Tag: Immigration

Denying Medical Care to ICE Detainees: Treating Their Needs as Optional 

In just one year, the number of people detained by Immigration and Customs Enforcement (ICE) has increased by over 75%, with a record 73,000 people held in detention as of mid-January. As anti-ICE protests across the country call attention to detainees, there is an increasing need to understand the questionable, frequently opaque conditions within ICE detention centers. 

There is mounting evidence that demonstrates ICE detention centers lack the infrastructure to provide basic care to those in the custody of ICE. Consequently, detainees are subjected to persistent medical neglect. These conditions, at least in part, persist due to a lack of legal accountability and legal protections. Immigration detention operates in a state of lawlessness, not because no law applies, but because courts have refused to enforce the law that already exists. The result is a system where ICE detainees routinely fail to receive necessary medical care, while the constitutional limits on that failure remain unenforced.

For those in ICE custody, many remain detained for months or years while their immigration cases proceed. During that time, detainees depend entirely on the government, or its private contractors, for their medical care. Yet, reports and court records consistently document delayed diagnoses, untreated chronic illnesses, failures to provide medication, inadequate mental health care, and preventable deaths. These failures are not isolated incidents. They are repeated offenses, and the law’s ability to serve as a tool to fight against these conditions has been strikingly meager. 

The Supreme Court has long made clear that when the government takes a person into custody and deprives them of their ability to care for themselves, it assumes an affirmative constitutional obligation to meet basic human needs, including medical care. In the prison context, the Court held in Estelle v. Gamble that “deliberate indifference” to a prisoner’s serious medical needs constitutes cruel and unusual punishment under the Eighth Amendment. That case established the floor: Once the state confines a person, medical neglect can qualify as a constitutional violation. 

But immigration detainees are not prisoners. Immigration detention is formally civil, not punitive; it is governed by the Fifth Amendment’s Due Process Clause. Under settled doctrine, civil detainees may not be subjected to conditions that amount to punishment. The Court articulated this principle in Bell v. Wolfish, holding that conditions of civil confinement must be reasonably related to legitimate governmental objectives and not excessive in relation to those objectives. If a condition lacks such a justification, courts may infer that it is punitive and, therefore, unconstitutional. The Court reinforced this affirmative duty framework in Youngberg v. Romeo, holding that when the state confines individuals and renders them dependent on institutional care, due process requires reasonable measures to ensure their safety and basic well-being. 

In theory, this constitutional framework could provide greater protection to ICE detainees than to convicted prisoners; however, courts have done the opposite, instead reinforcing executive deference related to ICE detention conditions. COVID-19 litigation exposed this flaw starkly. In cases like Hope v. Warden York County Prison and Fraihat v. U.S. Immigration & Customs Enforcement, federal appellate courts overturned lower-court orders that sought to protect medically vulnerable detainees. The courts emphasized ICE’s institutional competence and its stated detention interests, while declining to meaningfully scrutinize whether conditions had become unconstitutionally punitive. The consequence is that constitutional rights may exist, but they have been functionally unused. 

From a health policy perspective, judicial inaction could delay essential care. When legal obligations are unclear or unenforced, medical care becomes discretionary. ICE detention is not an exception to constitutional governance; it is a test of it. As long as courts treat immigration detention as a zone of exceptional deference, detainees’ health will remain subject to policy choice rather than legal duty. Until courts reckon with this discrepancy, detainees will continue to suffer the consequences. 

A Crisis of Accountability: Medical Neglect and Preventable Deaths in Immigration Detention

On September 14, 2025, Hasan Ali Moh’D Saleh, a lawful permanent resident, was arrested by Immigration and Customs Enforcement (ICE) and transferred to Krome Detention Center in Miami, Florida for removal proceedings. On October 10th, Saleh was transported to Larkin Community Hospital due to a fever; the next day, he was dead.

As immigration raids take place in front of cameras across the country, an unseen crisis has developed behind heavily guarded gates. With the escalation of Immigration and Customs Enforcement-Related Operations (ERO) in the United States under the second Trump Administration, there is mounting public outcry and a flurry of legal challenges concerning the lack of due process regarding the arrests of undocumented migrants, asylum seekers, and green card holders like Mr. Saleh. Conflicting narratives have emerged between advocates and authorities regarding the safety and welfare of individuals detained in ICE-related actions. 

As of September 2025, the Trump Administration is holding nearly 60,000 immigrants in ICE detention facilities around the country, not including those held by local authorities under detainer requests from ICE. Seven in ten people detained have no criminal convictions; the majority are working age adults who deny serious medical complaints at intake. Even so, detainees are dying in custody at record speed, most often due to illness, according to reports made public by ICE. 

The agency maintains that relevant details linked to ERO-related deaths are published on its website within two days. However, the “relevant details” connected to the demise of immigrants like Mr. Ismael Ayala-Uribe at age 39 are often cloudy. According to ICE records, Uribe was arrested on August 17th, 2025. On September 18th, nurses noted that Mr. Uribe was in “10 out of 10 pain” near his anus, so a physician ordered a pain reliever and fiber. By September 21st, he was vomiting, sweating, and his heart rhythm was abnormal, having deteriorated to the point that medical staff needed to transfer him to a local hospital. The ICE press release, replete with an account of Uribe’s crimes, arrests, and his DACA status, states that early on September 22nd, he became unresponsive and died.

In the landmark Supreme Court case, Estelle v. Gamble, the Court found that such unnecessary suffering is inconsistent with contemporary standards of decency, codifying the common law view that “[we are] required to care for the prisoner who cannot by reason of the deprivation of his liberty, care for himself.” Given the inmate’s complete reliance on staff for medical treatment, the Court explained that the “deliberate indifference to serious medical needs” constitutes the infliction of cruel and unusual punishment involving the “unnecessary and wanton infliction of pain” forbidden by the Eighth Amendment. The Court further held that such neglect by prison doctors and guards can result in torture or lingering death, and in less severe instances, cause unnecessary pain and suffering which serves no legitimate penological purpose.

Legislators have worked to gain oversight of detention centers for the purpose of investigating welfare complaints and medical standards in settings where patients do not have the autonomy to make informed decisions about their healthcare. NPR received a rare look inside ICE facilities via inspection reports from experts hired by The Department of Homeland Security. In the findings from 2017-2019, inspectors cited negligent medical care that, in some cases, contributed to detainee deaths. 

One inspection revealed that in the Calhoun County Correctional Center, a man in ICE custody was sent into general population with an open wound from surgery and no bandaging, even though he still had surgical drains in place. Jesse Dean, a detainee at the same facility, was never referred to a physician although he had been unable to eat, lost almost 20 pounds in a short time, and suffered from severe nausea; he died in custody from an undiagnosed gastrointestinal hemorrhage.

A joint study published by American Oversight revealed that the overwhelming majority of incidents such as Dean’s could have been prevented if ICE detention medical staff had provided timely and clinically appropriate medical care to include correct, appropriate, and complete diagnoses for detained immigrants.

After 2020, loss of life in ICE custody attributed to chronic or acute medical conditions declined, and spiked recently in correlation to Trump-mandated mass ERO’s:

As ICE arrests surge, concern continues to grow over rising morbidity and mortality rates in immigration detention centers, along with the absence of accountability or consequences for responsible parties. While an analysis of factors contributing to preventable detainee medical deaths cannot cure those who are no longer alive, an honest post-mortem inquiry into systemic failures is vital in order to safeguard the living.