The life of an Indian asylum seeker on hunger strike in US detention is at risk because of the “abysmal” treatment he is receiving from US Immigration and Customs Enforcement (Ice), which began force-feeding him two weeks ago, a doctor warned in court documents filed this week.

Dr Parveen Parmar, chief of the division of global emergency medicine at the University of Southern California, said in an affidavit that the 33-year-old asylum seeker, Ajay Kumar, is receiving “the worst medical care I have seen in my 10 years of practice”.

Kumar is one of three Indian men on hunger strike in an El Paso immigration detention center who is currently being force-fed – an act medical bodies and human rights groups have argued represents a form of inhumane and degrading treatment.

Three other men were also part of the hunger strike, which began on 8 July, but advocates do not know their current status because two of them were deported and a third was transferred to a detention facility in Florida. A seventh man has ended his strike.

The men have been in detention for nearly a year, or longer. The prolonged detention, coupled with their fear of political persecution for their activism in India, prompted the hunger strike.

It is only the second time advocates have documented force-feeding in Ice detention – the first was in January this year, when at least nine Indian men went on hunger strike.

The cases have been shrouded in secrecy, but on Tuesday, a federal judge made Parmar’s signed affidavit public, revealing the doctor’s concerns.

“As is clear from my review of his medical record, his health is at risk in Ice custody not solely from his hunger strike, but from the truly substandard medical care he is receiving in detention,” Parmar wrote.

After Parmar reviewed “roughly 471 pages” of Ice medical records and court testimony from an unnamed Ice doctor, she concluded the Ice doctor does not fully understand the consequences of prolonged starvation and lacked knowledge about basic medical facts. In separate court documents, the doctor is identified as Michelle Iglesias.

Ice did not respond to questions about its doctor or the hunger strikes.

The attorney representing Kumar’s asylum case, Linda Corchado, said she spoke to a very thin and frail Kumar on Tuesday – 17 days after the feeding tube had been inserted. He weighed 143lb when he started striking and has now dropped to 115 lb, she said. “He speaks well, and every now and then he’ll have to stop himself, and he’ll look downward and start swallowing hard and stop, then start talking again,” she said.

Corchado, director of legal services at Las Americas Immigrant Advocacy Center, represents two of the other hunger strikers in the El Paso Service Processing Center, including one who quit his protest when the feeding tube was inserted to his nose, causing bleeding and breathing problems that required the use of an oxygen mask.

She said he had been hospitalized for three days for a severe throat and nose infection and that Ice began the force-feeding the same day he left the hospital. A fourth hunger striker in El Paso is being represented by another attorney.

An excerpt of a letter written by an Indian detainee in the first few days of his hunger strike in an El Paso detention center. Photograph: Advocate Visitors with Immigrants in Detention (Avid)

The force-feeding process in immigration detention is shrouded in secrecy. News of a hunger strike reaches advocates by word-of-mouth and court orders to allow force-feeding are usually under seal.

The American Medical Association has repeatedly stated competent patients have a right to refuse medical interventions, even if they are lifesaving. When reports emerged of force-feeding in Ice detention earlier this year, the UN human rights office warned the US could be violating the UN convention against torture.

The advocacy group Freedom for Immigrants has documented at least 1,396 people on hunger strike in 18 detention facilities since May 2015.

In December and January, Ice force-fed at least six Indian men through plastic nasal tubes. Orders to allow force-feeding had been secured before, but there was no record of them being acted on until then. Four other detainees were also on hunger strike at the time in Miami, Phoenix, San Diego and San Francisco.

A glimpse into the force-feeding process was available at a 16 August court hearing, when Iglesias, the Ice doctor, described the force-feeding process she had recommended.

Iglesias said that at least 10 medical and detention center personnel were needed to conduct the procedure, according to Texas Monthly. She said six guards surround the detainee in case of resistance, an x-ray technician checks to be sure the tube was inserted correctly – a concern about force-feeding is the tube can accidentally be inserted into the lungs – and as many as five other detainees observe.

Iglesias told the court, repeatedly, that force-feeding is medically unethical but it was required by Ice regulations. “There wouldn’t be anyone in a hospital who would do it,” Iglesias said.

Iglesias also testified the feeding tube inserted into detainee’s noses was the same diameter as a plastic drinking straw, which would make them at least 1mm larger than the tubes used at the Guantánamo Bay detention facility, according to military standard operating procedure documents obtained by Al Jazeera in 2013.

Parmar, who testified that she regularly cares for detained patients in Los Angeles, said the medical records showed the Ice physician did not have a conversation with Kumar about the risks, benefits and alternatives to forced hydration and feeding in his language.

“This lack of appropriate attention to critically low blood pressure and astonishingly infrequent MD evaluations of a very ill patient, on whom treatments are being forced without their consent, would never be tolerated in any hospital and is, frankly, the worst medical care I have seen in my 10 years of practice,” Parmar said.

Parmar ender her assessment by recommending Kumar be released from detention while his asylum case moves through the courts.

‘Now I have no solution of my problem. My hope is broken,’ wrote a migrant on hunger strike in an El Paso detention center. He is now being force-fed Photograph: Advocate Visitors with Immigrants in Detention (Avid)

Margaret Brown Vega and Nathan Craig have been visiting the asylum seekers in El Paso once or twice a week since before the hunger strike began as part of their work with Advocate Visitors with Immigrants in Detention, a group that visits and corresponds with detained migrants.

On Sunday, they spoke to the men through a glass partition using telephone receivers they said the men struggled to hold up. The men were brought into the visitation room in wheelchairs because they are so weak from the lack of food. “Sometimes these guys look like walking dead,” Craig said.

One of the men, who is 5ft 9in, now weighs about 95lb. He crossed the southern border into the US to seek asylum after fleeing the Indian state of Punjab, where he said he was targeted for political activism.

He started the hunger strike after a judge denied his request for bond. On Wednesday, his appeal to have his asylum case reconsidered was denied.

Immigration judges have huge discretion in determining who can be released on bond, a legal right Donald Trump’s administration has worked to restrict. Efforts to limit bond, along with the Trump administration’s aggressive immigration clampdown, have seen detention rates skyrocket to an all-time high of more than 54,300 people.

In July 2018, a federal judge ordered the government to conduct individual reviews of more than 1,000 asylum seekers’ cases after lawyers sued the government for denying nearly all parole request for asylum seekers in five field offices, including El Paso, since early 2017.

Parole is only available to people who seek asylum at legal points of entry, while those who cross outside border checkpoints must apply for bond. Before Trump took office, parole was granted to more than nine out of 10 asylum seekers, according to the suit.

“When you look at people like my clients, who have constantly been sent to hospital for emergency care and are a huge expense to the government because they are hunger strikers, what is Ice’s prerogative to keep them detained?” Corchado said.

“It’s these desperate acts for release that are deeply troubling to me, but in my eyes it’s a symptom for something much deeper, which is the system we are operating now would rather keep an asylum seeker detained than release them into our country,” Corchado added.