U.S. Immigration and Customs Enforcement (ICE) arrests increased by approximately 40% from 2016, 26% of which were not criminal. The startling increase of deaths in custody is particularly worrying.  Of the eighteen deaths in ICE’s custody from 2012-2015, sixteen were due to a lack of proper care and found to be preventable. Recently, there have been more cases of preventable immigration detainee deaths and they should not go unnoticed.  The continuation of this issue is two-fold.  The first part stems from the new deportation priorities, and the second and main concentration is the treatment – or lack thereof – of detainees.

When President Obama was in office, he instituted deportation policies which prioritized detaining those who were “threats to national security, border security, and public safety.”  Under the Obama administration, detaining those convicted of misdemeanors, for example, was low priority compared to detaining convicted gang members.  However, President Trump issued an order rescinding all previous policies related to former President Obama’s deportation priorities. Instead, these new policies target a “much broader set of unauthorized persons for removal and empower individual enforcement officers with broad discretionary authority to apprehend and detain any immigrant believed to be in violation of immigration law […]”  This change creates a shift to a much wider focus on removing all immigrants who are “[…]believed to be in violation of immigration law[…]”

According to a report by Human Rights Watch (HRW), “170 people have died in custody since 2003.” One example of a patient who did not receive proper care is Raul Ernesto Morales Ramos, who died of organ failure with signs of widespread cancer. Throughout his time in detention, Mr. Morales-Ramos begged for care, yet did not receive any until a month before he died. According to experts, he had symptoms of widespread cancer for at least two years. Another preventable death was that of Tiombe Carlos, who committed suicide after a failed previous attempt. The ICE staff was aware of her deteriorating mental health condition, but failed to act. The pattern continues; just this year, six men and women reportedly died because of improper care in immigration detention.

ICE facilities are meant to abide by the INS Detention Standard, which holds that “All detainees shall have access to medical services that promote detainee health and general well-being.”  The standard includes a section, “Sick Call”, that outlines the opportunity detainees have to request healthcare services and the standard of care facilities are required to meet.  In addition to the INS Detention Standard, ICE facilities are bound by the International Covenant on Civil and Political Rights (ICCPR) and the UN Principles of Medical Ethics; both protect the rights of detainees and are ratified by the United States.  Article 10 of the ICCPR indicates that “All persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person.”  Additionally, according to the first principle of the UN Principles of Medical Ethics, health personnel are required to provide prisoners “[…] with protection of their physical and mental health and treatment of disease of the same quality and standard as is afforded to those who are not imprisoned or detained.”

Based on the data, not only are ICE facilities taking an approach that is the opposite of that outlined by the INS Detention Standard, but they also break international codes.  For Morales-Ramos to reach the point of begging for treatment – and in turn his life – is depriving him of “[…]respect for the inherent dignity of the human person.”  Furthermore, one can reasonably assume that a person who is not detained would not have had to beg, or wait until one month before his or her death for treatment. By both allowing Mr. Morales-Ramos to reach the point of begging for care then not providing any care until two months before his death, the facility violated both Article 10 of the ICCPR and the first principle of the UN Principles of Medical Ethics.  Similarly, if staff acted after Ms. Carlos’s first suicide attempt, her mental health could have improved. Instead, measures that an expert described as “woefully inadequate” were taken.

If there are not enough medical resources to safely detain the “broader set of unauthorized persons” indicated in Trump’s deportation policy, then either less people should be detained at a given time or measures to improve medical treatment of detainees should be implemented. The US government should hold facilities accountable for violating  the INS Detention Standard, the ICCPR and the UN Principles of Medical Ethics.  This would include performing more investigations to both account for cases, and to find the source of the inadequacy of medical treatment in the facilities.  The question is not whether ICE facilities have a duty to prevent these deaths; rather, when will the government enforce the standards to uphold this duty.