U.S. sponsor. Ingrid could not imagine Paulina traveling in the shape she was in, but the family was put in a line with others who were being readied for transport to the bus station in McAllen. Ingrid was desperate for another medical visit for Paulina, but she was afraid the guards would again get angry if she requested one. She asked to go to the bathroom, even though her true destination was the clinic. She snuck off with Paulina in her arms.

It was now over 70 hours since Paulina had first started to feel sick, and 50 hours after she’d started complaining of abdominal pain on her lower right side. For the first time, the medical staffer laid the child down and touched her belly. The staffer then told Ingrid that medicine was being ordered for Paulina but it wouldn’t arrive for two hours. It was about 3 p.m.

By 9 p.m., the medicine still hadn’t come, and Paulina said she could no longer stand the pain. While she was talking about this to Ingrid, she suddenly passed out. Finally, a medical staffer called for an ambulance.

Paulina came into the emergency room with a fever of 103.1 degrees, serious dehydration, a pulse of 170, and abdominal pain, according to medical records. She was quickly diagnosed with a ruptured appendix and peritonitis — a potentially fatal inflammation of the tissues around the organs, caused by bacteria leaking from the appendix. Within hours, she was given an appendectomy. She received large doses of intravenous antibiotics to counteract the peritonitis, and a tube was inserted into her belly to drain the infected fluid.

“Beyond Words”

The Intercept provided Dr. Dolly Sevier, a pediatrician who practices in South Texas, with Ingrid’s chronology of Paulina’s illness while in CBP detention. Sevier also reviewed records The Intercept obtained of Paulina’s treatment in the emergency room.

Based on that information, Sevier called CBP’s medical care of Paulina “negligent.” According to her mother’s chronology, Sevier said, the little girl should have been sent to an emergency room early on Sunday, less than a day after being put into Border Patrol detention, if only because medical staff there had already noted then that the little girl was dehydrated.

Sevier said that if Paulina had been properly examined, appendicitis would have been suspected by Sunday afternoon. When an infected appendix is untreated over days, it ruptures, creating the possibility of massive internal infection that can lead to death. Sevier theorizes that Paulina’s appendix ruptured on Tuesday night, which would explain why she lost consciousness. That was 2 1/2 days after she should have first been sent to an emergency room. If Ingrid’s account is accurate, Sevier said, CBP’s negligence is “beyond words.”

Thanks to her mother’s persistence, Paulina’s appendicitis was caught and treated in time, and today she is healthy. Ronal Francisco Romero was not so lucky. The 39-year-old Honduran was apprehended by Border Patrol on May 9 while crossing into the U.S. illegally. He was taken to the agency’s processing facility in McAllen and stayed there for five days, until May 14. Then he was transferred to a nearby ICE detention center in Los Fresnos, Texas. Within a few hours of arriving there, medical staff had him transported to a nearby hospital. He was put into intensive care and died hours later.