The asylum-seeking mothers with their young children don’t sleep well at the Berks family detention center in Leesport, Pennsylvania. That’s because multiple times per night guards shine flashlights into detainees’ rooms to make sure they’re still there, according to Jackie Kline, a volunteer attorney who represents women and children detained there,

It’s one of the many hardships detainees face at the 96-bed detention center, where mothers say their children lose weight and act out.

“The wails of children in family detention centers sound a lot like what you hear in that ProPublica recording,” said Bree Bernwanger, who was the managing attorney for the Dilley detention center Pro Bono Project in 2016. “This is all a part of the same strategy, and it’s dehumanizing.”

Advocates say President Donald Trump’s new executive order designed to stop family separations would result in a dramatic increase of family detentions, when parents and their children are locked up together. The practice grew under President Barack Obama, when the Department of Homeland Security responded to a surge of young migrants crossing the southern border by putting up facilities to detain them and their parents.

Currently, DHS has the capacity to hold a few thousand people in family detention. That number could explode, as Trump’s executive order calls for children and their parents to be detained together until their immigration cases are processed.

One big hurdle stands in the way: the Flores settlement, a 1997 consent decree that bars the detention of children, in most cases, for more than 20 days. Trump’s executive order directed the Justice Department to challenge Flores to try and expand the government’s power to detain families.

If the DOJ’s challenge to Flores is successful, advocates believe the practice of family detention could expand dramatically. And they argue this will put children at risk.

Kline said the majority of children detained at Berks lose weight.

“It’s not a typical diet for what clients are used to eating,” she said.

Bernwanger said she saw the same phenomenon at Dilley.

“I hear a chorus of mothers telling me, ‘My child won’t eat, they can’t hold it down, my child stopped eating, my child can’t eat,’” she said. “Over and over and over again. ‘My child is sick, I went to the clinic, they didn’t do anything.’”

“I had a mom the other day, crying, saying she didn’t know what to do because she thought her kid had lost over ten pounds, and that she used to be too heavy for her to carry, now she carries her around everywhere,” said Katy Murdza, who Advocacy Coordinator at the Dilley Pro Bono Project. Murdza added that the child was 4.

Christina Brown, a lawyer who works with clients who have been detained, said the medical care problems were startling.

“We’ve had people in family detention who have cancer scares and they were being told to take Ibuprofen and drink water,” she said.

Advocates said many children experience behavioral regression, when their development seems to reverse—wetting the bed, biting other children, and otherwise acting out.

Kline said her clients also complain that they don’t get adequate medical care.

“Everything is, ‘Oh, just drink more water,’ no matter what the issue is,” she said.

“We had a child who was throwing up blood and was not taken to the hospital,” Kline added. “She was throwing up blood for days.”

Murdza said in November, a 4-year-old girl was having diarrhea and wasn’t eating. “The doctor wasn’t taking it seriously, according to the mom, wasn’t providing treatment,” Murdza said. “And eventually the doctor said that she had bulimia—which did not sound right, especially considering that she was 4. And she lost 8 pounds.”

“You could see her ribs,” Murdza said the mother told her. “Her eyes looked sunken.”

“There was another 5-year-old that asked her mom, ‘When are we going to get out of this hell?’ a few weeks ago,” Murdza added. “Her mom told me that.”

ICE defends the practice of family separation. “ICE ensures that family residential centers operate in an open environment, which includes medical care, play rooms, social workers, educational services, and access to legal counsel,” said ICE spokesperson Sarah Rodriguez in a statement.

“As detailed in the June 2017 DHS Inspector General’s report, the family residential centers are ‘clean, well-organized, and efficiently run’ and the agency was found to be ‘addressing the inherent challenges of providing medical care and language services and ensuring the safety of families in detention.’”

Rodriguez also said ICE provides good medical care to the detainees in its custody.

“ICE takes very seriously the health, safety and welfare of those in our care. ICE is committed to ensuring the welfare of all those in the agency’s custody, including providing access to necessary and appropriate medical care,” she said. “Comprehensive medical care is provided to all individuals in ICE custody. All detainees receive a comprehensive physical exam within 14 days of arrival to identify medical, mental health and dental conditions that require monitoring or treatment. A detainee with a medical condition requiring follow-up treatment will be scheduled for as many appointments as needed, including with outside medical providers or facilities, if needed. All ICE detainees, regardless of location, can expect timely and appropriate responses to emergent medical requests, and timely medical care appropriate to the anticipated length of detention. At no time during detention will a detainee be denied emergent care.”

Advocates disagree.

“The argument that, ‘Well, family separation is abhorrent, it’s horrible, we shouldn’t be doing it—at least this is less horrible,’ I mean, that’s just not true,” Kline said. “It’s just horrible in a different way.”

And the detention has lasting consequences for how children view institutions, according to advocates.

“We’ve had kids who, they didn’t want to go into a school building because it looked like Berks,” Kline said. “And they were afraid that if they went into school, they would never come out again.”