After Sara and her family were released from the detention facility, they were dropped off at the Brownsville bus station. A city-funded van escorted them to the refugee respite center at Good Neighbor Settlement House. It’s one of many borderlands shelters, often run by faith-based nonprofits, where migrants can stop for a shower, clothes, and food before they travel across the country to meet up with sponsors or relatives. Soon after Sara and her family arrived at Good Neighbor, workers there called an ambulance: The baby had a 103-degree fever.

As an increasing number of asylum-seeking families stream across the southern border of the United States, lawyers, doctors, and even government inspectors have criticized the facilities run by Border Patrol for being overcrowded and unsanitary. Reports from those who have been allowed in say that there’s no soap, no toothbrushes, and people are getting very little sleep. Earlier this month, a Guatemalan mother tearfully testified before Congress about her 19-month-old daughter, who died from a respiratory infection shortly after she was released from the custody of Immigration and Customs Enforcement in May of 2018. “My beautiful girl is gone, but I hope her story will spur this country’s government to act, so that more children do not die because of neglect and mistreatment,” she said.

In early July, President Donald Trump signed an aid package aimed at improving conditions for detained migrants like Sara and her kids. Some of the $4.6 billion will fund Customs and Border Protection to provide medical care and food to migrants. But progressive Democrats were hoping for more reforms, such as higher medical standards in detention. The New York congresswoman and Democratic socialist Alexandria Ocasio-Cortez said that voting for the bill was akin to an “abdication of power.”

Last month, the number of migrants caught crossing the southern border dropped for the first time this year, as is typical in the hot summer months, but tens of thousands of migrants still cross every month and flood overcrowded detention centers. In May, an average of 4,600 people a day crossed the border illegally or without proper documents, according to a Department of Homeland Security memo. Because CBP’s detention capacity along the border is only 4,500, the conditions in the holding facilities are still at “crisis levels,” a DHS official told The Washington Post. In a statement on July 9, the DHS acting secretary, Kevin K. McAleenan, said, “We are past the breaking point and in a full-blown emergency.”

While some migrants might arrive sick from conditions in their home countries or on the way to the United States, some doctors I spoke with say that border facilities themselves have become a disease vector. Cursory medical screenings and crowded holding rooms leave tired and weak asylum seekers vulnerable to contracting illnesses both minor and severe. Some migrants become so ill that they’re rushed to the emergency room for treatment either while they’re still in detention or just after they’re released.